3141Predicting life-expectancy without recurrent vascular events in patients with cardiovascular disease: the REACH-SMART model

AbstractThe concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.

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Insulin resistance and risk of vascular events, interventions and mortality in type 1 diabetes

Acta Endocrinologica ◽

10.1530/eje-21-0636 ◽

2021 ◽

Author(s):

Marga A.g. Helmink ◽

Marieke de Vries ◽

Frank L.j. Visseren ◽

Wendela L. de Ranitz ◽

Harold W. de Valk ◽

...

Keyword(s):

Insulin Resistance ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Insulin Sensitivity ◽

Lower Risk ◽

Cardiovascular Events ◽

Additional Risk Factor ◽

Vascular Events ◽

All Cause Mortality

Objective: To identify determinants associated with insulin resistance and to assess the association between insulin resistance and cardiovascular events, vascular interventions and mortality in people with type 1 diabetes at high risk of cardiovascular disease . Design: Prospective cohort study. Methods: 195 people with type 1 diabetes from the Secondary Manifestations of ARTerial disease (SMART) cohort were included. Insulin resistance was quantified by the estimated glucose disposal rate (eGDR) with higher eGDR levels indicating higher insulin sensitivity (i.e. lower eGDR levels indicating higher insulin resistance). Linear regression models were used to evaluate determinants associated with eGDR. The effect of eGDR on cardiovascular events, cardiovascular events or vascular interventions (combined endpoint) and on all-cause mortality was analysed using Cox proportional hazards models adjusted for confounders. Results: In 195 individuals (median follow-up 12.9 years, IQR 6.7-17.0), a total of 25 cardiovascular events, 26 vascular interventions and 27 deaths were observed. High eGDR as a marker for preserved insulin sensitivity was independently associated with a lower risk of cardiovascular events (HR 0.75; 95%CI 0.61-0.91), a lower risk of cardiovascular events and vascular interventions (HR 0.74; 95%CI 0.63-0.87), and a lower risk of all-cause mortality (HR 0.81; 95%CI 0.67-0.98). Conclusions: Insulin resistance as measured by eGDR is an additional risk factor for cardiovascular disease in individuals with type 1 diabetes. Modification of insulin resistance by lifestyle interventions or pharmacological treatment could be a viable therapeutic target to lower the risk of cardiovascular disease.

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Aspirin Dose for Prevention of Cardiovascular Disease in Diabetics

Annals of Pharmacotherapy ◽

10.1345/aph.1c101 ◽

2003 ◽

Vol 37 (1) ◽

pp. 116-121 ◽

Cited By ~ 6

Author(s):

Sandra N Nowak ◽

Linda A Jaber

Keyword(s):

Cardiovascular Disease ◽

Aspirin Therapy ◽

Biomedical Literature ◽

Diabetic Patients ◽

Vascular Events ◽

Cardiovascular Protection ◽

Patients With Diabetes ◽

Relationship Of ◽

Key Terms ◽

Prevention Of Cardiovascular Disease

OBJECTIVE To determine whether a specific dose of aspirin can be recommended for prevention of cardiovascular disease in patients with diabetes. DATA SOURCE Biomedical literature was accessed through MEDLINE (1990–February 2002). Key terms included diabetes, cardiovascular protection, and aspirin. DATA SYNTHESIS Pharmacologic and clinical studies focusing on the dose–response relationship of aspirin therapy were reviewed. Evidence supports the benefit of low-dose aspirin therapy in reducing vascular events in secondary and primary prevention trials in various patient populations; however, some studies suggest larger doses of aspirin may be needed in certain patients. CONCLUSIONS Review of the evidence does not support a particular dose of aspirin for cardiovascular protection in diabetic patients. Clinical guidelines recommend aspirin therapy in the range of 81–325 mg/d. However, due to an increased prevalence of cardiovascular morbidity and disturbances in coagulation in diabetic patients, the dose of aspirin for prevention of cardiovascular disease in these individuals may be different from that in other populations and requires further evaluation.

