Association of Different Physical Activity Domains on All-Cause Mortality in Adults Participating in Primary Care in the Brazilian National Health System: 4-Year Follow-up

Background:Evidence has shown that physical activity (PA) is associated with low mortality risk. However, data about reduced mortality due to PA are scarce in developing countries and the dose–response relationship between PA from different domains and all-cause mortality remains unclear. Thus, the aim of this study is to investigate the association of PA from different domains on all-cause mortality among Brazilian adults.Methods:679 males and females composed the study sample. Participants were divided into quartile groups according to PA from different domains (occupational, sports, and leisure-time). Medical records were used to identify the cause of the death. Cox regression analysis was performed to determine the independent associations of PA from different domains and all-cause mortality.Results:During the follow-up period, 59 participants died. The most prevalent cause of death was circulatory system diseases (n = 20; 33.9% [21.8%–45.9%]). Higher scores of occupational (HR= 0.45 [95% CI: 0.20–0.97]), sports (HR= 0.44 [95% CI: 0.20–0.95]) and overall PA (HR= 0.40 [95% CI: 0.17–0.90]) were associated with lower mortality, even after adjustment for confounders.Conclusions:The findings in this study showed the importance of being active in different domains to reduce mortality risk.

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Low serum klotho associated with all-cause mortality among a nationally representative sample of American adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab308 ◽

2021 ◽

Author(s):

Jacob K Kresovich ◽

Catherine M Bulka

Keyword(s):

Physical Activity ◽

Mortality Risk ◽

Representative Sample ◽

Cox Regression ◽

The United States ◽

Risk Of Death ◽

All Cause Mortality ◽

Nationally Representative ◽

Low Serum

Abstract α-Klotho (klotho) is a protein involved in suppressing oxidative stress and inflammation. In animal models, it is reported to underlie numerous aging phenotypes and longevity. Among a nationally representative sample of adults aged 40 to 79 in the United States, we investigated whether circulating concentrations of klotho is a marker of mortality risk. Serum klotho was measured by ELISA on 10,069 individuals enrolled in the National Health and Nutrition Examination Survey between 2007-2014. Mortality follow-up data based on the National Death Index were available through December 31, 2015. After a mean follow-up of 58 months (range: 1-108), 616 incident deaths occurred. Using survey-weighted Cox regression models adjusted for age, sex and survey cycle, low serum klotho concentration (< 666 pg/mL) was associated with a 31% higher risk of death (compared to klotho concentration > 985 pg/mL, HR: 1.31, 95% CI: 1.00, 1.71, P= 0.05). Associations were consistent for mortality caused by heart disease or cancer. Associations of klotho with all-cause mortality did not appear to differ by most participant characteristics. However, we observed effect modification by physical activity, such that low levels of serum klotho were more strongly associated with mortality among individuals who did not meet recommendation-based physical activity guidelines. Our findings suggest that, among the general population of American adults, circulating levels of klotho may serve as a marker of mortality risk.

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1444Metabolically healthy obesity (MHO) in the Malmo Diet Cancer Study - epidemiology and prospective risks

European Heart Journal ◽

10.1093/eurheartj/ehz748.0079 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

J Korduner ◽

E Bachus ◽

A Jujic ◽

M Magnusson ◽

P M Nilsson

Keyword(s):

