scholarly journals Dietary flavonoid intakes and CVD incidence in the Framingham Offspring Cohort

2015 ◽  
Vol 114 (9) ◽  
pp. 1496-1503 ◽  
Author(s):  
Paul F. Jacques ◽  
Aedin Cassidy ◽  
Gail Rogers ◽  
Julia J. Peterson ◽  
Johanna T. Dwyer
Keyword(s):  
Repeated Measures ◽  
Proportional Hazards ◽  
Vegetable Intake ◽  
Cox Proportional Hazards ◽  
Offspring Cohort ◽  
Cvd Risk ◽  
Relative Risks ◽  
Meta Analyses ◽  
Multivariable Adjustment

AbstractThis study examines the relationship between long-term intake of six flavonoid classes and incidence of CVD and CHD, using a comprehensive flavonoid database and repeated measures of intake, while accounting for possible confounding by components of a healthy dietary pattern. Flavonoid intakes were assessed using a FFQ among the Framingham Offspring Cohort at baseline and three times during follow-up. Cox proportional hazards regression was used to characterise prospective associations between the natural logarithms of flavonoid intakes and CVD incidence using a time-dependent approach, in which intake data were updated at each examination to represent average intakes from previous examinations. Mean baseline age was 54 years, and 45 % of the population was male. Over an average 14·9 years of follow-up among 2880 participants, there were 518 CVD events and 261 CHD events. After multivariable adjustment, only flavonol intake was significantly associated with lower risk of CVD incidence (hazard ratios (HR) per 2·5-fold flavonol increase=0·86,Ptrend=0·05). Additional adjustment for total fruit and vegetable intake and overall diet quality attenuated this observation (HR=0·89,Ptrend=0·20 and HR=0·92,Ptrend=0·33, respectively). There were no significant associations between flavonoids and CHD incidence after multivariable adjustment. Our findings suggest that the observed association between flavonol intake and CVD risk may be a consequence of better overall diet. However, the strength of this non-significant association was also consistent with relative risks observed in previous meta-analyses, and therefore a modest benefit of flavonol intake on CVD risk cannot be ruled out.

scholarly journals Relationship of lycopene intake and consumption of tomato products to incident CVD

2013 ◽  
Vol 110 (3) ◽  
pp. 545-551 ◽  
Author(s):  
Paul F. Jacques ◽  
Asya Lyass ◽  
Joseph M. Massaro ◽  
Ramachandran S. Vasan ◽  
Ralph B. D'Agostino Sr
Keyword(s):  
Repeated Measures ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Supporting Evidence ◽  
Inverse Association ◽  
Cvd Risk ◽  
Stroke Incidence ◽  
Hazard Ratios ◽  
Increased Risk

Evidence for cardioprotective effects of lycopene is inconsistent. Studies of circulating lycopene generally report inverse associations with CVD risk, but studies based on lycopene intake do not. The failure of dietary studies to support the findings based on biomarkers may be due in part to misclassification of lycopene intakes. To address this potential misclassification, we used repeated measures of intake obtained over 10 years to characterise the relationship between lycopene intake and the incidence of CVD (n314), CHD (n171) and stroke (n99) in the Framingham Offspring Study. Hazard ratios (HR) for incident outcomes were derived from Cox proportional hazards regression models using logarithmically transformed lycopene intake adjusted for CVD risk factors and correlates of lycopene intake. HR were interpreted as the increased risk for a 2·7-fold difference in lycopene intake, a difference approximately equal to its interquartile range. Using an average of three intake measures with a 9-year follow-up, lycopene intake was inversely associated with CVD incidence (HR 0·83, 95 % CI 0·70, 0·98). Using an average of two intake measures and 11 years of follow-up, lycopene intake was inversely associated with CHD incidence (HR 0·74, 95 % CI 0·58, 0·94). Lycopene intake was unrelated to stroke incidence. The present study of lycopene intake and CVD provides supporting evidence for an inverse association between lycopene and CVD risk; however, additional research is needed to determine whether lycopene or other components of tomatoes, the major dietary source of lycopene, are responsible for the observed association.

Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Stephen P Glasser ◽  
Daniel L Halberg ◽  
Charles Sands ◽  
Paul Muntner ◽  
Monika Safford
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Pulse Pressure ◽  
Proportional Hazards ◽  
Linear Trend ◽  
Cox Proportional Hazards ◽  
Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

scholarly journals A Combined Prospective and Retrospective Comparison of Long-Term Functional Outcomes Suggests Delayed Loss of Ambulation and Pulmonary Decline with Long-Term Eteplirsen Treatment

2021 ◽  
pp. 1-14 ◽  
Author(s):  
Olga Mitelman ◽  
Hoda Z. Abdel-Hamid ◽  
Barry J. Byrne ◽  
Anne M. Connolly ◽  
Peter Heydemann ◽  
...  
Keyword(s):  
Natural History ◽  
Repeated Measures ◽  
Proportional Hazards ◽  
Clinical Care ◽  
Standard Of Care ◽  
Cox Proportional Hazards ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models

Background: Studies 4658-201/202 (201/202) evaluated treatment effects of eteplirsen over 4 years in patients with Duchenne muscular dystrophy and confirmed exon-51 amenable genetic mutations. Chart review Study 4658-405 (405) further followed these patients while receiving eteplirsen during usual clinical care. Objective: To compare long-term clinical outcomes of eteplirsen-treated patients from Studies 201/202/405 with those of external controls. Methods: Median total follow-up time was approximately 6 years of eteplirsen treatment. Outcomes included loss of ambulation (LOA) and percent-predicted forced vital capacity (FVC%p). Time to LOA was compared between eteplirsen-treated patients and standard of care (SOC) external controls and was measured from eteplirsen initiation in 201/202 or, in the SOC group, from the first study visit. Comparisons were conducted using univariate Kaplan-Meier analyses and log-rank tests, and multivariate Cox proportional hazards models with regression adjustment for baseline characteristics. Annual change in FVC%p was compared between eteplirsen-treated patients and natural history study patients using linear mixed models with repeated measures. Results: Data were included from all 12 patients in Studies 201/202 and the 10 patients with available data from 405. Median age at LOA was 15.16 years. Eteplirsen-treated patients experienced a statistically significant longer median time to LOA by 2.09 years (5.09 vs. 3.00 years, p < 0.01) and significantly attenuated rates of pulmonary decline vs. natural history patients (FVC%p change: –3.3 vs. –6.0 percentage points annually, p < 0.0001). Conclusions: Study 405 highlights the functional benefits of eteplirsen on ambulatory and pulmonary function outcomes up to 7 years of follow-up in comparison to external controls.

scholarly journals Effects of Low-density Lipoprotein Cholesterol on Cardiovascular Disease and All-cause Mortality in Elderly Patients (≥75 years old)

2021 ◽  
Author(s):  
Jiaxin Yu ◽  
xiaokun liu ◽  
shuohua chen ◽  
yan liu ◽  
hongmin liu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cox Proportional Hazards ◽  
Cvd Risk ◽  
Proportional Hazards Regression ◽  
All Cause Mortality ◽  
Level Group ◽  
The Ideal

