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Yeh YP, Lin TY, Yao YC, Hsu CY, Yen AMF, Chen SLS, Chen THH. New insights into three trajectories of omicron-related all-cause death reduced by COVID-19 booster vaccination. J Infect Public Health 2024; 17:735-740. [PMID: 38518679 DOI: 10.1016/j.jiph.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/29/2023] [Accepted: 03/04/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND The trajectories of all-cause deaths linked to omicron infections are rarely studied, especially in relation to the efficacy of booster shots. For assessing three epidemiological death trajectories, including dying from COVID-19, dying with COVID-19, and non-COVID-19 death, we offer a new COVID-19-and-death competing risk model that deals with the primary pathway (e.g., dying from COVID-19) competing with two other pathways. METHODS We applied this model to track three trajectories: deaths directly from COVID-19, deaths with COVID-19 as a contributing factor, and indirect non-COVID-19 deaths. The study used data from a Taiwanese cohort, covering periods of Omicron subvariants BA.2, BA.5, and BA.2.75. It focused on the effectiveness of monovalent and bivalent booster vaccines against these death trajectories. RESULTS The highest mortality was observed during the BA.2 phase, which decreased in the BA.5 period and increased again in the BA.2.75 period. Analyzing each trajectory, we noted similar trends in deaths directly from and with COVID-19, while non-COVID-19 deaths remained stable across subvariants. Booster vaccines reduced all-cause mortality by 58% (52%-62%) for BA.2, 70% (65%-75%) for BA.5%, and 75% (70%-80%) for BA.2.75, compared to incomplete vaccination. The reduction in deaths directly from COVID-19 was 66% (61%-72%) for BA.2, 78% (72%-84%) for BA.5%, and 85% (76%-93%) for BA.2.75. For deaths with COVID-19, the figures were 46% (36%-55%), 76% (68%-84%), and 90% (86%-95%). Additionally, the booster shots decreased non-COVID-19 deaths by 64% (63%-66%) for BA.2, 38% (36%-40%) for BA.5, and 19% (17%-21%) for BA.2.75. CONCLUSION Our competing risk analysis is effective for monitoring all-cause death trajectories amidst various Omicron infections. It provides insights into the impact of booster vaccines, especially bivalent ones, and highlights the consequences of inadequate healthcare for vulnerable groups.
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Affiliation(s)
- Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua, Taiwan
| | - Ting-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Ching Yao
- Changhua County Public Health Bureau, Changhua, Taiwan
| | - Chen-Yang Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Daichung Hospital, Miaoli, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Kodani E, Inoue H, Atarashi H, Okumura K, Yamashita T, Origasa H. Characteristics and outcomes in elderly patients with non-valvular atrial fibrillation and high bleeding risk: subanalysis of the J-RHYTHM Registry. Heart Vessels 2024; 39:330-339. [PMID: 38103100 PMCID: PMC10920444 DOI: 10.1007/s00380-023-02343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
Recently, a once-daily dose of edoxaban (15-mg) has been approved for stroke prevention in non-valvular atrial fibrillation (NVAF) patients aged ≥ 80 years, in whom standard oral anticoagulants are not recommended because of high bleeding risk (HBR), based on the ELDERCARE-AF trial. However, information regarding the characteristics and clinical outcomes among such patients is limited. Thus, this study aimed to clarify the characteristics and event rates in elderly patients with NVAF and HBR defined by the ELDERCARE-AF criteria. Of the 7406 NVAF outpatients included in the J-RHYTHM Registry, 60 patients with creatinine clearance (CrCl) < 15 mL/min were excluded. The remaining 7346 patients (age, 69.7 ± 9.9 years; men, 70.9%; warfarin use, 78.7%) were divided into three groups: Group 1, aged < 80 years (n = 6165); Group 2, aged ≥ 80 years without HBR (n = 584); and Group 3, aged ≥ 80 years with HBR (at least one of the followings; CrCl, 15-30 mL/min, history of bleeding, body weight ≤ 45 kg, and antiplatelet use) (n = 597, eligible for 15-mg edoxaban). Patients in Group 3 had a higher prevalence of comorbidities, and therefore, both higher thromboembolic and bleeding risk scores than in the other groups. During the 2-year follow-up period, the incidence rates (per 100 person-years) of thromboembolism in Groups 1, 2, and 3 were 0.7, 1.5, and 2.1 (P < 0.001), major hemorrhage, 0.8, 1.2, and 2.0 (P < 0.001), and all-cause death, 0.8, 2.6, and 4.6 (P < 0.001), respectively. Adjusted hazard ratios of Group 3 were 1.64 (95% confidence interval 0.89-3.04, P = 0.116) for thromboembolism, 1.53 (0.85-2.72, P = 0.154) for major hemorrhage, and 1.84 (1.19-2.85, P = 0.006) for all-cause death compared with Group 1. The NVAF Patients aged ≥ 80 years with HBR defined by the ELDERCARE-AF criteria were certainly at a higher adverse event risk, especially for all-cause death. Clinical trial registration: The J-RHYTHM Registry is registered in the University Hospital Medicine Information Network (UMIN) Clinical Trials Registry (unique identifier: UMIN000001569) http://www.umin.ac.jp/ctr/ .
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Affiliation(s)
- Eitaro Kodani
- Department of Cardiovascular Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan.
| | | | | | - Ken Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Qian X, Jia H, Wang J, He S, Yu M, Feng X, Gong Q, An Y, Wang X, Shi N, Li H, Zou Z, Li G, Chen Y. Circulating palmitoyl sphingomyelin levels predict the 10-year increased risk of cardiovascular disease death in Chinese adults: findings from the Da Qing Diabetes Study. Cardiovasc Diabetol 2024; 23:37. [PMID: 38245731 PMCID: PMC10800040 DOI: 10.1186/s12933-023-02116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Higher levels of palmitoyl sphingomyelin (PSM, synonymous with sphingomyelin 16:0) are associated with an increased risk of cardiovascular disease (CVD) in people with diabetes. Whether circulating PSM levels can practically predict the long-term risk of CVD and all-cause death remains unclear. This study aimed to investigate whether circulating PSM is a real predictor of CVD death in Chinese adults with or without diabetes. METHODS A total of 286 and 219 individuals with and without diabetes, respectively, from the original Da Qing Diabetes Study were enrolled. Blood samples collected in 2009 were used as a baseline to assess circulating PSM levels. The outcomes of CVD and all-cause death were followed up from 2009 to 2020, and 178 participants died, including 87 deaths due to CVD. Cox proportional hazards regression was used to estimate HRs and their 95% CIs for the outcomes. RESULTS Fractional polynomial regression analysis showed a linear association between baseline circulating PSM concentration (log-2 transformed) and the risk of all-cause and CVD death (p < 0.001), but not non-CVD death (p > 0.05), in all participants after adjustment for confounders. When the participants were stratified by PSM-tertile, the highest tertile, regardless of diabetes, had a higher incidence of CVD death (41.5 vs. 14.7 and 22.2 vs. 2.9 per 1000 person-years in patients with and without diabetes, respectively, all log-rank p < 0.01). Individuals with diabetes in the highest tertile group had a higher risk of CVD death than those in the lowest tertile (HR = 2.73; 95%CI, 1.20-6.22). CONCLUSIONS Elevated PSM levels are significantly associated with a higher 10-year risk of CVD death, but not non-CVD death, in Chinese adults with diabetes. These findings suggest that PSM is a potentially useful long-term predictor of CVD death in individuals with diabetes.
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Affiliation(s)
- Xin Qian
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongmei Jia
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Siyao He
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Yu
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxing Feng
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuhong Gong
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yali An
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuan Wang
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Shi
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Li
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Zhongmei Zou
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Guangwei Li
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
| | - Yanyan Chen
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Pezel T, Dillinger JG, Toupin S, Mirailles R, Logeart D, Cohen-Solal A, Unger A, Canuti ES, Beauvais F, Lafont A, Gonçalves T, Lequipar A, Gall E, Boutigny A, Ah-Sing T, Hamzi L, Lima JAC, Bousson V, Henry P. Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death. Diagn Interv Imaging 2023; 104:594-604. [PMID: 37353467 DOI: 10.1016/j.diii.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE The purpose of this study was to investigate the prognostic value of left atrioventricular coupling index (LACI) assessed by cardiac computed tomography (CT), to predict cardiovascular death in consecutive patients referred for cardiac CT with coronary analysis. MATERIALS AND METHODS Between 2010 and 2020, we conducted a single-centre study with all consecutive patients without known cardiovascular disease referred for cardiac CT. LACI was defined as the ratio of left atrial to left ventricle end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association between LACI and primary outcome after adjustment for traditional risk factors and cardiac CT angiography findings. RESULTS In 1,444 patients (mean age, 70 ± 12 [standard deviation] years; 43% men), 67 (4.3%) patients experienced cardiovascular death after a median follow-up of 6.8 (Q1, Q3: 5.9, 9.1) years. After adjustment, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI: 1.05-1.09] per 1% increment; P < 0.001), and all-cause death (adjusted HR, 1.05 [95% CI: 1.03-1.07] per 1% increment; P <0.001). After adjustment, a LACI ≥ 25% showed the best improvement in model discrimination and reclassification for predicting cardiovascular death above traditional risk factors and cardiac CT findings (C-statistic improvement: 0.27; Nnet reclassification improvement = 0.826; Integrative discrimination index =0.209, all P < 0.001; likelihood-ratio-test, P < 0.001). CONCLUSION LACI measured by cardiac CT is independently associated with cardiovascular death and all-cause death in patients without known cardiovascular disease referred for cardiac CT, with an incremental prognostic value over traditional risk factors and cardiac CT findings.
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Affiliation(s)
- Théo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France.
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Raphael Mirailles
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Damien Logeart
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alain Cohen-Solal
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Unger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Department of Cardiology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 1070 Brussels, Belgium
| | - Elena Sofia Canuti
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Florence Beauvais
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Lafont
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Trecy Gonçalves
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Boutigny
- Université Paris Cité, Service des Explorations Fonctionnelles, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Tania Ah-Sing
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Lounis Hamzi
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287-0409, USA
| | - Valérie Bousson
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
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Li B, Peng C, Wang Y, Ma R, Feng Y. The relationship between bile acids levels and the prognosis of patients with diabetes on maintenance hemodialysis: a retrospective study. Ren Fail 2023; 45:2226221. [PMID: 37340970 DOI: 10.1080/0886022x.2023.2226221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE There is a paucity of research on the association between bile acids (BAs) levels and all-cause death in patients with diabetes mellitus (DM) on maintenance hemodialysis (MHD). This study aimed to investigate the clinical characteristics of patients with DM on MHD according to different BAs levels and their impact on prognosis. METHODS A retrospective cohort of 1,081 patients on hemodialysis at Xindu People's Hospital and the First Affiliated Hospital of Chengdu Medical College were enrolled. Demographic and clinical characteristics were collected. The relationship between BAs and all-cause death risk was fitted using restricted cubic splines (RCS), and the BAs cutoff value was calculated. Patients were divided into low and high BAs groups based on the cutoff value. The primary endpoint was all-cause death and the secondary outcomes were deaths from cardiovascular events. RESULTS Finally, 387 patients with DM on MHD were included. The median BAs level of all patients was 4.0 μmol/L. The RCS-based BAs cutoff value was 3.5 μmol/L. The BAs levels correlated negatively with total cholesterol, low-density lipoprotein, and blood calcium levels. During the follow-up, 21.7% of the patients died. The multivariate Cox regression analysis demonstrated that patients with DM on MHD with higher BAs were associated independently with a decreased risk of all-cause death (HR =0.55; 95% CI, 0.35-0.81, p = 0.01) compared to those with lower BAs levels. CONCLUSIONS Higher BAs levels were associated with lower lipid levels in patients with DM on MHD. BAs is an independent risk factor for all-cause death in patients with DM on MHD.
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Affiliation(s)
- Bin Li
- Department of Geriatric Endocrinology, University of Electronic Science and Technology, Sichuan Academy of Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, P.R. China
| | - Cong Peng
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, P.R. China
| | - Yili Wang
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, P.R. China
| | - Rong Ma
- Department of Nephrology and Endocrinology, Xindu People's Hospital, Chengdu, Sichuan, P.R. China
| | - Ya Feng
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, P.R. China
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Wang R, Lunardi M, Hara H, Gao C, Ono M, Davierwala PM, Holmes DR, Mohr FW, Curzen N, Burzotta F, van Geuns RJ, Kappetein AP, Head SJ, Thuijs DJFM, Tao L, Garg S, Onuma Y, Wijns W, Serruys PW. Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization. Clin Res Cardiol 2023; 112:1302-1311. [PMID: 37150783 PMCID: PMC10449944 DOI: 10.1007/s00392-023-02211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following PCI/CABG in patients with three-vessel(3VD) and/or left main coronary artery disease(LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI/CABG. METHODS The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed. RESULTS A total of 330 out of 1800 patients (18.3%) underwent RR within 5 years. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs. 13.7%, p < 0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs. 26.1%, adjusted HR: 1.17, 95%CI 0.93-1.48, p = 0.187). In the PCI arm, RR was associated with a trend toward higher 10-year mortality (adjusted HR: 1.29, 95%CI 0.97-1.72, p = 0.075), while in the CABG arm, the trend was opposite (adjusted HR: 0.74, 95%CI 0.46-1.20, p = 0.219). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs. 17.6%, adjusted HR: 2.09, 95%CI 1.21-3.61, p = 0.008). CONCLUSION In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies. TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov ; SYNTAXES Unique identifier: NCT03417050. URL: https://www. CLINICALTRIALS gov ; SYNTAX Unique identifier: NCT00114972.
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Affiliation(s)
- Rutao Wang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
- Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Mattia Lunardi
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
- Department of Cardiology, University Hospital of Verona, Verona, Italy
| | - Hironori Hara
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
- Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Masafumi Ono
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Piroze M Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | | | - Friedrich W Mohr
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Cardiology Department, University Hospital Southampton, Southampton, UK
| | - Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Yoshinobu Onuma
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
| | - William Wijns
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.
- NHLI, Imperial College London, London, UK.
