Reduced cardiorespiratory fitness is a mediator of excess all-cause mortality in rheumatoid arthritis: the Trøndelag Health Study

ObjectivesInvestigate if low cardiorespiratory fitness (CRF) was associated with and acted as a mediator of excess all-cause mortality rate in persons suffering from rheumatoid arthritis (RA) compared with the general population.MethodsAll-cause mortality was analysed using Cox regression modelling in patients with RA (n=348) and controls (n=60 938) who took part in the second (1995–1997) and third (2006–2008) waves of the longitudinal population-based Trøndelag Health Study in Norway. A mediation analysis was performed to investigate if excess relative risk of mortality in RA was mediated by low estimated CRF (eCRF).ResultsDuring the follow-up until 31 December 2018 (mean 19.3 years), the mortality rate among patients with RA (n=127, 36.5%) was higher than among controls (n=12 942, 21.2%) (p<0.001). Among controls and patients with RA, 51% and 26%, respectively, had eCRF above the median for their age and sex (p<0.001). The final Cox model included RA status and eCRF, adjusted for hypertension, body mass index, smoking, cholesterol, diabetes and creatinine. eCRF below median for sex and age category was associated with increased mortality (p<0.001). The total excess relative risk of mortality in patients with RA was 28% (95% CI 2% to 55%, p=0.035), in which RA itself contributed 5% and the direct and indirect contributions of low eCRF accounted for 23%.ConclusionsLow eCRF was an important mediator of the increased all-cause mortality rate found in RA. Our data indicate that patients with RA should be given advice to perform physical activity that increases CRF, along with optimised treatment with antirheumatic drugs, from the time of diagnosis.

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Prediction of All-Cause Mortality Using an Echocardiography-Based Risk Score in Hemodialysis Patients

Cardiorenal Medicine ◽

10.1159/000507727 ◽

2020 ◽

pp. 1-11

Author(s):

Jing Zhu ◽

Chao Tang ◽

Han Ouyang ◽

Huaying Shen ◽

Tao You ◽

...

Keyword(s):

Risk Factors ◽

Cox Model ◽

Prognostic Score ◽

Basic Model ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Cardiac Valve Regurgitation ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Aim: To derive an echocardiography-based prognostic score for a 3-year risk of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Methods: 173 ESRD patients hospitalized in the second affiliated hospital of Soochow University from January 1, 2010, to July 31, 2016, were enrolled and followed up for 3 years. All subjects began to receive HD from recruitment. Baseline clinical and echocardiographic parameters were collected and screened for risk factors using univariate and multivariate analysis. The prognostic value of echocardiographic indexes was determined by concordance indexes and reclassification assay. Restricted cubic spline models (RCS) and forest plots were employed to visualize the association between risk factors and all-cause mortality. A multivariate nomogram including the identified factors was developed to estimate the prognosis. Results: After multivariate adjustment for advanced age, hypertension, diabetes, and decreased hemoglobin (Hb), echocardiographic indexes including left atrial diameter index (LADI), cardiac valvular calcification, and moderate to severe cardiac valve regurgitation were independently associated with the risk of 3-year mortality in HD patients. RCS showed that age, Hb, and LADI were positively associated with the risk of mortality. Adding multiple echocardiographic indexes to a basic model containing age, hypertension, diabetes, and Hb increased the concordance index and improved reclassification. A multivariate Cox model-derived nomogram showed the association between each factor and mortality by the end of follow-up. Conclusions: Echocardiographic indexes showed independent predictive power for mortality in ESRD patients and may constitute a promising prognostic tool in this population.

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Explanatory Style in Patients with Rheumatoid Arthritis: An Unrecognized Predictor of Mortality

The Journal of Rheumatology ◽

10.3899/jrheum.160026 ◽

2016 ◽

Vol 44 (2) ◽

pp. 170-173 ◽

Cited By ~ 1

Author(s):

Aaron D. Crowson ◽

Robert C. Colligan ◽

Eric L. Matteson ◽

John M. Davis ◽

Cynthia S. Crowson

Keyword(s):

