scholarly journals Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study

BMJ ◽  
2019 ◽  
pp. l1580 ◽  
Author(s):  
Yan Xie ◽  
Benjamin Bowe ◽  
Yan Yan ◽  
Hong Xian ◽  
Tingting Li ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gastrointestinal Cancer ◽  
Circulatory System ◽  
Upper Gastrointestinal Cancer ◽  
Circulatory System Diseases ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Upper Gastrointestinal

AbstractObjectiveTo estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs).DesignLongitudinal observational cohort study.SettingUS Department of Veterans Affairs.ParticipantsNew users of PPIs (n=157 625) or H2 blockers (n=56 842).Main outcome measuresAll cause mortality and cause specific mortality associated with taking PPIs (values reported as number of attributable deaths per 1000 patients taking PPIs).ResultsThere were 45.20 excess deaths (95% confidence interval 28.20 to 61.40) per 1000 patients taking PPIs. Circulatory system diseases (number of attributable deaths per 1000 patients taking PPIs 17.47, 95% confidence interval 5.47 to 28.80), neoplasms (12.94, 1.24 to 24.28), infectious and parasitic diseases (4.20, 1.57 to 7.02), and genitourinary system diseases (6.25, 3.22 to 9.24) were associated with taking PPIs. There was a graded relation between cumulative duration of PPI exposure and the risk of all cause mortality and death due to circulatory system diseases, neoplasms, and genitourinary system diseases. Analyses of subcauses of death suggested that taking PPIs was associated with an excess mortality due to cardiovascular disease (15.48, 5.02 to 25.19) and chronic kidney disease (4.19, 1.56 to 6.58). Among patients without documented indication for acid suppression drugs (n=116 377), taking PPIs was associated with an excess mortality due to cardiovascular disease (22.91, 11.89 to 33.57), chronic kidney disease (4.74, 1.53 to 8.05), and upper gastrointestinal cancer (3.12, 0.91 to 5.44). Formal interaction analyses suggested that the risk of death due to these subcauses was not modified by a history of cardiovascular disease, chronic kidney disease, or upper gastrointestinal cancer. Taking PPIs was not associated with an excess burden of transportation related mortality and death due to peptic ulcer disease (as negative outcome controls).ConclusionsTaking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.

Hyperuricemia and Cardiovascular Disease

2019 ◽  
Vol 25 (6) ◽  
pp. 700-709 ◽  
Author(s):  
Shuangshuang Zhang ◽  
Yong Wang ◽  
Jinsong Cheng ◽  
Ning Huangfu ◽  
Ruochi Zhao ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Kidney Disease ◽  
Kidney Stones ◽  
Treatment Plan ◽  
Circulatory System ◽  
Special Focus ◽  
Positive Effects

Purine metabolism in the circulatory system yields uric acid as its final oxidation product, which is believed to be linked to the development of gout and kidney stones. Hyperuricemia is closely correlated with cardiovascular disease, metabolic syndrome, and chronic kidney disease, as attested by the epidemiological and empirical research. In this review, we summarize the recent knowledge about hyperuricemia, with a special focus on its physiology, epidemiology, and correlation with cardiovascular disease. This review also discusses the possible positive effects of treatment to reduce urate levels in patients with cardiovascular disease and hyperuricemia, which may lead to an improved clinical treatment plan.

scholarly journals Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes: The Impact of Chronic Kidney Disease

2005 ◽  
Vol 16 (11) ◽  
pp. 3403-3410 ◽  
Author(s):  
Panagiotis T. Vlagopoulos ◽  
Hocine Tighiouart ◽  
Daniel E. Weiner ◽  
John Griffith ◽  
Dan Pettitt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
All Cause Mortality ◽  
The Impact