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Kurokawa T, Otaki Y, Takahashi H, Watanabe T, Shikama T, Tamura H, Kato S, Nishiyama S, Arimoto T, Watanabe M. Impact of estimated plasma volume status on clinical outcomes in patients with lower extremity artery disease who underwent endovascular therapy. Hypertens Res 2023; 46:2005-2015. [PMID: 37286869 DOI: 10.1038/s41440-023-01315-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023]
Abstract
Lower extremity artery disease (LEAD) is an arterial occlusive disease associated with high morbidity and mortality. Estimated plasma volume status (ePVS), a marker of plasma volume expansion and contraction, is gaining attention in the field of cardiovascular diseases. However, the impact of ePVS on the clinical outcomes of patients with LEAD remains unclear. We calculated ePVS using two different formulas, Kaplan-Hakim (KH-ePVS) and Duarte (D-ePVS), in 288 patients (mean age, 73 years; 77% male) with LEAD who underwent the first endovascular therapy (EVT), and prospectively followed them up between 2014 and 2019. All patients were divided into two groups based on the median ePVS values. The primary endpoints were composite events, including all-cause death and major adverse limb events (death/MALE). The median follow-up duration was 672 days. There were 183, 40 and 65 patients in Fontaine classes II, III, and IV, respectively. The median KH-ePVS and D-ePVS was 5.96 and 5.09, respectively. The ePVS significantly increased with advancing Fontaine classes. Kaplan-Meier analysis demonstrated that the high ePVS group had higher rates of death/MALE than the low ePVS group. Multivariate Cox proportional hazard analysis revealed that each ePVS was an independent predictor for death/MALE after adjusting for confounding risk factors. The prognostic ability for death/MALE was significantly improved by adding ePVS to the basic predictors. ePVS was associated with LEAD severity and clinical outcomes, suggesting that ePVS could be an additional risk factor for death/MALE in patients with LEAD who underwent EVT. We demonstrated that the association between ePVS and the clinical outcomes of patients with LEAD. The prognostic ability for death/MALE was significantly improved by adding ePVS to the basic predictors. LEAD lower extremity artery disease, MALE major adverse limb events, PVS plasma volume status.
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Affiliation(s)
- Tasuku Kurokawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Taku Shikama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Shigehiko Kato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Han Y, Shi J, Gao P, Zhang L, Niu X, Fu N. The weight-adjusted-waist index predicts all-cause and cardiovascular mortality in general US adults. Clinics (Sao Paulo) 2023; 78:100248. [PMID: 37441866 PMCID: PMC10362289 DOI: 10.1016/j.clinsp.2023.100248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The authors examined the relationship between Weight-adjusted Waist Index (WWI) and all-cause and cardiovascular mortality among adults in the US. METHODS This prospective cohort study included 26,882 individuals who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2014. WWI was calculated as waist circumference divided by the square root of weight. The main outcomes of this study were all-cause mortality and cardiovascular mortality. Mortality status and cause of death were determined by NHANES-linked National Death Index records through December 31, 2015. Cox proportional hazard models and Kaplan-Meier analysis were used to estimate Hazard Ratios (HR) and 95% CIs for mortality for all causes and cardiovascular diseases. RESULTS A total of 26,882 participants with a mean WWI of 10.89 ± 0.01, of whom 49.23% were male. The average follow-up time was 68.95 ± 1.07 months, and 1870 participants were determined as deceased (4.99%), including 349 cardiovascular death (0.88%). The Kaplan-Meier analysis demonstrated a significant difference in all-cause and cardiovascular mortality between patients with WWI <11.33 and ≥11.33 (both log-rank test p < 0.0001). The fully adjusted Cox proportional hazard model indicated that a higher WWI level (≥ 11.33) was associated with an increased 95% risk for cardiovascular mortality (HR = 1.95, 95% CI 1.30‒2.93) and 68% risk for all-cause death (HR = 1.68, 95% CI 1.41‒2.00) compared with the counterparts. CONCLUSIONS Elevated WWI levels were associated with a higher risk of cardiovascular mortality and all-cause mortality independently.
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Affiliation(s)
- Ying Han
- Department of Endocrinology and Metabolism (Rheumatism and Immunity), Haibin People's Hospital, Tianjin Binhai New Area, PR China
| | - Jieli Shi
- Department of Endocrinology and Metabolism (Rheumatism and Immunity), Haibin People's Hospital, Tianjin Binhai New Area, PR China.
| | - Pengfei Gao
- Department of Endocrinology and Metabolism (Rheumatism and Immunity), Haibin People's Hospital, Tianjin Binhai New Area, PR China
| | - Lin Zhang
- Department of Endocrinology and Metabolism (Rheumatism and Immunity), Haibin People's Hospital, Tianjin Binhai New Area, PR China
| | - Xuejiao Niu
- Department of Endocrinology and Metabolism (Rheumatism and Immunity), Haibin People's Hospital, Tianjin Binhai New Area, PR China
| | - Na Fu
- Department of Endocrinology and Metabolism (Rheumatism and Immunity), Haibin People's Hospital, Tianjin Binhai New Area, PR China
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9
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Cai H, Yan J, Liu S, Li P, Ding L, Zhan Y, Lu J, Li Z, Zhu M, Gao Y, Gong X, Ban H, Gu L, Zhou W, Wang J, Mou S. Paxlovid for hospitalized COVID-19 patients with chronic kidney disease. Antiviral Res 2023:105659. [PMID: 37369283 PMCID: PMC10290896 DOI: 10.1016/j.antiviral.2023.105659] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND COVID-19 causes significant mortality during the recent pandemic. Data regarding the effectiveness of Paxlovid on COVID-19 patients with chronic kidney disease (CKD, eGFR <90 ml/min) are limited. METHODS A retrospective cohort study was performed on the clinical data of the hospitalized adult patients with confirmed COVID-19 infection collected at Renji Hospital from April 7, 2022 to June 21, 2022. The association of Paxlovid treatment with early (within 5 days post diagnosis) or late (5 days or later post diagnosis) initiation time with clinical outcomes was assessed by Cox proportional hazards regression model with time-dependent covariates. RESULT 1279 of 2387 enrollees were included in the study. Patients with early initiation of Paxlovid had a lower all-cause death rate compared to those with late initiation or without Paxlovid treatment (P = 0.046). For the CKD patients with Charlson comorbidity index (CCI) > 7, the early initiation of Paxlovid was associated with a lower all-cause death rate compared to the later initiation or the lack of Paxlovid treatment (P = 0.041). Cox regression analyses revealed that eGFR (HR 4.21 [95%, CI 1.62-10.99]), Paxlovid treatment (0.32 [0.13-0.77]), CCI (4.32 [1.64-11.40]), ICU admission (2.65 [1.09-6.49]), hsCRP (3.88 [1.46-7.80]), chronic liver disease (4.02 [1.09-14.85]) were the independent risk factors for all-cause death for CKD patients after adjusting for demographics and biochemical indexes. CONCLUSIONS All-cause death, invasive ventilation, and ICU admission were all significantly lowered by an early initiation of Paxlovid treatment in COVID-19 patients with severe CKD.
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Affiliation(s)
- Hong Cai
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Jiayi Yan
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China; Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, 201210, China.
| | - Shang Liu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Ping Li
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Li Ding
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yaping Zhan
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jiayue Lu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Zhenyuan Li
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Mingli Zhu
- Departent of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yuan Gao
- Departent of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - XingRong Gong
- Department of Medical Administration, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Haiqun Ban
- Infection Management Office, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Leyi Gu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Weibin Zhou
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, NY, 10029, USA
| | - Jieying Wang
- Clinical Research Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal, Dialysis, Research CenterRen Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China; Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, 201210, China
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Yang S, Diao Z, Liu W, Guo W. Effect of dialytic phosphate reduction rate on mortality in maintenance hemodialysis patients: a matched case-control study. BMC Nephrol 2023; 24:167. [PMID: 37308828 DOI: 10.1186/s12882-023-03199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/14/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Phosphates, similar to urea, are small molecular substances that can be cleared during dialysis. Dialytic phosphate reduction rate (PRR) may, to some extent, be related to the relative amount of phosphates cleared during dialysis. However, few studies have evaluated the associations between PRR and mortality in maintenance hemodialysis (MHD) patients. In this study, we investigated the association between PRR and clinical outcomes in MHD patients. METHODS This was a retrospective, matched case-control study. Data were collected from the Beijing Hemodialysis Quality Control and Improvement Center. Patients were divided into four groups according to PRR quartile. Age, sex, and diabetes were matched between the groups. The primary outcome was all-cause death, and the secondary outcome was cardiocerebrovascular death. RESULTS The study cohort comprised 4063 patients who were divided into four groups according to the PRR quartile: group PRR1 (< 48.35%), group PRR2 (48.35% - 54.14%), group PRR3 (54.14% - 59.14%), and group PRR4 (≥ 59.14%). We enrolled 2172 patients (543 in each study group) by case-control matching. The all-cause death rates were as follows: group PRR1: 22.5% (122/543), group PRR2: 20.1% (109/543), group PRR3: 19.3% (105/543), and group PRR4: 19.3% (105/543). No significant differences in all-cause and cardiocerebrovascular death rates according to the Kaplan-Meier survival curves were found between the groups (log-rank test, P > 0.05). Multivariable Cox regression analysis revealed no significant differences in all-cause and cardiocerebrovascular death rates between the four groups (P = 0.461; adjusted hazard ratio, 0.99; 95% confidence interval, 0.97 - 1.02 versus P = 0.068; adjusted hazard ratio, 0.99; 95% confidence interval, 0.97 - 1.00, respectively). CONCLUSIONS Dialytic PRR was not significantly associated with all-cause death and cardiocerebrovascular death in MHD patients.
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Affiliation(s)
- Shuixiu Yang
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
- Blood Purification Center, Guiyang Public Health Clinical Center, Guiyang, 550001, Guizhou, China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Wang Guo
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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11
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Liu S, Jiang C, Liu Y, Zhang Y, Qiu X, Luo J, Xu Y, Wang J. The effectiveness of COVID-19 vaccination against all-cause mortality in patients with type 2 diabetes mellitus: the observation during the initial period of the cancellation of the "Dynamic Zero Policy" in mainland China. Diabetes Res Clin Pract 2023; 200:110694. [PMID: 37164159 PMCID: PMC10165863 DOI: 10.1016/j.diabres.2023.110694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
AIMS This study aims to assess the effectiveness of COVID-19 vaccination against all-cause death in patients with type 2 diabetes mellitus (T2DM). METHODS Subjects were patients with T2DM who were administered by general practitioner (GP). Use electronic exchange platform to obtain the information on COVID-19 vaccination, all-cause deaths and risk factors. Logistic regression models were used to calculate the odd ratio (OR) and 95% CI for the association between COVID-19 vaccination and mortality. The vaccine effectiveness (VE) was calculated as (1- adjusted OR) ×100%. RESULTS A total of 27,156 subjects had 53.81%, 17.65%, and 23.43% coverage for the booster, full, and partial COVID-19 vaccination, reported 328 deaths and a mortality of 1.2%. The adjusted OR (95%CI) was 0.85(0.60-1.21) for those received partial vaccination, 0.31(0.22-0.43) for those received full vaccination, and 0.12(0.08-0.18) for those received booster vaccination, compared to the unvaccinated individuals. The VE (95%CI) was 88.00(82.30-91.80) of booster vaccination, 69.30(56.60-78.30) of full vaccination, and 17.60(-17.10-42.00) of partial vaccination. CONCLUSION COVID-19 vaccination could effectively prevent the all-cause death in patients with T2DM during the omicron variant outbreak period, after the cancellation of the "Dynamic Zero Policy" in mainland China.
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Affiliation(s)
- Shijun Liu
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China.
| | - Caixia Jiang
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
| | - Yan Liu
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
| | - Yan Zhang
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
| | - Xin Qiu
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
| | - Jun Luo
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
| | - Yuyang Xu
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
| | - Jing Wang
- HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
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12
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Sun Y, Jin L, Dian Y, Shen M, Zeng F, Chen X, Deng G. Oral Azvudine for hospitalised patients with COVID-19 and pre-existing conditions: a retrospective cohort study. EClinicalMedicine 2023; 59:101981. [PMID: 37193346 PMCID: PMC10167478 DOI: 10.1016/j.eclinm.2023.101981] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND As the COVID-19 pandemic continues to spread, the number of associated deaths continues to increase, especially among those with pre-existing conditions. Azvudine is recommended as a priority treatment for patients with COVID-19, but its efficacy in patients with pre-existing conditions is unknown. METHODS This is a single-centre, retrospective cohort study between December 5, 2022 and January 31, 2023 in Xiangya Hospital of Central South University in China to evaluate the clinical efficacy of Azvudine in hospitalised patients with COVID-19 and pre-existing conditions. Patients with Azvudine and controls were propensity score-matched (1:1) for age, gender, vaccination status, time from symptom onset to treatment exposure, severity at admission, concomitant treatments initiated at admission. The primary outcome was a composite outcome of disease progression, and the secondary outcome was each of these individual disease progression outcomes. The univariate Cox regression model was used to estimate a hazard ratio (HR) with 95% confidence interval (CI) for each result between the groups. FINDINGS We identified 2118 hospitalised patients with COVID-19 during the study period, with a follow-up of up to 38 days. After exclusions and propensity score matching, we included 245 Azvudine recipients and 245 matched controls. Azvudine recipients had lower crude incidence rate of composite disease progression outcome compared with matched controls (7.125/1000 person-days vs. 16.004/1000 person-days, P = 0.018). There was no significant difference in all-cause death between these two groups (1.934/1000 person-days vs. 4.128/1000 person-days, P = 0.159). Azvudine treatment was associated with significantly lower risks of composite disease progression outcome compared with matched controls (HR: 0.49; 95% CI: 0.27-0.89, P = 0.016). A significant difference in all-cause death was not found (HR: 0.45; 95% CI: 0.15-1.36, P = 0.148). INTERPRETATION These findings indicate that Azvudine therapy showed substantial clinical benefits in hospitalised patients with COVID-19 and pre-existing conditions, and should be considered for this population of patients. FUNDING This work was supported by the National Natural Science Foundation of China (Grant Nos. 82103183 to F. Z., 82102803, 82272849 to G. D.), National Natural Science Foundation of Hunan Province (Grant Nos. 2022JJ40767 to F. Z., 2021JJ40976 to G. D.), Huxiang Youth Talent Program (Grant Nos. 2022RC1014 to M.S.) and Ministry of Industry and Information Technology of China (Grant Nos. TC210804V to M.S.).