Mortality Risk ◽

Cox Regression ◽

University Hospital ◽

Cross Sectional ◽

Cox Regression Analysis ◽

Cancer Study ◽

All Cause Mortality ◽

Prospective Risk ◽

Morbidity Risk

Abstract Background/Aims Metabolically healthy obesity (MHO) is a controversial topic, since the underlying mechanisms and contributing factors behind this phenotype remain unclear. Here we aimed to investigate the characteristics of MHO, as well as prospective mortality risk. Method A cross-sectional analysis was carried out in a subsample of 3,812 obese subjects (BMI ≥30 kg/m2) selected from the Malmo Diet Cancer Study (MDCS) cohort (n=28,403). Subjects with MHO (n=1182; mean age 58±7 years) were defined by having no records of hospitalization in the national Swedish Hospital Discharge Register prior to the baseline examination, other than hospitalization due to normal deliveries or external injuries. MHO subjects were further compared to subjects with metabolically unhealthy obesity, MUO (n=2,630; mean age 60±7 years), and all non-obese individuals (n=24,591; mean age 58±8 years) in the cohort study. Moreover, prospective risk analyses for incident morbidity and mortality were carried out by Cox regression. Results Compared to MOU individuals (one-way ANOVA), MHO individuals were younger (58±7 years vs. 60±7 years, p=0.001) and more likely to be male (41.2% vs 37.1%, p=0.016). MHO individuals reported a significantly lower proportion of sedentary life style than MUO (17.4% vs. 21.9%, p=0.009), and were more likely to hold a university degree (13.4% vs. 9.4%, p=0.003). Furthermore, MHO individuals had significantly lower HbA1c (p=0.012), fasting plasma glucose (p=0.001) and triglyceride levels (p=0.011) as compared to their MOU counterparts. Cox-regression analysis adjusted for age, sex, smoking and blood pressure (follow-up time 20±6 years) showed both a significantly lower all-cause mortality risk for MHO individuals as compared to MUO (HR 0.74, 95% CI: 0.66–0.82; p=0.001), as well as lower total incident cardiovascular (CV) morbidity risk (HR 0.69, 95% CI: 0.60–0.80; p=0.001). Interestingly, when comparing MHO individuals to all non-obese individuals in the MDCS, there were no significant differences in neither mortality risk (p=0.9), nor incident CV morbidity risk (p=0.7). All-cause mortality risk Conclusion Compared to MUO individuals, MHO individuals presented with a higher level of education- and physical activity together with a more favorable lipid- and glucose profile. MHO individuals were at significantly lower prospective risk of total- and cardiovascular mortality during 20-years follow-up, as compared to MOU individuals. Notably, no significant differences could be seen in mortality and CV morbidity risks when comparing MHO subjects to all non-obese individuals in the total cohort. Acknowledgement/Funding The Research Council of Sweden and Skane University Hospital Funds and Foundations (Sweden)

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POS0141 ACTIVE SCREENING FOR GOUT IDENTIFIES A LARGER CARDIOVASCULAR POPULATION AT HIGH MORTALITY RISK

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1872 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 282.2-282

Author(s):

S. Ruiz-Simón ◽

I. Calabuig ◽

M. Gomez-Garberi ◽

M. Andrés

Keyword(s):

High Mortality ◽

Mortality Risk ◽

Cardiovascular Events ◽

Cox Regression ◽

Field Studies ◽

High Mortality Risk ◽

Active Screening ◽

Tertiary Centre ◽

All Cause Mortality

Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal

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Vascular and Cardiac Prognostic Determinants in Patients with Gynecological Cancers: A Six-Year Follow-up Study

Applied Sciences ◽

10.3390/app11136091 ◽

2021 ◽

Vol 11 (13) ◽

pp. 6091

Author(s):

Pietro Scicchitano ◽

Marco Tucci ◽

Gabriella Ricci ◽

Michele Gesualdo ◽

Santa Carbonara ◽

...

Keyword(s):

Brachial Artery ◽

Cox Regression ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Controlled Study ◽