Aspirin in the primary prevention of cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
L Ashton ◽  
J Burton ◽  
N Brunskill ◽  
L Gray ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Primary Prevention ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
All Cause Mortality ◽  
Randomised Controlled ◽  
Prevention Of Cardiovascular Disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular disease (CVD) is a major cause of morbidity and mortality in individuals with chronic kidney disease (CKD). Aspirin is widely used in secondary prevention of cardiovascular disease. Its use in primary prevention, particularly in CKD, is less clear. Previous reviews have offered inconclusive findings for the benefit of aspirin in CKD. Recent trials have been completed that may help provide more conclusive answers in CKD. Purpose This study aimed to assess the role of aspirin in the primary prevention of CVD and its associated adverse events in individuals with CKD. Methods A pre-defined protocol registered with PROSPERO (CRD42014008860) was used. The OVID Medline and EMBASE databases were searched for studies from 1996 to the 15th September 2020. Abstracts and full-texts were screened independently by two reviewers. Randomised controlled trials that compared aspirin to placebo in individuals with non-endstage CKD without CVD nor primary renal disease were included. The primary outcomes of interests were: CVD, major and minor bleeding events. Secondary outcomes of interest were: all-cause mortality, coronary artery disease and stroke. A meta-analysis was conducted using a random-effects model to calculate a pooled relative risk (RR). Results Five trials were included with 434 CVD events in 7,825 individuals with CKD. Aspirin offered no statistically significant benefit in reduction of CVD events (RR = 0.79, 95%CI: 0.57, 1.09) but significantly increased both minor (RR = 2.62, 95%CI: 1.64, 4.20) and major bleeding (RR= 1.51, 95%CI: 1.13, 2.02) events compared to placebo. Aspirin conferred no benefit for all-cause mortality (RR= 0.89, 95%CI: 0.64, 1.22), coronary heart disease (RR= 0.66, 95%CI: 0.27, 1.63) and stroke (RR= 0.94, 95%CI: 0.55, 1.58). Conclusion Aspirin cannot be recommended for the primary prevention of CVD in individuals with CKD as it offers no conclusive benefit and increases the risk of bleeding. Other strategies to optimise CVD primary prevention in individuals with CKD should be prioritised.

scholarly journals Impact of Retinopathy and Systemic Vascular Comorbidities on All-Cause Mortality

2021 ◽  
Author(s):  
Zhuoting Zhu ◽  
Xianwen Shang ◽  
Wei Wang ◽  
Jason Ha ◽  
Yifan Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Vascular Risk ◽  
Term Survival ◽  
Joint Effects ◽  
Risk Of Mortality ◽  
All Cause Mortality

AbstractAims/hypothesisTo investigate the joint effects of retinopathy and systemic vascular comorbidities on mortality.MethodsThis study included 5703 participants (≥40 years old) from the 2005-2008 National Health and Nutrition Examination Survey. The Early Treatment Diabetic Retinopathy Study grading scale was used to evaluate the retinopathy status. Systemic vascular comorbidities included diabetes mellitus (DM), high blood pressure (HBP), chronic kidney disease (CKD) and cardiovascular disease (CVD). Time to death was calculated as the time from baseline to either the date of death or censoring (December 31st, 2015), whichever came first. Risks of mortality were estimated using Cox proportional hazards models.ResultsAfter adjusting for confounders, the presence of retinopathy predicted higher all-cause mortality (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.09-1.81). The all-cause mortality among participants with both retinopathy and systemic vascular comorbidities including DM (HR, 1.63; 95% CI, 1.06-2.50), HBP (HR, 1.46; 95% CI, 1.03-2.08), CKD (HR, 1.71; 95% CI, 1.24-2.35) and CVD (HR, 1.88; 95% CI, 1.19-2.96) was significantly higher than that among those without either condition.Conclusions/interpretationIn this prospective study, individuals with retinopathy had increased all-cause mortality. The joint effects of retinopathy and major systemic vascular comorbidities increased the all-cause mortality further, suggesting that more extensive vascular risk factor assessment and management are needed to detect the burden of vascular pathologies and improve long-term survival in individuals with retinopathy.Research in contextWhat is already known about this subject?Retinopathy has been recognized as an independent risk factor for mortality.What is the key question?What are the joint effects of retinopathy and systemic vascular comorbidities (including diabetes mellitus, hypertension and chronic kidney disease and cardiovascular disease) on mortality?What are the new findings?Consistent evidence on the increased risk of mortality among individuals with retinopathy was noted in a large sample of middle-aged and older adults.The co-occurrence of retinopathy and systemic vascular conditions (diabetes mellitus, hypertension and chronic kidney disease and cardiovascular disease) further increased all-cause mortality independent of other covariates.How might this impact on clinical practice in the foreseeable future?Individuals with retinopathy may benefit from a comprehensive vascular assessment.Intensive vascular risk reduction is needed in the management of patients with retinopathy and and micro- or macrovascular disorders.Highlighted the importance of retinopathy screening using retinal imaging for identifying individuals at high risk of mortality, particularly among individuals with systemic vascular comorbidities.

scholarly journals A Healthy Beverage Score and Risk of Chronic Kidney Disease Progression, Incident Cardiovascular Disease, and All-Cause Mortality in the Chronic Renal Insufficiency Cohort

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Emily A Hu ◽  
Cheryl A M Anderson ◽  
Deidra C Crews ◽  
Katherine T Mills ◽  
Jiang He ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Ckd Progression ◽  
Sweetened Beverages ◽  
Lower Likelihood ◽  
All Cause Mortality ◽  
Incident Cardiovascular Disease