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Affiliation(s)
- Yuming Sun
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Centre of Personalised Diagnostic and Therapeutic Technology, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Centre of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, China
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Liping Jin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Centre of Personalised Diagnostic and Therapeutic Technology, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Centre of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, China
| | - Yating Dian
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Centre of Personalised Diagnostic and Therapeutic Technology, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Centre of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Centre of Personalised Diagnostic and Therapeutic Technology, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Centre of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Furong Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Centre of Personalised Diagnostic and Therapeutic Technology, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Centre of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, China
| | - Guangtong Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Centre of Personalised Diagnostic and Therapeutic Technology, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Centre of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, China
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Zhang Y, Huang Z, Hu S, Si J, Cheng S, Chen Z, Xue J, Lou X, Peng H, Li Z, Ouyang M, Gao X, Zeng W. The association of preoperative high-sensitivity cardiac troponin i and long-term outcomes in colorectal cancer patients received tumor resection surgery. Cardiooncology 2023; 9:12. [PMID: 36864502 PMCID: PMC9979437 DOI: 10.1186/s40959-023-00162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/06/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the association between preoperative hs-cTnI and long-term mortality and major adverse cardiovascular events (MACE) in colorectal cancer patients. METHODS This single-center retrospective cohort study included 1105 consecutive colorectal cancer patients who received tumor resection surgery between January 2018 and June 2020. Inclusion criteria were an age ≥ 18 years and had been tested for hs-cTnI on admission within 7 days prior to tumor resection surgery. Exclusion criteria were emergent surgery, failure to received tumor resection surgery, hospital death, there was clinical evidence of unstable coronary artery disease or pulmonary embolism occurred before operation according to medical record. The primary endpoint was all-cause death. Secondary endpoint was major adverse cardiovascular events (MACE). RESULTS A total of 1105 patients were enrolled: 1032 with normal hs-cTnI and 73 with elevated hs-cTnI. The mean follow-up was 24.4 ± 10.8 months, 176 patients died and 39 patients met MACE. In the elevated troponin group, 50%, 32.1% and 17.9% died from cancer, cardiovascular and other causes, while those in the normal troponin group were 75.7%, 2% and 22.3%, there was statistical difference between 2 groups (P < 0.001). Patients with elevated preoperative hs-cTnI had significantly higher mortality (P < 0.001) and more MACE (P < 0.001) compared with those with normal hs-cTnI. A propensity-matching analysis were performed, resulting in 151 patients with normal hs-cTnI and 60 patients with elevated hs-cTnI. The matched population had the similar results for all-cause death (P = 0.009) and MACE (P = 0.001). The results were consistent after further excluding 147 patients who had received chemoradiotherapy prior to surgery in subgroup analysis. The results of multivariate Cox regression analysis shown that hs-cTnI was one of the best predictors for all-cause death (hazard ratio [HR] 2.278; 95% confidence interval [CI] 1.19-4.361) and MACE (HR, 3.523; 95%CI, 1.477-8.403) in total populations, similar results were found in subgroup analysis. CONCLUSIONS Colorectal cancer patients without myocardial ischemia manifestation but with elevated hs-cTnI prior to tumor resection surgery were at increased risk for long-term all-cause death and MACE, irrespective of whether they have received chemoradiotherapy prior to surgery.
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Affiliation(s)
- Yitao Zhang
- grid.488525.6Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655 China ,grid.484195.5Guangdong Provincial Key Laboratory of colorectal and pelvic floor diseases, Guangzhou, 510655 China
| | - Zicheng Huang
- grid.484195.5Guangdong Provincial Key Laboratory of colorectal and pelvic floor diseases, Guangzhou, 510655 China ,grid.488525.6Department of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655 China
| | - Sutian Hu
- grid.488525.6Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655 China
| | - Jinhong Si
- grid.488525.6Department of Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655 China ,grid.284723.80000 0000 8877 7471He Xian Memorial Hospital, Southern Medical University, Guangzhou, 511402 China
| | - Shiyao Cheng
- grid.488525.6Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655 China
| | - Zhichong Chen
- grid.488525.6Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655 China
| | - Jiaojie Xue
- grid.488525.6Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655 China
| | - Xue Lou
- grid.488525.6Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655 China
| | - Huajing Peng
- grid.412615.50000 0004 1803 6239Department of Nephrology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
| | - Zequan Li
- grid.412615.50000 0004 1803 6239Department of Plastic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
| | - Mao Ouyang
- Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655, China.
| | - Xiang Gao
- Guangdong Provincial Key Laboratory of colorectal and pelvic floor diseases, Guangzhou, 510655, China. .,Department of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
| | - Weijie Zeng
- Department of Cardiovascular Internal Medicine, the Sixth Affiliated Hospital of Sun Yat-Sen University, No.26, the second crossroad of YuanCun, Tianhe District, Guangzhou, 510655, China. .,Guangdong Provincial Key Laboratory of colorectal and pelvic floor diseases, Guangzhou, 510655, China.
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Tsaban G, Peles I, Barrett O, Abramowitz Y, Shmueli H, Alnsasra H, Cafri C, Zahger D, Koifman E. Nonobstructive coronary atherosclerosis is associated with adverse prognosis among patients diagnosed with myocardial infarction without obstructive coronary arteries. Atherosclerosis 2023; 366:8-13. [PMID: 36652749 DOI: 10.1016/j.atherosclerosis.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/10/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS The prognostic impact of nonobstructive coronary artery disease (CAD), as opposed to normal coronary arteries, on long-term outcomes of patients with myocardial infarction with no obstructive coronary arteries (MINOCA) is unclear. We aimed to address the association between nonobstructive-CAD and major adverse events (MAE) following MINOCA. METHODS We conducted a retrospective cohort study of consecutive MINOCA patients admitted to a large referral medical center between 2005 and 2018. Patients were classified according to coronary angiography as having either normal-coronaries or nonobstructive-CAD. The primary outcome was MAE, defined as the composite of all-cause mortality and recurrent acute coronary syndrome (ACS). RESULTS Of the 1544 MINOCA patients, 651 (42%) had normal coronaries, and 893 (58%) had CAD. The mean age was 61.2 ± 12.6 years, and 710 (46%) were females. Nonobstructive-CAD patients were older and less likely to be females, with higher rates of diabetes, hypertension, dyslipidemia, atrial fibrillation, and chronic renal-failure (p < 0.05). At a median follow-up of 7 years, MAE occurred in 203 (23%) patients and 67 (10%) patients in the nonobstructive-CAD and normal-coronaries groups, respectively (p < 0.01). In multivariable models, nonobstructive -CAD was significantly associated with long-term MAE [adjusted-hazard-ratio (aHR):1.67, 95% confidence-interval (95%CI):1.25-2.23; p < 0.001]. Other factors associated with a higher MAE-risk were older-age (aHR:1.05,95%CI:1.03-1.06; p < 0.001) and left ventricular ejection-fraction<40% (aHR:3.04,95%CI:2.03-4.57; p < 0.001), while female-sex (aHR:0.72, 95%CI: 0.56-0.94; p=0.014) and sinus rhythm at presentation (aHR:0.66, 95%CI: 0.44-0.98; p=0.041) were associated with lower MAE-risk. CONCLUSIONS In MINOCA, nonobstructive-CAD is independently associated with a higher MAE-risk than normal-coronaries. This finding may promote risk-stratification of patients with nonobstructive-CAD-MINOCA who require tighter medical follow-up and treatment optimization.
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Affiliation(s)
- Gal Tsaban
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel.
| | - Ido Peles
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - Orit Barrett
- Department of Cardiology, Soroka University Medical Center, Beersheba, Israel; Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - Yigal Abramowitz
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Hezzy Shmueli
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Hilmi Alnsasra
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Carlos Cafri
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Doron Zahger
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel; Department of Cardiology, Soroka University Medical Center, Beersheba, Israel
| | - Edward Koifman
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
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15
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Peikert A, Claggett BL, Kim K, Udell JA, Joseph J, Desai AS, Farkouh ME, Hegde SM, Hernandez AF, Bhatt DL, Gaziano JM, Talbot HK, Yancy C, Anand I, Mao L, Cooper LS, Solomon SD, Vardeny O. Association of post-vaccination adverse reactions after influenza vaccine with mortality and cardiopulmonary outcomes in patients with high-risk cardiovascular disease: the INVESTED trial. Eur J Heart Fail 2023; 25:299-310. [PMID: 36335639 DOI: 10.1002/ejhf.2716] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Influenza vaccination is associated with reduced cardiopulmonary morbidity and mortality among patients with heart failure or recent myocardial infarction. The immune response to vaccination frequently results in mild adverse reactions (AR), which leads to vaccine hesitancy. This post hoc analysis explored the association between vaccine-related AR and morbidity and mortality in patients with high-risk cardiovascular disease. METHODS AND RESULTS The INVESTED trial randomized 5260 patients with recent heart failure hospitalization or acute myocardial infarction to high-dose trivalent or standard-dose quadrivalent inactivated influenza vaccine. We examined the association between vaccine-related AR and adverse clinical outcomes across both treatment groups in propensity-adjusted models. Among 5210 participants with available information on post-vaccination symptoms, 1968 participants (37.8%) experienced a vaccine-related AR. Compared to those without AR, post-vaccination AR, most commonly injection site pain (60.3%), were associated with lower risk for the composite of all-cause death or cardiopulmonary hospitalization (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.75-0.92, p < 0.001), cardiopulmonary hospitalizations (HR 0.85 [95% CI 0.76-0.95], p = 0.003), all-cause death (HR 0.77 [95% CI 0.62-0.96], p = 0.02), cardiovascular hospitalizations (HR 0.88 [95% CI 0.78-0.99], p = 0.03) and non-cardiopulmonary hospitalizations (HR 0.80 [95% CI 0.69-0.92], p = 0.003). While mild (76.4%) and moderate (20.6%) AR were most common and together associated with lower risk for the primary outcome (HR 0.81 [95% CI 0.74-0.90], p < 0.001), severe AR (2.9%) were related to increased risk (HR 1.68 [95% CI 1.17-2.42], p = 0.005). CONCLUSION Mild to moderate post-vaccination reactions after influenza vaccine were associated with reduced risk of cardiopulmonary hospitalizations and all-cause mortality in patients with high-risk cardiovascular disease, while severe reactions may indicate increased risk. Mild to moderate AR to influenza vaccination may be a marker of immune response and should not deter future vaccinations.
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jacob A Udell
- Peter Munk Cardiac Centre, University Health Network and Women's College Hospital, University of Toronto, Toronto, ONT, Canada
| | - Jacob Joseph
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ONT, Canada
| | - Sheila M Hegde
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Michael Gaziano
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston, MA, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Clyde Yancy
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Inder Anand
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Lawton S Cooper
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA
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16
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Yamashita T, Akao M, Atarashi H, Ikeda T, Koretsune Y, Okumura K, Shimizu W, Suzuki S, Tsutsui H, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Morishima Y, Takita A, Inoue H. Effect of Polypharmacy on Clinical Outcomes in Elderly Patients With Non-Valvular Atrial Fibrillation - A Sub-Analysis of the ANAFIE Registry. Circ J 2022; 87:6-16. [PMID: 35858804 DOI: 10.1253/circj.cj-22-0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This All Nippon AF in the Elderly (ANAFIE) Registry sub-analysis evaluated the impact of polypharmacy on 2-year outcomes in a large, elderly (aged ≥75 years) Japanese population with non-valvular atrial fibrillation (NVAF).Methods and Results: The ANAFIE Registry was a multicenter, prospective, observational study with a 24-month follow-up period. Of 32,275 enrolled NVAF patients, 31,419 were grouped by the number of prescribed concomitant medications (other than oral anticoagulants [OACs]): 0-4 [38.8%], 5-8 [43.3%], and ≥9 [17.9%]). Patients receiving more concomitant medications were older, had poor renal function, and suffered more comorbidities than those receiving fewer concomitant medications. Several patient background factors, including diabetes mellitus, myocardial infarction, and chronic kidney disease, were significantly correlated with an increased number of concomitant medications. With increasing medications, OAC prescription rates decreased, but the warfarin prescription rate increased, and the cumulative incidence rates of stroke/systemic embolic events (SEE), major bleeding, gastrointestinal bleeding, fracture/falls, cardiovascular events, cardiovascular death, and all-cause death significantly increased (each, P<0.05). In multivariate analysis, increasing medications was independently associated with increases in these events, except for stroke/SEE. There were no significant interactions between the number of medications and anticoagulant treatment with direct OAC or warfarin concerning the incidence of these events. CONCLUSIONS Polypharmacy was frequent among elderly patients with NVAF who were older with more comorbidities, and was independently associated with a higher incidence of extracranial events.
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Affiliation(s)
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | | | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, National Hospital Organization Kyushu Medical Center
| | - Takenori Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd
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17
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Ikeda T, Yamashita T, Akao M, Atarashi H, Koretsune Y, Okumura K, Shimizu W, Suzuki S, Tsutsui H, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Morishima Y, Takita A, Inoue H. Prognostic impact of heart rate during atrial fibrillation on clinical outcomes in elderly non-valvular atrial fibrillation patients: ANAFIE Registry sub-cohort study. J Cardiol 2022; 81:441-449. [PMID: 36427691 DOI: 10.1016/j.jjcc.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Elderly patients with atrial fibrillation (AF) are at a higher risk for all-cause mortality and heart failure. Rate control is an essential component in AF management. This exploratory study assessed the relationship between resting heart rate during AF at baseline and clinical outcomes in Japanese elderly non-valvular AF (NVAF) patients, using the All Nippon AF In the Elderly Registry (ANAFIE) dataset. METHODS This sub-cohort included patients who agreed to participate and presented with AF at enrollment in the ANAFIE study. They were categorized into six groups according to the resting heart rate during AF. Outcomes included 2-year cumulative incidences of stroke/systemic embolic events (SEE), ischemic stroke, major bleeding, cardiovascular (CV) events, CV death, all-cause death, and net clinical outcome, a composite of stroke/SEE, major bleeding, and all-cause death. RESULTS Of the 8292 patients included in this sub-cohort (paroxysmal, 1496; non-paroxysmal, 6796), 90 % of patients were using anticoagulants. Higher heart rate was more frequently reported in women and in patients with paroxysmal AF and was associated with increased use of direct oral anticoagulants (DOACs) and antiarrhythmic drugs. Heart rate ≥110 beats per minute (bpm) was associated with a significantly higher incidence of cardiac events and numerically higher incidences of CV death and all-cause death compared with a heart rate of 60 to <80 bpm, all of which were driven by an increased risk in patients with non-paroxysmal AF. Hazard ratios by the type of anticoagulant for each clinical outcome were comparable across all heart rate categories, indicating no significant interactions. CONCLUSIONS Elderly Japanese patients with non-paroxysmal NVAF and a heart rate ≥110 bpm have an increased risk of cardiac events. There was no interaction between heart rate category and the relative risk of adverse clinical events in patients taking DOACs compared with those taking warfarin.