Rheumatoid Arthritis ◽

Mortality Rate ◽

Minnesota Multiphasic Personality Inventory ◽

Explanatory Style ◽

Population Based ◽

Similar Magnitude ◽

Risk Of Mortality ◽

Increased Risk ◽

Comparison Cohort ◽

Pessimistic Explanatory Style

Objective.To determine whether pessimistic explanatory style altered the risk for and mortality of patients with rheumatoid arthritis (RA).Methods.The study included subjects from a population-based cohort with incident RA and a non-RA comparison cohort who completed the Minnesota Multiphasic Personality Inventory.Results.Among 148 RA and 135 non-RA subjects, pessimism was associated with development of rheumatoid factor (RF)–positive RA. Pessimism was associated with an increased risk of mortality [HR 2.88 with similar magnitude to RF+ (HR 2.28)].Conclusion.Pessimistic explanatory style was associated with an increased risk of developing RA and increased mortality rate in patients with RA.

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Long-Term Effect of Non-Selective Beta-Blockers in Patients With Rheumatoid Arthritis After Myocardial Infarction—A Nationwide Cohort Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.726044 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sheng-Fu Liu ◽

Chih-Kuo Lee ◽

Kuan-Chih Huang ◽

Lian-Yu Lin ◽

Mu-Yang Hsieh ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Myocardial Infarction ◽

Protective Effect ◽

Lower Risk ◽

Beta Blockers ◽

Term Survival ◽

Risk Of Mortality ◽

All Cause Mortality ◽

The Impact

Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients.Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups.Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs.Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.

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Risk of Complications in Children With Adrenal Insufficiency and Covid-19

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1467 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A721-A721

Author(s):

Manish Gope Raisingani

Keyword(s):

Relative Risk ◽

Mortality Rate ◽

Adrenal Insufficiency ◽

Endotracheal Intubation ◽

Health Care Organizations ◽

The Body ◽

P Value ◽

Complication Rates ◽

Intubation Rate ◽

Risk Of Mortality

Abstract Background: Adrenal insufficiency may put a person at higher risk with infections due to a lack of normal stress response by the body. Limited data has been available in pediatric adrenal insufficiency with Covid-19 Methods: We used TriNetX, with a large COVID-19 database, collecting real-time electronic medical records data. We compared children (0-18 years) who were diagnosed with Covid-19 with and without Adrenal insufficiency. This database collected information from 54 health care organizations Results: Mortality rate in children with Covid-19 and Adrenal insufficiency was 2.246% (19/846). Mortality rate in children with Covid-19 without adrenal insufficiency was 0.097 % (244/252211). Relative risk of mortality for children with Covid-19 and Adrenal insufficiency was 23.2 with a p value of < 0.0001. Endotracheal intubation rate in children with Covid-19 and Adrenal insufficiency was 1.418% (12/846). Endotracheal intubation rate in children with Covid-19 without Adrenal insufficiency was 0.065% (165/252211). Relative risk of endotracheal intubation for children with Covid-19 and Adrenal insufficiency was 21.68 with a p value of < 0.0001. Sepsis rate in children with Covid-19 and Adrenal insufficiency was 6.974% (59/846). Sepsis rate in children with Covid-19 without Adrenal insufficiency was 0.274% (691/252211). Relative risk of sepsis for children with Covid-19 and Adrenal insufficiency was 25.45 with a p value of < 0.00001. Conclusion: Mortality rate, endotracheal and sepsis showed increased association in children with Adrenal insufficiency and Covid-19 versus children with Covid-19 and no Adrenal insufficiency. Further studies with larger sample size are needed to study complication rates of Covid-19 and Adrenal insufficiency.

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Abstract 13468: The Interaction Between the Prognostic Value of Chronotropic Incompetence and Cardiorespiratory Fitness: The Henry Ford Exercise Testing (FIT) Project

Circulation ◽

10.1161/circ.132.suppl_3.13468 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Waqas T Qureshi ◽

Wesley T O'Neal ◽

Clinton A Brawner ◽

Jonathan K Ehrman ◽

Steven J Keteyian ◽

...

