P1194RISK FACTORS FOR CARDIOVASCULAR DEATH IN NON-DIABETIC PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Andreea Gabriella Andronesi ◽  
Luminita Iliuta ◽  
Cristina Cristache ◽  
Bogdan Marian Sorohan ◽  
Gabriela Elena Lupusoru ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Sudden Cardiac Death ◽  
Calcium Phosphate ◽  
Arterial Stiffness ◽  
Cardiac Death ◽  
Cardiovascular Death ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Phosphate Product

Abstract Background and Aims Chronic kidney disease and especially end stage renal disease are important public health issues with increasing incidence and significant economic burden. Despite advances in peritoneal dialysis (PD), mortality is still high mostly because of cardiovascular morbidity and mortality. The aim of the present study was to identify prognostic risk factors for cardiovascular death in non-diabetic PD patients. Method We performed a prospective study in which we included non-diabetic patients in stable PD programme for at least 6 months. Clinical, biological, heart and carotid ultrasound and arterial stiffness (evaluated through applanation tonometry) parameters were analysed. Independent risk factors for cardiovascular death were identified by logistic regression using IBM SPSS ver. 20.0. Results We included 246 consecutive non-diabetic patients (118F, 128M), mean age 56.3 + 15.7 years (20-85). Mean follow up was 6.5+1.1 years. 36 patients (14.6%) died because of cardiovascular reasons - sudden cardiac death 13 patients, acute coronary syndrome 8 patients, ischemic stroke 8 patients, and heart failure 7 patients. Individuals with cardiovascular death were significantly older (64.6±14.2 vs 54.7±15.5 years, p=0.01), with signs of malnutrition, inflammation and associated anemia - significantly lower total cholesterol (150.2±43.0 vs 194.3±58.2 mg/dl, p=0.002), serum albumin (2.9±0.4 vs 3.5±0.7 g/dl, p=0.002) and hemoglobin (9.7±1.1 vs 10.7±1.4 g/dl, p=0.007) and significantly higher serum fibrinogen (568.7±121.3 vs 509.8±115.0 mg/dl, p=0.04) and C-reactive protein (6.7+1.2 vs 9.5+0.9 mg/l, p=0.02). In univariate analysis risk for cardiovascular death was higher in patients with renal hypertensive disease (OR 4.0, 95%CI 1.4-11.5, p=0.01), iPTH serum level <150 pg/ml (OR 6.6, 95%CI: 2.3-18.9, p<0.001), left ventricular hypertrophy (OR 10.6, 95%CI 2.3-18.9, p=0.001) and diastolic dysfunction (OR 4.0, 95%CI 1.2-14.9, p=0.02). Compared to patients with an iPTH between 150-300 pg/ml, both patients with lower iPTH and also higher iPTH had an increased risk for cardiovascular death (OR=1.6, 95%CI: 1.2-2.0; p<0.001 for iPTH<150 pg/ml, and OR =1.2, 95%CI:1.04-1.34; p=0.01 for iPTH<300 pg/ml). Patients with cardiovascular death had signs of subclinic atherosclerosis- intima-media thickness at carotid level >0.9 mm (OR 4.3, 95%CI 1.1-16.3, p=0.02) and higher pulse wave velocity as a sign of increased arterial stiffness (11.9+2.5 vs 8.6+2.6 m/s, p=0.04). After adjusting for potential confounders, independent predictive factors for cardiovascular death were male gender, calcium-phosphate product>55 mg2/dl2, iPTH<150 pg/ml and peripheral arterial disease (Table 1). Conclusion We found an increased risk for cardiovascular death in non-diabetic PD patients, mostly because of sudden cardiac death. Malnutrition, inflammation, but especially abnormal mineral metabolism (both increased calcium-phosphate product and low bone turnover) were identified as risk factors for cardiovascular death and are potentially treatable risk factors to improve cardiovascular outcome in PD patients. A better understanding of pathogenesis and risk factors for cardiovascular death in PD may help improve patients’ management and thus their long-term survival.

