scholarly journals Increased risk of developing peripheral artery disease in hemodialysis patients receiving statin treatments: a population-based cohort study in Taiwan

2019 ◽  
Vol 35 (10) ◽  
pp. 1753-1760 ◽  
Author(s):  
Yueh-Han Hsu ◽  
Fung-Chang Sung ◽  
Chih-Hsin Muo ◽  
Shao-Yuan Chuang ◽  
Chun-Ming Chen ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Arterial Disease ◽  
Statin Treatment ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Moderate Intensity ◽  
Increased Risk ◽  
Artery Disease ◽  
Peripheral Arterial

Abstract Background Few investigations have evaluated the influences on peripheral arterial disease (PAD) risk of statin treatment in hemodialysis (HD) subjects with hyperlipidemia (HL). Methods From the National Health Insurance Research Dataset, we identified 3658 HD patients with statin therapy for HL as the statin cohort, and then selected, by 1:1 propensity score matching, 3658 HD patients with HL but without statin use as the nonstatin cohort in 2000–07. The cohorts were followed through until the end of 2011. We used Cox proportional hazards regression analysis to assess the hazard ratio (HR) of PAD development. Results The average follow-up period was 4.18 years; the incident PAD risk was 1.35-fold greater in statin users than in nonusers (16.87 versus 12.46/1000 person-years), with an adjusted HR (aHR) of 1.34 for PAD [95% confidence interval (CI) 1.12–1.62]. The PAD risk increases were significant for patients receiving fluvastatin (aHR 1.88; 95% CI 1.12–3.14) and atorvastatin (aHR 1.60; 95% CI 1.24–2.08). The risk increased with higher annual average statin dosage (P for trend <0.0001); the risk was higher for those receiving moderate-intensity statin treatment. The sensitivity test revealed similar findings. Conclusions HD patients with HL on statin medication were at increased PAD risk, which increased with cumulative statin dosage. Thorough considerations are needed before prescribing statins to HD patients.

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 Visual impairment and risk of dementia in two population-based prospective cohorts: UK Biobank and EPIC-Norfolk

2021 ◽  
Author(s):  
Thomas J Littlejohns ◽  
Shabina Hayat ◽  
Robert Luben ◽  
Carol Brayne ◽  
Megan Conroy ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Uk Biobank ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
Promising Target ◽  
Increased Risk

Abstract Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there are a lack of large studies with objective measures of vison and with more than ten years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and EPIC-Norfolk. In both cohorts, visual acuity was measured using a “logarithm of the minimum angle of resolution” (LogMAR) chart and categorised as no (≤0.30 LogMAR), mild (&gt;0.3 - ≤0.50 LogMAR), and moderate to severe (&gt;0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62,206 UK Biobank and 7,337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk. respectively, 1,113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% Confidence Interval [CI] 0.92-1.72) and 2.16 (95% CI 1.37-3.40), in UK Biobank, and 1.05 (95% CI 0.72-1.53) and 1.93 (95% CI 1.05-3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but were not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention, however the possibility of reverse causation cannot be excluded.

Cerebrovascular disease after placental abruption

Neurology ◽  
2019 ◽  
Vol 93 (12) ◽  
pp. e1148-e1158
Author(s):  
Cande V. Ananth ◽  
Anne Vinkel Hansen ◽  
Mitchell S.V. Elkind ◽  
Michelle A. Williams ◽  
Janet W. Rich-Edwards ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Birth Registry ◽  
Cerebrovascular Complications ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
National Patient

ObjectiveTo test whether abruption during pregnancy is associated with long-term cerebrovascular disease by assessing the incidence and mortality from stroke among women with abruption.MethodsWe designed a population-based prospective cohort study of women who delivered in Denmark from 1978 to 2010. We used data from the National Patient Registry, Causes of Death Registry, and Danish Birth Registry to identify women with abruption, cerebrovascular events, and deaths. The outcomes included deaths resulting from stroke and nonfatal ischemic and hemorrhagic strokes. We fit Cox proportional hazards regression models for stroke outcomes, adjusting for the delivery year, parity, education, and smoking.ResultsThe median (interquartile range) follow-up in the nonabruption and abruption groups was 15.9 (7.8–23.8) and 16.2 (9.6–23.1) years, respectively, among 828,289 women with 13,231,559 person-years of follow-up. Cerebrovascular mortality rates were 0.8 and 0.5 per 10,000 person-years among women with and without abruption, respectively (hazard ratio [HR] 1.6, 95% confidence interval [CI] 0.9–3.0). Abruption was associated with increased rates of nonfatal ischemic stroke (HR 1.4, 95% CI 1.1–1.7) and hemorrhagic stroke (HR 1.4, 95% CI 1.1–1.9). The association of abruption and stroke was increased with delivery at <34 weeks, when accompanied by ischemic placental disease, and among women with ≥2 abruptions. These associations are less likely to have been affected by unmeasured confounding.ConclusionAbruption is associated with increased risk of cerebrovascular morbidity and mortality. Disruption of the hemostatic system manifesting as ischemia and hemorrhage may indicate shared etiologies between abruption and cerebrovascular complications.

