Renal Function and Death in Older Women: Which eGFR Formula Should We Use?

Background. The Berlin Initiative Study (BIS) eGFR equations were developed specifically for aged populations, but their predictive validity compared to standard formulae is unknown in older women.Methods. In a prospective study of 1289 community-dwelling older women (mean age 79.5 years), we compared the performance of the BIS1 SCr-based equation to the CKD-EPIcrand the BIS2 SCr- and Scysc-based equation to the CKD-EPIcr,cyscto predict cardiovascular and all-cause mortality.Results. Prevalence of specific eGFR category (i.e., ≥75, 60–74, 45–59, and <45) according to eGFR equation was 12.3%, 38.4%, 37.3%, and 12.0% for BIS1; 48.3%, 27.8%, 16.2%, and 7.8% for CKD-EPIcr; 14.1%, 38.6%, 37.6%, and 9.6% for BIS2; and 33.5%, 33.4%, 22.0%, and 11.1% for CKD-EPIcr,cysc, respectively. Over9±4years, 667 (51.8%) women died. For each equation, women with eGFR <45 were at increased risk of mortality compared to eGFR ≥75 [adjusted HR (95% CI): BIS1, 1.5 (1.1–2.0); CKD-EPIcr, 1.7 (1.3–2.2); BIS2, 2.0 (1.4–2.8); CKD-EPIcr,cysc, 1.8 (1.4–2.3);p-trend <0.01]. Net reclassification analyses found no material difference in discriminant ability between the BIS and CKD-EPI equations. Results were similar for cardiovascular death.Conclusions. Compared to CKD-EPI, BIS equations identified a greater proportion of older women as having CKD but performed similarly to predict mortality risk. Thus, the BIS equations should not replace CKD-EPI equations to predict risk of death in older women.

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Sudden death in patients with sleep apnea: a systematic review and meta-analysis

10.1101/2020.05.06.20093641 ◽

2020 ◽

Author(s):

Emily S. Heilbrunn ◽

Paddy Ssentongo ◽

Vernon M. Chinchilli ◽

Anna E. Ssentongo

Keyword(s):

Sleep Apnea ◽

Sudden Death ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Cardiac Mortality ◽

Risk Of Death ◽

Risk Of Mortality ◽

Obstructive Sleep ◽

Increased Risk ◽

All Cause Mortality

AbstractBackgroundOver 1 billion individuals across the globe experience some form of sleep apnea, and this number is steadily rising. Obstructive sleep apnea (OSA) can negatively influence one’s quality of life and potentially increase the risk of mortality. However, this association between OSA and mortality has not been comprehensively and thoroughly explored. This meta-analysis was conducted to conclusively estimate the risk of death for all-cause mortality and cardiovascular mortality in OSA patients.Study Design4,613 articles from databases including PUBMED, OVID & Joana Briggs, and SCOPUS were comprehensively assessed by two reviewers (AES & ESH) for inclusion criteria. 28 total articles were included, with 22 of them being used for quantitative analysis. Pooled effects of all-cause mortality, cardiac mortality, and sudden death were calculated by utilizing the metaprop function in R Statistical Software and the random-effects model with appropriate 95% confidence intervals.ResultsAnalysis on 42,032 individuals revealed that those with OSA were twice as likely to die from cardiac mortality compared to those without sleep apnea (HR= 1.94, 95%CI 1.39-2.70). Likewise, individuals with OSA were 1.7 times as likely to die from all-cause sudden death compared to individuals without sleep apnea (HR= 1.74, 95%CI 1.40-2.10). There was a significant dose response relationship between severity of sleep apnea and incidence risk of death, where those with severe sleep apnea wereConclusionsIndividuals with obstructive sleep apnea are at an increased risk for all-cause mortality and cardiac mortality. Further research related to appropriate interventions and treatments are necessary in order to reduce this risk and optimize survival in this population.Key MessagesWhat is the key question?Are individuals with sleep apnea at an increased risk for cardiovascular mortality and sudden death?What is the bottom Line?Sleep apnea is associated with an increased risk of cardiovascular mortality and sudden death, with a dose response relationship, where those with severe sleep apnea are at the highest risk of mortality.Why read on?This is the first systematic review and meta-analyses to synthesize and quantify the risk of mortality in those with sleep apnea, highlighting important directions for future research.Prospero Registration IDCRD42020164941