Abstract Background: The associations of low-density lipoprotein cholesterol (LDL-C) with cardiovascular disease (CVD) and all-cause mortality are unclear in elderly(≥75 years) Chinese individuals.Methods: A total of 3674 individuals aged 75 or older underwent medical examinations at the Kailuan Group in 2006. Participants were divided into three groups by LDL_C values: the ideal level (LDL-C <2.6 mmol/l), appropriate level (2.6 mmol/l≤ LDL-C＜3.4 mmol/l) and elevated level (LDL-C≥3.4 mmol/l) groups. CVD and all-cause mortality events were recorded during the follow-up period. The Cox proportional hazards regression model was applied to evaluate the effect of LDL-C on CVD and all-cause mortality events.Results: The average follow-up time was 9.87±3.60 years.After adjustment for confounding factors, the multivariate Cox proportional hazards regression model showed that CVD risk in the elevated group was 1.46 (95% CI, 1.08-1.97), acute myocardial infarction risk was 2.08 (95% CI, 1.26-3.44), and all-cause mortality risk in the appropriate level group and elevated group was 1.12 (95% CI, 1.00-1.25) and 1.17 (95% CI, 1.00-1.36), respectively, compared with those in the ideal level group. For every standard deviation increase in LDL-C, CVD risk increased by 10%, acute myocardial infarction risk increased by 21%, and all-cause mortality event risk increased by 4%. No association was found between elevated LDL-C levels and the risk of stroke.Conclusions: In the elderly population, elevated LDL-C levels are a risk factor for CVD and all-cause mortality.

scholarly journals The Importance of Screening for Thyroid Cancer in Patients with Metabolic Syndrome or its Components: A Nationwide Population-Based Cohort Study.

2021 ◽  
Author(s):  
Jae Hyun Park ◽  
Hyun Seok Cho ◽  
Gilseong Moon ◽  
Jong Ho Yoon
Keyword(s):  
Metabolic Syndrome ◽  
Thyroid Cancer ◽  
Large Scale ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Relative Risks ◽  
Increased Risk ◽  
Korean National Health Insurance

Abstract Background The rapidly increasing coincidence of thyroid cancer and metabolic syndrome (MS) in recent decades suggests an association between the two disorders. To investigate this association, we conducted a nationwide study of a large-scale patient cohort. Methods Between 2009 and 2011, data were collected by the Korean National Health Insurance Service for 4,658,473 persons aged 40–70 years without thyroid cancer. During the 6-year follow-up period, participants were monitored for the development of thyroid cancer. The relative risks and incidences of thyroid cancer were calculated using multivariate Cox proportional hazards regression analyses after adjusting for age and body mass index. Results At the end of the study, 47,325 subjects (1.0%) were newly diagnosed with thyroid cancer. The risk of thyroid cancer was significantly elevated in men and women with MS or MS components, except for hyperglycaemia (p = 0.723) or hypertriglyceridemia (p = 0.211) in men. The incidence of thyroid cancer per 10,000 person-years in individuals with MS was significantly higher in men (6.2, p < 0.001) and women (21.3, p < 0.001) compared to those without MS. Additionally, the risk of thyroid cancer increased significantly with an increasing number of MS components even in individuals with only one or two MS components. Conclusions MS and its components were significantly associated with increased risk of developing thyroid cancer. Patients with MS or MS components should be regularly screened for thyroid cancer to enable swift therapeutic response in this at-risk population.

scholarly journals Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma

2017 ◽  
Vol 127 (5) ◽  
pp. 1117-1125 ◽  
Author(s):  
Myung-Hoon Han ◽  
Je il Ryu ◽  
Choong Hyun Kim ◽  
Jae Min Kim ◽  
Jin Hwan Cheong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Subdural Hematoma ◽  
Repeated Measures ◽  
Proportional Hazards ◽  
Medical Center ◽  
Chronic Subdural Hematoma ◽  
Cox Proportional Hazards ◽  
Risk Factors For Recurrence

OBJECTIVEChronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals.METHODSKaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up.RESULTSThis study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03–2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m2), and a bilateral operation.CONCLUSIONSThis study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.