Cardiovascular Risk Factors among Career Firefighters

AAOHN Journal ◽  
2009 ◽  
Vol 57 (10) ◽  
pp. 415-424 ◽  
Author(s):  
Dana C. Drew-Nord ◽  
OiSaeng Hong ◽  
Erika S. Froelicher ◽  
Phyllis Berryman ◽  
Eileen Lukes
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Cardiac Death ◽  
Cardiovascular Death ◽  
Physical Work ◽  
Physical Work Demands ◽  
Increased Risk

Sudden cardiac death is the leading cause of on-duty death among firefighters. Determining firefighters' risk of cardiovascular death or all-cause mortality, cardiovascular risk factor profiles, and energy demands while firefighting may aid in understanding why this occupational group is at risk for on-duty sudden cardiac death. A literature review conducted between 2006 and 2009 did not demonstrate that firefighters are at increased risk of all-cause death compared to the general population. In addition, cardiovascular risk profiles of firefighters are similar to those of the general population. Firefighters may be part of the national obesity epidemic; their hypertension and hypercholesteremia often are not diagnosed or are undertreated. The combination of personal cardiovascular risk factors and extreme physical work demands may contribute to sudden cardiac death in this population.

scholarly journals Vital exhaustion and sudden cardiac death in the Atherosclerosis Risk in Communities Study

Heart ◽  
2017 ◽  
Vol 104 (5) ◽  
pp. 423-429 ◽  
Author(s):  
Brittany M Bogle ◽  
Nona Sotoodehnia ◽  
Anna M Kucharska-Newton ◽  
Wayne D Rosamond
Keyword(s):  
Risk Factors ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Disease Risk ◽  
Ventricular Tachyarrhythmia ◽  
Atherosclerosis Risk In Communities ◽  
Vital Exhaustion ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Aric Study

ObjectiveVital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study.MethodsThe ARIC Study is a predominately biracial cohort of men and women, aged 45–64 at baseline, initiated in 1987 through random sampling in four US communities. VE was measured using the Maastricht questionnaire between 1990 and 1992 among 13 923 individuals. Cox proportional hazards models were used to examine the hazard of out-of-hospital SCD across tertiles of VE scores.ResultsThrough 2012, 457 SCD cases, defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual, were identified in ARIC by physician record review. Adjusting for age, sex and race/centre, participants in the highest VE tertile had an increased risk of SCD (HR 1.48, 95% CI 1.17 to 1.87), but these findings did not remain significant after adjustment for established cardiovascular disease risk factors (HR 0.94, 95% CI 0.73 to 1.20).ConclusionsAmong participants of the ARIC study, VE was not associated with an increased risk for SCD after adjustment for cardiovascular risk factors.

Abstract 14760: Myocardial Scarring by Magnetic Resonance Predicts Sudden Cardiac Death in Pediatric Patients With Hypertrophic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lars Grosse-Wortmann ◽  
Laurine van der Wal ◽  
Aswathy Vaikom House ◽  
Lee Benson ◽  
Raymond Chan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Pediatric Patients ◽  
Risk Markers ◽  
C Statistic ◽  
Increased Risk ◽  
Traditional Risk Factors