ABSTRACT Background Beverages are a source of calories and other bioactive constituents but are an understudied aspect of the diet. Different beverages have varying effects on health outcomes. Objectives We created the Healthy Beverage Score (HBS) to characterize participants’ beverage patterns and examined its association with chronic kidney disease (CKD) progression, incident cardiovascular disease (CVD), and all-cause mortality among individuals with CKD. Methods We conducted a prospective analysis of 2283 adults aged 21–74 y with a baseline estimated glomerular filtration rate of 20–70 mL · min−1 · 1.73 m−2 from the Chronic Renal Insufficiency Cohort. Diet was assessed using a 124-item FFQ at visit 1 (2003–2008). The HBS, ranging from 7 to 28 possible points, consisted of 7 components, each scored from 1 to 4 based on rank distribution by quartile, except alcohol, which was based on sex-specific cutoffs. Participants were given more points for higher consumption of low-fat milk and of coffee/tea, for moderate alcohol, and for lower consumption of 100% fruit juice, whole-fat milk, artificially sweetened beverages, and sugar-sweetened beverages. CKD progression, incident CVD, and mortality were ascertained through January 2018. We conducted multivariable Cox proportional hazards models. Results There were 815 cases of CKD progression, 285 cases of incident CVD, and 725 deaths over a maximum of 14 y of follow-up. Compared with participants in the lowest tertile of the HBS, participants in the highest tertile had a 25% lower likelihood of CKD progression (HR: 0.75; 95% CI: 0.63, 0.89; P-trend = 0.001) and a 17% lower likelihood of all-cause mortality (HR: 0.83; 95% CI: 0.69, 1.00; P-trend = 0.04) after adjusting for sociodemographic, clinical, and dietary factors. There was no significant trend for incident CVD. Conclusions Among individuals with CKD, a healthier beverage pattern was inversely associated with CKD progression and all-cause mortality. Beverage intake may be an important modifiable target in preventing adverse outcomes for individuals with CKD.

scholarly journals Associations of 1,5-Anhydroglucitol and 2-Hour Glucose with Major Clinical Outcomes in the Atherosclerosis Risk in Communities (ARIC) Study

2020 ◽  
Vol 5 (6) ◽  
pp. 1296-1306
Author(s):  
Bethany Warren ◽  
Alexandra K Lee ◽  
Christie M Ballantyne ◽  
Ron C Hoogeveen ◽  
James S Pankow ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Atherosclerosis Risk In Communities ◽  
C Statistic ◽  
Atherosclerosis Risk ◽  
All Cause Mortality ◽  
Diagnosed Diabetes ◽  
Aric Study

Abstract Background 1,5-Anhydroglucitol (1,5-AG) is a novel biomarker of glycemic control proposed to monitor recent hyperglycemic excursions in persons with diabetes. The clinical utility of 1,5-AG outside of diagnosed diabetes is unclear, but it may identify people at high risk for diabetes and its complications. We compared associations of 1,5-AG with 2-h glucose for risk of major clinical complications. Research Design and Methods We prospectively followed 6644 Atherosclerosis Risk in Communities (ARIC) Study participants without diagnosed diabetes for incident diagnosed diabetes, chronic kidney disease, cardiovascular disease, and all-cause mortality for ∼20 years. We assessed associations of 1,5-AG and 2-h glucose (modeled categorically and continuously with restricted cubic splines) with adverse outcomes using Cox models and evaluated improvement in risk discrimination using Harrell’s c-statistic. Results 1,5-AG <10 µg/mL was statistically significantly associated with incident diabetes (HR: 2.70, 95% CI 2.31, 3.15), and showed suggestion of association with the other outcomes compared to 1,5-AG ≥10 µg/mL. Continuous associations of 1,5-AG with outcomes displayed a clear threshold effect, with risk associations generally observed only <10 µg/mL. Comparing associations of 1,5-AG and 2-h glucose with outcomes resulted in larger c-statistics for 2-h glucose than 1,5-AG for all outcomes (difference in c-statistic [2-h glucose -1,5-AG] for diagnosed diabetes: 0.17 [95%CI, 0.15, 0.19]; chronic kidney disease 0.02 [95%CI 0.00, 0.05]; cardiovascular disease 0.03 [95%CI, 0.00, 0.06]; and all-cause mortality 0.04 [95%CI, 0.02, 0.06]). Conclusions In this community-based population without diagnosed diabetes, low 1,5-AG was modestly associated with major clinical outcomes and did not outperform 2-h glucose.

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