Abstract P338: Medical Cost Hardship and Incident Cardiovascular Disease (CVD) Among High Risk Individuals in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Lindsay R Pool ◽  
Jared P Reis ◽  
Reto Auer ◽  
David R Jacobs ◽  
Catarina I Kiefe ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Medical Cost ◽  
Proportional Hazards ◽  
Hospital Admissions ◽  
Cox Proportional Hazards ◽  
Time Varying ◽  
Cvd Risk ◽  
Risk Factor Control

Introduction: Having trouble paying for medical care (i.e., medical cost hardship) may impair disease management and thus increase risk of clinical CVD events among adults with CVD risk factor conditions. Hypothesis: We hypothesized medical cost hardship was associated with incidence of CVD among individuals with diagnosed hypertension, hypercholesterolemia, or diabetes. Methods: CARDIA recruited 5,115 individuals aged 18-30 years in 1985-6 (year 0); we included 2,273 participants who self-reported hypertension, hypercholesterolemia, or diabetes or were taking prescription medications for these conditions at years 10, 15, 20, or 25 (45.2% of all participants). At these visits, medical cost hardship was also queried. CVD events were adjudicated from records of hospital admissions, outpatient procedures, and deaths through 2013. Median follow-up time from initial risk factor diagnosis was 12.4 years. Adjusted Cox proportional hazards models determined hazard ratios (HRs) for the first incident CVD event, examining initial and time-varying medical cost hardship. Results: At first report of hypertension, hypercholesterolemia, or diabetes, 27% of subjects reported medical cost hardship, while 51% did so at subsequent examinations. There were 131 CVD events during follow-up. Adjusting for demographic and socioeconomic factors, initial medical cost hardship was a more robust predictor of incident CVD than time-varying cost hardship, HRs 1.54 (95% CI: 1.03, 2.30) and 1.36 (0.88, 2.12), respectively (Table). Risk factor control partially attenuated the association between medical cost hardship and CVD, as did access to healthcare. We found no significant interaction by race and sex. Conclusions: Medical cost hardship was associated with incident CVD in this sample of high-risk individuals, possibly via risk factor control or access to care. Identification of cost hardship at the time of high-risk diagnosis may facilitate connection to low-cost care, improving risk factor control and preventing clinical CVD.

scholarly journals Fish consumption and the risk of myocardial infarction and stroke in the German arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Germany)

2013 ◽  
Vol 110 (6) ◽  
pp. 1118-1125 ◽  
Author(s):  
Tilman Kühn ◽  
Birgit Teucher ◽  
Rudolf Kaaks ◽  
Heiner Boeing ◽  
Cornelia Weikert ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischaemic Stroke ◽  
Fish Consumption ◽  
Proportional Hazards ◽  
Haemorrhagic Stroke ◽  
Cox Proportional Hazards ◽  
Inverse Association ◽  
Meta Analyses ◽  
Prospective Investigation

Recent meta-analyses have confirmed that fish consumption is related to decreased risks of ischaemic stroke and fatal CHD, while there seem to be no clear associations between fish consumption and the risks of haemorrhagic stroke and non-fatal CHD. As no studies in German populations have been reported to date, we assessed whether fish consumption as recorded by FFQ between 1994 and 1998 was related to incident myocardial infarction (MI) and stroke within the German arm of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards regression analyses were conducted based on the data of 48 315 participants aged 35–65 years at baseline. The median fish intake was 16·4 g/d (25th–75th percentile 8·2–28·8 g/d). During a mean follow-up of 8·1 years, 605 incident MI and 525 incident strokes have been documented. After multiple adjustment, fish consumption was not related to incident MI (hazard ratio (HR) 0·84, 95 % CI 0·66, 1·08, Ptrend= 0·21) or stroke (HR 0·96, 95 % CI 0·73, 1·26, Ptrend= 0·67). Separate analyses for fatal MI, ischaemic stroke and haemorrhagic stroke did not show significant associations, either. With regard to non-fatal MI, there was a non-significant trend for an inverse association (HR 0·78, 95 % CI 0·59, 1·03, Ptrend= 0·07). Overall, fish consumption was not related to the risks of MI and stroke in the EPIC-Germany study.