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Association of Longitudinal Change in High-Sensitivity Troponin with All-Cause Mortality in Coronary Artery Disease: The Heart and Soul Study

Cardiology ◽

10.1159/000503954 ◽

2020 ◽

Vol 145 (2) ◽

pp. 63-70

Author(s):

Yaanik B. Desai ◽

Rakesh K. Mishra ◽

Qizhi Fang ◽

Mary A. Whooley ◽

Nelson B. Schiller

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

High Sensitivity ◽

Community Dwelling ◽

Longitudinal Change ◽

Clinical Variables ◽

Risk Of Death ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease

Background: Serial increases in high-sensitivity cardiac troponin (hs-cTnT) have been associated with death in community-dwelling adults, but the association remains uninvestigated in those with coronary artery disease (CAD). Methods: We measured hs-cTnT at baseline and after 5 years in 635 ambulatory Heart and Soul Study patients with CAD. We also performed echocardiography at rest and after treadmill exercise at baseline and after 5 years. Participants were subsequently followed for the outcome of death. We used a multivariable-adjusted Cox proportional hazards model to evaluate the association between 5-year change in hs-cTnT and subsequent all-cause mortality. Results: Of the 635 subjects, there were 386 participants (61%) who had an increase in hs-cTnT levels between baseline and year 5 measurements (median increase 5.6 pg/mL, IQR 3.2–9.9 pg/mL). There were 182 deaths after a mean 4.2-year follow-up after the year 5 visit. After adjusting for clinical variables, a >50% increase in hs-cTnT between baseline and year 5 was associated with a nearly 2-fold increased risk of death from any cause (hazard ratio 1.7, 95% confidence interval 1.1–2.7). When addition of year 5 hs-cTnT was compared to a model including clinical variables and baseline hs-cTnT, there was a modest but statistically significant increase in C-statistic from 0.82 to 0.83 (p = 0.04). Conclusion: In ambulatory patients with CAD, serial increases in hs-cTnT over time are associated with an increased risk of death.

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Abstract P017: Serum N-Carboxymethyl-Lysine and Risk of Mortality in Older Adults

Circulation ◽

10.1161/circ.129.suppl_1.p017 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Mary Lou Biggs ◽

David Benkeser ◽

Joachim Ix ◽

Jorge Kizer ◽

Luc Djousse ◽

...

Keyword(s):

Renal Failure ◽

Mortality Risk ◽

Community Dwelling ◽

Cardiovascular Health Study ◽

Risk Of Death ◽

Risk Of Mortality ◽

Organ Systems ◽

Increased Risk ◽

Carboxymethyl Lysine ◽

The Mean

Advanced glycation end products (AGEs) are compounds formed by the non-enzymatic glycation of proteins, lipids, and nucleic acids, and are thought to play a role in the pathogenesis of diseases across multiple organ systems. Carboxymethyl-lysine (CML) is a dominant AGE found in tissue proteins and in the circulation, and a commonly used AGE biomarker. Only a few epidemiological studies have evaluated the association between circulating CML and mortality risk, and none have evaluated the association between CML and cause-specific non-CVD mortality. We measured CML by ELISA on serum specimens collected from 3,373 Cardiovascular Health Study participants in 1996. Participants were followed for death through 2010, and cause of death was classified using death certificates, medical records, and proxy interview. We used Cox regression to estimate the relative risk of total and cause-specific mortality associated with circulating CML, adjusting for confounders (Models 1 & 2) and estimated glomerular filtration rate (eGFR) as a potential mediator (Model 3). We tested whether sex or diabetes modified the association between CML and mortality. The mean age among participants was 78 years and 60% were women. The mean CML level among participants was 629 ng/mL. Over median follow-up of 10 years, 2,322 deaths occurred (73.4 per 1,000 person-years). After adjustment for confounders (Models 1 & 2), CML was associated with an increased risk of death from CVD, dementia, infection, fracture/trauma, and renal failure (Table). Aside from renal failure, adjustment for eGFR attenuated the HR estimates modestly. There was no evidence for effect modification of the association of CML and all-cause mortality risk by sex or diabetes. In a cohort of community-dwelling older individuals, elevated circulating CML was associated with increased risk of mortality from cardiovascular causes, dementia, infection, fracture/trauma, and renal failure. A portion of the increased risk may be mediated through decreased renal function.

