scholarly journals Incremental changes in QRS duration as predictor for cardiovascular disease: a 21-year follow-up of a randomly selected general population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaojing Chen ◽  
Per-Olof Hansson ◽  
Erik Thunström ◽  
Zacharias Mandalenakis ◽  
Kenneth Caidahl ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
General Population ◽  
Cardiovascular Events ◽  
Population Sample ◽  
Cox Regression Analysis ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Qrs Duration ◽  
Group 1

AbstractThe QRS complex has been shown to be a prognostic marker in coronary artery disease. However, the changes in QRS duration over time, and its predictive value for cardiovascular disease in the general population is poorly studied. So we aimed to explore if increased QRS duration from the age of 50–60 is associated with increased risk of major cardiovascular events during a further follow-up to age 71. A random population sample of 798 men born in 1943 were examined in 1993 at 50 years of age, and re-examined in 2003 at age 60 and 2014 at age 71. Participants who developed cardiovascular disease before the re-examination in 2003 (n = 86) or missing value of QRS duration in 2003 (n = 127) were excluded. ΔQRS was defined as increase in QRS duration from age 50 to 60. Participants were divided into three groups: group 1: ΔQRS < 4 ms, group 2: 4 ms ≤ ΔQRS < 8 ms, group 3: ΔQRS ≥ 8 ms. Endpoints were major cardiovascular events. And we found compared with men in group 1 (ΔQRS < 4 ms), men with ΔQRS ≥ 8 ms had a 56% increased risk of MACE during follow-up to 71 years of age after adjusted for BMI, systolic blood pressure, smoking, hyperlipidemia, diabetes and heart rate in a multivariable Cox regression analysis (HR 1.56, 95% CI:1.07–2.27, P = 0.022). In conclusion, in this longitudinal follow-up over a decade QRS duration increased in almost two out of three men between age 50 and 60 and the increased QRS duration in middle age is an independent predictor of major cardiovascular events.

Incremental Changes in Qrs Duration as Predictor for Incident Cardiovascular Disease: a Prospective Follow-up of a Randomly Selected General Population Sample During a Decade Beyond

2021 ◽  
Author(s):  
Xiaojing Chen ◽  
Per-Olof Hansson ◽  
Erik Thunström ◽  
Zacharias Mandalenakis ◽  
Kenneth Caidahl ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
General Population ◽  
Cardiovascular Events ◽  
Population Sample ◽  
Cox Regression Analysis ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Qrs Duration ◽  
Group 1

Abstract Background: The QRS complex has been shown to be a prognostic marker in coronary artery disease. However, the changes in QRS duration over time, and its predictive value for cardiovascular disease in the general population is poorly studied.Hypothesis: Increased QRS duration from the age of 50 to 60 is associated with increased risk of major cardiovascular events during a further follow-up to age 71. Method: A random population sample of 798 men born in 1943 were examined in 1993 at 50 years of age, and re-examined in 2003 at age 60 and 2014 at age 71. Participants who developed cardiovascular disease before the re-examination in 2003 (n=86) or missing value of QRS duration in 2003 (n=127) were excluded. ΔQRS was defined as increase in QRS duration from age 50 to 60. Participants were divided into three groups: group 1: ΔQRS <4ms, group 2: 4ms ≤ ΔQRS < 8ms, group 3: ΔQRS ≥ 8ms. Endpoints were major cardiovascular events. Result: Compared with men in group 1 (ΔQRS < 4ms), men with ΔQRS ≥ 8ms had a 56% increased risk of MACE during follow-up to 71 years of age after adjusted for BMI, systolic blood pressure, smoking, hyperlipidemia, diabetes and heart rate in a multivariable Cox regression analysis (HR 1.56, 95% CI:1.07-2.27, P=0.022).Conclusion: In this longitudinal follow-up over a decade QRS duration increased in almost two out of three men between age 50 and 60. The increased QRS duration in middle age is an independent predictor of major cardiovascular events.

Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review

Lupus ◽  
2017 ◽  
Vol 26 (14) ◽  
pp. 1463-1472 ◽  
Author(s):  
S Fasano ◽  
D P Margiotta ◽  
L Navarini ◽  
L Pierro ◽  
I Pantano ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Cardiovascular Event ◽  
Lupus Erythematosus ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Systemic Lupus ◽  
Increased Risk

Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000–2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

scholarly journals Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000856 ◽  
Author(s):  
Xiao-jing Chen ◽  
Salim Bary Barywani ◽  
Per-Olof Hansson ◽  
Erik Östgärd Thunström ◽  
Annika Rosengren ◽  
...  
Keyword(s):  
Heart Rate ◽  
General Population ◽  
Cardiovascular Events ◽  
Population Sample ◽  
Resting Heart Rate ◽  
Risk Of Death ◽  
Increased Risk ◽  
Old Men ◽  
The Impact ◽  
Random Population Sample

BackgroundResting heart rate (RHR), a known cardiovascular risk factor, changes with age. However, little is known about the association between changes in RHR and the risk of cardiovascular events. The purpose of this study was therefore to assess the impact of RHR at baseline, and the change in RHR over time, on the risk of all-cause death and cardiovascular events.DesignA random population sample of men born in 1943 who were living in Gothenburg, Sweden was prospectively followed for a 21-year period.MethodsParticipants were examined three times: first in 1993 and then re-examined in 2003 and 2014. At each visit, a clinical examination, an ECG and laboratory analyses were performed. Change in RHR between 1993 and 2003 was defined as a decrease if RHR decreased by 5 beats per minute (bpm), an increase if RHR increased by 5 bpm or stable if the RHR change was <4bpm).ResultsParticipants with a baseline RHR of >75 bpm in 1993 had about a twofold higher risk of all-cause death (HR 2.3, CI 1.2 to 4.7, p=0.018), cardiovascular disease (CVD) (HR 1.8, CI 1.1 to 3.0, p=0.014) and coronary heart disease (CHD) (HR 2.2, CI 1.1 to 4.5, p=0.025) compared with those with <55 bpm in 1993. Participants with a stable RHR between 1993 and 2003 had a 44% decreased risk of CVD (HR 0.56, CI 0.35 to 0.87, p=0.011) compared with participants with an increasing RHR. Furthermore, every beat increase in heart rate from 1993 was associated with a 3% higher risk for all-cause death, 1% higher risk for CVD and 2% higher risk for CHD.ConclusionHigh RHR was associated with an increased risk of death and cardiovascular events in men from the general population. Moreover, individuals with an increase in RHR between 50 and 60 years of age had worse outcome.

Outcome in biopsy-proven Lupus nephritis: Evaluation of biopsies from the Norwegian Kidney Biopsy Registry

Lupus ◽  
2017 ◽  
Vol 26 (8) ◽  
pp. 881-885 ◽  
Author(s):  
G E Norby ◽  
G Mjøen ◽  
R Bjørneklett ◽  
B E Vikse ◽  
H Holdaas ◽  
...  
Keyword(s):  
General Population ◽  
Lupus Nephritis ◽  
Confidence Interval ◽  
Cardiovascular Events ◽  
Causes Of Death ◽  
Cox Regression ◽  
Population Sample ◽  
All Cause Mortality ◽  
Class Iv

Objective To evaluate long-term mortality and end-stage renal disease (ESRD) in a cohort of Norwegian patients with biopsy-proven lupus nephritis (LN). Methods Renal biopsies were obtained from 178 patients with LN from 1988 until 2007. Mortality rate and death causes were provided by Statistics Norway and ESRD data were provided by the Norwegian Renal Registry. Risk factors for all-cause mortality were evaluated by Cox regression. Standardized mortality ratio (SMR) was compared to observed deaths in a matched general population sample. Results Mean age was 37.6 (±14.4) years, and median time of follow-up was 8.5 years (0–26.2). Thirty-six patients (20.2%) died during follow-up. The SMR for all-cause mortality was 5.6 (Confidence interval [CI] 3.7–7.5). In an adjusted multivariate analysis proliferative glomerulonephritis (LN class IV) was independently associated with all-cause mortality; hazard ratio (HR) 2.6 (Confidence interval [CI] 1.2–5.7 p = 0.017). Main causes of death were infections (47.2%) and cardiovascular events 8 (22.2%). Thirty-six patients (20.2%) reached ESRD. Conclusions Biopsy-proven LN is associated with increased mortality compared to the general population. LN class IV is associated with all-cause mortality. Infections and cardiovascular events were the most common causes of death. Patients with LN have a high incidence of ESRD.

scholarly journals Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study

BMJ ◽  
2021 ◽  
pp. m4948
Author(s):  
Sumathi Swaminathan ◽  
Mahshid Dehghan ◽  
John Michael Raj ◽  
Tinku Thomas ◽  
Sumathy Rangarajan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cohort Study ◽  
Cardiovascular Events ◽  
Total Mortality ◽  
Whole Grains ◽  
Refined Grains ◽  
White Rice ◽  
Major Cardiovascular Events