Gynecological Cancers ◽

Roc Curve Analysis ◽

Cox Regression Analysis ◽

All Cause Mortality

Background: The aim of this study was to assess the role of cardiac and vascular parameters as all-cause mortality determinants in patients suffering from gynecological cancers. Methods: This was an observational, prospective, non-randomized, and non-controlled study. Forty-seven consecutive patients (mean age: 58 ± 13 years) were enrolled after cancer staging. All patients underwent evaluation of vascular (common carotid intima-media thickness (mean C-IMT), flow-mediated dilation of the brachial artery (FMD), and antero-posterior diameter of the infrarenal abdominal aorta (APAO)) and cardiac function and morphology before cancer-related interventions. A 6-year follow-up was carried out to assess the overall survival of the whole population. Results: Twenty patients (42%) died by the time of the 6-year follow-up. The brachial artery FMD values were higher in the survivors than the non-survivors (9.71 ± 3.53% vs. 6.13 ± 2.62%, p < 0.001), as well as the LVEF (60.8 ± 3.0% vs. 57.8 ± 4.4%, p = 0.009). There were no differences in the mean C-IMT, APAO, and other echocardiographic parameters. ROC curve analysis identified a baseline LVEF < 57% and FMD value < 5.8% as the best cut-offs. Kaplan–Meier evaluation showed that the LVEF, tricuspid annular plane systolic excursion, and FMD were the best predictors of all-cause mortality, although only the LVEF and FMD were confirmed in multivariate Cox regression analysis. Conclusions: The LVEF and brachial artery FMD are independent prognostic determinants in patients with gynecological cancers.

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P1885Cha2ds-2vasc score lacks of ability to predict mortality in patients attending the emergency department with atrial fibrillation in the presence of troponin i

European Heart Journal ◽

10.1093/eurheartj/ehz748.0633 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M I Gonzalez Del Hoyo ◽

G Cediel ◽

A Carrasquer ◽

G Bonet ◽

K Vasquez-Nunez ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Emergency Department ◽

Regression Analysis ◽

Troponin I ◽

Cox Regression ◽

Cox Regression Analysis ◽

All Cause Mortality

Abstract Background CHA2DS2-VASc score has been used as a surrogate marker for predicting outcomes beyond thromboembolic risk in patients with atrial fibrillation (AF). Likewise, cardiac troponin I (cTnI) is a predictor of mortality in AF. Purpose This study aimed to investigate the association of cTnI and CHA2DS2-VASc score with long-term prognosis in patients admitted to the emergency department with AF. Methods A retrospective cohort study conducted between January 2012 and December 2013, enrolling patients admitted to the emergency department with AF and having documented cTnI measurements. CHA2DS2-VASc score was estimated. Primary endpoint was 5-year all-cause mortality, readmission for heart failure (HF), readmission for myocardial infarction (MI) and the composite end point of major adverse cardiac events defined as death, readmission for HF or readmission for MI (MACE). Results A total of 578 patients with AF were studied, of whom 252 patients had elevated levels of cTnI (43.6%) and 334 patients had CHA2DS2-VASc score >3 (57.8%). Patients with elevated cTnI tended to be oldercompared with those who did not have cTnI elevation and were more frequently comorbid and of higher ischemic risk, including hypertension, prior MI, prior HF, chronic renal failure and peripheral artery disease. The overall median CHA2DS2-VASc score was higher in those with cTnI elevation compared to those patients elevated cTnI levels (4.2 vs 3.3 points, p<0.001). Main diagnoses at hospital discharge were tachyarrhythmia 30.3%, followed by heart failure 17.7%, respiratory infections 9.5% and acute coronary syndrome 7.3%. At 5-year follow-up, all-cause death was significantly higher for patients with cTnI elevation compared with those who did not have cTnI elevation (56.4% vs. 27%; logrank test p<0.001). Specifically, for readmissions for HF and readmissions for MI there were no differences in between patients with or without cTnI elevation. In addition, MACE was reached in 165 patients (65.5%) with cTnI elevation, compare to 126 patients (38.7%) without cTnI elevation (p<0.001). On multivariable Cox regression analysis, cTnI elevation was an independent predictor of all-cause death (hazard ratio, 1.67, 95% confidence interval [CI]: 1.24–2.26, p=0.001) and of MACE (hazard ratio 1.47, 95% confidence interval 1.15–1.88; P=0.002), but it did not reach statistical significance for readmissions for MI and readmissions for HF. CHA2DS2-VASc score was a predictor on univariate Cox regression analysis for each endpoint, but it did not reach significance on multivariable Cox regression analysis for any endpoint. Conclusions cTnI is independently associated with long-term all-cause mortality in patients attending the emergency department with AF. cTnI compared to CHA2DS2-VASc score is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of patients with atrial fibrillation.