Abstract MP24: Urinary Potassium Excretion and Risk of Developing Hypertension

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Lyanne M Kieneker ◽  
Ron T Gansevoort ◽  
Edith J Feskens ◽  
Johanna M Geleijnse ◽  
Gerjan Navis ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Smoking Status ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Potassium Excretion ◽  
Parental History ◽  
Increased Risk ◽  
Urinary Potassium ◽  
End Stage

Background: Potassium supplementation lowers blood pressure (BP) in randomized controlled trials, but the long-term effect of dietary potassium intake on risk of hypertension has not yet been established. Objective: To examine the association of 24h urinary excretions of potassium, reflecting dietary uptake, with risk of hypertension. Methods: We used data from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, community-based, observational cohort of Dutch men and women aged 28-75 years. Potassium excretion was measured at baseline (1997-98) and during follow-up (2001-03) in two consecutive 24h urine specimens. Risk of hypertension (defined as BP ≥140/90 mmHg, or initiation of BP-lowering drugs) was studied in 5,511 normotensive subjects not using BP-lowering drugs at baseline. We used Cox proportional hazards regression analysis with time-dependent covariates. Results: Baseline median potassium excretion was 72 mmol/24h (Q1-Q3: 57-85 mmol/24h). During a median follow-up of 7.6 years (Q1-Q3: 5.0-9.3 years), 1172 subjects developed hypertension. We observed a nonlinear association between potassium excretion and risk of hypertension (P=0.005; Figure ). This association was in such a way that the lowest sex-specific tertile of potassium excretion (men: <68 mmol/24h; women: <58 mmol/24h) had an increased risk of hypertension (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.08-1.37) after adjustment for age and sex, compared to the upper two tertiles. Further adjustment for body mass index, smoking status, alcohol intake, parental history of hypertension (HR, 1.25; 95% CI, 1.11-1.41), and additionally for 24h urinary excretions of sodium, magnesium, and calcium (HR, 1.23; 95% CI, 1.08-1.40) did not materially affect the association. Conclusions: In this population-based cohort, low potassium excretion was associated with an increased risk of developing hypertension. Figure: Association between 24h urinary potassium excretion and risk of hypertension.

Increased risk of stroke after trigeminal neuralgia – a population-based follow-up study

Cephalalgia ◽  
2011 ◽  
Vol 31 (8) ◽  
pp. 937-942 ◽  
Author(s):  
Shin-Liang Pan ◽  
Li-Sheng Chen ◽  
Ming-Fang Yen ◽  
Yueh-Hsia Chiu ◽  
Hsiu-Hsi Chen
Keyword(s):  
Trigeminal Neuralgia ◽  
Proportional Hazards ◽  
Underlying Mechanism ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Follow Up Study ◽  
Medical Disorders ◽  
Increased Risk

Background: There are no reports on the risk of stroke after trigeminal neuralgia (TN). The aim of this population-based follow-up study was to investigate whether the occurrence of TN is associated with a higher risk of developing stroke. Methods: A total of 1453 people with at least three ambulatory visits in 2001 with the principal diagnosis of TN were enrolled in the TN cohort. The non-TN cohort consisted of 5812 age- and sex-matched, randomly sampled subjects without TN. The 2-year stroke-free survival rate between the two groups was compared using the Kaplan-Meier method. The Cox proportional hazards regression model was used to estimate the hazard ratio of stroke after adjustment for demographic and clinical covariates. Results: In the TN cohort, 73 patients developed stroke during follow-up, while in the non-TN cohort, 157 subjects suffered a stroke. The crude hazard ratio of stroke for the subjects with TN was 1.86 (95% CI, 1.41–2.45; p < 0.0001). The adjusted hazard ratio was 1.76 (95% CI, 1.33–2.33; p < 0.0001) after adjusting for demographic characteristics and comorbid medical disorders. Conclusion: This study showed a significantly increased risk of developing stroke after TN. Further studies are needed to investigate the underlying mechanism of this association.

scholarly journals Association of Circulating Hepatocyte Growth Factor and Risk of Incident Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis

Angiology ◽  
2020 ◽  
Vol 71 (6) ◽  
pp. 544-551
Author(s):  
Parveen K. Garg ◽  
Petra Buzkova ◽  
Christina L. Wassell ◽  
Matthew Allison ◽  
Michael Criqui ◽  
...  
Keyword(s):  
Growth Factor ◽  
Hepatocyte Growth Factor ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Ethnic Study ◽  
Increased Risk ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Hepatocyte Growth

Higher levels of hepatocyte growth factor (HGF) have been associated with the presence of peripheral arterial disease (PAD), but prospective associations are unknown. We examined the association of circulating HGF levels with incident PAD. Between 2000 and 2002, HGF was measured in 6742 Multi-Ethnic Study of Atherosclerosis participants without PAD. Incident clinical PAD, adjudicated on the basis of a positive history for the presence of disease-related symptoms or treatment, was ascertained through 2015. Incident low ankle-brachial index (ABI), defined as an ABI < 0.9 and a decline of ≥ 0.15, was assessed among 5736 individuals who had an ABI > 0.9 at baseline and ≥1 follow-up ABI measurement 3 to 10 years later. There were 116 clinical PAD and 197 low ABI events that occurred over a median follow-up of 14 and 9 years, respectively. After adjustment for demographic and clinical variables, a standard deviation increment of HGF (303 ng/L) was associated with an increased risk of clinical PAD (hazard ratio: 1.21; 95% confidence interval [CI]: 1.05-1.39) but not a low ABI (rate ratio: 1.03; 95% CI: 0.85-1.25). In conclusion, higher HGF levels were modestly associated with an increased risk of developing clinical PAD.

scholarly journals Vasoactive Biomarkers Associated With Long-Term Incidence of Symptomatic Peripheral Arterial Disease and Mortality

Angiology ◽  
2021 ◽  
pp. 000331972098773
Author(s):  
Ardwan Dakhel ◽  
Gunnar Engström ◽  
Olle Melander ◽  
Stefan Acosta ◽  
Shahab Fatemi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peripheral Arterial Disease ◽  
Proportional Hazards ◽  
Arterial Disease ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Peripheral Arterial

We evaluated if plasma biomarkers can predict incident peripheral arterial disease (PAD) and mortality in a longitudinal cohort study. Men (n = 3618) and women (n = 1542) were included in the Malmö Preventive Project and underwent analysis of: C-terminal endothelin-1 (CT-proET-1), N-Terminal prosomatostatin (NT-proSST), midregional proatrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and copeptin. Participants were followed up for incident PAD and mortality until December 31, 2016. Median follow-up was 11.2 years (interquartile range 9.4-12.2). Cumulative incidence of PAD was 4.3% (221/5160), 4.5% in men (164/3618) and 3.7% in women (57/1542; P = .174). In an adjusted Cox proportional hazards regression model, higher CT-proET-1 (hazard ratio [HR] 1.8; 95% confidence interval [CI] 1.4-2.3), NT-proSST (HR 1.5; 95% CI 1.2-2.0), and MR-proANP (HR 1.7; 95% CI 1.3-2.3) were independently associated with incident PAD, and higher CT-proET-1 (HR 1.3; 95% CI 1.2-1.5), NT-proSST (HR 1.2; 95% CI 1.1-1.3), MR-proANP (HR 1.4; 95% CI 1.3-1.6), PCT (HR 1.1; 95% CI 1.0-1.2), and copeptin (HR 1.2; 95% CI 1.1-1.4) were independently associated with mortality. Increased levels of CT-proET-1, NT-proSST, and MR-proANP were independently associated with incident PAD, whereas all the vasoactive biomarkers were independently associated with mortality during follow-up.

D-dimer as a marker for cardiovascular and arterial thrombotic events in patients with peripheral arterial disease

2013 ◽  
Vol 110 (08) ◽  
pp. 233-243 ◽  
Author(s):  
Hugo Cate ◽  
Arina ten Cate-Hoek ◽  
Marie-Claire Kleinegris
Keyword(s):  
Cardiovascular Events ◽  
Meta Analysis ◽  
Arterial Disease ◽  
Specific Information ◽  
Increased Risk ◽  
Near Term ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
D Dimer

