scholarly journals Risk of Cardiovascular Events after Covid-19: a double-cohort study

2021 ◽  
Author(s):  
Larisa G Tereshchenko ◽  
Adam Bishop ◽  
Nora Fisher-Campbell ◽  
Jacqueline Levene ◽  
Craig Morris ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Events ◽  
Average Treatment Effect ◽  
Secondary Outcome ◽  
Simple Random Sample ◽  
Composite Outcome ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Primary Composite Outcome

Objective: To determine absolute and relative risks of either symptomatic or asymptomatic SARS-CoV-2 infection for late cardiovascular events and all-cause mortality. Methods: We conducted a retrospective double-cohort study of patients with either symptomatic or asymptomatic SARS-CoV-2 infection [COVID-19(+) cohort] and its documented absence [COVID-19(-) cohort]. The study investigators drew a simple random sample of records from all Oregon Health & Science University (OHSU) Healthcare patients (N=65,585) with available COVID-19 test results, performed 03.01.2020 - 09.13.2020. Exclusion criteria were age < 18y and no established OHSU care. The primary outcome was a composite of cardiovascular morbidity and mortality. All-cause mortality was the secondary outcome. Results: The study population included 1355 patients (mean age 48.7 ± 20.5 y; 770(57%) female, 977(72%) white non-Hispanic; 1072(79%) insured; 563(42%) with cardiovascular disease (CVD) history). During a median 6 months at risk, the primary composite outcome was observed in 38/319 (12%) COVID-19(+) and 65/1036 (6%) COVID-19(-) patients (p=0.001). In Cox regression adjusted for demographics, health insurance, and reason for COVID-19 testing, SARS-CoV-2 infection was associated with the risk of the primary composite outcome (HR 1.71; 95%CI 1.06-2.78; p=0.029). Inverse-probability-weighted estimation, conditioned for 31 covariates, showed that for every COVID-19(+) patient, the average time to all-cause death was 65.5 days less than when all these patients were COVID-19(-): average treatment effect on the treated -65.5 (95%CI -125.4 to -5.61) days; p=0.032. Conclusions: Either symptomatic or asymptomatic SARS-CoV-2 infection is associated with increased risk of late cardiovascular outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period.

scholarly journals Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

2017 ◽  
Vol 176 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Olaf M Dekkers ◽  
Erzsébet Horváth-Puhó ◽  
Suzanne C Cannegieter ◽  
Jan P Vandenbroucke ◽  
Henrik Toft Sørensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Arterial Embolism ◽  
Registration System ◽  
Increased Risk ◽  
All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

scholarly journals P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tatsunori Toida ◽  
Reiko Toida ◽  
Shou Ebihara ◽  
Shigehiro Uezono ◽  
Hiroyuki Komatsu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Cardiovascular Events ◽  
Chronic Renal Disease ◽  
Risk Index ◽  
Hemodialysis Patients ◽  
Drug Prescriptions ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background and Aims Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge. Method Study design: Cohort study. Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital. Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis. Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up. Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference. Results Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge. Conclusion Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.

P6363Achieved blood pressure and cardiovascular outcomes in hypertensives

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H.-Y Park ◽  
N.-K Lim ◽  
W.-H Kim ◽  
J.-W Lee ◽  
M.-C Cho
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Health Examination ◽  
Composite Outcome ◽  
Younger Patients ◽  
Hypertensive Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk