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Affiliation(s)
- Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
| | | | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takenori Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | | | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
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18
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Ueno Y, Ikeda S, Motokawa T, Honda T, Kurobe M, Akashi R, Yonekura T, Yoshimuta T, Eguchi M, Kawano H, Maemura K. Comparison of Effectiveness and Safety Among 3 Direct Oral Anticoagulants in Patients With Venous Thromboembolism - A Single-Center Retrospective Study. Circ Rep 2022; 4:533-541. [PMID: 36408357 PMCID: PMC9638511 DOI: 10.1253/circrep.cr-22-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 08/22/2023] Open
Abstract
Background: Direct oral anticoagulants (DOACs), including edoxaban, rivaroxaban, and apixaban, are administered for the treatment of venous thromboembolism (VTE) in Japan. However, only a few reports have compared the effectiveness and safety of these DOACs. Methods and Results: We retrospectively enrolled 702 patients who received DOACs for VTE treatment between September 2014 and March 2020. We investigated patient demographics, VTE recurrence, major bleeding, and mortality until March 2021, and compared them among the 3 DOACs. Most patients (~70%; n=496) were prescribed edoxaban, followed by apixaban (n=107) and rivaroxaban (n=99). Age, body mass index, renal function, and the proportion of cancer patients did not differ significantly among the DOACs. Edoxaban was administered relatively more in women with low body weight and anemia. The rate of pulmonary embolism was significantly lower among patients receiving edoxaban than apixaban or rivaroxaban (24.4% vs. 41.1% and 53.5%, respectively). VTE reoccurred in 2 patients administered apixaban and 1 patient administered edoxaban. The cumulative incidence of major bleeding at 1 year was 11.7%, 18.5%, and 9.0% in the edoxaban, apixaban, and rivaroxaban groups, respectively. There were no significant differences in the cumulative incidence of major bleeding and all-cause death, estimated by Kaplan-Meier analysis, among the DOACs (log-rank P=0.316 and 0.722, respectively). Conclusions: The safety of the 3 DOACs did not differ significantly in clinical settings, despite differences in patient demographics.
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Affiliation(s)
- Yuki Ueno
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tetsufumi Motokawa
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomohiro Honda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Masaya Kurobe
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Ryohei Akashi
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tsuyoshi Yonekura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tsuyoshi Yoshimuta
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Masamichi Eguchi
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
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Xu N, Zhu P, Yao Y, Jiang L, Jia S, Yuan D, Xu J, Wang H, Song Y, Gao L, Gao Z, Song L, Zhao X, Chen J, Yang Y, Xu B, Gao R, Yuan J. Big Endothelin-1 and long-term all-cause death in patients with coronary artery disease and prediabetes or diabetes after percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2022; 32:2147-2156. [PMID: 35843800 DOI: 10.1016/j.numecd.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/15/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS The present study aimed to examine the association between big endothelin-1 (big ET-1) and long-term all-cause death in patients with coronary artery disease (CAD) and different glucose metabolism status. METHODS AND RESULTS We consecutively enrolled 8550 patients from January 2013 to December 2013. Patients were categorized according to both status of glucose metabolism status [Diabetes Mellitus (DM), Pre-Diabetes (Pre-DM), Normoglycemia (NG)] and big ET-1 levels. Primary endpoint was all-cause death. During a median of 5.1-year follow-up periods, 301 all-cause deaths occurred. Elevated big ET-1 was significantly associated with long-term all-cause death (adjusted HR: 2.230, 95%CI 1.629-3.051; p < 0.001). Similarly, patients with DM, but not Pre-DM, had increased risk of all-cause death compared with NG group (p < 0.05). When patients were categorized by both status of glucose metabolism and big ET-1 levels, high big ET-1 were associated with significantly higher risk of all-cause death in Pre-DM (adjusted HR: 2.442, 95% CI 1.039-5.740; p = 0.041) and DM (adjusted HR: 3.162, 95% CI 1.376-7.269; p = 0.007). The Kaplan-Meier curve indicated that DM patients with the highest big ET-1 levels were associated with the greatest risk of all-cause death (p < 0.05). CONCLUSIONS The present data indicate that baseline big ET-1 levels were independently associated with the long-term all-cause death in DM and Pre-DM patients with CAD undergoing PCI, suggesting that big ET-1 may be a valuable marker in patients with impaired glucose metabolism.
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Affiliation(s)
- Na Xu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Zhu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sida Jia
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Deshan Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Xu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanhuan Wang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijian Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhan Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueyan Zhao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jilin Chen
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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20
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Mayer O, Bruthans J, Seidlerová J, Gelžinský J, Kučera R, Karnosová P, Mateřánková M, Wohlfahrt P, Cífková R, Filipovský J. High leptin status indicates an increased risk of mortality and heart failure in stable coronary artery disease. Nutr Metab Cardiovasc Dis 2022; 32:2137-2146. [PMID: 35843790 DOI: 10.1016/j.numecd.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Leptin is an adipocyte-derived peptide involved in energy homeostasis and body weight regulation. The position of leptin in cardiovascular pathophysiology remains controversial. Some studies suggest a detrimental effect of hyperleptinemia on the cardiovascular (CV) system, while others assume the role of leptin as a neutral or even protective factor. We have explored whether high leptin affects the mortality and morbidity risk in patients with stable coronary heart disease. METHODS AND RESULTS We followed 975 patients ≥6 months after myocardial infarction or coronary revascularization in a prospective study. All-cause or cardiovascular death, non-fatal cardiovascular events (recurrent myocardial infarction, stroke, or any revascularization), and hospitalizations for heart failure (HF) we used as outcomes. High serum leptin concentrations (≥18.9 ng/mL, i.e., 4th quartile) were associated with worse survival, as well as with a higher incidence of fatal vascular events or hospitalizations for HF. Even after full adjustment for potential covariates, high leptin remained to be associated with a significantly increased 5-years risk of all-cause death [Hazard risk ratio (HRR) 2.10 (95%CIs:1.29-3.42), p < 0.003], CV death [HRR 2.65 (95%CIs:1.48-4.74), p < 0.001], and HF hospitalization [HRR 1.95 (95% CIs:1.11-3.44), p < 0.020]. In contrast, the incidence risk of non-fatal CV events was only marginally and non-significantly influenced [HRR 1.27 (95%CIs:0.76-2.13), p = 0.359]. CONCLUSIONS High leptin concentration entails an increased risk of mortality, apparently driven by fatal CV events and future worsening of HF, on top of conventional CV risk factors and the baseline status of left ventricular function.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Radek Kučera
- Laboratory of Immunochemical Diagnostics, University Hospital, Pilsen, Czech Republic
| | - Petra Karnosová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
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21
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Kim DK, Ko GJ, Choi YJ, Jeong KH, Moon JY, Lee SH, Hwang HS. Glycated hemoglobin levels and risk of all-cause and cause-specific mortality in hemodialysis patients with diabetes. Diabetes Res Clin Pract 2022; 190:110016. [PMID: 35870571 DOI: 10.1016/j.diabres.2022.110016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
AIM Adequate glycemic control is fundamental for improving clinical outcomes in hemodialysis patients with diabetes. However, the target for glycated hemoglobin (HbA1c) level and whether cause-specific mortality differs based on HbA1c levels remain unclear. METHODS A total of 24,243 HD patients with diabetes were enrolled from a multicenter, nationwide registry. We examined the association between HbA1c levels and the risk of all-cause and cause-specific mortality. RESULTS Compared to patients with HbA1c 6.5%-7.5%, patients with HbA1c 8.5-9.5% and ≥9.5% were associated with a 1.26-fold (95% CI, 1.12-1.42) and 1.56-fold (95% CI, 1.37-1.77) risk for all-cause mortality. The risk of all-cause mortality did not increase in patients with HbA1c < 5.5%. In cause-specific mortality, the risk of cardiovascular deaths significantly increased from small increase of HbA1c levels. However, the risk of other causes of death increased only in patients with HbA1c > 9.5%. The slope of HR increase with increasing HbA1c levels was significantly faster for cardiovascular causes than for other causes. CONCLUSIONS There was a linear relationship between HbA1c levels and risk of all-cause mortality in hemodialysis patients, and the risk of cardiovascular death increased earlier and more rapidly, with increasing HbA1c levels, compared with other causes of death.
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Affiliation(s)
- Dae Kyu Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Gang Jee Ko
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun Jin Choi
- Biomedical Research Institute, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ju Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea.
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22
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Huang R, Wang Z, Chen J, Bao X, Xu N, Guo S, Gu R, Wang W, Wei Z, Wang L. Prognostic value of triglyceride glucose (TyG) index in patients with acute decompensated heart failure. Cardiovasc Diabetol 2022; 21:88. [PMID: 35641978 PMCID: PMC9158138 DOI: 10.1186/s12933-022-01507-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022] Open
Abstract
Background The triglyceride glucose (TyG) index has been proposed as a reliable marker of insulin resistance (IR) and an independent predictor of cardiovascular disease risk. However, its prognostic value in patients with acute decompensated heart failure (ADHF) remains unclear. Methods A total of 932 hospitalized patients with ADHF from January 1st, 2018 to February 1st, 2021 were included in this retrospective study. The TyG index was calculated as ln [fasting triglyceride level (mg/dL) × fasting plasma glucose level (mg/dL)/2]. Patients were divided into tertiles according to TyG index values. The primary endpoints were all-cause death, cardiovascular (CV) death and major adverse cardiac and cerebral events (MACCEs) during follow-up. We used multivariate adjusted Cox proportional hazard models and restricted cubic spline analysis to investigate the associations of the TyG index with primary endpoints. Results During a median follow-up time of 478 days, all-cause death, CV death and MACCEs occurred in 140 (15.0%), 103 (11.1%) and 443 (47.9%) cases, respectively. In multivariate Cox proportional hazard models, the risk of incident primary endpoints was associated with the highest TyG tertile. After adjustment for confounding factors, hazard ratios (HRs) for the highest tertile (TyG index ≥ 9.32) versus the lowest tertile (TyG index < 8.83) were 2.09 (95% confidence interval [CI], 1.23–3.55; p = 0.006) for all-cause death, 2.31 (95% CI, 1.26–4.24; p = 0.007) for CV death and 1.83 (95% CI, 1.18–3.01; p = 0.006) for MACCEs. Restricted cubic spline analysis also showed that the cumulative risk of primary endpoints increased as TyG index increased. When the TyG index was used as a continuous variable, the hazard ratios of the three primary endpoints rapidly increased within the higher range of the TyG index (all cause death, TyG > 9.08; CV death, TyG > 9.46; MACCEs, TyG > 9.87). Conclusions The elevated TyG index was independently associated with poor prognosis, and thus would be useful in the risk stratification in patients with ADHF.
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Affiliation(s)
- Rong Huang
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Ziyan Wang
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, 210008, Jiangsu, China
| | - Jianzhou Chen
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Xue Bao
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Nanjiao Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Simin Guo
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Rong Gu
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Weimin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.
| | - Zhonghai Wei
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.
| | - Lian Wang
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China. .,Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, 210008, Jiangsu, China.
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23
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Xi H, Cheng GL, Hu FF, Li SN, Deng X, Zhou Y. The Use of Lipoprotein-Associated Phospholipase A2 in a Chinese Population to Predict Cardiovascular Events. Biomed Environ Sci 2022; 35:206-214. [PMID: 35317900 DOI: 10.3967/bes2022.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk of cardiovascular events in a Chinese population, with a long-term follow-up. METHODS A random sample of 2,031 participants (73.6% males, mean age = 60.4 years) was derived from the Asymptomatic Polyvascular Abnormalities Community study (APAC) from 2010 to 2011. Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay (ELISA). The composite endpoint was a combination of first-ever stroke, myocardial infarction (MI) or all-cause death. Lp-PLA2 associations with outcomes were assessed using Cox models. RESULTS The median Lp-PLA2 level was 141.0 ng/mL. Over a median follow-up of 9.1 years, we identified 389 events (19.2%), including 137 stroke incidents, 43 MIs, and 244 all-cause deaths. Using multivariate Cox regression, when compared with the lowest Lp-PLA2 quartile, the hazard ratios with 95% confidence intervals for developing composite endpoints, stroke, major adverse cardiovascular events, and all-cause death were 1.77 (1.24-2.54), 1.92 (1.03-3.60), 1.69 (1.003-2.84), and 1.94 (1.18-3.18) in the highest quartile, respectively. Composite endpoints in 145 (28.6%) patients occurred in the highest quartile where Lp-PLA2 (159.0 ng/mL) was much lower than the American Association of Clinical Endocrinologists recommended cut-off point, 200 ng/mL. CONCLUSION Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population. The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.
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Affiliation(s)
- Hui Xi
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Guan Liang Cheng
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Fei Fei Hu
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Song Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Xuan Deng
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Yong Zhou
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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24
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Wang A, Tian X, Zuo Y, Xu Q, Meng X, Chen P, Li H, Wang Y. Urine ketone bodies and adverse outcomes in patients with acute ischemic stroke or TIA. Atheroscler Plus 2022; 48:20-26. [PMID: 36644558 PMCID: PMC9833217 DOI: 10.1016/j.athplu.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/16/2022] [Accepted: 03/05/2022] [Indexed: 01/18/2023]
Abstract
Background and aims Urine ketone bodies have been considered as predictors of stroke in diabetic patients, however, the role of urine ketone bodies in the prognosis of stroke has not been investigated well. This study aimed to investigate the association between urine ketone bodies and adverse outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods This study enrolled 14 015 patients with AIS or TIA who screened for urine ketone bodies from the Third China National Stroke Registry. Status of urine ketone bodies were classified into negative, suspicious positive and positive. The outcomes were all-cause death and poor functional outcomes (modified Rankin Scale [mRS] 2-6/3-6) at 3 months and 1 year. Multivariable Cox proportional hazards regressions and logistic regressions were adopted to explore the associations. Results Participants with negative, suspicious positive and positive urine ketone bodies were 12979 (92.61%), 480 (3.42%) and 556 (3.97%). After multivariate adjustment, patients with positive urine ketone bodies had a higher risk of all-cause death (hazard ratio, 1.74; confidence interval [CI], 1.07-2.83), a higher proportion of mRS score 2-6 (Odds ratio [OR], 1.85; 95% CI, 1.51-2.27), mRS score 3-6 (OR, 2.00; 95% CI, 1.61-2.48) at 3 months, compared to those with negative urine ketone bodies. Significant associations persisted at 1 year. Furthermore, there was no significant interaction of diabetes status and alcohol use with urine ketone bodies. Conclusions Positive urine ketone bodies can independently predict all-cause death and poor functional outcomes in patients with AIS or TIA.