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The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients

BMC Nephrology ◽

10.1186/s12882-019-1570-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Woong-pyo Hong ◽

Yu-Ji Lee

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Mortality Risk ◽

Cox Regression ◽

Target Range ◽

Dialysis Adequacy ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality ◽

High Bmi

Abstract Background Although hemodialysis (HD) adequacy, single-pool Kt/Vurea (spKt/V), is inversely correlated with body size, each is known to affect patient survival in the same direction. Therefore, we sought to examine the relationship between HD adequacy and mortality according to body mass index (BMI) in HD patients and explore a combination effect of BMI and HD adequacy on mortality risk. Methods We retrospectively reviewed patient data from the Korean Society of Nephrology registry, a nationwide database of medical records of HD patients, from January 2001 to June 2017. We included patients ≥18 years old who were receiving maintenance HD. Patients were categorized into three groups according to baseline BMI (< 20 (low), 20 to < 23 (normal), and ≥ 23 (high) kg/m2). Baseline spKt/V was divided into six categories. Results Among 18,242 patients on HD, the median follow-up duration was 5.2 (IQR, 1.9–8.9) years. Cox regression analysis showed that, compared to the reference (spKt/V 1.2–1.4), lower and higher baseline spKt/V were associated with greater and lower risks for all-cause mortality, respectively. However, among patients with high BMI (n = 5588), the association between higher spKt/V and lower all-cause mortality was attenuated in all adjusted models (Pinteraction < 0.001). Compared to patients with normal BMI and spKt/V within the target range (1.2–1.4), those with low BMI had a higher risk for all-cause mortality at all spKt/V levels. However, the gap in mortality risk became narrower for higher values of spKt/V. Compared to patients with normal BMI and spKt/V in the target range, those with high BMI and spKt/V < 1.2 were not at increased risk for mortality despite low dialysis adequacy. Conclusions The association between spKt/V and mortality in HD patients may be modified by BMI.

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Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Cardiology ◽

10.1159/000471845 ◽

2017 ◽

Vol 138 (1) ◽

pp. 26-33 ◽

Cited By ~ 3

Author(s):

Xili Lu ◽

Wei Wang ◽

Ling Zhu ◽

Yilu Wang ◽

Kai Sun ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

Fragmented Qrs ◽

All Cause Mortality ◽

The Relationship ◽

Cvd Mortality

Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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Living alone vs. living with someone as a predictor of mortality after a bone fracture in older age

Aging Clinical and Experimental Research ◽

10.1007/s40520-020-01511-5 ◽

2020 ◽

Vol 32 (9) ◽

pp. 1697-1705

Author(s):

Kaisa Koivunen ◽

Elina Sillanpää ◽

Mikaela von Bonsdorff ◽

Ritva Sakari ◽

Katja Pynnönen ◽

...

Keyword(s):

Mortality Risk ◽

Living Arrangements ◽

Cox Regression ◽

Living Arrangement ◽

Living Alone ◽

Cox Regression Analysis ◽

Health Decline ◽

Fracture Time ◽

Incidence And Mortality

Abstract Background Living alone is a risk factor for health decline in old age, especially when facing adverse events increasing vulnerability. Aim We examined whether living alone is associated with higher post-fracture mortality risk. Methods Participants were 190 men and 409 women aged 75 or 80 years at baseline. Subsequent fracture incidence and mortality were followed up for 15 years. Extended Cox regression analysis was used to compare the associations between living arrangements and mortality risk during the first post-fracture year and during the non-fracture time. All participants contributed to the non-fracture state until a fracture occurred or until death/end of follow-up if they did not sustain a fracture. Participants who sustained a fracture during the follow-up returned to the non-fracture state 1 year after the fracture unless they died or were censored due to end of follow-up. Results Altogether, 22% of men and 40% of women sustained a fracture. During the first post-fracture year, mortality risk was over threefold compared to non-fracture time but did not differ by living arrangement. In women, living alone was associated with lower mortality risk during non-fracture time, but the association attenuated after adjustment for self-rated health. In men, living alone was associated with increased mortality risk during non-fracture time, although not significantly. Conclusion The results suggest that living alone is not associated with pronounced mortality risk after a fracture compared to living with someone.