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Effects of Physical Activity on Life Expectancy With Cardiovascular Disease

Archives of Internal Medicine ◽

10.1001/archinte.165.20.2355 ◽

2005 ◽

Vol 165 (20) ◽

pp. 2355 ◽

Cited By ~ 241

Author(s):

Oscar H. Franco

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Life Expectancy

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The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-Year Diabetes Cohort Study

Diabetes Care ◽

10.2337/dc19-2137 ◽

2020 ◽

Vol 43 (8) ◽

pp. 1750-1758

Author(s):

Eric Yuk Fai Wan ◽

Weng Yee Chin ◽

Esther Yee Tak Yu ◽

Ian Chi Kei Wong ◽

Esther Wai Yin Chan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Life Expectancy ◽

Direct Medical Cost ◽

Medical Cost ◽

The Impact

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Leveraging a Landmark Trial of Primary Cardiovascular Disease Prevention in Human Immunodeficiency Virus: Introduction From the REPRIEVE Coprincipal Investigators

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa098 ◽

2020 ◽

Vol 222 (Supplement_1) ◽

pp. S1-S7 ◽

Cited By ~ 3

Author(s):

Steven K Grinspoon ◽

Pamela S Douglas ◽

Udo Hoffmann ◽

Heather J Ribaudo

Keyword(s):

Cardiovascular Disease ◽

Human Immunodeficiency Virus ◽

Disease Prevention ◽

Gender Diversity ◽

Coronary Plaque ◽

Cardiovascular Disease Prevention ◽

Population Characteristics ◽

Vascular Events ◽

Global Epidemic ◽

Immunodeficiency Virus

Abstract The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) is the largest study of cardiovascular disease in human immunodeficiency virus. Enrolling 7770 participants from 2015 to 2019 with sites across 5 continents, REPRIEVE will assess the effects of a statin as a cardiovascular disease prevention strategy in people with HIV (PWH) receiving antiretroviral therapy (ART). Although the primary purpose of REPRIEVE, and its substudy assessing coronary plaque, is to assess cardiovascular outcomes, the trial is a rich source of data on population characteristics and critical comorbidities in PWH, particularly across Global Burden of Disease (GBD) regions, reflective of the ethnic, racial, and gender diversity in this global epidemic. The purpose of this Supplement is to leverage the rich phenotyping in REPRIEVE, to provide data on detailed patterns of baseline ART and immune function by GBD region, reproductive aging among cisgender women, and data on the participation and clinical characteristics of transgender participants. We also leveraged REPRIEVE to assess critical comorbidities, including renal dysfunction, muscle function and frailty, and myocardial steatosis. REPRIEVE is a remarkable collaboration between funders, trial networks, clinical research sites, clinical and data coordinating centers, and willing participants who devoted their time to make the trial possible.

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Blood Pressure in Adulthood and Life Expectancy With Cardiovascular Disease in Men and Women

Hypertension ◽

10.1161/01.hyp.0000173433.67426.9b ◽

2005 ◽

Vol 46 (2) ◽

pp. 280-286 ◽

Cited By ~ 156

Author(s):

Oscar H. Franco ◽

Anna Peeters ◽

Luc Bonneux ◽

Chris de Laet

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Life Expectancy ◽

Men And Women

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Lipoprotein(a) and Cardiovascular Disease in Ethnic Chinese: The Chin-Shan Community Cardiovascular Cohort Study

Clinical Chemistry ◽

10.1373/clinchem.2007.090969 ◽

2008 ◽

Vol 54 (2) ◽

pp. 285-291 ◽

Cited By ~ 19

Author(s):

Kuo-Liong Chien ◽

Hsiu-Ching Hsu ◽

Ta-Chen Su ◽

Fung-Chang Sung ◽

Ming-Fong Chen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Chinese Adults ◽

Vascular Events ◽

Community Based ◽

Lipoprotein A ◽

Ethnic Chinese ◽

Total Death ◽

Age Range

Abstract Background: Little is known about lipoprotein(a) [Lp(a)] as a predictor of vascular events among ethnic Chinese. We prospectively investigated the association of Lp(a) with cardiovascular disease and all-cause death in a community-based cohort. Methods: We conducted a community-based prospective cohort study of 3484 participants (53% women; age range, 35–97 years) who had complete lipid measurements and were free of a cardiovascular disease history at the time of recruitment. Over a median follow-up of 13.8-years, we documented 210 cases of stroke, 122 cases of coronary heart disease (CHD), and 781 deaths. Results: The incidences for each event increased appreciably with Lp(a) quartile for stroke and all-cause death, but not for CHD. Baseline Lp(a) concentration by quartile was not significantly associated with stroke, all-cause death, and CHD in multivariate analyses. The multivariate relative risk was significant for stroke at the 90th and 95th percentiles and for total death at the 95th and 99th percentiles. Conclusions: Our findings suggest a threshold relationship with little gradient of risk across lower Lp(a) values for stroke and all-cause death in Chinese adults.