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Affiliation(s)
- Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Qin Xu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pan Chen
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Corresponding author. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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25
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Alkabbani W, Gamble JM, Eurich DT, Minhas-Sandhu JK, Shah BR, Alsabbagh MW, Zongo A. Risk of hospitalization and death associated with sodium glucose cotransporter-2 inhibitors: A comparison with five other classes of antidiabetic drugs. Diabetes Metab 2022; 48:101305. [PMID: 34808344 DOI: 10.1016/j.diabet.2021.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
AIM We assessed the risk of all-cause hospitalization and all-cause death associated with the use of Sodium Glucose Cotransporter-2 inhibitors (SGLT2i). METHODS Population-based propensity scores-matched cohort study of new users of metformin who subsequently initiated SGLT2i compared to those who initiated dipeptidyl peptidase-4 inhibitors (DPP4i) (primary comparison), sulfonylureas, thiazolidinediones, GLP1-Receptors agonists, and insulin, respectively. Alberta (Canada) health administrative data and United Kingdom Clinical Practice Research Datalink (CPRD) data were used to assess the study outcomes. Conditional Cox regressions were performed to assess the risk of each outcome, separately for each dataset and then results were combined using random-effects meta-analysis. RESULTS For SGLT2i versus DPP4i, 7531 and 1647 SGLT2i-DPP4i matched pairs were analyzed in Alberta and CPRD data respectively. The mean age of patients was 56 and 57 years, and 39% and 43% were females, respectively in Alberta and CPRD cohorts. Compared with DPP-4-i, SGLT2i use was associated with a significant lower risk of all-cause hospitalization (combined hazard ratio (HR): 0.84, 95% confidence interval (95%CI): 0.75-0.95), and all-cause death (0.56, 0.38-0.83). SGLT2i use was also associated with a significant lower risk of all-cause hospitalization and all-cause death when compared to sulfonylureas (HRs: 0.80, 95%CI: 0.71-0.90 and 0.56, 95%CI: 0.38-0.82, respectively) and insulin (HRs: 0.55, 95%CI: 0.41-0.74, and 0.33, 95%CI: 0.24-0.46, respectively). CONCLUSIONS SGLT2i initiation was associated with a decreased risk of all-cause hospitalization and all-cause death when compared to DPP4i, sulfonylureas, and insulin.
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Affiliation(s)
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, AB, Canada
| | - Jasjeet K Minhas-Sandhu
- School of Pharmacy, University of Waterloo, ON, Canada; School of Public Health, University of Alberta, AB, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, ON, Canada; Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Arsène Zongo
- Faculty of pharmacy, Université Laval, Canada; CHU de Quebec -Université Laval Research Centre, Quebec, Canada.
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26
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Shen X, He S, Wang J, Qian X, Wang H, Zhang B, Chen Y, Li H, Li G. Phenotype of higher post-load insulin response as a predictor of all-cause mortality and cardiovascular mortality in the Chinese non-diabetic population. Diabetol Metab Syndr 2022; 14:19. [PMID: 35090539 PMCID: PMC8796343 DOI: 10.1186/s13098-022-00786-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
AIM This study aimed to assess whether a higher insulin response increased the long-term risk of mortality in a non-diabetic population. METHODS A total of 446 people with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) who participated in the Da Qing Diabetes Study, were stratified into quartiles subgroups according to their baseline insulin area under the curve (AUC) during oral glucose tolerance test, defined as Q1, Q2, Q3 and Q4. The participants were followed from 1986 to 2016 to assess the risk of death in association with the magnitude of post-load insulin response. RESULTS Over 30 years, the rates of all cause death were 9.94, 14.81, 15.02, and 17.58 per 1000 person-years across the four groups respectively. The rate for cardiovascular disease (CVD) death was 5.14, 6.50, 6.80 and 10.47 per 1000 person-years. Compared with Q1, the risk of all-cause death was significantly higher in participants in Q4 (HR = 2.14, 95% CI 1.34-3.42), Q3 (HR = 1.94, 95% CI 1.20-3.14), and Q2 group (HR = 1.70, 95% CI 1.06-2.74). In the Fine-Gray model with non-CVD death as competing risk, the increased insulin AUC were also significantly associated with the CVD death (Q4 vs Q1, HR = 2.04, 95% CI 1.10-3.79). In the fractional polynomial regression analysis, a nonlinear association between insulin AUC and all-cause and CVD death was demonstrated. In addition, insulin AUC was associated with a progressively higher risk of all-cause death and CVD death (fractional power 3, P < 0.001). CONCLUSION A higher post-load insulin response was significantly associated with a long-term increased risk of all-cause and CVD deaths in the Chinese non-diabetic population. It suggests that people featured by this phenotype is a potential important target for further intervention.
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Affiliation(s)
- Xiaoxia Shen
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Siyao He
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, No. 9 Zhongkang Street, Saltu District, Daqing, 163411, Heilongjiang, China
| | - Xin Qian
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Hui Wang
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Yanyan Chen
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Hui Li
- Department of Cardiology, Da Qing First Hospital, No. 9 Zhongkang Street, Saltu District, Daqing, 163411, Heilongjiang, China
| | - Guangwei Li
- Center of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.
- Department of Endocrinology, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.
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Shibata K, Tokushige A, Imamura M, Ikeda Y, Ohishi M. Evaluating the Khorana risk score of gastrointestinal cancer patients during initial chemotherapy as a predictor of patient mortality: A retrospective study. J Cardiol 2021:S0914-5087(21)00355-5. [PMID: 34924239 DOI: 10.1016/j.jjcc.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Khorana risk score (KRS) has been recommended for predicting the incidence of cancer-associated thrombosis (CAT). However, it has been reported KRS was not useful in predicting CAT, but rather in predicting death by setting high scores for the primary tumor site or a low prevalence of severe obesity. METHODS A total of 260 consecutive patients with no history of thrombosis and who started initial chemotherapy for gastrointestinal cancer from January 2017 to December 2018 at our hospital were divided into three groups according to KRS; they were observed until December 2019 [122 patients (46.9%) in the low-risk group, 114 patients (43.8%) in the intermediate-risk group, and 24 patients (9.2%) in the high-risk group]. The incidence of CAT and all-cause death were compared among the three groups. RESULTS The median age of the patients was 67 years; 63.5% were men. CAT was observed in 61 patients (26.1%); 84 patients (37.9%) died during the observation period. The incidence rate of CAT was similar among the three groups (log-rank p = 0.4); but all-cause death showed a significant difference among the three groups (high-risk group: 58.2%, intermediate-risk group: 44.6%, low-risk group: 27.5%, log-rank p = 0.002). In the multivariate analysis, the high-risk KRS group remained at increased risk for all-cause death (HR, 2.83; 95% CI, 1.37-5.83; p = 0.005), but not with CAT. CONCLUSIONS The KRS at the start of chemotherapy for gastrointestinal cancer is not effective in predicting CAT, but it is effective in predicting prognosis in patients with gastrointestinal cancer.
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Zhao H, Sheng Z, Tan Y, Chen R, Zhou J, Li J, Zhao Q, Wang Y, Zhao X, Chen Y, Zhou P, Liu C, Song L, Yan H. High Human Antimicrobial Peptide LL-37 Level Predicts Lower Major Adverse Cardiovascular Events after an Acute ST-Segment Elevation Myocardial Infarction. J Atheroscler Thromb 2021; 29:1499-1510. [PMID: 34853213 PMCID: PMC9529390 DOI: 10.5551/jat.63221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims: We previously associated acute ST-elevation myocardial infarction (STEMI) with decreased plasma LL-37 levels. Therefore, this study investigated whether plasma LL-37 levels could predict ischemic cardiovascular events in patients after STEMI.
Methods: We prospectively collected peripheral plasma samples and clinical and laboratory data from consecutive patients who presented with STEMI and underwent primary percutaneous coronary intervention at Fuwai Hospital between April and November 2017. Enzyme-linked immunosorbent assay measured plasma LL-37 levels, and we followed the patients for 3 years. Major adverse cardiovascular events (MACEs) were a composite of all-cause mortality, reinfarction, unscheduled revascularization, or ischemic stroke.
Results: The study included 302 patients divided into high (≥ median) and low LL-37 level (<median) groups.
The cumulative incidence of MACE (29.1% vs. 12.6%, p=0.0003), all-cause death (12.6% vs. 3.3%, p=0.003),
reinfarction (7.1% vs. 2.0%, p=0.04), and unscheduled revascularization (13.0% vs. 5.4%, p=0.04) were higher in the low than those in the high LL-37 level group.
Multivariable Cox regression analysis showed that higher LL-37 level independently predicted lower risks of MACE (hazard ratio [HR] 0.390; 95% confidence interval [CI] 0.227–0.669; p<0.001),
all-cause death (HR 0.324; 95%CI 0.119–0.879; p=0.027), and unscheduled revascularization (HR 0.391; 95%CI 0.171–0.907; p=0.027).
Conclusions: High basal plasma level of human LL-37 may predict lower 3-year risks of ischemic cardiovascular events in patients after STEMI.
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Affiliation(s)
- Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.,Department of Cardiology, China-Japan Friendship Hospital
| | - Yu Tan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.,Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences
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Sheng M, Yang J, Bao M, Chen T, Cai R, Zhang N, Chen H, Liu M, Wu X, Zhang B, Liu Y, Chao J. The relationships between step count and all-cause mortality and cardiovascular events: A dose-response meta-analysis. J Sport Health Sci 2021; 10:620-628. [PMID: 34547483 PMCID: PMC8724621 DOI: 10.1016/j.jshs.2021.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND A goal of 10,000 steps per day is widely advocated, but there is little evidence to support that goal. Our purpose was to examine the dose-response relationships between step count and all-cause mortality and cardiovascular disease risk. METHODS Cochrane Central Register of Controlled Trials, EMBASE, OVID, PubMed, Scopus, and Web of Science databases were systematically searched for studies published before July 9, 2021, that evaluated the association between daily steps and at least 1 outcome. RESULTS Sixteen publications (12 related to all-cause mortality, 5 related to cardiovascular disease; and 1 article contained 2 outcomes: both all-cause death and cardiovascular events) were eligible for inclusion in the meta-analysis. There was evidence of a nonlinear dose-response relationship between step count and risk of all-cause mortality or cardiovascular disease (p = 0.002 and p = 0.014 for nonlinearity, respectively). When we restricted the analyses to accelerometer-based studies, the third quartile had a 40.36% lower risk of all-cause mortality and a 35.05% lower risk of cardiovascular event than the first quartile (all-cause mortality: Q1 = 4183 steps/day, Q3 = 8959 steps/day; cardiovascular event: Q1 = 3500 steps/day, Q3 = 9500 steps/day; respectively). CONCLUSION Our meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults, with nonlinear dose-response patterns.
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Affiliation(s)
- Mingxin Sheng
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Junyue Yang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Min Bao
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Tianzhi Chen
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - Ruixue Cai
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Na Zhang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Hongling Chen
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Minqi Liu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Xueyu Wu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Bowen Zhang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Yiting Liu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Jianqian Chao
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China.
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30
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Onozuka D, Tanoue Y, Nomura S, Kawashima T, Yoneoka D, Eguchi A, Ng CFS, Matsuura K, Shi S, Makiyama K, Uryu S, Kawamura Y, Takayanagi S, Gilmour S, Hayashi TI, Miyata H, Sera F, Sunagawa T, Takahashi T, Tsuchihashi Y, Kobayashi Y, Arima Y, Kanou K, Suzuki M, Hashizume M. Reduced mortality during the COVID-19 outbreak in Japan, 2020: a two-stage interrupted time-series design. Int J Epidemiol 2021; 51:75-84. [PMID: 34718594 PMCID: PMC8856001 DOI: 10.1093/ije/dyab216] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) continues to be a major global health burden. This study aims to estimate the all-cause excess mortality occurring in the COVID-19 outbreak in Japan, 2020, by sex and age group. Methods Daily time series of mortality for the period January 2015–December 2020 in all 47 prefectures of Japan were obtained from the Ministry of Health, Labour and Welfare, Japan. A two-stage interrupted time-series design was used to calculate excess mortality. In the first stage, we estimated excess mortality by prefecture using quasi-Poisson regression models in combination with distributed lag non-linear models, adjusting for seasonal and long-term variations, weather conditions and influenza activity. In the second stage, we used a random-effects multivariate meta-analysis to synthesize prefecture-specific estimates at the nationwide level. Results In 2020, we estimated an all-cause excess mortality of −20 982 deaths [95% empirical confidence intervals (eCI): −38 367 to −5472] in Japan, which corresponded to a percentage excess of −1.7% (95% eCI: −3.1 to −0.5) relative to the expected value. Reduced deaths were observed for both sexes and in all age groups except those aged <60 and 70–79 years. Conclusions All-cause mortality during the COVID-19 outbreak in Japan in 2020 was decreased compared with a historical baseline. Further evaluation of cause-specific excess mortality is warranted.
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Affiliation(s)
- Daisuke Onozuka
- Department of Medical Informatics and Clinical Epidemiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Tanoue
- Institute for Business and Finance, Waseda University, Tokyo, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Kawashima
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Mathematical and Computing Science, Tokyo Institute of Technology, Tokyo, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Akifumi Eguchi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kentaro Matsuura
- Department of Management Science, Graduate School of Engineering, Tokyo University of Science, Tokyo, Japan.,HOXO-M Inc., Tokyo, Japan
| | - Shoi Shi
- Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Laboratory for Synthetic Biology, RIKEN Center for Biosystems Dynamics Research, Osaka, Japan
| | | | - Shinya Uryu
- Center for Environmental Biology and Ecosystem Studies, National Institute for Environmental Studies (NIES), Tokyo, Japan
| | - Yumi Kawamura
- RIKEN Center for Sustainable Resource Science, Saitama, Japan
| | | | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Takehiko I Hayashi
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Ibaraki, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications 'G. Parenti', University of Florence, Florence, Italy
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, Tokyo, Japan
| | - Takuri Takahashi
- Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuuki Tsuchihashi
- Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, Tokyo, Japan
| | - Yusuke Kobayashi
- Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuzo Arima
- Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazuhiko Kanou
- Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, Tokyo, Japan
| | - Motoi Suzuki
- Infectious Disease Surveillance Center, the National Institute of Infectious Diseases, Tokyo, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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31
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Wang R, Serruys PW, Gao C, Hara H, Takahashi K, Ono M, Kawashima H, O'leary N, Holmes DR, Witkowski A, Curzen N, Burzotta F, James S, van Geuns RJ, Kappetein AP, Morel MA, Head SJ, Thuijs DJFM, Davierwala PM, O'Brien T, Fuster V, Garg S, Onuma Y. Ten-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary artery disease. Eur Heart J 2021; 43:56-67. [PMID: 34405232 PMCID: PMC8720143 DOI: 10.1093/eurheartj/ehab441] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Aims The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. Methods and results The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: −7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: −6.5%, 22.5%, P = 0.227). Conclusions The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.
