465 Evaluating the Impact of Sleep Disordered Breathing on Adverse Cardiovascular Outcomes After Bariatric Surgery

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A183-A184
Author(s):  
Catherine Heinzinger ◽  
Pornprapa Chindamporn ◽  
James Bena ◽  
Lu Wang ◽  
Alex Milinovich ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Sleep Disordered Breathing ◽  
Proportional Hazards ◽  
Reference Group ◽  
Cleveland Clinic ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Post Bariatric Surgery

Abstract Introduction Sleep disordered breathing (SDB), including obstructive sleep apnea (OSA) and obesity-associated sleep hypoventilation (OASH), has well-characterized adverse effects on the cardiovascular system and increases morbidity and mortality. Long-term impact on cardiovascular outcomes post-bariatric surgery, however, remains unclear. We hypothesize that patients with SDB have increased frequency of major adverse cardiovascular events (MACE) post-bariatric surgery than those without. Methods Patients undergoing polysomnography (PSG) prior to bariatric surgery at The Cleveland Clinic from 2011–2018 were retrospectively examined and followed up from date of last surgery to 2019, including the perioperative period. Primary predictors include moderate-severe OSA, i.e. apnea hypopnea index(AHI)>15, and OASH, i.e. body mass index (BMI)≥30kg/m2 and either end-tidal CO2≥45mmHg or serum bicarbonate≥27mEq/L. MACE (coronary artery events, cerebrovascular events, heart failure or atrial fibrillation)-free probability was compared using hazard ratios estimated from Cox proportional hazards models on four groups: OASH with moderate-severe OSA (N=492), OASH-only (N=442), moderate-severe OSA-only (N=203), and a reference group without OASH or moderate-severe OSA (N=243). Multivariable Cox proportional hazards models adjusting for age, sex, BMI were fit on MACE survival. Analysis was performed based on an overall significance level of 0.05, using SAS software (version 9.4, Cary, NC). Results The sample comprised 1380 patients: age: 43.5±12 years, BMI: 49±9 kg/m2, 17.7% male, 63.7% White. Risk of MACE across the groups bordered significance (p=0.051). Compared to the reference group, the OASH with moderate-severe OSA group had higher risk of MACE (HR2.53, 95%CI:1.07–6.00,p=0.035). Patients with moderate-severe OSA had higher risk of MACE than those with AHI<15 (HR1.94, 95%CI:1.20–3.13,p=0.007). Patients with severe OSA had higher risk of MACE than those AHI<30 (HR2.01, 95%CI:1.28–3.14,p=0.002). For every 5-unit AHI increase, risk of MACE increased by 6% (HR1.056, 95%CI:1.029–1.084,p<0.001) with slight reduction in point estimates in adjusted models. Conclusion Preliminary data from this largest-to-date sample of systematically phenotyped patients with SDB undergoing bariatric surgery show significant differences in risk of MACE and MACE-free survival mitigated after consideration of obesity. Further investigation to elucidate effect modification by obesity and metabolic factors is needed. Support (if any) Cleveland Clinic Transformative Resource Neuroscience Award

scholarly journals Minimum Threshold of Bariatric Surgical Weight Loss for Initial Diabetes Remission

2021 ◽  
Author(s):  
Douglas Barthold ◽  
Elizabeth Brouwer ◽  
Lee J. Barton ◽  
David E. Arterburn ◽  
Anirban Basu ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Proportional Hazards ◽  
Reference Group ◽  
Diabetes Remission ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Design And Methods ◽  
Time Varying Covariates

<b>Objective:</b> There are few studies testing the amount of weight loss necessary to achieve initial remission of type 2 diabetes (T2DM) following bariatric surgery and no published studies using weight loss to predict initial T2DM remission in sleeve gastrectomy (SG) patients. <p><b>Research Design and Methods:</b> Cox proportional hazards models examined the relationship between initial T2DM remission and percent total weight loss (%TWL) after bariatric surgery. Categories of %TWL were included in the model as time-varying covariates. </p> <p><b>Results:</b> Patients (N=5,928) were 73% female, 49.8<u>+</u>10.3 years old, had BMI of 43.8<u>+</u>6.92 kg/m<sup>2</sup>, and 57% had Roux-en-Y gastric bypass (RYGB). Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of their T2DM (mean time to remission 1.0 year). Using 0-5% TWL as the reference group in Cox proportional hazards models, patients were more likely to remit with each 5% increase in TWL until 20% TWL (range from HR=1.97 to 2.92). When categories above >25% TWL were examined, all had a likelihood of initial remission similar to 20-25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0-5% TWL, even if they were using insulin at the time of surgery.</p> <p><b>Conclusions: </b>Weight loss after bariatric surgery is strongly associated with initial T2DM remission; however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. Achieving this threshold is also associated with initial remission even in patients who traditionally experience lower rates of remission, such as patients taking insulin.</p>

scholarly journals Minimum Threshold of Bariatric Surgical Weight Loss for Initial Diabetes Remission