Introduction: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has been shown to be an independent predictor of sudden cardiac death (SCD) in adults with hypertrophic cardiomyopathy (HCM). The clinical significance of LGE in pediatric HCM patients is unknown. Hypothesis: LGE improves the SCD risk prediction in children with HCM. Methods: We retrospectively analyzed the CMR images and reviewed the outcomes pediatric HCM patients. Results: Amongst the 720 patients from 30 centers, 73% were male, with a mean age of 14.2±4.8 years. During a mean follow up of 2.6±2.7 years (range 0-14.8 years), 34 experienced an episode of SCD or equivalent. LGE (Figure 1A) was present in 34%, with a mean burden of 14±21g, or 2.5±8.2g/m2 (6.2±7.7% of LV myocardium). The presence of ≥1 adult traditional risk factor (family history of SCD, syncope, LV thickness >30mm, non-sustained ventricular tachycardia on Holter) was associated with an increased risk of SCD (HR=4.6, p<0.0001). The HCM Risk-Kids score predicted SCD (p=0.002). The presence of LGE was strongly associated with an increased risk (HR=3.8, p=0.0003), even after adjusting for traditional risk factors (HR adj =3.2, p=0.003) or the HCM Risk-Kids score (HR adj =3.5, p=0.003). Furthermore, the burden of LGE was associated with increased risk (HR=2.1/10% LGE, p<0.0001). LGE burden remained independently associated with an increased risk for SCD after adjusting for traditional risk factors (HRadj=1.5/10% LGE, p=0.04) or HCM Risk-Kids (HRadj=1.9/10% LGE, p=0.0018, Figure 1B). The addition of LGE burden improved the predictive model using traditional risk markers (C statistic 0.67 vs 0.77, p=0.003) and HCM Risk-Kids (C statistic 0.68 vs 0.74, p=0.045). Conclusions: Quantitative LGE is an independent risk factor for SCD in pediatric patients with HCM and improves the performance of traditional risk markers and the HCM Risk-Kids Score for SCD risk stratification in this population.

scholarly journals FP625CONTINUOUS ECG MONITORING IN NON-DIABETIC PERITONEAL DIALYSIS PATIENTS MAY IDENTIFY PATIENTS AT INCREASED RISK FOR SUDDEN CARDIAC DEATH

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Andreea Andronesi ◽  
Luminita Iliuta ◽  
Bogdan Obrisca ◽  
Bogdan Sorohan ◽  
Gabriela Lupusoru ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ecg Monitoring ◽  
Dialysis Patients ◽  
Increased Risk

“Get Firefighters Moving”: Marketing a Physical Fitness Intervention to Reduce Sudden Cardiac Death Risk in Full-Time Firefighters

2009 ◽  
Vol 15 (3) ◽  
pp. 85-99 ◽  
Author(s):  
John A. Staley
Keyword(s):  
Risk Factors ◽  
Sudden Cardiac Death ◽  
Physical Fitness ◽  
Social Marketing ◽  
Cardiac Death ◽  
Team Sports ◽  
Cardiac Risk ◽  
Full Time ◽  
Cardiac Risk Factors ◽  
Increased Risk

Firefighters as an occupational group are at increased risk for a cardiac-related injury, with the largest proportion (44%) of firefighter on-duty mortality due to sudden cardiac death. As poor physical fitness behaviors are a contributing factor to this risk, a social marketing approach was used to design and market a competitive team-sports intervention to improve physical fitness and reduce cardiac risk factors in a group of full-time firefighters. This article describes how social marketing principles were used in the design and implementation of the “Get Firefighters Moving” physical fitness intervention. This includes strategic development of the marketing plan, with discussion of audience segmentation and the marketing mix used to implement the intervention. Preliminary findings are also presented, as they suggest improvement in cardiac risk factors including blood pressure, cardiovascular class, flexibility, and percent body fat.

Risk stratification for sudden cardiac death in the general population

ESC CardioMed ◽  
2018 ◽  
pp. 2305-2308
Author(s):  
Efstathios K. Iliodromitis ◽  
Dimitrios Farmakis
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Increased Risk ◽  
Artery Disease

There are three main groups in the general population as far as sudden cardiac death (SCD) is concerned: individuals without a known history or predisposing factors for heart disease; individuals with known risk factors for heart disease or SCD; and patients with diagnosed ischaemic, structural, or electrical cardiac conditions, acquired or genetic, that are associated with an increased risk for SCD. Although SCD literature focuses mainly on patients with known heart disease, approximately 50% of SCD cases occur in individuals belonging to the first two groups. The annual incidence of SCD in the general population ranges between 0.6 and greater than 1.4 per 1000 individuals. SCD occurs more commonly in men than in women and with an incidence that increases with age due to the increase in coronary artery disease. The commonest aetiologies for SCD in the general population are coronary artery disease and cardiomyopathy, accounting for 80% and 10–15% of cases, respectively. A number of factors have been related to an increased risk for SCD in the general population including genetic predisposition, risk factors for atherosclerosis, strenuous physical activity and sports, electrocardiographic abnormalities, elevated levels of biomarkers, and abnormalities in imaging and other diagnostic techniques. However, large-scale prospective studies that confirm the feasibility, clinical efficacy, and cost-effectiveness of using these factors for broad mass screening for SCD are generally lacking and therefore risk stratification for SCD in the general population remains challenging.