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Affiliation(s)
- Rutao Wang
- Department of Cardiology, Xijing Hospital, Changle West Road 127, Xi'an 710032, China.,Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Imperial College London, Exhibition Rd, London SW7 2BX, UK
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Changle West Road 127, Xi'an 710032, China.,Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Neil O'leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - David R Holmes
- Department of Cardiology, Mayo ClinicSchool of Medicine, 200 First St. SW Rochester, MN 55905, USA
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
| | - Nick Curzen
- Cardiology Department, University Hospital Southampton, Coxford Rd, Southampton SO16 5YA, UK
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjolds vag 14B SE-752 37, Uppsala, Sweden
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Dr Molewaterplein 40, 3015 GE Rotterdam, The Netherlands
| | - Marie-Angele Morel
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Dr Molewaterplein 40, 3015 GE Rotterdam, The Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Dr Molewaterplein 40, 3015 GE Rotterdam, The Netherlands
| | - Piroze M Davierwala
- Department of Cardiac Surgery, Heart Centre Leipzig, Strumpelstrasse 39, Leipzig 4289, Germany
| | - Timothy O'Brien
- Regenerative Medicine Institute, CURAM, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Valentin Fuster
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicina at Mount Sinai School, 1 Gustave L. Levy Place, 10029-5674 New York, NY, USA
| | - Scot Garg
- Department of Cardiology, East Lancashire Hospitals NHS Trust, Haslingden Rd, Blackburn BB2 3HH, Lancashire, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
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Shimamoto S, Yamada S, Hiyamuta H, Arase H, Taniguchi M, Tsuruya K, Nakano T, Kitazono T. Association of the nutritional risk index for Japanese hemodialysis patients with long-term mortality: The Q-Cohort Study. Clin Exp Nephrol 2021; 26:59-67. [PMID: 34403008 DOI: 10.1007/s10157-021-02124-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 08/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Protein-energy wasting (PEW) is a risk factor for mortality in patients undergoing hemodialysis. Recently, a nutritional risk index for Japanese hemodialysis patients (NRI-JH) has been proposed as a surrogate index of PEW. However, no study has determined the association of the NRI-JH with long-term mortality in patients undergoing hemodialysis. Furthermore, the validity of the NRI-JH has not been confirmed. METHODS In total, 3046 patients undergoing hemodialysis and registered in the Q-Cohort Study were followed up for 10 years. The NRI-JH was calculated on the basis of body mass index and serum levels of albumin, total cholesterol, and creatinine. The patients were divided into four groups according to the NRI-JH scores: 0-3 (G1, n = 1343), 4-7 (G2, n = 1136), 8-10 (G3, n = 321), and 11-13 (G4, n = 246). We examined the association between the NRI-JH and the 4-year and 10-year risks of all-cause, cardiovascular, and infection-related deaths using the Cox proportional hazards model. RESULTS During the follow-up period, 647 patients died during the first 4 years, and 1503 patients died within 10 years. The 4-year prognosis was analyzed and compared with the lowest NRI-JH score group. Multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause death were 1.93 (1.57-2.38), 2.68 (2.05-3.50), and 3.16 (2.40-4.16) in the G2, G3, and G4 groups, respectively. Similarly, a higher NRI-JH score was associated with an increased risk of cardiovascular and infection-related deaths. CONCLUSION A higher NRI-JH score was associated with an increased risk of long-term mortality in patients undergoing maintenance hemodialysis. TRIAL REGISTRATION The study protocol was registered in the University Hospital Medical Information Network (UMIN) clinical trial registry (UMIN ID: 000000556).
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Affiliation(s)
- Sho Shimamoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | | | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan.
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
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Hirota N, Suzuki S, Arita T, Yagi N, Otsuka T, Yamashita T. Prediction of biological age and all-cause mortality by 12-lead electrocardiogram in patients without structural heart disease. BMC Geriatr 2021; 21:460. [PMID: 34380426 PMCID: PMC8359578 DOI: 10.1186/s12877-021-02391-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background There is a well-established relationship between 12-lead electrocardiogram (ECG) and age and mortality. Furthermore, there is increasing evidence that ECG can be used to predict biological age. However, the utility of biological age from ECG for predicting mortality remains unclear. Methods This was a single-center cohort study from a cardiology specialized hospital. A total of 19,170 patients registered in this study from February 2010 to March 2018. ECG was analyzed in a final 12,837 patients after excluding those with structural heart disease or with pacing beats, atrial or ventricular tachyarrhythmia, or an indeterminate axis (R axis > 180°) on index ECG. The models for biological age were developed by principal component analysis (BA) and the Klemera and Doubal’s method (not adjusted for age [BAE] and adjusted for age [BAEC]) using 438 ECG parameters. The predictive capability for all-cause death and cardiovascular death by chronological age (CA) and biological age using the three algorithms were evaluated by receiver operating characteristic analysis. Results During the mean follow-up period of 320.4 days, there were 55 all-cause deaths and 23 cardiovascular deaths. The predictive capabilities for all-cause death by BA, BAE, and BAEC using area under the curves were 0.731, 0.657, and 0.685, respectively, which were comparable to 0.725 for CA (p = 0.760, 0.141, and 0.308, respectively). The predictive capabilities for cardiovascular death by BA, BAE, and BAEC were 0.682, 0.685, and 0.692, respectively, which were also comparable to 0.674 for CA (p = 0.775, 0.839, and 0.706, respectively). In patients aged 60–74 years old, the area under the curves for all-cause death by BA, BAE, and BAEC were 0.619, 0.702, and 0.697, respectively, which tended to be or were significantly higher than 0.482 for CA (p = 0.064, 0.006, and 0.005, respectively). Conclusion Biological age by 12-lead ECG showed a similar predictive capability for mortality compared to CA among total patients, but partially showed a significant increase in predictive capability among patients aged 60–74 years old. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02391-8.
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Affiliation(s)
- Naomi Hirota
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan.
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
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Li M, Cheng J, Zhao J, Xue W, Bao H, Song Y, Qin L. Relationship between intact parathyroid hormone and all-cause death, cardiovascular events, and ectopic calcification in patients with diabetic kidney disease: A retrospective study. Diabetes Res Clin Pract 2021; 177:108926. [PMID: 34161808 DOI: 10.1016/j.diabres.2021.108926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
AIM We aimed to investigate the relationship between intact parathyroid hormone (iPTH) levels and all-cause death, cardiovascular events, and ectopic calcification in patients with diabetic kidney disease (DKD). METHODS In this retrospective cohort study, we collected the clinical data of 508 patients with clinically diagnosed DKD. The primary and secondary outcomes were all-cause death or cardiovascular events and ectopic calcification, respectively. We used different regression methods to analyze the relationship between various clinical parameters and the two clinical outcomes. RESULTS We found that iPTH was a risk factor for all-cause death and cardiovascular events (hazards ration [HR]: 2.817, 95% confidence interval [CI]: 1.045-6.562, P = 0.016). Meanwhile, diabetes duration (HR: 1.090, 95% CI: 1.045-1.138, P < 0.0001), triglycerides (TG) (HR: 1.254, 95% CI: 1.049-1.499, P = 0.013), and iPTH (HR: 1.954, 95% CI: 1.001-3.813, P = 0.049) were independent risk factors for ectopic calcification. In contrast to patients with lower iPTH levels (iPTH < 31.7 pg/mL), patients with higher iPTH levels (iPTH ≥ 31.7 pg/mL) had increased ectopic calcification rate (P = 0.002) and decreased survival time (P < 0.001). CONCLUSION In patients with DKD, higher iPTH levels were significantly related to worsen clinical outcomes.
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Affiliation(s)
- Mengyuan Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jiafen Cheng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jian Zhao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Wen Xue
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Hui Bao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Yaxiang Song
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
| | - Ling Qin
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
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35
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Kurasawa S, Hishida M, Imaizumi T, Okazaki M, Nishibori N, Kondo T, Kasuga H, Maruyama S. All-cause and cardiovascular mortality in patients undergoing hemodialysis with aortic sclerosis and mild-to-moderate aortic stenosis: A cohort study. Atherosclerosis 2021; 331:12-19. [PMID: 34256259 DOI: 10.1016/j.atherosclerosis.2021.06.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/28/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Mild-to-moderate aortic stenosis (AS) and aortic sclerosis, a precursor of AS, are associated with mortality in the general population; however, their association in patients undergoing hemodialysis with higher morbidity of AS is unknown. Thus, we investigated the mortality of aortic sclerosis and mild-to-moderate AS in patients undergoing hemodialysis. METHODS This was a retrospective multicenter cohort study of consecutive patients undergoing hemodialysis at nine dialysis facilities who underwent screening echocardiography between January 2008 and December 2019. We investigated the mortality of patients with aortic sclerosis or mild-to-moderate AS using multivariable Cox proportional hazards regression. RESULTS Among 1,878 patients undergoing hemodialysis, those with normal aortic valves, aortic sclerosis, mild AS, moderate AS, severe AS, and prosthetic aortic valves were 844 (45%), 793 (42%), 161 (8.6%), 38 (2.0%), 11 (0.6%), and 31 (1.7%), respectively. After excluding patients with severe AS and prosthetic aortic valves, we performed comparative analysis on 1,836 patients (mean age, 67 years; 66% male). In a median follow-up of 3.6 years, crude death rates (per 100 person-years) were 5.2, 10.6, and 13.0 in patients with normal aortic valves, aortic sclerosis, and mild-to-moderate AS, respectively. Compared with normal aortic valves, both aortic sclerosis and mild-to-moderate AS were associated with all-cause and cardiovascular death: adjusted hazard ratios (95% confidence intervals) were 1.36 (1.13-1.65) and 1.36 (1.02-1.80) for all-cause death; and 1.52 (1.06-2.17) and 1.74 (1.04-2.92) for cardiovascular death, respectively. CONCLUSIONS Aortic sclerosis and mild-to-moderate AS were independent risk factors for all-cause and cardiovascular death in patients undergoing hemodialysis.
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Affiliation(s)
- Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masaki Okazaki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiro Nishibori
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirotake Kasuga
- Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Wang R, Tomaniak M, Takahashi K, Gao C, Kawashima H, Hara H, Ono M, van Klaveren D, van Geuns RJ, Morice MC, Davierwala PM, Mack MJ, Witkowski A, Curzen N, Berti S, Burzotta F, James S, Kappetein AP, Head SJ, Thuijs DJFM, Mohr FW, Holmes DR, Tao L, Onuma Y, Serruys PW. Impact of chronic obstructive pulmonary disease on 10-year mortality after percutaneous coronary intervention and bypass surgery for complex coronary artery disease: insights from the SYNTAX Extended Survival study. Clin Res Cardiol 2021; 110:1083-1095. [PMID: 33710385 PMCID: PMC8238698 DOI: 10.1007/s00392-021-01833-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Aims To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD. Methods Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy. Results COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56–2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59–1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67–0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (pinteraction = 0.544). Conclusions COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050 Graphic abstract ![]()
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Affiliation(s)
- Rutao Wang
- Department of Cardiology, Xijing Hospital, Xi'an, China
- Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Xi'an, China
- Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Nick Curzen
- Cardiology Department, University Hospital Southampton, Southampton, UK
| | - Sergio Berti
- Cardiology Department, Heart Hospital-Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Friedrich W Mohr
- Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | | | - Ling Tao
- Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), P.O. University Road, Galway, H91 TK33, Ireland.
- NHLI, Imperial College London, London, UK.
- Erasmus University Medical Center, Rotterdam, The Netherlands.
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Chopard R, Jimenez D, Serzian G, Ecarnot F, Falvo N, Kalbacher E, Bonnet B, Capellier G, Schiele F, Bertoletti L, Monreal M, Meneveau N. Renal dysfunction improves risk stratification and may call for a change in the management of intermediate- and high-risk acute pulmonary embolism: results from a multicenter cohort study with external validation. Crit Care 2021; 25:57. [PMID: 33563311 PMCID: PMC7874488 DOI: 10.1186/s13054-021-03458-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/01/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Renal dysfunction influences outcomes after pulmonary embolism (PE). We aimed to determine the incremental value of adding renal dysfunction, defined by estimated glomerular filtration rate (eGFR), on top of the European Society of Cardiology (ESC) prognostic model, for the prediction of 30-day mortality in acute PE patients, which in turn could lead to the optimization of acute PE management. METHODS We performed a multicenter, non-interventional retrospective post hoc analysis based on a prospectively collected cohort including consecutive confirmed acute PE stratified per ESC guidelines. We first identified which of three eGFR formulae most accurately predicted death. Changes in global model fit, discrimination, calibration and reclassification parameters were evaluated with the addition of eGFR to the prognostic model. RESULTS Among 1943 patients (mean age 67.3 (17.1), 50.4% women), 107 (5.5%) had died at 30 days. The 4-variable Modification of Diet in Renal Disease (eGFRMDRD4) formula predicted death most accurately. In total, 477 patients (24.5%) had eGFRMDRD4 < 60 ml/min. Observed mortality was higher for intermediate-low-risk and high-risk PE in patients with versus without renal dysfunction. The addition of eGFRMDRD4 information improved model fit, discriminatory capacity, and calibration of the ESC model. Reclassification parameters were significantly increased, yielding 18% reclassification of predicted mortality (p < 0.001). Predicted mortality reclassifications across risk categories were as follows: 63.1% from intermediate-low risk to eGFR-defined intermediate-high risk, 15.8% from intermediate-high risk to eGFR-defined intermediate-low risk, and 21.0% from intermediate-high risk to eGFR-defined high risk. External validation in a cohort of 14,234 eligible patients from the RIETE registry confirmed our findings with a significant improvement of Harrell's C index and reclassification parameters. CONCLUSION The addition of eGFRMDRD4-derived renal dysfunction on top of the prognostic algorithm led to risk reclassification within the intermediate- and high-risk PE categories. The impact of risk stratification integrating renal dysfunction on therapeutic management for acute PE requires further studies.
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Affiliation(s)
- Romain Chopard
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France. .,EA3920, University of Burgundy Franche-Comté, Besançon, France. .,F-CRIN, INNOVTE, Saint-Etienne, France.