2021 ◽  
Author(s):  
Douglas Barthold ◽  
Elizabeth Brouwer ◽  
Lee J. Barton ◽  
David E. Arterburn ◽  
Anirban Basu ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Proportional Hazards ◽  
Reference Group ◽  
Diabetes Remission ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Design And Methods ◽  
Time Varying Covariates

<b>Objective:</b> There are few studies testing the amount of weight loss necessary to achieve initial remission of type 2 diabetes (T2DM) following bariatric surgery and no published studies using weight loss to predict initial T2DM remission in sleeve gastrectomy (SG) patients. <p><b>Research Design and Methods:</b> Cox proportional hazards models examined the relationship between initial T2DM remission and percent total weight loss (%TWL) after bariatric surgery. Categories of %TWL were included in the model as time-varying covariates. </p> <p><b>Results:</b> Patients (N=5,928) were 73% female, 49.8<u>+</u>10.3 years old, had BMI of 43.8<u>+</u>6.92 kg/m<sup>2</sup>, and 57% had Roux-en-Y gastric bypass (RYGB). Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of their T2DM (mean time to remission 1.0 year). Using 0-5% TWL as the reference group in Cox proportional hazards models, patients were more likely to remit with each 5% increase in TWL until 20% TWL (range from HR=1.97 to 2.92). When categories above >25% TWL were examined, all had a likelihood of initial remission similar to 20-25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0-5% TWL, even if they were using insulin at the time of surgery.</p> <p><b>Conclusions: </b>Weight loss after bariatric surgery is strongly associated with initial T2DM remission; however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. Achieving this threshold is also associated with initial remission even in patients who traditionally experience lower rates of remission, such as patients taking insulin.</p>

Abstract T MP48: Androgen Suppression in Patients with Prostate Cancer Increases Incidence of Combined Cardiovascular Outcomes

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Zuber S Ali ◽  
Danielle M Greere ◽  
Robyn L Shearer ◽  
Syed Ali Gardezi ◽  
Arshad Jahangir
Keyword(s):  
Prostate Cancer ◽  
Proportional Hazards ◽  
Age Groups ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Elevated Risk ◽  
Disease Stage ◽  
Cox Proportional Hazards Models ◽  
Androgen Suppression

Introduction: Androgen suppression therapy for prostate cancer is controversial due to adverse fatal and non-fatal cardiovascular outcomes reported in some studies. However, effects of androgen suppression on stroke have not been fully assessed in the elderly. Methods: Patients diagnosed with prostate cancer during 2007-2013 in a large community-based healthcare system were identified from the Cancer Registry, electronic records, and billing codes. Those who underwent androgen suppression therapy with Gonadotropin-releasing hormone agonist (GnRH) were propensity-matched to patients treated without androgen suppression therapy by age at cancer diagnosis, race/ethnicity, disease stage and outcome, body mass index and use of surgery, radiation, and chemotherapy. Tests of independence and Cox proportional hazards models were used to examine effects of hormone therapy on acute myocardial infarction (AMI), stroke, and mortality outcomes. Models also adjusted for patient comorbidities. Results: A total of 1282 patients and 641 matched-pairs were identified, with mean diagnosis age of 69 yr and follow-up period of 3.05 yr. Effects of androgen suppression therapy on AMI (P=0.051) and stroke (P=0.062) were of marginal to non-significance, but adjusted-odds of death and combined AMI, stroke, and death were 1.61 times (P=0.002; odds ratio [OR] 95% CI: 1.19-2.18) and 1.70 times (P<0.001; OR 95% CI: 1.26-2.28) greater, respectively, for men with than without androgen suppression. An interaction of androgen suppression and age-group (<65 yr, 65-74 yr, >74 yr) was discovered for combined outcomes, suggesting increased probability of AMI, stroke, and/or death with age (8.6-20.0%; P=0.003) for patients without androgen suppression but elevated risk of outcomes across all age groups (18.3-22.4%; P=0.546) for men treated with androgen suppression therapy. Conclusion: Endogenous androgen suppression presents elevated risk of combined cardiovascular and death outcomes, especially for men <65 yr.