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Relative Risk of Cardiovascular Disease after Treatment for Aggressive Non-Hodgkin’s Lymphoma.

Blood ◽

10.1182/blood.v106.11.2831.2831 ◽

2005 ◽

Vol 106 (11) ◽

pp. 2831-2831

Author(s):

E. C. Moser ◽

E. M. Noordijk ◽

F. E. van Leeuwen ◽

S. le Cessie ◽

J. W. Baars ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Chronic Heart Failure ◽

Hodgkin Lymphoma ◽

Risk Model ◽

Salvage Treatment ◽

Excess Risk ◽

Vascular Events ◽

Increased Risk

Abstract Cardiovascular complications after therapy for Hodgkin lymphoma have been related to radiotherapy on the mediastinum, but have only incidentally been studied in NHL. As cardiovascular disease occurs commonly in the normal population, it is important to realize that risk factors as age, hypertension and life-style (diet and smoking) may be more outspoken in patients with NHL, who are generally older than patients with Hodgkin lymphoma. Moreover, although most patients with aggressive NHL will initially receive only chemotherapy, many will be treated with more than one therapy modality, incorporating stem cell transplantation or radiotherapy, because of early failure or relapses. Therefore, risk estimation of cardiovascular disease in NHL patients requires comparison to population-based rates. Here, we evaluated whether patients with aggressive NHL treated in 4 EORTC trials between 1980–1999 have an increased excess cardiovascular risk, compared to Dutch population rates. Relative risks (RR) and absolute excessive risks (AER per 1000 person-years) of cardiovascular disease were determined in 476 (Dutch and Belgian) patients and compared to incidence rates from the Continuous Morbidity Registry Nijmegen. Analyses were restricted to those patients treated with at least 6 cycles of doxorubicin-based chemotherapy and with a minimal follow-up time of 0.5 years. Only serious late events requiring daily medication and/or clinical interventions were recorded. Cumulative incidences of cardiovascular disease were estimated in the competing risk model by Gray with death by any cause as competing event. The overall cumulative incidence of cardiovascular disease was 12% at 5 and 22% at 10 years. At a median follow-up of 8.4 years, 66 cases of chronic heart failure (RR 5.4, 95% CI 4.1–6.9, AER 20.8), 17 myocardial infarctions (RR 1.2; 0.8–1.8, AER 0.8), 12 strokes (RR 1.8; 1.1–2.4, AER 1.5) and 9 other large vessel occlusions were registered. The large vascular events including strokes occurred in 16/21 patients after radiotherapy given in the same area. Pre-existent hypertension, NHL at young age (<55 years) and (any) salvage treatment increased risk of cardiovascular disease. Excess risk for myocardial infarction or stroke after radiotherapy on respectively the mediastinum or neck depended on cumulative radiation dose and was only seen after more than 40 Gy. Excess risk for chronic heart failure was registerd in both non-irradiated (RR 4.4) and irradiated patients, with an extremely high RR of 32 (13.7–57.0) if >40 Gy had been given. In conclusion, NHL patients treated with doxorubicin-based chemotherapy, especially those who are young, have hypertension, or received salvage treatment or radiotherapy above 40 Gy, are at high risk of cardiovascular disease and need lifelong monitoring in this regard.

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Prevention of Premature Mortality Among Patients with Schizophrenia: The Need for Primary Prevention Efforts in Cardiovascular Disease

CNS Spectrums ◽

10.1017/s1092852900003114 ◽

2008 ◽

Vol 13 (S10) ◽

pp. 9-10 ◽

Cited By ~ 1

Author(s):

Charles H. Hennekens

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Primary Prevention ◽

General Population ◽

Life Expectancy ◽

Premature Mortality ◽

The United States ◽

Average Life ◽

Average Life Expectancy ◽

United States Today

Patients with schizophrenia have a markedly reduced lifespan compared with the general population. In the United States today, patients with schizophrenia have an average life expectancy of ∼61 years, about 20% lower than that of the general population, in which life expectancy is ∼76 years.

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