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Department of Medicine, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Guillaume Serzian
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Nicolas Falvo
- Department of Internal Medicine, University Hospital Dijon-Bourgogne, Dijon, France
| | - Elsa Kalbacher
- Medical Oncology Unit, University Hospital Besançon, Besançon, France
| | | | - Gilles Capellier
- EA3920, University of Burgundy Franche-Comté, Besançon, France.,Medical Intensive Care Unit, University Hospital Jean Minjoz, Besançon, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, Saint-Etienne University Hospital, Saint-Etienne, France.,INSERM CIC1408 and INSERM UMR 1059, Saint-Etienne, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, Besançon, France.,F-CRIN, INNOVTE, Saint-Etienne, France
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38
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Mayer O, Bruthans J, Seidlerová J, Karnosová P, Mateřánková M, Gelžinský J, Rychecká M, Opatrný J, Wohlfahrt P, Kučera R, Trefil L, Cífková R, Filipovský J, Vermeer C. The coincidence of low vitamin K status and high expression of growth differentiation factor 15 may indicate increased mortality risk in stable coronary heart disease patients. Nutr Metab Cardiovasc Dis 2021; 31:540-551. [PMID: 33257192 DOI: 10.1016/j.numecd.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Matrix Gla protein (MGP) is a natural inhibitor of vascular calcification critically dependent on circulating vitamin K status. Growth differentiation factor 15 (GDF-15) is a regulatory cytokine mainly of the inflammatory and angiogenesis pathways, but potentially also involved in bone mineralization. We sought to determine whether these two circulating biomarkers jointly influenced morbidity and mortality risk in patients with chronic coronary heart disease (CHD). METHODS AND RESULTS 894 patients ≥6 months after myocardial infarction and/or coronary revascularization at baseline were followed in a prospective study. All-cause and cardiovascular mortality, non-fatal cardiovascular events (myocardial infarction, stroke, any revascularization), and hospitalization for heart failure (HF) were followed as outcomes. Desphospho-uncarboxylated MGP (dp-ucMGP) was used as a biomarker of vitamin K status. Both, increased concentrations of dp-ucMGP (≥884 pmol/L) and GDF-15 (≥1339 pg/mL) were identified as independent predictors of 5-year all-cause or cardiovascular mortality. However, their coincidence further increased mortality risk. The highest risk was observed in patients with high dp-ucMGP plus high GDF-15, not only when compared with those with "normal" concentrations of both biomarkers [HR 5.51 (95% CI 2.91-10.44), p < 0.0001 and 6.79 (95% CI 3.06-15.08), p < 0.0001 for all-cause and cardiovascular mortality, respectively], but even when compared with patients with only one factor increased. This pattern was less convincing with non-fatal cardiovascular events or hospitalization for HF. CONCLUSIONS The individual coincidence of low vitamin K status (high dp-ucMGP) and high GDF-15 expression predicts poor survival of stable CHD patients.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Petra Karnosová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Martina Rychecká
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Jan Opatrný
- Department of Cardiology, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Radek Kučera
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Ladislav Trefil
- Department of Clinical Biochemistry and Hematology, University Hospital, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Cees Vermeer
- Cardiovascular Research Institute CARIM, Maastricht University, the Netherlands
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Guan S, Fang X, Gu X, Zhang Z, Tang Z, Wu X, Liu H, Wang C. The link of depression, untreated hypertension, and diabetes with mortality in postmenopausal women: A cohort study. Clin Exp Hypertens 2021; 43:1-6. [PMID: 32715792 DOI: 10.1080/10641963.2020.1790584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the association of depression, as well as untreated hypertension or diabetes with all-cause death in community-based postmenopausal women in Beijing. METHODS A cohort of 863 community-based postmenopausal women with no history of cardiovascular heart disease (CHD), stroke, cancer, or dementia was investigated on 20 July-28 September 2009 at baseline. Depression was diagnosed using the 30-item Center for Epidemiologic Studies Depression (CES-D) scale with CES-D ≥ 11. Meanwhile, data on health behavior, physical comorbidity, and social support at baseline were collected. These individuals were followed up from 20 July to 30 August 2014. All-cause mortality and cause of death were surveyed. RESULTS After a median follow-up of 4.97 years, 120 subjects died of all-cause. Twenty-four died of stroke, 19 died of myocardial infarction, 21 died of cancer. The others died of aging, infection, and accident. Depression and untreated HP were significantly associated with all-cause mortality in Cox models after full adjustment for all of the potential confounders (Depression HR: 2.16, 95%CI: 1.35-3.46; Untreated hypertension HR: 1.84, 95%CI: 1.12-3.02). However, negative correlation of untreated diabetes on all-cause mortality was observed in this population (HR: 1.36, 95%CI: 0.75-2.49). When depression was co-existing with hypertension/diabetes, the HR for mortality elevated significantly (Depression co-existing with hypertension HR = 3.87, 95% CI: 2.07-7.23; Depression co-existing with diabetes HR = 5.02, 95% CI: 1.5-16.79). CONCLUSIONS It is suggested we should take sufficient care of postmenopausal females with depression and control blood pressure and glucose more effectively. Abbreviations: HP: Hypertension; DM: Diabetes; TC: Cholesterol; TG: Triglyceride; BMI: Body-Mass Index; CES-D: Center for Epidemiologic Studies Depression; CDC: Centers for Disease Control and Prevention; HR: Hazard Ratio; CI: Confidence Interval; ADL: Activities of daily living scale.
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Affiliation(s)
- Shaochen Guan
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Xianghua Fang
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Xiang Gu
- Division of Geriatric Nephrology, Beijing Friendship Hospital, Capital Medical University , Beijing, Xicheng, China
| | - Zhongying Zhang
- Department of Geriatrics, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China
| | - Zhe Tang
- Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Xiaoguang Wu
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Hongjun Liu
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Chunxiu Wang
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
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Wang C, Ni W, Yao Y, Just A, Heiss J, Wei Y, Gao X, Coull BA, Kosheleva A, Baccarelli AA, Peters A, Schwartz JD. DNA methylation-based biomarkers of age acceleration and all-cause death, myocardial infarction, stroke, and cancer in two cohorts: The NAS, and KORA F4. EBioMedicine 2020; 63:103151. [PMID: 33279859 PMCID: PMC7724153 DOI: 10.1016/j.ebiom.2020.103151] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022] Open
Abstract
Background DNA methylation (DNAm) may play a role in age-related outcomes. It is not yet known which DNAm-based biomarkers of age acceleration (BoAA) has the strongest association with age-related endpoints. Methods We collected the blood samples from two independent cohorts: the Normative Ageing Study, and the Cooperative Health Research in the Region of Augsburg cohort. We measured epigenome-wide DNAm level, and generated five DNAm BoAA at baseline. We used Cox proportional hazards model to analyze the relationships between BoAA and all-cause death. We applied the Fine and Gray competing risk model to estimate the risk of BoAA on myocardial infarction (MI), stroke, and cancer, accounting for death of other reasons as the competing risks. We used random-effects meta-analyses to pool the individual results, with adjustment for multiple testing. Findings The mean chronological ages in the two cohorts were 74, and 61, respectively. Baseline GrimAgeAccel, and DNAm-related mortality risk score (DNAmRS) both had strong associations with all-cause death, MI, and stroke, independent from chronological age. For example, a one standard deviation (SD) increment in GrimAgeAccel was significantly associated with increased risk of all-cause death [hazard ratio (HR): 2.01; 95% confidence interval (CI), 1.15, 3.50], higher risk of MI (HR: 1.44; 95% CI, 1.16, 1.79), and elevated risk of stroke (HR: 1.42; 95% CI, 1.06, 1.91). There were no associations between any BoAA and cancer. Interpretation From the public health perspective, GrimAgeAccel is the most useful tool for identifying at-risk elderly, and evaluating the efficacy of anti-aging interventions. Funding National Institute of Environmental Health Sciences of U.S., Harvard Chan-NIEHS Center for Environmental Health, German Federal Ministry of Education and Research, and the State of Bavaria in Germany.
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Affiliation(s)
- Cuicui Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, West of Landmark Center, Boston, MA 02215, United States.
| | - Wenli Ni
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Yueli Yao
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Allan Just
- Department of Environmental Medicine, and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jonathan Heiss
- Department of Environmental Medicine, and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, West of Landmark Center, Boston, MA 02215, United States
| | - Xu Gao
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brent A Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, West of Landmark Center, Boston, MA 02215, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Anna Kosheleva
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, West of Landmark Center, Boston, MA 02215, United States
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Institute of Medical Information Science, Biometry, and Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Joel D Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, West of Landmark Center, Boston, MA 02215, United States
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Ji C, Gao J, Huang Z, Chen S, Wang G, Wu S, Jonas JB. Estimated pulse wave velocity and cardiovascular events in Chinese. Int J Cardiol Hypertens 2020; 7:100063. [PMID: 33447784 PMCID: PMC7803041 DOI: 10.1016/j.ijchy.2020.100063] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022] Open
Abstract
The estimated pulse-wave velocity (ePWV) as measure for arterial wall stiffness is associated with an increased risk of cardiovascular disease (CVDs) and all-cause death in Western populations. We investigated the association between ePWV and the incidence of CVDs (myocardial infarction, cerebral infarction, cerebral hemorrhage) and all-cause death in Chinese. The community-based longitudinal Kailuan Study included 98,348 participants undergoing biennial clinical examinations. During a mean follow-up of 10.32 ± 2.14 years, 6967 CVD events (myocardial infarction, n = 1610; cerebral infarction, n = 4634; cerebral hemorrhage, n = 1071) and 9780 all-cause deaths occurred. Stratified by age, sex and presence of cardiovascular risk factors, the incidence of CVDs and all-cause death were higher (P < 0.01) in individuals with ePWV values ≥ 10 m/s than in those with ePWV values < 10 m/s. After adjusting for age, age squared and other conventional cardiovascular risk factors, an ePWV value of ≥10 m/s or each ePWV increase by 1 m/s increased (P < 0.01) the risk for CVDs by 32% (Hazard ratio (HR):1.32; 95% confidence interval (CI):1.23–1.42) and 22% (HR:1.22; 95%CI:1.18–1.27), respectively, and increased the risk for all-cause death significantly (P < 0.01) by 28% (HR:1.28; 95%CI:1.20–1.37) and 10% (HR:1.10; 95%CI:1.07–1.13), respectively. The mean brachial-ankle PWV, measured in 43,208 individuals, was 15.30 ± 3.51 cm/s, with a mean difference of 6.45 m/s (95% limits of agreement:1.24–11.7) to the ePWV. Independently of cardiovascular risk factors, ePWV was associated with CVDs and all-cause mortality in Chinese.
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Affiliation(s)
- Chunpeng Ji
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, 063000, China
| | - Jingli Gao
- Intensive-Care Unit, Kailuan General Hospital, North China University of Science and Technology, Tangshan, 063000, China
| | - Zhe Huang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, 063000, China
| | - Shuohua Chen
- Health Care Center, Kailuan Medical group; Tangshan, 063000, China
| | - Guodong Wang
- Health Care Center, Kailuan Medical group; Tangshan, 063000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, 063000, China
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany.,Department of Ophthalmology, Medical Faculty Mannheim of the Heidelberg University, Mannheim, Germany
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Tamiya H, Tamura Y, Mochi S, Akazawa Y, Mochi Y, Banba N, Nakatani Y, Hoshiai M, Ueno A, Nagao M, Tomoe T, Onozaki M, Uema A, Kawabe A, Sugiyama T, Yasu T. Extended Sedentary Time Increases the Risk of All-Cause Death and New Cardiovascular Events in Patients With Diabetic Kidney Disease. Circ J 2020; 84:2190-2197. [PMID: 33116002 DOI: 10.1253/circj.cj-20-0407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sedentary behavior may be an independent risk factor for cardiovascular events. This study aimed to clarify the effects of extended sedentary time in patients with diabetic kidney disease (DKD) on the risk of all-cause death and new events.Methods and Results:A prospective cohort study was performed over 39 months. The study included 173 patients with DKD who completed the International Physical Activity Questionnaire (IPAQ) (101 men; mean age, 71±11 years); 37 patients (21.4%) were diagnosed with cardiovascular disease (CVD). New events were defined as all-cause death, cerebral stroke, or CVD requiring hospitalization or commencing hemodialysis (HD). Data were analyzed using a multivariate Cox proportional hazard regression model with variables, including sedentary time. There were 34 cases of new events during the observation period, including 4 cases of stroke, 20 cases of CVD, 4 cases of HD implementation, and 6 cases of death. Hazard ratio (HR) calculations for the new event onset group identified sedentary time as a significant independent variable. The independent variable that was identified as a significant predictor of new events was the sedentary time (60 min/day; HR: 1.23, 95% CI: 1.05-1.45, P=0.012). CONCLUSIONS Extended sedentary time increased the risk of new cardiovascular or renal events and/or all-cause death in patients with DKD.
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Affiliation(s)
- Hajime Tamiya
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center
| | - Yuma Tamura
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center
| | - Syusuke Mochi
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center
| | - Yusuke Akazawa
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center
| | - Yumi Mochi
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center
| | - Nobuyuki Banba
- Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center
| | - Yuki Nakatani
- Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center
| | - Megumi Hoshiai
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Asuka Ueno
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Moeko Nagao
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Takashi Tomoe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Masato Onozaki
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Atsuko Uema
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Atsuhiko Kawabe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Takushi Sugiyama
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
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Saitoh M, Saji M, Kozono-Ikeya A, Arimitsu T, Sakuyama A, Ueki H, Nagayama M, Isobe M. Hospital-Acquired Functional Decline and Clinical Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation. Circ J 2020; 84:1083-1089. [PMID: 32461504 DOI: 10.1253/circj.cj-19-1037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to assess the relationship between hospital-acquired functional decline and the risk of mid-term all-cause death in older patients undergoing transcatheter aortic valve implantation (TAVI).Methods and Results:In total, 463 patients (mean age 85 years, interquartile range [IQR]: 82, 88) undergoing elective TAVI at Sakakibara Heart Institute between 2010 and 2018, who were followed up for 3 years, were enrolled in the study. Hospital-acquired functional decline after TAVI, which was defined by at least a 1-point decrease on the Short Physical Performance Battery before discharge compared to the preoperative score, was assessed. A total of 113 patients (24.4%) showed hospital-acquired functional decline after TAVI, and 50 (11.3%) patients died over a mean follow-up period of 1.9±0.8 years. Kaplan-Meier survival curves indicated that hospital-acquired functional decline was significantly associated with all-cause mortality (log-rank test, P=0.001). On multivariate Cox regression analysis, hospital-acquired functional decline was associated with a higher risk of all-cause mortality (OR 2.108, 95% CI 1.119-3.968, P=0.021) independent of sex, body mass index, advanced chronic kidney disease, and preoperative frailty, as assessed by the modified essential frail toolkit. CONCLUSIONS Hospital-acquired functional decline is associated with mid-term all-cause mortality in older patients following TAVI. Trajectory of functional status is a vital sign, and it is useful for risk stratification in older patients following TAVI.