Death in Rural Georgia: A Historical Comparison of Georgians and Ossets in the Kistauri Commune

2020 ◽  
Vol 45 (4) ◽  
pp. 457-478
Author(s):  
Tinatin Zurabishvili ◽  
Rennie Lee ◽  
Rebecca Jean Emigh
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Republic Of Georgia ◽  
Age At Death ◽  
Proportional Hazards Models ◽  
Independent Variables ◽  
Historical Comparison ◽  
Factors Influencing ◽  
Cox Proportional Hazards Models ◽  
Residency Status

This article examines the factors influencing age at death in the multiethnic villages, comprised mostly of Georgians and Ossets, in the Kistauri commune in the eastern Republic of Georgia between 1897 and 1997. The data are analyzed with Cox proportional hazards models using age at death as the dependent variable, and ethnicity, gender, marital status, residency status, and year of birth as the independent variables. The results show that Georgians lived longer than Ossets. Individuals who had ever been married lived longer than those who had not. The results perhaps reflect harsher living conditions for Ossets, the ethnic minority, despite Soviet ideologies about equality.

scholarly journals The prognostic role of plasma fibrinogen in adult secondary hemophagocytic lymphohistiocytosis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Guangli Yin ◽  
Changfeng Man ◽  
Jiayu Huang ◽  
Shengen Liao ◽  
Xin Gao ◽  
...  
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Inflection Point ◽  
Proportional Hazards ◽  
Cubic Spline ◽  
Cox Proportional Hazards ◽  
Plasma Fibrinogen ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Cubic Spline Curve ◽  
Secondary Hemophagocytic Lymphohistiocytosis

Abstract Background In adult patients with secondary hemophagocytic lymphohistiocytosis (sHLH), no valid immune biomarker has been available for predicting the prognosis of untreated sHLH patients. Methods Circulating plasma levels of fibrinogen (FIB) were measured at diagnosis in 293 cases of adult sHLH. We categorized FIB levels into tertiles. Multivariable Cox proportional hazards models were used to evaluate the relationship between FIB and survival. Restricted cubic spline models and two-piecewise Cox proportional hazards models were used to address the nonlinear association between FIB and mortality. Results During a median follow-up of 52 (interquartile ranges, 18–221) days, 208 deaths occurred, with 137 deaths in malignancy-associated hemophagocytic lymphohistiocytosis (MHLH) and 71 deaths in non-malignancy-associated hemophagocytic lymphohistiocytosis (non-MHLH). After multivariable adjustment, compared with the highest tertile of FIB, the hazard ratios (HRs) with 95% confidence intervals (CIs) of survival for tertile 2 and tertile 1 were 1.06 (0.90–1.24) and 0.84 (0.71–0.98), respectively. The restricted cubic spline curve displayed a nonlinear and inverse relationship between FIB and mortality. Furthermore, the threshold effect analysis demonstrated that the inflection point for the curve was at an FIB level of 1.76 g/L. The HRs (95% CIs) for survival were 0.68 (0.55–0.83) and 1.08 (0.96–1.21) on the left and right side of the inflection point, respectively. Conclusions These results suggest that plasma fibrinogen is nonlinearly and inversely associated with the risk of mortality in adult secondary hemophagocytic lymphohistiocytosis.

scholarly journals Risk of depressive disorders after tobacco smoking cessation: a retrospective cohort study in Fukuoka, Japan

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025124 ◽  
Author(s):  
Takako Fujita ◽  
Akira Babazono ◽  
Yumi Harano ◽  
Peng Jiang
Keyword(s):  
Smoking Cessation ◽  
Cohort Study ◽  
Survival Analysis ◽  
Retrospective Cohort ◽  
Depressive Disorders ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Significant Difference

ObjectiveWe sought to examine the effect of smoking cessation on subsequent development of depressive disorders.DesignThis was a retrospective cohort study.MethodsWe used administrative claim and health check data from fiscal years 2010 to 2014, obtained from the largest health insurance association in Fukuoka, Japan. Study participants were between 30 and 69 years old. The end-point outcome was incidence of depressive disorders. Survival analysis and Cox proportional hazards models were conducted. The evaluated potential confounders were sex, age, standard monthly income and psychiatric medical history.ResultsThe final number of participants was 87 255, with 7841 in the smoking cessation group and 79 414 in the smoking group. The result of survival analysis showed no significant difference in depressive disorders between the two groups. The results of Cox proportional hazards models showed no significant difference by multivariate analysis between participants, including users of smoking cessation medication (HR 1.04, 95% Cl 0.89 to 1.22) and excluding medication use (HR 0.97, 95% Cl 0.82 to 1.15).ConclusionsThe present study showed that there were no significant differences with respect to having depressive disorders between smoking cessation and smoking groups. We also showed that smoking cessation was not related to incidence of depressive disorders among participants, including and excluding users of smoking cessation medication, after adjusting for potential confounders. Although the results have some limitations because of the nature of the study design, our findings will provide helpful information to smokers, health professionals and policy makers for improving smoking cessation.