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Abstract 17216: Upright T Wave in Lead AVR and Risk of Mortality: A Systematic Review and Meta-Analysis

Circulation ◽

10.1161/circ.142.suppl_3.17216 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

laith A derbas ◽

Raed Qarajeh ◽

Anas Noman ◽

Mohammed Al Amoodi ◽

Ala Mohsen ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Meta Analysis ◽

Adverse Outcomes ◽

Risk Scores ◽

Risk Of Death ◽

T Wave ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Lead Avr

Background: Multiple observational studies have shown that positive T wave in lead AVR (PTAVR) on 12-lead electrocardiogram is associated with an increased risk of adverse outcomes including death. We sought to review the literature and conduct a meta-analysis to estimate the risk of mortality in patients with PTAVR. Methods: We searched multiple databases to investigate the association between PTAVR and risk of death. Studies that reported adjusted odds ratio (OR) or hazards ratio (HR) of the association between PTAVR and risk of death (all cause or cardiovascular mortality) were included. We used inverse variance approach to pool adjusted OR /HR and it’s 95 % confidence interval using a random effects model meta-analysis. Results: Out of 140 relevant studies, 17 studies were eligible. Twelve studies reported all-cause mortality and enrolled 4,122 patients, 1976 (47.9%) were males. PTAVR was associated with a significant increase in all-cause mortality, with a pooled adjusted OR 2.44, 95% CI [1.76-3.39], heterogeneity I 2 = 86%. Five studies reported cardiovascular mortality and enrolled 31,713 patients, 27,628 (87.1%) were males. PTAVR was associated with a significant increase in cardiovascular mortality, with a pooled adjusted OR 2.34, 95% CI [1.82-3.0], heterogeneity I 2 = 68%. Conclusion: Our findings suggest that PTAVR is significantly associated with a higher risk of death from any cause as well cardiovascular mortality. Lead AVR, an often neglected lead, should be carefully interpreted as it may provide important prognostic information. Further studies are warranted to examined the prognostic value of PTAVR in risk stratification when added to existing cardiovascular risk scores.

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The Influence of Apparent Temperature on Mortality in the Kintampo Health and Demographic Surveillance Area in the Middle Belt of Ghana: A Retrospective Time-Series Analysis

Journal of Environmental and Public Health ◽

10.1155/2020/5980313 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Kenneth Wiru ◽

Felix Boakye Oppong ◽

Oscar Agyei ◽

Charles Zandoh ◽

Obed Ernest Nettey ◽

...

Keyword(s):

Relative Risk ◽

Apparent Temperature ◽

Extreme Weather Events ◽

Diurnal Changes ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Lag Period ◽

Related Mortality

Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. Here, we assessed the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship using mortality and weather data archived over an eleven-year period. An overdispersed Poisson regression and distributed lag nonlinear models were used for this analysis. With these models, we analysed the relative risk of mortality at different temperature values over a 10-day lag period. By and large, we observed a nonlinear association between mean daily apparent temperature and all-cause mortality. An assessment of different temperature values over a 10-day lag period showed an increased risk of death at the lowest apparent temperature (18°C) from lag 2 to 4 with the highest relative risk of mortality (RR = 1.61, 95% CI: 1.2, 2.15, p value = 0.001) occurring three days after exposure. The relative risk of death also varied between males (RR = 0.31, 95% CI: 0.10, 0.94) and females (RR = 4.88, 95% CI: 1.40, 16.99) by apparent temperature and lag. On the whole, males are sensitive to both temperature extremes whilst females are more vulnerable to low temperature-related mortality. Accordingly, our findings could inform efforts at reducing temperature-related mortality in this context and other settings with similar environmental and demographic characteristics.