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Light-Intensity Physical Activity and All-Cause Mortality

American Journal of Health Promotion ◽

10.4278/ajhp.150515-arb-882 ◽

2016 ◽

Vol 31 (4) ◽

pp. 340-342 ◽

Cited By ~ 35

Author(s):

Paul D. Loprinzi

Keyword(s):

Physical Activity ◽

Light Intensity ◽

Mortality Risk ◽

Weight Status ◽

Vigorous Physical Activity ◽

National Sample ◽

Poverty Level ◽

All Cause Mortality ◽

Intensity Physical Activity

Purpose. Research demonstrates that moderate-to-vigorous physical activity (MVPA) is associated with a reduced risk of all-cause mortality. Few studies have examined the effects of light-intensity physical activity on mortality. Therefore, the purpose of this study was to examine the association between objectively measured light-intensity physical activity and all-cause mortality risk. Design. Longitudinal. Setting. National Health and Nutrition Examination Survey 2003–2006 with follow-up through December 31, 2011. Subjects. Five thousand five hundred seventy-five U.S. adults. Measures. Participants wore an accelerometer for at least 4 days and completed questionnaires to assess sociodemographics and chronic disease information, with blood samples taken to assess biological markers. Follow-up mortality status was assessed via death certificate data from the National Death Index. Analysis. Cox proportional hazard model. Results. After adjusting for accelerometer-determined MVPA, age, gender, race-ethnicity, cotinine, weight status, poverty level, C-reactive protein, and comorbid illness, for every 60-minute increase in accelerometer-determined light-intensity physical activity, participants had a 16% reduced hazard of all-cause mortality (hazard ratio = .84; 95% confidence interval: .78–.91; p < .001). Conclusion. In this national sample of U.S. adults, light-intensity physical activity was inversely associated with all-cause mortality risk, independent of age, MVPA, and other potential confounders. In addition to MVPA, promotion of light-intensity physical activity is warranted.

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Can a simple measure of vigorous physical activity predict future mortality? Results from the OXCHECK study

Public Health Nutrition ◽

10.1079/phn2003548 ◽

2004 ◽

Vol 7 (4) ◽

pp. 557-562 ◽

Cited By ~ 14

Author(s):

Melvyn Hillsdon ◽

Margaret Thorogood ◽

Mike Murphy ◽

Lesley Jones

Keyword(s):

Physical Activity ◽

Cox Regression ◽

Vigorous Physical Activity ◽

Previous History ◽

Self Report ◽

Moderate Intensity ◽

Risk Of Death ◽

All Cause Mortality ◽

Intensity Physical Activity

AbstractBackground:As epidemiological studies have become more complex, demands for short, easily administered measures of risk factors have increased. This study investigates whether such a measure of physical activity is associated with the risk of death from all causes and death from specific causes.Methods:A prospective follow-up study of 11 090 men and women, aged 35–64 years, recruited from five UK general practices who responded to a postal questionnaire in 1989. Self-reported frequency of vigorous-intensity physical activity and data on confounding factors were collected at baseline survey. Death notifications up to 31 December 2001 were provided by the Office for National Statistics. The relative risk (and 95% confidence interval) of dying associated with each level of exposure to physical activity was estimated by the hazard ratio in a series of Cox regression models.Results:After > 10 years' follow-up there were 825 deaths among the 10 522 subjects with no previous history of angina or myocardial infarction. Participation in vigorous exercise was associated with a significantly lower risk of all-cause mortality. Similar associations were found for ischaemic heart disease and cancer mortality, although the relationships were not significant at the 5% level.Conclusions:Simple measures of self-reported vigorous physical activity are associated with the risk of future mortality, at least all-cause mortality in a somewhat selected group. Interpretation of the finding should be treated with caution due to the reliance on self-report and the possibility that residual confounding may underlie the associations. Because moderate-intensity physical activity is also beneficial to health, short physical activity questionnaires should include measures of such physical activity in the future.

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