Keyword(s):

Confidence Interval ◽

Regression Model ◽

Cardiorespiratory Fitness ◽

Cox Regression ◽

Stress Test ◽

Exercise Stress ◽

Chronotropic Incompetence ◽

Metabolic Equivalents ◽

Social Security Death Index ◽

All Cause Mortality

Background: Cardiorespiratory fitness (CRF) and chronotropic incompetence (CI) have both been associated with increased all - cause mortality. We tested the hypothesis that the association of CI with all - cause mortality is modified by a CRF level above and below 10 metabolic equivalents of task (METs). Methods: We included 43,402 patients who completed a clinical exercise stress test between 1991 and 2009. Patients on AV nodal blocking agents, antiarrhythmics and with known coronary artery disease/heart failure were excluded. Patients were followed-up for a mean duration of 11.5±5.2 years for all-cause mortality ascertained by a search of the social security death index in April 2013. CRF was estimated in metabolic equivalents of task (METs). Cox proportional hazards regression models were used to assess the risk of all - cause mortality associated with CI with adjustments for confounders. Results: Compared to no CI, patients with CI were older (51±12 vs. 54±13 years), less often white (68% vs. 58%), dyslipidemic (41% vs. 37%) and more likely to be hypertensive (46% vs. 60%), diabetic (15% vs. 22%), and smoke (40% vs. 51%). On average, patients with CI had lower CRF (9.8±2.8 vs. 7.4±3.0, p <.001). In adjusted Cox regression model, CI was associated with higher risk of mortality [Hazard ratio (HR), 2.12; 95% confidence interval (2.00 -2.27); p<.001)]. The association of CI and mortality was attenuated when METs was included as a covariate in the regression model [HR, 1.49; 95% confidence interval (1.39-1.61); p<.001]. There was a significant interaction of CRF ≥ 10 METs with the association of CI and mortality (p interaction 0.004) which is shown in Figure 1. This was a subaditive and multiplicative interaction of CRF with CI. Conclusions: This study demonstrates that CRF attenuates the mortality risk associated with CI. In addition, patients with CI in the presence of CRF ≥ 10 METs have a much lower risk than patients with CI and lower CRF.

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Association of Body Mass Index and Waist Circumference with All-Cause Mortality in Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm9051289 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1289

Author(s):

Chang Seong Kim ◽

Kyung-Do Han ◽

Hong Sang Choi ◽

Eun Hui Bae ◽

Seong Kwon Ma ◽

...

Keyword(s):

Body Mass Index ◽

Waist Circumference ◽

Mortality Rate ◽

Body Mass ◽

The Body ◽

National Health Insurance System ◽

Cox Regression Analysis ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Nationally Representative

In this study based on a large nationally representative sample of Korean adults, we investigated the potential associations of the body mass index (BMI) and waist circumference (WC) with mortality in patients undergoing hemodialysis. We obtained the data of 18,699 participants >20 years of age who were followed up with for 4 years and for whom BMI and WC information were available, using a nationally representative dataset from the Korean National Health Insurance System. Patients were stratified into five levels by their baseline BMI and into six levels by their WC (5-cm increments). A total of 4975 deaths occurred during a median follow-up period of 48.2 months. Participants with a higher BMI had a lower mortality rate than those with a lower BMI. In a fully adjusted Cox regression analysis, being overweight and obese was associated with a significantly lower relative risk of all-cause mortality relative to the reference group. Conversely, the mortality rate was higher among participants with a high WC than among those with a low WC. Participants with the highest WC had a higher risk of mortality, while those with the lowest WC level had a significantly lower risk of mortality. In conclusion, all-cause mortality was positively associated with WC, a measure of abdominal obesity, and inversely associated with BMI, a measure of body volume, in patients undergoing hemodialysis.

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Association of Malnutrition, Left Ventricular Ejection Fraction Category, and Mortality in Patients Undergoing Coronary Angiography: A Cohort With 45,826 Patients

Frontiers in Nutrition ◽

10.3389/fnut.2021.740746 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ziling Mai ◽

Zhidong Huang ◽

Wenguang Lai ◽

Huanqiang Li ◽

Bo Wang ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Coronary Angiography ◽

Regression Models ◽

Cox Regression ◽

Density Lipoprotein ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Risk Of Mortality ◽