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The Influence of Education and Apolipoprotein ε4 on Mortality in Community-Dwelling Elderly Men and Women

Journal of Aging Research ◽

10.1155/2018/6037058 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Duke Appiah ◽

Richard N. Baumgartner

Keyword(s):

College Education ◽

The Elderly ◽

Community Dwelling ◽

Elderly Men ◽

Risk Of Death ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Mortality Hazard Ratio ◽

Apolipoprotein E Genotype

We investigated the risk of death in relation to the apolipoprotein ε4 allele and evaluated how it interacts with education in 504 elderly adults (mean age 73 years, 65.3% women) who were enrolled in 1993 into the New Mexico Aging Process Study. During 9 years of follow-up, apolipoprotein ε2 appeared to be associated with a lower risk for all-cause mortality (hazard ratio (HR) = 0.73, 95% confidence interval (CI): 0.30–1.71) compared to apolipoprotein ε3 carriers in models adjusted for age, sociodemographic variables, medical conditions, adiposity, and lifestyle factors. The apolipoprotein ε4 allele conferred almost a threefold elevated risk of mortality (HR = 2.76, CI: 1.42–5.37). An interaction between education and apolipoprotein e4 (p=0.027) was observed with the HR of mortality among e4 carriers compared to noncarriers being 1.59 (0.64–3.96) for those with ≥college education; 6.66 (1.90–23.4) for those with some college or trade; and 14.1 (3.03–65.6) for participants with ≤high school education. No significant interaction was identified between apolipoprotein E genotype and cognitive function for mortality risk. These findings suggest that genetic (apolipoprotein ε4) and environmental (education) factors act interactively to influences survival in the elderly with higher education attenuating the adverse effect of apolipoprotein ε4 on mortality.

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Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study

European Heart Journal ◽

10.1093/eurheartj/ehz071 ◽

2019 ◽

Vol 40 (25) ◽

pp. 2021-2028 ◽

Cited By ~ 9

Author(s):

Antonios Douros ◽

Markus Tölle ◽

Natalie Ebert ◽

Jens Gaedeke ◽

Dörte Huscher ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Cardiovascular Events ◽

Antihypertensive Treatment ◽

Antihypertensive Drugs ◽

Community Dwelling ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

Abstract Aims To assess whether blood pressure (BP) values below 140/90 mmHg during antihypertensive treatment are associated with a decreased risk of all-cause mortality in community-dwelling older adults. Methods and results Within the Berlin Initiative Study, we assembled a cohort of patients ≥70 years treated with antihypertensive drugs at baseline (November 2009–June 2011). End of prospective follow-up was December 2016. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality associated with normalized BP [systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg] compared with non-normalized BP (SBP ≥140 mmHg or DBP ≥90 mmHg) overall and after stratification by age or previous cardiovascular events. Among 1628 patients (mean age 81 years) on antihypertensive drugs, 636 exhibited normalized BP. During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with an increased risk of all-cause mortality (incidence rates: 60.3 vs. 48.5 per 1000/year; HR 1.26; 95% CI 1.04–1.54). Increased risks were observed in patients ≥80 years (102.2 vs. 77.5 per 1000/year; HR 1.40; 95% CI 1.12–1.74) and with previous cardiovascular events (98.3 vs. 63.6 per 1000/year; HR 1.61; 95% CI 1.14–2.27) but not in patients aged 70–79 years (22.6 vs. 22.7 per 1000/year; HR 0.83; 95% CI 0.54–1.27) or without previous cardiovascular events (45.2 vs. 44.4 per 1000/year; HR 1.16, 95% CI 0.90–1.48). Conclusion Blood pressure values below 140/90 mmHg during antihypertensive treatment may be associated with an increased risk of mortality in octogenarians or elderly patients with previous cardiovascular events.

