Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study

Background: Hypoglycemia has been postulated to contribute to falls risk in older adults with type 2 diabetes. However, few studies have prospectively examined the association between severe hypoglycemia and falls, both important causes of morbidity and mortality. <div>Methods: We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) Study with diagnosed diabetes at Visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes (1996-2013). Secondary analyses examined hospitalized falls and falls with fracture. We calculated incidence rates and used Cox regression models to evaluate the independent associations of severe hypoglycemia with falls occurring after Visit 4 through 2013. Results: Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event, either before baseline or during the median of 13.1 years of follow-up. The crude incidence rate of falls among persons without severe hypoglycemia was 2.17 per 100 person-years (PY) (95%CI: 1.93-2.44), compared to 8.81 per 100PY (6.73-11.53) with severe hypoglycemia. After adjustment, severe hypoglycemia was associated with over twofold higher risk of falls (hazard ratio (HR) 2.23, 95%CI 1.61-3.07). Associations were consistent in subgroups defined by age, sex, race, BMI, duration of diabetes, or functional difficulty. Conclusions: Severe hypoglycemia was associated with a substantially higher risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes. </div>

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Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

10.2337/figshare.12315224.v1 ◽

2020 ◽

Author(s):

Alexandra K. Lee ◽

Stephen P. Juraschek ◽

B. Gwen Windham ◽

Clare J. Lee ◽

A. Richey Sharrett ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Cohort Analysis ◽

Severe Hypoglycemia ◽

Emergency Department Visits ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Risk Of Falls ◽

Aric Study

Background: Hypoglycemia has been postulated to contribute to falls risk in older adults with type 2 diabetes. However, few studies have prospectively examined the association between severe hypoglycemia and falls, both important causes of morbidity and mortality. <div>Methods: We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) Study with diagnosed diabetes at Visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes (1996-2013). Secondary analyses examined hospitalized falls and falls with fracture. We calculated incidence rates and used Cox regression models to evaluate the independent associations of severe hypoglycemia with falls occurring after Visit 4 through 2013. Results: Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event, either before baseline or during the median of 13.1 years of follow-up. The crude incidence rate of falls among persons without severe hypoglycemia was 2.17 per 100 person-years (PY) (95%CI: 1.93-2.44), compared to 8.81 per 100PY (6.73-11.53) with severe hypoglycemia. After adjustment, severe hypoglycemia was associated with over twofold higher risk of falls (hazard ratio (HR) 2.23, 95%CI 1.61-3.07). Associations were consistent in subgroups defined by age, sex, race, BMI, duration of diabetes, or functional difficulty. Conclusions: Severe hypoglycemia was associated with a substantially higher risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes. </div>

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Electrophysiological ventricular substrate of stroke: a prospective cohort study in the Atherosclerosis Risk in Communities (ARIC) study

BMJ Open ◽

10.1136/bmjopen-2020-048542 ◽

2021 ◽

Vol 11 (9) ◽

pp. e048542

Author(s):

John A Johnson ◽

Kazi T Haq ◽

Katherine J Lutz ◽

Kyle K Peters ◽

Kevin A Paternostro ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Disease Risk ◽

Left Ventricular ◽

Premature Ventricular Contractions ◽

Atherosclerosis Risk In Communities ◽

Cardiac Memory ◽

Atherosclerosis Risk ◽

Aric Study

ObjectivesThe goal of the study was to determine an association of cardiac ventricular substrate with thrombotic stroke (TS), cardioembolic stroke (ES) and intracerebral haemorrhage (ICH).DesignProspective cohort study.SettingThe Atherosclerosis Risk in Communities (ARIC) study in 1987–1989 enrolled adults (45–64 years), selected as a probability sample from four US communities (Minneapolis, Minnesota; Washington, Maryland; Forsyth, North Carolina; Jackson, Mississippi). Visit 2 was in 1990–1992, visit 3 in 1993–1995, visit 4 in 1996–1998 and visit 5 in 2011–2013.ParticipantsARIC participants with analysable ECGs and no history of stroke were included (n=14 479; age 54±6 y; 55% female; 24% black). Ventricular substrate was characterised by cardiac memory, spatial QRS-T angle (QRS-Ta), sum absolute QRST integral (SAIQRST), spatial ventricular gradient magnitude (SVGmag), premature ventricular contractions (PVCs) and tachycardia-dependent intermittent bundle branch block (TD-IBBB) on 12-lead ECG at visits 1–5.OutcomeAdjudicated TS included a first definite or probable thrombotic cerebral infarction, ES—a first definite or probable non-carotid cardioembolic brain infarction. Definite ICH was included if it was the only stroke event.ResultsOver a median 24.5 years follow-up, there were 899 TS, 400 ES and 120 ICH events. Cox proportional hazard risk models were adjusted for demographics, cardiovascular disease, risk factors, atrial fibrillation, atrial substrate and left ventricular hypertrophy. After adjustment, PVCs (HR 1.72; 95% CI 1.02 to 2.92), QRS-Ta (HR 1.15; 95% CI 1.03 to 1.28), SAIQRST (HR 1.20; 95% CI 1.07 to 1.34) and time-updated SVGmag (HR 1.19; 95% CI 1.08 to 1.32) associated with ES. Similarly, PVCs (HR 1.53; 95% CI 1.03 to 2.26), QRS-Ta (HR 1.08; 95% CI 1.01 to 1.16), SAIQRST (HR 1.07; 95% CI 1.01 to 1.14) and time-updated SVGmag (HR 1.11; 95% CI 1.04 to 1.19) associated with TS. TD-IBBB (HR 3.28; 95% CI 1.03 to 10.46) and time-updated SVGmag (HR 1.23; 95% CI 1.03 to 1.47) were associated with ICH.ConclusionsPVC burden (reflected by cardiac memory) is associated with ischaemic stroke. Transient cardiac memory (likely through TD-IBBB) precedes ICH.

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