Abstract Objective To evaluate the association between intakes of refined grains, whole grains, and white rice with cardiovascular disease, total mortality, blood lipids, and blood pressure in the Prospective Urban and Rural Epidemiology (PURE) study. Design Prospective cohort study. Setting PURE study in 21 countries. Participants 148 858 participants with median follow-up of 9.5 years. Exposures Country specific validated food frequency questionnaires were used to assess intakes of refined grains, whole grains, and white rice. Main outcome measure Composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios were estimated for associations of grain intakes with mortality, major cardiovascular events, and their composite by using multivariable Cox frailty models with random intercepts to account for clustering by centre. Results Analyses were based on 137 130 participants after exclusion of those with baseline cardiovascular disease. During follow-up, 9.2% (n=12 668) of these participants had a composite outcome event. The highest category of intake of refined grains (≥350 g/day or about 7 servings/day) was associated with higher risk of total mortality (hazard ratio 1.27, 95% confidence interval 1.11 to 1.46; P for trend=0.004), major cardiovascular disease events (1.33, 1.16 to 1.52; P for trend<0.001), and their composite (1.28, 1.15 to 1.42; P for trend<0.001) compared with the lowest category of intake (<50 g/day). Higher intakes of refined grains were associated with higher systolic blood pressure. No significant associations were found between intakes of whole grains or white rice and health outcomes. Conclusion High intake of refined grains was associated with higher risk of mortality and major cardiovascular disease events. Globally, lower consumption of refined grains should be considered.

scholarly journals Serum NT-pro-BNP Levels Predict Cardiovascular Events in Acromegaly Patients

2021 ◽  
Author(s):  
Marta Ragonese ◽  
Gianluca Di Bella ◽  
Federica Spagnolo ◽  
Loredana Grasso ◽  
Angela Alibrandi ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Population ◽  
Brain Natriuretic Peptide ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Roc Analysis ◽  
Middle Term ◽  
Increased Risk

Abstract Background Acromegaly is associated with an increased risk of fatal and non-fatal cardiovascular (CV) events. Controlling acromegaly decreases, but does not normalize this risk. Brain natriuretic peptide (BNP) assessment is used in the general population for the diagnosis of heart failure and to predict ischemic recurrences and mortality. This is a retrospective, longitudinal, monocenter study that evaluates the role of serum N-terminal fragment of BNP (NT-pro-BNP) for predicting CV events in acromegaly patients. Methods Serum NT-pro-BNP levels were measured in 76 patients with acromegaly (23 males, 57.7±1.5 years), and compared with other predictors of CV events. NT-pro-BNP cut-off value discriminating the occurrence of CV events was determined by ROC analysis. CV events were recorded during a follow-up of 78.6±6.4 months. Results CV events occurred in 9.2% of patients. Mean log(NT-pro-BNP) concentration was higher in patients who experienced CV events than in those who did not (p<0.01) and in patients who died due to CV events than in those who died due to other causes (p<0.01). Based on the ROC curve, a cut-off value of 91.55 pg/mL could predict CV events (OR 19.06). Log(NT-pro-BNP) was lower in surgically treated patients by surgery (p<0.05), and in those cured by neurosurgery (p<0.02). Conclusions High NT-pro-BNP value is an independent middle-term predictor of fatal or non-fatal CV events in patients with acromegaly. According to this parameter, surgically treated patients show lower CV risk than those managed with medical therapy, especially if the disease is cured.

scholarly journals Prevalence of metabolic syndrome within hypertensive population and the risk of developing atherosclerotic cardiovascular diseases

2015 ◽  
Vol 10 (2) ◽  
pp. 187-194
Author(s):  
Gabriel Cristian BEJAN ◽  
◽  
Dumitru MATEI ◽  
Adela IANCU ◽  
◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Cardiovascular Diseases ◽  
Urban Areas ◽  
Cardiovascular Events ◽  
Insulin Resistance Syndrome ◽  
Major Cardiovascular Events ◽  
Hypertensive Population ◽  
Increased Risk ◽  
Atherosclerotic Cardiovascular Diseases