Stroke, Timing of Atrial Fibrillation Diagnosis, and Risk of Death

Neurology ◽  
2021 ◽  
Vol 96 (12) ◽  
pp. e1655-e1662
Author(s):  
Anjali Bhatla ◽  
Yuliya Borovskiy ◽  
Ronit Katz ◽  
Matthew C. Hyman ◽  
Parin J. Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Inception Cohort ◽  
Stroke Event ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Multivariable Adjustment

ObjectiveTo evaluate the prognosis of patients with ischemic stroke according to the timing of an atrial fibrillation (AF) diagnosis, we created an inception cohort of incident stroke events and compared the risk of death between patients with stroke with (1) sinus rhythm, (2) known AF (KAF), and (3) AF diagnosed after stroke (AFDAS).MethodsWe used the Penn AF Free study to create an inception cohort of patients with incident stroke. Mortality events were identified after linkage with the National Death Index through June 30, 2017. We also evaluated initiation of anticoagulants and antiplatelets across the study duration. Cox proportional hazards models evaluated associations between stroke subtypes and death.ResultsWe identified 1,489 individuals who developed an incident ischemic stroke event: 985 did not develop AF at any point during the study period, 215 had KAF before stroke, 160 had AF detected ≤6 months after stroke, and 129 had AF detected >6 months after stroke. After a median follow-up of 4.9 years (interquartile range 1.9–6.8), 686 deaths occurred. The annualized mortality rate was 8.8% in the stroke, no AF group; 12.2% in the KAF group; 15.8% in the AFDAS ≤6 months group; and 12.7% in the AFDAS >6 months group. Patients in the AFDAS ≤6 months group had the highest independent risk of all-cause mortality even after multivariable adjustment for demographics, clinical risk factors, and the use of antithrombotic therapies (hazard ratio 1.62 [1.22–2.14]). Compared to the stroke, no AF group, those with KAF had a higher mortality risk that was rendered nonsignificant after adjustment.ConclusionsThe AFDAS group had the highest risk of death, which was not explained by comorbidities or use of antithrombotic therapies.

scholarly journals Intrinsic Frequencies of Carotid Pressure Waveforms Predict Heart Failure Events

Hypertension ◽  
2021 ◽  
Author(s):  
Leroy L. Cooper ◽  
Jian Rong ◽  
Niema M. Pahlevan ◽  
Derek G. Rinderknecht ◽  
Emelia J. Benjamin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Vascular System ◽  
Cox Proportional Hazards ◽  
Frequency Variation ◽  
Cvd Risk ◽  
Generation Cohorts ◽  
Heart Study ◽  
The Difference

Intrinsic frequencies (IFs) derived from arterial waveforms are associated with cardiovascular performance, aging, and prevalent cardiovascular disease (CVD). However, prognostic value of these novel measures is unknown. We hypothesized that IFs are associated with incident CVD risk. Our sample was drawn from the Framingham Heart Study Original, Offspring, and Third Generation Cohorts and included participants free of CVD at baseline (N=4700; mean age 52 years, 55% women). We extracted 2 dominant frequencies directly from a series of carotid pressure waves: the IF of the coupled heart and vascular system during systole (ω 1 ) and the IF of the decoupled vasculature during diastole (ω 2 ). Total frequency variation (Δω) was defined as the difference between ω 1 and ω 2 . We used Cox proportional hazards regression models to relate IFs to incident CVD events during a mean follow-up of 10.6 years. In multivariable models adjusted for CVD risk factors, higher ω 1 (hazard ratio [HR], 1.14 [95% CI], 1.03–1.26]; P =0.01) and Δω (HR, 1.16 [95% CI, 1.03–1.30]; P =0.02) but lower ω 2 (HR, 0.87 [95% CI, 0.77–0.99]; P =0.03) were associated with higher risk for incident composite CVD events. In similarly adjusted models, higher ω 1 (HR, 1.23 [95% CI, 1.07–1.42]; P =0.004) and Δω (HR, 1.26 [95% CI, 1.05–1.50]; P =0.01) but lower ω 2 (HR, 0.81 [95% CI, 0.66–0.99]; P =0.04) were associated with higher risk for incident heart failure. IFs were not significantly associated with incident myocardial infarction or stroke. Novel IFs may represent valuable markers of heart failure risk in the community.

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