MiR-340 Expression As a Prognostic Marker to Guide Clinical Decision-Making in Acute Myeloid Leukemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2728-2728
Author(s):  
Tingting Shao ◽  
Yuan Feng ◽  
Ninghan Zhang ◽  
Rong Wang ◽  
Ting Pan ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hematopoietic Stem ◽  
Proportional Hazards Models ◽  
Chemotherapy Group ◽  
Cox Proportional Hazards Models ◽  
Hoxa Genes ◽  
Acute Myeloid

Background: Acute myeloid leukemia (AML) is an aggressive hematological disease. Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) and chemotherapy are major treatment regimens for AML. However, prognostic markers cannot guide the decision for a specific treatment, as they are related with a various prognosis regardless of the given treatment. HOXA (homeobox A) genes cluster could promote tumor survival, proliferation, invasion, and increase the resistance of AML. The aim of this study was to screen potential miRNAs (microRNAs) that would target HOXA genes, and evaluate the utility of miRNAs in AML, help patients choose a better treatment between chemotherapy and allo-HCST. Methods: Clinical data and RNA-Seq expression data of selected cases were provided by The Cancer Genome Atlas (TCGA). Genome-wide screening was performed to identify miRNA in a heterogeneous AML population. Univariable Cox proportional hazards models and Multivariable Cox proportional hazards models were employed to identify whether OS and EFS would be affected by other variables. Results: In this study, totally 162 AML patients were recruited. All patients were firstly divided into the chemotherapy and allo-HSCT groups. Subsequently, according to median values of miR-340, patients were divided into miR-340high and miR-340low expressers, respectively. In chemotherapy group, no difference was found in clinical characteristics, such as the median age, FAB subtypes, karyotypes and genes mutation between miR-340high and miR-340low expressers. However, miR-340low expressers often accompanied with high first relapse rate or death rate in one year than high expressers (P=0.012; 82.2% vs 55.6%). To identify the independent prognostic role of miR-340 in chemotherapy group patients, Univariable and Multivariable Cox proportional hazards models were performed. We found that miR-340lowpatients showed shorter OS (P=0.0005; 5-year OS, 35.6% vs. 5.4%) and EFS (P=0.0005) compared with high expressers. In multivariable analysis, miR-340low patients showed reduced OS (P=0.004; HR: 2.07) and EFS (P=0.01; HR: 1.909) after adjusting other co-variates, such as age, WBC count and several genes mutation in chemotherapy group. Therefore, low miR-340 amounts could be an independent adverse bio-marker in AML patients undergoing chemotherapy. However, in the allo-HSCT group, miR-340 expression level was not associated with outcome in AML patients. To further explore the potential of allo-HSCT in overcoming the adverse characteristics of low miR-340 amounts, the whole 162 patients were regrouped into miR-340low and miR-340high groups. Then patients were divided into chemotherapy and allo-HSCT subgroups. Subgroup analysis revealed that miR-340low patients had significantly longer OS (P<0.0001; HR: 0.316; 95%CI: 0.167-0.459) and EFS (P=0.002; HR: 0.391; 95%CI: 0.231-0.622) in allo-HSCT subgroup than in chemotherapy subgroup (Figure 1). However, in cases highly expressing miR-340, no difference in survival events was detected between the two treatment subgroups. These findings indicated, allo-HSCT may overcome the adverse prognostic effects of low mir-340 expression. Therefore, for low miR-340 cases, early allo-HSCT may be a better option. To explore underlying biological functions of miR-340, we examined gene expression signatures related to the miR-340 expression in AML patients. We observed 135 genes expression levels that associated with miR-340 expression, with 61 and 74 showing positive and negative correlations, respectively. Gene Ontology showed that these genes involved in cellular and developmental processes, transcription regulation, immune system process, cell apoptosis and proliferation, myeloid cell differentiation and hematopoietic organ development. Furthermore, miR-340 expression was negatively correlated with HOXA and HOXB cluster levels. Strikingly, HOXA10, HOXB2, MEIS1 and PRDM16 were predicted miR-340 targets according to in silico analysis. The results hint a prospective regulatory mechanism that links miR-340 to HOXA genes associated with AML. Conclusions: Our data indicate that decreased miR-340 expression predicts an adverse prognosis and allo-HSCT may overcome the potential adverse characteristics of low miR-340 expression. Therefore, lower miR-340 cases should be strongly considered for early allo-HSCT. Disclosures No relevant conflicts of interest to declare.

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