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Frailty Status and All-Cause Mortality in the Community-Dwelling Older People: An Umbrella Review

Innovation in Aging ◽

10.1093/geroni/igaa057.1580 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 488-489

Author(s):

A R M Saifuddin Ekram ◽

Joanne Ryan ◽

Carlene Britt ◽

Sara Espinoza ◽

Robyn Woods

Keyword(s):

Older People ◽

Systematic Reviews ◽

Community Dwelling ◽

Umbrella Review ◽

Frailty Phenotype ◽

Frailty Status ◽

Increased Risk ◽

All Cause Mortality ◽

Community Dwelling Older People ◽

Meta Analyses

Abstract Frailty is increasingly recognised for its association with adverse health outcomes including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aimed to map which frailty scale could best predict the relationship between frailty and all-cause mortality among community-dwelling older people. According to the PRISMA guidelines, Medline, Embase, EBSCOhost and Web of Science databases were searched to identify eligible systematic reviews and meta-analyses which examined the association between frailty and all-cause mortality in the community-dwelling older people. Relevant data were extracted and summarised qualitatively. Methodological quality was assessed by AMSTAR-2 checklist. Five moderate-quality systematic reviews with a total of 374,529 participants were identified. Of these, two examined the frailty phenotype and its derivatives, two examined the cumulative deficit models and the other predominantly included studies assessing frailty with the FRAIL scale. All of the reviews found a significant association between frailty status and all-cause mortality. The magnitude of association varied between individual studies, with no consistent pattern related to the frailty measures that were used. In conclusion, regardless of the measure used to assess frailty status, it is associated with an increased risk of all-cause mortality.

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416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease

International Psychogeriatrics ◽

10.1017/s1041610220002690 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 132-132

Author(s):

Liliana P. Ferreira ◽

Núria Santos ◽

Nuno Fernandes ◽

Carla Ferreira

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Adverse Events ◽

Mortality Risk ◽

Antipsychotic Treatment ◽

Serious Adverse Events ◽

Risk Of Death ◽

Mesh Terms ◽

Risk Of Mortality ◽

Increased Risk

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

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Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2020-215322 ◽

2021 ◽

pp. thoraxjnl-2020-215322

Author(s):

Hyun Woo Lee ◽

Chang-Hwan Yoon ◽

Eun Jin Jang ◽

Chang-Hoon Lee

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Severe Disease ◽

Renin Angiotensin System ◽

Angiotensin Ii Receptor ◽

Angiotensin System ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Receptor Blockers

BackgroundThe association of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) with disease severity of patients with COVID-19 is still unclear. We conducted a systematic review and meta-analysis to investigate if ACEI/ARB use is associated with the risk of mortality and severe disease in patients with COVID-19.MethodsWe searched all available clinical studies that included patients with confirmed COVID-19 who could be classified into an ACEI/ARB group and a non-ACEI/ARB group up until 4 May 2020. A meta-analysis was performed, and primary outcomes were all-cause mortality and severe disease.ResultsACEI/ARB use did not increase the risk of all-cause mortality both in meta-analysis for 11 studies with 12 601 patients reporting ORs (OR=0.52 (95% CI=0.37 to 0.72), moderate certainty of evidence) and in 2 studies with 8577 patients presenting HRs. For 12 848 patients in 13 studies, ACEI/ARB use was not related to an increased risk of severe disease in COVID-19 (OR=0.68 (95% CI=0.44 to 1.07); I2=95%, low certainty of evidence).ConclusionsACEI/ARB therapy was not associated with increased risk of all-cause mortality or severe manifestations in patients with COVID-19. ACEI/ARB therapy can be continued without concern of drug-related worsening in patients with COVID-19.

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