Metabolic syndrome, also called insulin resistance syndrome or excess of catecholamines, is represented by several cardiometabolic factors that result in increased incidence of cardiovascular disease and type 2 diabetes. Due to sedentary lifestyle and hypercaloric food, with a high percent of saturated fats and carbohydrates, that characterize modern lifestyle of the population, especially in urban areas, the prevalence of metabolic syndrome recorded an ascending slope that makes it a very topical issue for the medical world. During the years 2013-2014 we conducted an observational study on a sample of 111 hypertensive patients without major cardiovascular events such as myocardial infarction or stroke, with age between 48 and 83 years, in whom we determined the prevalence of metabolic syndrome and cardiovascular disease. The survey results showed an increased prevalence of metabolic syndrome, considering that we related to a hypertensive population, and an increased risk of non-fatal atherosclerotic cardiovascular diseases in men and fatal cardiovascular events in next 10 years especially for women.

scholarly journals The Value of Blood Urea Nitrogen in the Prediction of Risks of Cardiovascular Disease in an Older Population

2021 ◽  
Vol 8 ◽  
Author(s):  
Qin Lan ◽  
Liang Zheng ◽  
Xiaohui Zhou ◽  
Hong Wu ◽  
Nicholas Buys ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Blood Urea Nitrogen ◽  
Cox Regression ◽  
Older Population ◽  
Urea Nitrogen ◽  
Cox Regression Analysis ◽  
Increased Risk

Background: High blood urea nitrogen (BUN) is associated with adverse outcomes in patients with cardiac disease risks. However, no study has explored whether BUN can predict the risk of cardiovascular disease (CVD) in the healthy older population. This study aims to explore the incidence and risk factors of CVD among a healthy older population community in China.Design and Methods: This study was designed as a cohort study with a 4-year follow-up. We recruited 5,000 older people among 137,625 residents of the Gaohang community. In the baseline, subjects were asked to participate in medical screening and biological tests, and answered survey questions. During the follow-up period (2014–2017), the researchers regularly tested the subjects' indicators and assessment scales. We monitored the occurrence of CVD and explored the relationship between BUN and CVD via a Cox regression analysis.Results: During the follow-up, subjects were newly diagnosed with CVD including heart failure (HF), heart disease events, atrial fibrillation, diabetes, hypertension, metabolic syndrome, and kidney disease. The Cox regression analysis found an association between baseline BUN and incident CVD in female subjects, with higher BUN associated with increased risk of AF in females and kidney disease in both male and females. No association was found between BUN and CVD in male subjects.Conclusions: Current results indicate that BUN is a valuable predictive biomarker of CVD. A higher BUN level (&gt;13.51 mg/dL) is associated with an increased occurrence of HF but a decreased occurrence of diabetes and metabolic symptoms in normal older females.

scholarly journals Blood Pressure Classification of 2017 Associated With Cardiovascular Disease and Mortality in Young Chinese Adults

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 251-258 ◽  
Author(s):  
Shouling Wu ◽  
Yongjian Song ◽  
Shuohua Chen ◽  
Mengyi Zheng ◽  
Yihan Ma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cox Regression ◽  
Chinese Adults ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
New Guidelines ◽  
Stage 1

The American College of Cardiology/American Heart Association introduced new guidelines for blood pressure (BP) classification in 2017. We explored associations between the newly defined categories and eventual cardiovascular disease (CVD) events, stroke, and all-cause mortality in young Chinese adults. In the community-based Kailuan Study, 16 006 participants aged 18 to 40 years and examined at baseline in 2006/2007 underwent 2-yearly follow-up examinations up to 2016 to 2017. Taking the highest BP reading recorded by manual sphygmomanometry at baseline in 2006 to 2007, we categorized the BP according to the new guidelines. Outcome parameters were CVD events, stroke, and all-cause mortality. During follow-up (mean: 10.9±0.63 years), we observed 458 events (CVD, 167; stroke, 119; and all-cause death, 172). After multivariable adjustment, hazard ratios for CVD events were for elevated BP 0.80 (95% CI, 0.28–2.30), stage 1 hypertension 1.82 (95% CI, 1.12–2.94), and stage 2 hypertension 3.54 (95% CI, 2.18–5.77) versus normal BP. Similar results were obtained for stroke and all-cause death. In Cox regression analysis with BP category entered as time-dependent covariate, stage 1 hypertension was not associated with increased risk ( P >0.10). In the subgroup of individuals taking antihypertensive medication during follow-up, none of the BP categories was significantly associated with the incidence of CVD events. During a mean follow-up of 10.9 years, the newly defined category of stage 1 hypertension in young untreated Chinese adults aged <40 years at baseline was associated with an increased risk for CVD, stroke, and all-cause mortality. This increased risk occurred, however, after progression to stage 2 hypertension. The data may help validating the new BP classification system for young adult Chinese.

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