scholarly journals Secondary risk factors of sudden cardiac death and genes of arterial hypertension

2020 ◽  
Vol 12 (3) ◽  
pp. 27-34
Author(s):  
Vasilii A. Kachnov ◽  
Vadim V. Tyrenko ◽  
Svetlana N. Kolyubaeva ◽  
Lilia A. Myakoshina ◽  
Alexandra S. Buntovskaya
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Sudden Cardiac Death ◽  
Arterial Hypertension ◽  
Qt Interval ◽  
Cardiac Death ◽  
Risk Variant ◽  
Corrected Qt Interval ◽  
Increased Risk ◽  
Heterozygous Variant

Purpose. To study the influence of polymorphisms of arterial hypertension genes and their various combinations on individual risk factors of sudden cardiac death. Materials and methods. 319 young people from 18 to 24 years of age who are entering military service by conscription were examined. The survey identified 69 individuals with signs of increased risk of sudden cardiac death after being examined for secondary risk factors of sudden cardiac death and taken a blood test to determine the polymorphisms of the genes AGT 521 CT, GNB3 825 CT, CYP11B2 344 CT, NOS3 786 TC. Results. The greatest influence on the severity of secondary risk factors was exerted by the following variants of a combination of gene polymorphisms: AGT 521 CT and NOS3 786 TC in the individuals with a heterozygous risk variant, both genes showed a significant increase in the duration of the corrected QT interval, heart rate, and a decrease in heart rate variability. AGT 521 CT and CYP11B2 344 CT homozygous risk variant of the CYP11B2 344 CT and the heterozygous risk variant AGT 521 CT is associated with a longer duration of the corrected QT interval, and the heterozygous risk variant for both genes is associated with higher heart rate values. AGT 521 CT and GNB3 825 CT combination of a homozygous risk variant of the gene GNB3 825 CT and the heterozygous variant of the gene AGT 521 CT is associated with the greatest effect on a heart rate. Conclusions. The presence of a homozygous risk variant of the gene NOS3 786 TC, a heterozygous risk variant of the gene GNB3 825 CT is prognostically unfavorable for its effect on the severity of secondary risk factors for sudden cardiac death. The combination of the heterozygous variant AGT 521 CT with a heterozygous variant of NOS3 786 TC and a homozygous risk variant by the gene CYP11B2 344 CT and the heterozygous risk variant AGT 521 CT are also the most unfavorable in terms of its effect on secondary risk factors for sudden cardiac death. Secondary risk factors of sudden cardiac death are influenced by both individual polymorphisms of genes of arterial hypertension, and their various combinations.

scholarly journals Risk of Typical Diabetes-Associated Complications in Different Clusters of Diabetic Patients: Analysis of Nine Risk Factors

2021 ◽  
Vol 11 (5) ◽  
pp. 328
Author(s):  
Michael Leutner ◽  
Nils Haug ◽  
Luise Bellach ◽  
Elma Dervic ◽  
Alexander Kautzky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Diabetic Patients ◽  
Complication Risk ◽  
Increased Risk ◽  
Icd 10 ◽  
Healthy Control ◽  
Design And Methods ◽  
The Relationship ◽  
Observation Period