All Cause Mortality

Background: The regulatory effect of the left ventricular ejection fraction (LVEF) categories on the association of malnutrition and all-cause mortality in patients undergoing coronary angiography (CAG) have not been adequately addressed.Methods: Forty-five thousand eight hundred and twenty-six patients consecutively enrolled in the Cardiorenal ImprovemeNt (CIN) study (ClinicalTrials.gov NCT04407936) from January 2008 to July 2018 who underwent coronary angiography (CAG). The Controlling Nutritional Status (CONUT) score was applied to 45,826 CAG patients. The hazard ratios of mortality across combined LVEF and/or malnutrition categories were estimated by Cox regression models. Variables adjusted for in the Cox regression models included: age, gender, hypertension (HT), DM, PCI, coronary artery disease (CAD), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TRIG), chronic kidney disease (CKD), statins, atrial fibrillation (AF), anemia, and stroke. Population attributable risk (PAR) was estimated for eight groups stratified by nutritional status and LVEF categories.Results: In our study, 42,181(92%) of patients were LVEF ≥ 40%, of whom, 41.55 and 9.34% were in mild and moderate or severe malnutrition status, respectively, while 46.53 and 22.28% in mild and moderate or severe malnutritional status among patients with LVEF < 40%. During a median follow-up time of 4.5 years (percentile 2.8–7.1), 5,350 (11.7%) patients died. After fully adjustment, there is no difference of mortality on malnutrition in LVEF < 40% group (mild, moderate and severe vs. normal, HR (95%CI): [1.00 (0.83–0.98)], [1.20 (0.95–1.51)], [1.41 (0.87–2.29)], respectively, p for trend =0.068), but malnutrition was related to markedly increased risk of mortality in LVEF ≥ 40% group (mild, moderate, and severe vs. normal, HR (95%CI): [1.21 (1.12–1.31)], [1.56 (1.40–1.74)], and [2.20(1.67–2.90)], respectively, p for trend < 0.001, and p for interaction < 0.001). Patients with LVEF ≥ 40% had a higher malnutrition-associated risk of mortality and a higher PAR than those with LVEF < 40%.Conclusions: Malnutrition is common in CAG patients and it has a greater effect on all-cause mortality and a higher PAR in patients with LVEF ≥ 40% than LVEF < 40%.

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women.

10.21203/rs.2.22585/v2 ◽

2020 ◽

Author(s):

Masuma Novak ◽

Margda waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Abstract Background. This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods. Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n=524). Mortality data were analyzed until 2012 through Swedish national registers. Results. Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5 334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78 - 2.96; all-cause HR 1.32, 95% CI 0.77 - 2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14 - 4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04 - 5.65). Conclusions. Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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The relative risk of mortality to the population on the Krasnoyarsk in the period when the air quality standards are exceeded

10.25743/sdm.2021.96.48.050 ◽

2021 ◽

Author(s):

D.A. Chernykh ◽

E.N. Bel’skaia ◽

O.V. Taseiko

Keyword(s):

Particulate Matter ◽

Relative Risk ◽

Air Quality ◽

Mortality Rate ◽

Risk Model ◽

Quality Standards ◽

Relative Increase ◽

Risk Of Mortality ◽

The City ◽

Relative Risk Model

A study was carried out to assess the effect of concentrations of particulate matter (PM10), nitrogen dioxide (NO2) and formaldehyde (F) exceeding the MPC on the mortality rate of the population of the city of Krasnoyarsk for 10 years (from 2000 to 2004 and from 2014 to 2018). The relative increase in mortality from exposure to the pollutants under study was determined using the relative risk model.

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Malnutrition Affects Cholesterol Paradox in Coronary Artery Disease: a 41,229 Chinese Cohort Study

10.21203/rs.3.rs-266119/v1 ◽

2021 ◽

Author(s):

Bo Wang ◽

Jin Liu ◽

Shiqun Chen ◽

Ming Ying ◽

Guanzhong Chen ◽

...

Keyword(s):

Cox Regression ◽

Cox Model ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Kaplan Meier ◽

All Cause Mortality ◽

Chinese Cohort ◽

Artery Disease

Abstract Background: Several studies found that baseline low LDL-C concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which was called “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. We objected to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.Method: A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018, and divided into two groups (LDL-C < 1.8 mmol/L, n=4,863; LDL-C ≥ 1.8 mmol/L, n = 36,366). We used Kaplan-Meier method and Cox regression analyses to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result: In this real-world cohort (mean age 62.94 years; 74.94% male), there were 5257 incidents of all-cause death during a median follow-up of 5.20 years [Inter-quartile range (IQR): 3.05-7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low LDL-C level (<1.8mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment of nutritional status, risk of all-cause mortality of patients with low LDL-C level decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).Conclusion: Our results demonstrate that the cholesterol paradox persisted in CAD patients, but disappeared after accounting for the effects of malnutrition.

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