Abstract Background/Introduction Lowering blood pressure is very beneficial in reducing the risk of cardiovascular morbidity and mortality. But, the extent of optimal target blood pressure in hypertensive patients is still controversial. Purpose The objectives of this study were to assess the level of proper systolic and diastolic blood pressure to prevent cardiovascular events in older and younger patients. Methods We used the National Sample Cohort from the National Health Insurance Service of 2007 to 2013 in Korea and analyzed data from 44,462 hypertensive patients aged from 20 to 84, treated with one or more antihypertensive agents and participated at least one general health examination. Achieved systolic and diastolic blood pressure (SBP/DBP) were categorized by exclusive average achieved SBP (<120, <130, <140, <150, and ≥150 mmHg) and DBP (<70, <80, <90, <100, and ≥100 mmHg) categories using the blood pressure measurements of one or more available health examinations. The primary outcome was defined as composite, which was the first occurred event among admissions of myocardial infarction, stroke, and heart failure or cardiovascular death. Secondary outcomes were individual components of composite outcome and all-cause death. Results Of 44,462 patients, 5,478 (12.3%), 13,410 (30.2%), 15,021 (33.8%), 7,051 (15.9%), and 3,502 (7.9%) patients achieved SBP <120 mm Hg, 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and ≥150 mm Hg, respectively. During the median follow-up of 6.8 years, 2,151 (4.8%) died by all-cause of death, and 2,463 (5.5%) met the criteria of composite outcome. In elderly patients, compared with achieved SBP 120–129 (reference), there was no significant increase in risk at SBP 130–139 mm Hg and 140–149 mm Hg, but SBP 150 mm Hg or more was positively associated with significant risk of composite outcome and all-cause death, with HR of 1.29 (95% CI, 1.11–1.51) and 1.66 (95% CI, 1.43–1.92), respectively (Figure). On the other hand, in younger patients, the risk for incidence of composite outcome was significantly increased both at SBP 140–149 mm Hg (HR, 1.39; 95% CI, 1.11–1.73) and 150 mm Hg or more (HR, 2.00; 95% CI, 1.53–2.62) In addition, an achieved SBP 130 mm Hg and more was also significantly associated with all-cause death with HR of 1.27 (95% CI, 1.00–1.62). Compared with 120–129 mm Hg, elderly patients who had achieved SBP less than 120 mm Hg were more likely to have increased risk for composite outcome (HR, 1.29; 95% CI, 1.10–1.52), but not in younger patients (HR, 1.01; 95% CI, 0.78–1.30). Conclusion In conclusion, an intensive lowering of blood pressure is more likely to increase the risk rather than to prevent major cardiovascular events and all-cause death, particularly in older than younger. Therefore, an intensive blood pressure lowering of SBP/DBP below 120/70 mm Hg in the elderly should be avoided. Acknowledgement/Funding The Korea National Institute of Health research grant 2017-NI63001-00

scholarly journals RISK OF ADVERSE OUTCOMES IN HOSPITALIZED PATIENTS WITH AUTOIMMUNE DISEASE AND COVID-19: A MATCHED COHORT STUDY FROM NEW YORK CITY

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S44-S44
Author(s):  
Adam Faye ◽  
Kate Lee ◽  
Monika Laszkowska ◽  
Judith Kim ◽  
John Blackett ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Cohort Study ◽  
Intensive Care ◽  
Autoimmune Disease ◽  
Intensive Care Unit Admission ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Composite Outcome ◽  
Increased Risk

Abstract Objective To examine the impact of autoimmune disease on the composite outcome of intensive care unit admission, intubation, or death, from COVID-19 in hospitalized patients. Methods Retrospective cohort study of 186 patients hospitalized with COVID-19 between March 1st–April 15th, 2020 at New York-Presbyterian Hospital/Columbia University Irving Medical Center. The cohort included 62 patients with autoimmune disease and 124 age- and sex- matched controls. The primary outcome was a composite of intensive care unit admission, intubation, and death, with secondary outcome assessing time to in-hospital death. Baseline demographics, comorbidities, medications, vital signs, and laboratory values were collected. Conditional logistic regression and Cox proportional hazards regression were used to assess the association between autoimmune disease and clinical outcomes. Results Patients with autoimmune disease were more likely to have at least one comorbidity (25.8% vs. 12.9%, p=0.03), take chronic immunosuppressive medications (66.1% vs. 4.0%, p&lt;0.01), and have had a solid organ transplant (16.1% vs. 1.6%, p&lt;0.01). There were no significant differences in intensive care unit admission (14.2% vs. 19.4%, p=0.44), intubation (14.2% vs. 17.7%, p=0.62) or death (17.5% vs. 14.5%, p=0.77). On multivariable analysis, patients with autoimmune disease were not at an increased risk for a composite outcome of intensive care unit admission, intubation, or death (adjOR 0.79, 95%CI 0.37–1.67). On Cox regression, autoimmune disease was not associated with in-hospital mortality (adjHR 0.73, 95%CI 0.33–1.63). Conclusion Among patients hospitalized with COVID-19, individuals with autoimmune disease did not have an increased risk of a composite outcome of intensive care unit admission, intubation, or death. Kaplan-Meier curve examining death, stratified by the presence or absence of autoimmune disease in all 186 patients, with 16 patients censored as of 4/29/2020

scholarly journals Effect of tofacitinib on cardiovascular events and all-cause mortality in patients with immune-mediated inflammatory diseases: a systematic review and meta-analysis of randomized controlled trials