Objectives: Diabetic patients are often diagnosed with several comorbidities. The aim of the present study was to investigate the relationship between different combinations of risk factors and complications in diabetic patients. Research design and methods: We used a longitudinal, population-wide dataset of patients with hospital diagnoses and identified all patients (n = 195,575) receiving a diagnosis of diabetes in the observation period from 2003–2014. We defined nine ICD-10-codes as risk factors and 16 ICD-10 codes as complications. Using a computational algorithm, cohort patients were assigned to clusters based on the risk factors they were diagnosed with. The clusters were defined so that the patients assigned to them developed similar complications. Complication risk was quantified in terms of relative risk (RR) compared with healthy control patients. Results: We identified five clusters associated with an increased risk of complications. A combined diagnosis of arterial hypertension (aHTN) and dyslipidemia was shared by all clusters and expressed a baseline of increased risk. Additional diagnosis of (1) smoking, (2) depression, (3) liver disease, or (4) obesity made up the other four clusters and further increased the risk of complications. Cluster 9 (aHTN, dyslipidemia and depression) represented diabetic patients at high risk of angina pectoris “AP” (RR: 7.35, CI: 6.74–8.01), kidney disease (RR: 3.18, CI: 3.04–3.32), polyneuropathy (RR: 4.80, CI: 4.23–5.45), and stroke (RR: 4.32, CI: 3.95–4.71), whereas cluster 10 (aHTN, dyslipidemia and smoking) identified patients with the highest risk of AP (RR: 10.10, CI: 9.28–10.98), atherosclerosis (RR: 4.07, CI: 3.84–4.31), and loss of extremities (RR: 4.21, CI: 1.5–11.84) compared to the controls. Conclusions: A comorbidity of aHTN and dyslipidemia was shown to be associated with diabetic complications across all risk-clusters. This effect was amplified by a combination with either depression, smoking, obesity, or non-specific liver disease.

Association between digoxin use and sudden cardiac death in individuals with the rs10494366 variant of the NOS1AP gene

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Soroush ◽  
A Aarnoudse ◽  
F Shokri ◽  
M Van Den Berg ◽  
F Ahmadizar ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Smoking Status ◽  
Adaptor Protein ◽  
Therapeutic Window ◽  
P Value ◽  
Qtc Interval ◽  
Total Study Population ◽  
Increased Risk

Abstract Background Digoxin is one of the oldest cardiovascular medications still used to treat heart failure and atrial fibrillation. Due to its narrow therapeutic window, it is associated with life threatening intoxication and arrhythmias, and with QTc-shortening. Common genetic variation in the nitric oxide synthase-1 adaptor protein (NOS1AP) has been associated with QTc interval prolongation. Purpose We investigated whether the rs10494366 variant of the NOS1AP gene modified the risk of SCD in patients using digoxin. Methods In a prospective population-based cohort study, we included data of the three cohorts, started as of January 1st, 1991 until January 1st 2014. Digoxin current use on the date of cardiac death in cases and the same day of follow-up in the remainder of the cohort was a time-dependent exposure. The main outcome was SCD defined as sudden and unexpected death as a result of cardiac causes, according to international criteria. Identification and adjudication of SCD was performed independently, before the start of this study. We used Cox proportional hazard regression analysis to investigate the associations between NOS1AP rs10494366 variant and incident SCD among digoxin users compared to non-users. Associations were adjusted for age, sex (model 1) in addition to BMI, prevalent diabetes, myocardial infarction, baseline hypertension and smoking status (past, current, never) (model 2). Results We included 14,594 individuals, with a mean age of 65.3 (SD 10.3) years. Almost 59% were female. The cumulative incidence of SCD was 9.5% (609 cases) by the end of follow up. Among them, 98 (16%) individuals were exposed to digoxin at the time of death. In model 1, NOS1AP rs10494366 variant was not associated with SCD in the total study population. However, an interaction term of the gene with the daily dose of digoxin was significantly associated with increased risk of SCD (p-value 0.0001). In model 2, the risk of SCD in current users of digoxin was 4.2 [95% CI 1.3–13.8] for the GG genotype; 2.1 [95% CI 1.1–4.2] for the GT genotype, and 1.5 [95% CI 0.7–3.2] for the TT genotype. Conclusion NOS1AP rs10494366 variant modified the risk of sudden cardiac death in users of digoxin. Our study suggests that individuals with the homozygous minor GG allele have a fourfold increased risk of sudden cardiac death. Funding Acknowledgement Type of funding source: None

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