SummaryPeripheral artery disease (PAD) is associated with an increased risk for cardiovascular events. D-dimers are a marker for hypercoagulability and are linked with thrombotic events in patients with venous as well as arterial thrombosis. The predictive value of plasma D-dimer levels in relation to cardiovascular events in patients with PAD is not unambiguously established. It was our objective to gather evidence evaluating the value of D-dimer as a predictor of arterial thrombotic events patients with PAD. The Pubmed, Embase, and Cochrane databases were searched (January 1980-November 2012), and 65 abstracts were found. The strategy was supplemented with manual review of reference lists. Case-control, cohort or prospective cohort studies that measured fibrin D-dimer in patients with PAD, were included. Studies were excluded if there was no follow-up for arterial thrombotic events or when no specific information on D-dimer was available. The search yielded 10 studies for our analysis, comprising 2,420 patients with PAD, with a total of 1,036 cardiovascular events in 10,599 patient-years. Two studies with a follow-up of one year showed that fibrin D-dimer predicts both deterioration of PAD and subsequent thrombotic events. Five out of six studies with a median follow-up of 2–4 years revealed that an increased D-dimer is predictive of various arterial thrombotic events including mortality. Two studies with a longer follow-up (over 6 years) did not show an independent association between increased D-dimer levels, arterial thrombotic events and CVD mortality. In conclusion, an increased D-dimer appeared to be independently associated with a two times increased risk of near-term cardiovascular events (relative risk 2.30, 95% confidence interval 1.43–3.68). However formal meta-analysis was only feasible for four out of 10 included studies. Due to the extended heterogeneity of the included studies cautious interpretation of these data is warranted.

Abstract 17580: Angina Pectoris in Diabetic Patients: Insights From the Duke Databank for Cardiovascular Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Robert J Mentz ◽  
Adam Z Banks ◽  
Samuel Broderick ◽  
Adam D DeVore ◽  
Karen Chiswell ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Proportional Hazards ◽  
Medical Center ◽  
Cox Proportional Hazards ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Duke University ◽  
Artery Disease

Background: Angina pectoris (AP) has different prognostic implications in various populations. Patients with diabetes mellitus (DM) may experience neuropathy such that AP may not be perceived in the setting of coronary artery disease (CAD). The association between the presence or absence of AP in DM patients with CAD is unknown. Methods: We analyzed DM patients with obstructive CAD who underwent coronary angiography at Duke University Medical Center from 2002 to 2011 and compared patients without AP to those with AP. DM and AP were defined based on physician-obtained past medical history at catheterization. Patients were categorized as no AP, atypical AP or typical AP within the 6 weeks prior. We assessed the association with subsequent cardiovascular (CV) death/CV hospitalization and all-cause mortality in patients with no or atypical AP relative to typical AP using multivariable Cox proportional hazards analysis. Results: In the Duke Databank, 5550 patients met criteria for inclusion and 1732 (31%) had no AP, 1075 (19%) had atypical AP and 2743 (50%) had typical AP. Those without AP more often had a prior MI and lower ejection fraction, but had similar HbA1c values compared to those with atypical AP or typical AP. Over a median follow-up of 5.4 years (IQR: 2.9-8.8), the lack of recent AP was associated with increased risk for outcomes (Table). Following adjustment, the lack of recent AP was independently associated with increased mortality compared to typical AP. Conclusions: In DM patients with CAD, the lack of AP was associated with increased mortality, but similar risk for CV events compared to patients with typical AP. Future studies are needed to assess whether these findings are related to increased severity of disease in those without AP or whether AP leads to differential management that improves survival.

scholarly journals Non-Adherence to Statin Treatment in Older Patients with Peripheral Arterial Disease Depending on Persistence Status

Biomedicines ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. 378
Author(s):  
Martin Wawruch ◽  
Gejza Wimmer ◽  
Jan Murin ◽  
Martina Paduchova ◽  
Miriam Petrova ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Binary Logistic Regression ◽  
Arterial Disease ◽  
Statin Treatment ◽  
Adherence To Treatment ◽  
Factors Associated ◽  
Increased Risk ◽  
Proportion Of Days Covered ◽  
Peripheral Arterial

The effectiveness of statins in secondary prevention of peripheral arterial disease (PAD) largely depends on patients’ adherence to treatment. The aims of our study were: (a) to analyze non-adherence during the whole follow-up in persistent patients, and only during persistence for non-persistent patients; (b) to identify factors associated with non-adherence separately among persistent and non-persistent patients. A cohort of 8330 statin users aged ≥65 years, in whom PAD was newly diagnosed between January 2012–December 2012, included 5353 patients persistent with statin treatment, and 2977 subjects who became non-persistent during the 5-year follow-up. Non-adherence was defined using the proportion of days covered <80%. Patient- and statin-related characteristics associated with non-adherence were identified with binary logistic regression. A significantly higher proportion of non-adherent patients was found among non-persistent patients compared to persistent subjects (43.6% vs. 29.6%; p < 0.001). Associated with non-adherence in both persistent and non-persistent patients was high intensity statin treatment, while in non-persistent patients, it was employment and increasing number of medications. In patients with a poor adherence during their persistent period, an increased risk for discontinuation may be expected. However, there is also non-adherence among persistent patients. There are differences in factors associated with non-adherence depending on patients’ persistence.

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