2019 ◽  
Vol 11 ◽  
pp. 1759720X1989549 ◽  
Author(s):  
Wenhui Xie ◽  
Shiyu Xiao ◽  
Yanrong Huang ◽  
Xiaoying Sun ◽  
Zhuoli Zhang
Keyword(s):  
Randomized Controlled Trials ◽  
Cardiovascular Events ◽  
Inflammatory Diseases ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Immune Mediated ◽  
Increased Risk ◽  
All Cause Mortality

Background: We aimed to systematically assess a possible association of tofacitinib therapy with cardiovascular events (CVEs) and all-cause mortality. Methods: Systematic searches of PubMed, Embase, and Cochrane Library were conducted from inception through March 2019. Randomized controlled trials in patients with immune-mediated inflammatory diseases (IMIDs) reporting safety data were included. Included studies compared tofacitinib with placebo or 5 mg tofacitinib with 10 mg tofacitinib. The primary and secondary outcome measures were all CVEs [major adverse cardiovascular events (MACEs)/venous thromboembolism events (VTEs)] and all-cause mortality. Results: 29 studies randomizing 13,611 patients were included. Compared with placebo, there was no significant increased risk of all CVEs (OR = 1.07, 95% CI 0.49–2.34), MACEs (OR 1.54, 95% CI 0.42–5.59), or all-cause mortality (OR = 1.13, 95% CI 0.26–4.95), but a decreased rate of VTEs (OR 0.03, 95% CI 0.00–0.21) in patients with IMIDs initiating tofacitinib. Meanwhile, paired comparison showed 10 mg tofacitinib twice daily was associated with a significantly lower incidence of all CVEs (OR = 0.56, 95% CI 0.33–0.96), MACEs (OR = 0.48, 95% CI 0.22–1.05), or all-cause mortality (OR = 0.47, 95% CI 0.19–1.17), but a trend toward an increase in VTEs risk (OR = 1.47, 95% CI 0.25–8.50), compared with the 5 mg regimen. Conclusion: Compared with placebo, there was no augmented risk of CVEs and all-cause mortality in patients with IMIDs following tofacitinib treatment in a short-term perspective, whereas 10 mg twice daily tofacitinib appeared to be associated with reduction in cardiovascular and all-cause mortality risks, except VTEs, relative to the 5 mg twice daily dose. Long-term studies and postmarketing risk monitoring are increasingly needed to develop a better understanding.

scholarly journals Risk of Adverse Outcomes in Hospitalized Patients with Autoimmune Disease and COVID-19: A Matched Cohort Study from New York City

2020 ◽  
pp. jrheum.200989 ◽  
Author(s):  
Adam S. Faye ◽  
Kate E. Lee ◽  
Monika Laszkowska ◽  
Judith Kim ◽  
John William Blackett ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Autoimmune Disease ◽  
Intensive Care Unit Admission ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Composite Outcome ◽  
Increased Risk

Objective To examine the impact of autoimmune disease on the composite outcome of intensive care unit admission, intubation, or death, from COVID-19 in hospitalized patients. Methods Retrospective cohort study of 186 patients hospitalized with COVID-19 between March 1st–April 15th, 2020 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center. The cohort included 62 patients with autoimmune disease and 124 age- and sex-matched controls. The primary outcome was a composite of intensive care unit admission, intubation, and death, with secondary outcome assessing time to in-hospital death. Baseline demographics, comorbidities, medications, vital signs, and laboratory values were collected. Conditional logistic regression and Cox proportional hazards regression were used to assess the association between autoimmune disease and clinical outcomes. Results Patients with autoimmune disease were more likely to have at least one comorbidity (25.8% vs. 12.9%, p=0.03), take chronic immunosuppressive medications (66.1% vs. 4.0%, p<0.01), and have had a solid organ transplant (16.1% vs. 1.6%, p<0.01). There were no significant differences in intensive care unit admission (14.2% vs. 19.4%, p=0.44), intubation (14.2% vs. 17.7%, p=0.62) or death (17.5% vs. 14.5%, p=0.77). On multivariable analysis, patients with autoimmune disease were not at an increased risk for a composite outcome of intensive care unit admission, intubation, or death (adjOR 0.79, 95%CI 0.37-1.67). On Cox regression, autoimmune disease was not associated with in-hospital mortality (adjHR 0.73, 95%CI 0.33-1.63). Conclusion Among patients hospitalized with COVID-19, individuals with autoimmune disease did not have an increased risk of a composite outcome of intensive care unit admission, intubation, or death.

Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

2021 ◽  
pp. 1-25
Author(s):  
Qionggui Zhou ◽  
Xuejiao Liu ◽  
Yang Zhao ◽  
Pei Qin ◽  
Yongcheng Ren ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Normal Weight ◽  
Sensitivity Analyses ◽  
Hypertension Status ◽  
Moderation Effect ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Chinese Cohort ◽  
The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

Abstract 3739: The Influence of Albuminuria on Mortality in Patients with Stable Coronary Artery Disease

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Scott D Solomon ◽  
Julie Lin ◽  
Caren G Solomon ◽  
Kathleen Jablonski ◽  
Madeline Murguia Rice ◽  
...  
Keyword(s):  
Coronary Disease ◽  
Systolic Function ◽  
Cardiovascular Death ◽  
Creatinine Ratio ◽  
Normal Range ◽  
Albumin Creatinine Ratio ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
All Cause Mortality

Background: Patients with chronic kidney disease are at increased risk for cardiovascular morbidity and mortality. We assessed the association between albuminuria and death or cardiovascular events among patients with stable coronary disease. Methods: We studied patients enrolled in the Prevention of Events with an ACE Inhibitor (PEACE) trial, in which patients with chronic stable coronary disease and preserved systolic function were randomized to trandolapril or placebo and followed for a median of 4.8 years. The urinary albumin to creatinine ratio (ACR) assessed in a core laboratory in 2977 patients at baseline and in 1339 patients at follow-up (mean 34 months) was related to estimated glomerular filtration rate (eGFR) and outcomes. Results: The majority of patients (73%) had a baseline albumin/creatinine ratio within the normal range. Independent of the eGFR and other baseline covariates, a higher albumin/creatinine ratio even within the normal range was associated with increased risks for all-cause mortality (p < 0.001) and cardiovascular death (p = 0.01). The effect of trandolapril therapy on outcomes was not significantly modified by the level of albuminuria. Nevertheless, trandolapril therapy was associated with a significantly lower mean follow-up ACR (12.5 ug/mg vs 14.6 ug/mg, p = 0.0002), after adjusting for baseline ACR, time between collections and other covariates. An increase in ACR over time was associated with increased risk of cardiovascular death (HR per log ACR 1.74, 95% confidence intervals 1.08–2.82). Conclusions: Albuminuria, even in low levels within the normal range, is an independent predictor of cardiovascular and all-cause mortality.

scholarly journals Association of Body Weight Variability with Adverse Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3381
Author(s):  
Sang Heon Suh ◽  
Tae Ryom Oh ◽  
Hong Sang Choi ◽  
Chang Seong Kim ◽  
Eun Hui Bae ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Body Weight ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Body Weight Gain ◽  
Absolute Difference ◽  
Composite Outcome ◽  
Increased Risk ◽  
All Cause Mortality

To investigate the association of body weight variability (BWV) with adverse cardiovascular (CV) outcomes in patient with pre-dialysis chronic kidney disease (CKD), a total of 1867 participants with pre-dialysis CKD from Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) were analyzed. BWV was defined as the average absolute difference between successive values. The primary outcome was a composite of non-fatal CV events and all-cause mortality. Secondary outcomes were fatal and non-fatal CV events and all-cause mortality. High BWV was associated with increased risk of the composite outcome (adjusted hazard ratio (HR) 1.745, 95% confidence interval (CI) 1.065 to 2.847) as well as fatal and non-fatal CV events (adjusted HR 1.845, 95% CI 1.136 to 2.996) and all-cause mortality (adjusted HR 1.861, 95% CI 1.101 to 3.145). High BWV was associated with increased risk of fatal and non-fatal CV events, even in subjects without significant body weight gain or loss during follow-up periods (adjusted HR 2.755, 95% CI 1.114 to 6.813). In conclusion, high BWV is associated with adverse CV outcomes in patients with pre-dialysis CKD.

scholarly journals Left Ventricular Mass Regression, All-Cause and Cardiovascular Mortality in Chronic Kidney Disease: A Meta-Analysis

2021 ◽  
Author(s):  
Kevin C. Maki ◽  
Meredith L. Wilcox ◽  
Mary R. Dicklin ◽  
Rahul Kakkar ◽  
Michael H. Davidson
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular Mass ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
Ventricular Mass ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥ 12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 38 trials with duration ≥ 12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 8 of other types of interventions. All-cause mortality was reported in 116/2385 (4.86%) subjects in intervention groups and 161/2404 (6.70%) subjects in control groups. The pooled RR estimate of the 24 trials ≥ 12 months with ≥ 1 event in ≥ 1 group was 0.72 (95% CI 0.57 to 0.91, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥ 6 months (31 trials), ≥ 9 months (26 trials), and > 12 months (9 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.66, 95% CI 0.38 to 1.15. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

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