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Affiliation(s)
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute
| | | | | | | | - Hiromichi Ueki
- Department of Rehabilitation, Sakakibara Heart Institute
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Osawa K, Bessho A, Fuke S, Moriyama S, Mizobuchi A, Daido S, Tanaka M, Yumoto A, Saito H, Ito H. Coronary artery calcification scoring system based on the coronary artery calcium data and reporting system (CAC-DRS) predicts major adverse cardiovascular events or all-cause death in patients with potentially curable lung cancer without a history of cardiovascular disease. Heart Vessels 2020; 35:1483-1493. [PMID: 32444933 DOI: 10.1007/s00380-020-01624-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
The coronary artery calcium data and reporting system (CAC-DRS) is a novel reporting system based on CAC severity. Lung cancer patients have a high risk of cardiovascular disease (CVD), for which CAC severity may provide additional prognostic information. Using non-gated, non-contrast computed tomography (CT), we evaluated the CAC-DRS for predicting CVD and all-cause death in patients with potentially curable resected lung cancer. We retrospectively studied 309 consecutive patients without a history of CVD (mean age 67.4 ± 8.2 years, 61% male) who underwent curative surgery for non-small-cell lung cancer between May 2012 and March 2019 at the Japanese Red Cross Okayama Hospital. Time to incidence of major adverse cardiac events (MACEs) (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and all-cause death was analyzed using Fine and Gray and Cox regression models. The CAC-DRS score was assessed using standard chest CT without electrocardiogram gating. During 52-months' median follow-up, 43 patients (13.4%) developed incident MACEs or died from any cause; the pathological cancer stages were Ia (n = 20), Ib (n = 8), IIa (n = 2), IIb (n = 2) and IIIa (n = 11). Patients had a graded increase in incidence of MACEs or all-cause death with increasing categories of CAC-DRS. The CAC-DRS score was significantly associated with incident MACEs or all-cause death after adjusting for confounding factors (hazard ratio 1.18; 95% confidence interval 1.10-1.25, p < 0.01). In conclusion, the CAC-DRS score on non-gated standard CT can predict incident MACEs and/or all-cause death in patients with potentially curable resected lung cancer. Lung cancer survivors with a greater CAC-DRS category may need more active management of cardiovascular risk factors.
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Affiliation(s)
- Kazuhiro Osawa
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan.
| | - Akihiro Bessho
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Soichiro Fuke
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan
| | - Shigeharu Moriyama
- Department of Thoracic Surgery, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Asako Mizobuchi
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan
| | - Shunsuke Daido
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan
| | - Masamichi Tanaka
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan
| | - Akihisa Yumoto
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan
| | - Hironori Saito
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
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Arai R, Suzuki S, Kano H, Semba H, Arita T, Yagi N, Otsuka T, Matsuno S, Matsuhama M, Kato Y, Uejima T, Oikawa Y, Okumura Y, Yajima J, Yamashita T. Role of dipstick proteinuria for predicting cardiovascular events: a Japanese cardiovascular hospital database analysis. Heart Vessels 2020; 35:1256-69. [PMID: 32248254 DOI: 10.1007/s00380-020-01596-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 03/27/2020] [Indexed: 12/21/2022]
Abstract
Initial screening for proteinuria by urine dipstick test (UDT) may be useful for predicting clinical outcomes. The Shinken Database includes all the new patients visiting the Cardiovascular Institute Hospital in Tokyo, Japan. Patients for whom UDT was performed at their initial visit between 2004 and 2010 (n = 7131) were divided into three groups according to the test results: negative, trace, and positive (1+ to 4+) proteinuria. During the mean follow-up period of 3.4 years, 233 (3.1%) deaths, 255 (3.6%) heart failure (HF) events, and 106 (1.5%) ischemic stroke (IS) events occurred. Prevalence of atherothrombotic risks increased with an increase in the amounts of proteinuria. The incidence of all-cause death, HF and IS events increased significantly from negative to trace to positive proteinuria groups (log rank test, P for trend < 0.001). Multivariate analysis revealed independent association between proteinuria and all-cause death [hazard ratio (HR): 1.50, 95% confidence interval (CI) 1.07-2.10], HF (HR: 1.55, 95% CI 1.14-2.12), and IS (HR: 2.08, 95% CI 1.26-3.45). Even trace proteinuria was independently associated with HF (HR: 1.64, 95% CI 1.07-2.53) and IS (HR: 2.17, 95% CI 1.14-4.11) and with all-cause death (HR: 1.56, 95% CI 0.99-2.47). In conclusions, dipstick proteinuria was independently associated with cardiovascular events and death, suggesting that the UDT is a useful tool for evaluating patients' risk for such adverse events.
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Li M, Ye ZC, Li CM, Zhao WB, Tang H, Liu X, Peng H, Lou TQ. The influence of cardiac valvular calcification on all-cause and cardiovascular mortality in maintenance hemodialysis patients. Int Urol Nephrol 2020; 52:943-951. [PMID: 32239335 DOI: 10.1007/s11255-020-02448-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the effect of cardiac valve calcification (CVC) on all-cause and cardiovascular mortality in maintenance hemodialysis (MHD) patients. METHODS A retrospective cohort study was conducted in 183 long-term hemodialysis patients with complete follow-up data from January 1, 2012, to December 30, 2015. The baseline data between CVC and non-CVC groups were compared. Kaplan-Meier method was used to analyze all-cause and cardiovascular mortality. The effect of CVC on prognosis was analyzed using the Cox proportional hazard regression model and subgroup analysis. RESULTS Among 183 patients under hemodialysis, 104 (56.8%) were males, with an average age of 56.1 ± 17.0 years and 68 (37.2%) were complicated with valvular calcification. The median follow-up period was 30.8 months. All-cause and cardiovascular mortality were 50% vs. 14.8% and 25% vs. 7.0% in the CVC and non-CVC groups, respectively (P < 0.05). Kaplan-Meier indicated that differences in all-cause and cardiovascular mortality were statistically significant between the two groups (P < 0.001). Cox regression analysis showed that CVC significantly increased all-cause (hazards ratio [HR] 2.161 [1.083-4.315]) and cardiovascular mortality (3.435 [1.222-9.651]) after adjusting for multiple factors. Meanwhile, CVC also increases the incidence of new-onset cardiovascular events. Subgroup analysis revealed that all-cause and cardiovascular mortality were significantly higher in patients with aortic valve calcification (AVC) than in patients with mitral valve calcification (MVC). Multivariate calibration showed that AVC increased the risk of cardiovascular death (HR 5.486 [1.802-16.702]) (P < 0.05), whereas MVC did not. By further comparing the echocardiographic data of the two groups, the incidence of LVH and pulmonary hypertension in the AVC group was significantly higher than that in the MVC group. CONCLUSION Valve calcification increases the risk of all-cause and cardiovascular mortality in MHD patients, also new-onset cardiovascular events, and aortic valve calcification contributes more to the risk of cardiovascular mortality.
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Affiliation(s)
- Ming Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China
| | - Zeng-Chun Ye
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China
| | - Can-Ming Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China
| | - Wen-Bo Zhao
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China
| | - Hua Tang
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China
| | - Hui Peng
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China.
| | - Tan-Qi Lou
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People's Republic of China.
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Tseng WC, Wu MH, Chiu SN, Chen HC, Kao FY, Huang SK. Cumulative postnatal risk of pediatric sudden death and all-cause mortality in nationwide birth cohorts of Taiwan and the United States. J Formos Med Assoc 2020; 119:1842-1853. [PMID: 32173231 DOI: 10.1016/j.jfma.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate the cumulative postnatal risk of pediatric sudden death (SD) for each neonate and the temporal/regional differences which are still unclear. METHODS We established a birth cohort (2000-2014) from our national database and obtained reference data about the United States (US) from the national website. RESULTS Among 3,097,277 live births, we identified 1661 children with SD (56.8% male). The postnatal cumulative risk of SD was 0.35, 0.49, 0.56 and 0.59/1000 by age 0, 5, 11 and 14 years. Coexisting cardiac diagnosis was noted in 347 (20.9%) and non-cardiac diagnosis in 300 (18.1%) patients. Cumulative all-cause mortality was 5.3, 6.78, 7.63 and 8.06/1000 by age 0, 5, 11 and 14 years. Risks of SD and all-cause death decreased over birthyear. SD risk decreased particularly after the 2008 birthyear. Risks of SD and all-cause death were the highest in Eastern Taiwan, but SD/all-cause death ratio was high in Taipei metropolitan and Northern Taiwan. Cumulative risk of SD (0.54/1000 by age 14) and all-cause mortality (9.06/1000 by age 14) in the US decreased over time. African-Americans were at the highest risks of SD and all-cause mortality. However, American-Indians/Alaska-natives exhibited the highest SD/all-cause death ratio. CONCLUSION This study provides the cumulative risk of SD (1 in 1694 newborns) by age 14 years. The time trend underlines the effect of medical advance and education on SD prevention. Distinct regional/ethnic differences in risks of SD and all-cause death in Taiwan and the US indicate the necessity of different strategies to diminish the disparity.
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Mei-Hwan Wu
- Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan.
| | - Sheunn-Nan Chiu
- Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Hui-Chi Chen
- Obstetrics and Gynecology, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Feng-Yu Kao
- Administration of National Health Insurance, Taipei, Taiwan
| | - San-Kuei Huang
- Administration of National Health Insurance, Taipei, Taiwan
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Temma T, Nagai T, Watanabe M, Kamada R, Takahashi Y, Hagiwara H, Koya T, Nakao M, Omote K, Kamiya K, Iwano H, Yamamoto K, Yoshikawa T, Saito Y, Anzai T. Differential Prognostic Impact of Atrial Fibrillation in Hospitalized Heart Failure Patients With Preserved Ejection Fraction According to Coronary Artery Disease Status - Report From the Japanese Nationwide Multicenter Registry. Circ J 2020; 84:397-403. [PMID: 32009066 DOI: 10.1253/circj.cj-19-0963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is an important prognostic determinant in heart failure (HF) with preserved ejection fraction (HFpEF). However, it is unclear which HFpEF phenotypes are affected by AF in terms of long-term clinical outcomes because HFpEF is a heterogeneous syndrome with comorbidities such as coronary artery disease (CAD). In this study we determined the differential prognostic significance of AF in HFpEF patients according to CAD status.Methods and Results:Data for 408 hospitalized HFpEF patients enrolled in the Japanese Heart Failure Syndrome with Preserved Ejection Fraction Nationwide Multicenter Registry were analyzed. Patients were divided into 4 groups according to the presence of AF and CAD. The primary outcome was the composite of all-cause death and HF rehospitalization. The incidence of adverse events was higher in the AF-non-CAD than non-AF-non-CAD group (P=0.004). On multivariable Cox regression analysis with prespecified confounders, AF-non-CAD was significantly associated with an increased risk of adverse events than non-AF-non-CAD (adjusted HR, 1.91; 95% CI: 1.02-3.92) regardless of the type of AF. In contrast, risk was comparable between the AF-CAD and non-AF-CAD groups (adjusted HR, 1.24; 95% CI: 0.64-2.47). CONCLUSIONS In HFpEF patients without CAD, AF was independently related to adverse events, indicating that intensive management of AF would have more beneficial effects particularly in HFpEF patients without CAD.
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Affiliation(s)
- Taro Temma
- Department of Telemedicine for Comprehensive Heart Failure Management, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Masaya Watanabe
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Rui Kamada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Yumi Takahashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Hikaru Hagiwara
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Taro Koya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Motoki Nakao
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | - Toshihisa Anzai
- Department of Telemedicine for Comprehensive Heart Failure Management, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.,Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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Liu H, Feng W, Zhang D. Association of ADHD medications with the risk of cardiovascular diseases: a meta-analysis. Eur Child Adolesc Psychiatry 2019; 28:1283-1293. [PMID: 30143889 DOI: 10.1007/s00787-018-1217-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Abstract
This meta-analysis was conducted to evaluate the association between Attention deficit hyperactivity disorder (ADHD) medications and risk of sudden death/arrhythmia, stroke, myocardial infarction as well as all-cause death. We searched PubMed, Web of Science and China National Knowledge Infrastructure from 1950 to May 2018. All observational studies that the exposure of interest was ADHD medications, the outcome of interest was sudden death/arrhythmia, stroke, myocardial infarction as well as all-cause death, and the study reported relative risks (RRs) with 95% confidence intervals (95% CIs) were included. Pooled RRs were estimated by random-effects model. Subgroup analyses were conducted to examine the effects of study design, population, Country, follow-up duration, female proportion, covariates adjustment on the risk of sudden death/arrhythmia. Eight articles with ten studies (4,221,929 participants) were included in this meta-analysis about the association between ADHD medications and risk of sudden death/arrhythmia. The pooled RRs with 95% CIs of sudden death/arrhythmia for ADHD medications were 1.39 (1.06, 1.83). The result of the cohort study was 1.24 (0.84, 1.83). The pooled RRs between ADHD medications and stroke, myocardial infarction, all-cause death were 1.00 (0.74, 1.35), 0.91 (0.79, 1.05), 0.89 (0.54, 1.45), respectively. As for methylphenidate, the pooled RRs between methylphenidate and sudden death/arrhythmia, stroke, myocardial infarction, all-cause death were 1.46 (1.03, 2.07), 0.92 (0.70, 1.21), 0.97 (0.77, 1.23), 1.00 (0.49, 2.04), respectively. Based on the results of cohort studies, there was no correlation between ADHD medications and sudden death/arrhythmia, stroke, myocardial infarction and all-cause death. However, some of the confidence intervals do not exclude modest elevated risks, e.g., for sudden death/arrhythmia.
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Affiliation(s)
- Hui Liu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 38 Dengzhou Road, Shibei District, Qingdao, 266021, Shandong Province, China
| | - Wenjing Feng
- Department of Geriatric Internal Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 38 Dengzhou Road, Shibei District, Qingdao, 266021, Shandong Province, China.
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Ashrafi-Asgarabad A, Behroozi A, Safiri S. The predictive value of plasma catestatin for all-cause and cardiac deaths in chronic heart failure patients: Methodological issues. Peptides 2019; 118:169738. [PMID: 28185816 DOI: 10.1016/j.peptides.2017.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 12/12/2016] [Accepted: 01/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Abbas Behroozi
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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