Hypertension and the Risk of All-Cause and Cause-Specific Mortality: An Outcome-Wide Association Study of 67 Causes of Death in the National Health Interview Survey

Background. Few studies have assessed the association between hypertension and risk of detailed causes of death. We investigated the association between hypertension and all-cause mortality and 67 causes of death in a large cohort. Methods. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for self-reported hypertension vs. no hypertension and mortality. Adults aged ≥18 years ( n = 213798 ) were recruited in 1997-2004 and followed through December 31, 2006. Results. During 5.81 years of follow-up, 11254 deaths occurred. Self-reported hypertension vs. no hypertension was associated with increased risk of all-cause mortality ( HR = 1.25 , 95% CI: 1.19-1.31) and mortality from septicemia (HR =1.66, 1.06-2.59), other infectious parasitic diseases ( HR = 2.67 , 1.09-6.51), diabetes mellitus ( HR = 1.97 , 1.45-2.67), circulatory disease ( HR = 1.49 , 1.37-1.61), hypertensive heart disease ( HR = 3.23 , 2.00-5.20), ischemic heart disease ( HR = 1.35 , 1.23-1.49), acute myocardial infarction ( HR = 1.50 , 1.27-1.77), other chronic ischemic heart diseases ( HR = 1.35 , 1.17-1.56), all other forms of heart disease ( HR = 1.51 , 1.21-1.89), primary hypertension and renal disease ( HR = 3.11 , 1.82-5.30), cerebrovascular disease ( HR = 1.64 , 1.37-1.97), other circulatory system diseases ( HR = 1.71 , 1.09-2.69), other chronic lower respiratory diseases ( HR = 1.39 , 1.12-1.73), other chronic liver disease ( HR = 1.89 , 1.06-3.37), renal failure ( HR = 1.91 , 1.33-2.74), motor vehicle accidents ( HR = 1.60 , 1.07-2.37), and all other diseases (HR =1.30, 1.10-1.54), but with lower risk of uterine cancer ( HR = 0.37 , 95% CI: 0.15-0.90) and Alzheimer’s disease ( HR = 0.65 , 95% CI: 0.47-0.92). Conclusion. Hypertension was associated with increased risk of all-cause mortality and 17 out of 67 causes of death, with most of these being circulatory disease outcomes, however, some of the remaining associations are unlikely to be causal. Further studies are needed to clarify associations with less common causes of death and potential causality across outcomes.

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Increased Remnant Cholesterol Explains Part of Residual Risk of All-Cause Mortality in 5414 Patients with Ischemic Heart Disease

Clinical Chemistry ◽

10.1373/clinchem.2015.253757 ◽

2016 ◽

Vol 62 (4) ◽

pp. 593-604 ◽

Cited By ~ 52

Author(s):

Anne-Marie K Jepsen ◽

Anne Langsted ◽

Anette Varbo ◽

Lia E Bang ◽

Pia R Kamstrup ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

Hazard Ratio ◽

Residual Risk ◽

Ischemic Heart ◽

Increased Risk ◽

All Cause Mortality ◽

Remnant Cholesterol

Abstract BACKGROUND Increased concentrations of remnant cholesterol are causally associated with increased risk of ischemic heart disease. We tested the hypothesis that increased remnant cholesterol is a risk factor for all-cause mortality in patients with ischemic heart disease. METHODS We included 5414 Danish patients diagnosed with ischemic heart disease. Patients on statins were not excluded. Calculated remnant cholesterol was nonfasting total cholesterol minus LDL and HDL cholesterol. During 35836 person-years of follow-up, 1319 patients died. RESULTS We examined both calculated and directly measured remnant cholesterol; importantly, however, measured remnant cholesterol made up only 9% of calculated remnant cholesterol at nonfasting triglyceride concentrations <1 mmol/L (89 mg/dL) and only 43% at triglycerides >5 mmol/L (443 mg/dL). Multivariable-adjusted hazard ratios for all-cause mortality compared with patients with calculated remnant cholesterol concentrations in the 0 to 60th percentiles were 1.2 (95% CI, 1.1–1.4) for patients in the 61st to 80th percentiles, 1.3 (1.1–1.5) for the 81st to 90th percentiles, 1.5 (1.1–1.8) for the 91st to 95th percentiles, and 1.6 (1.2–2.0) for patients in the 96th to 100th percentiles (trend, P < 0.001). Corresponding values for measured remnant cholesterol were 1.0 (0.8–1.1), 1.2 (1.0–1.4), 1.1 (0.9–1.5), and 1.3 (1.1–1.7) (trend, P = 0.006), and for measured LDL cholesterol 1.0 (0.9–1.1), 1.0 (0.8–1.2), 1.0 (0.8–1.3), and 1.1 (0.8–1.4) (trend, P = 0.88). Cumulative survival was reduced in patients with calculated remnant cholesterol ≥1 mmol/L (39 mg/dL) vs <1 mmol/L [log-rank, P = 9 × 10−6; hazard ratio 1.3 (1.2–1.5)], but not in patients with measured LDL cholesterol ≥3 mmol/L (116 mg/dL) vs <3 mmol/L [P = 0.76; hazard ratio 1.0 (0.9–1.1)]. CONCLUSIONS Increased concentrations of both calculated and measured remnant cholesterol were associated with increased all-cause mortality in patients with ischemic heart disease, which was not the case for increased concentrations of measured LDL cholesterol. This suggests that increased concentrations of remnant cholesterol explain part of the residual risk of all-cause mortality in patients with ischemic heart disease.

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OP0219 THE ASSOCIATION OF PSORIATIC ARTHRITIS WITH ALL-CAUSE MORTALITY AND LEADING CAUSES OF DEATH IN PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1895 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 131.1-131

Author(s):

A. Haddad ◽

W. Saliba ◽

I. Lavi ◽

A. Batheesh ◽

S. Kasem ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Causes Of Death ◽

Ischemic Heart ◽

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

All Cause Mortality ◽

History Of

Background:Data on the association between PsA and mortality remains conflicting as it has been hampered by small sample size with few events and the potential for confounders of selection and severity biases from clinic-based studies.Objectives:To examine the association between PsA and all-cause mortality in a cohort of PsA patients and matched controls, using data from a population-based large medical record database.Methods:Patients with newly diagnosis of PsA between January 1st, 2003 and December 31st, 2018 from the Clalit Health database were identified. 4 controls without PsA were selected and matched to cases of PsA by age (within 1 year), sex, ethnicity (Jewish vs. non-Jewish), and index date. The two groups were followed from the index date until the first occurrence of death from any cause or end of follow-up (June 30, 2019). Data on mortality and on the immediate cause of death was based on the Notification of Death form legally required by the Israeli Ministry of the Interior for every deceased person in the country. Demographic data including age, sex, ethnicity (Jewish or Arab), and socioeconomic status (SES) at inception were retrieved from the CHS database. Data regarding tobacco use (ever), obesity, body mass index, diabetes mellitus, hyperlipidemia, hypertension, ischemic heart disease, prior cerebrovascular accident, congestive heart failure, chronic renal failure, chronic obstructive pulmonary disease, cirrhosis, prior malignancy, psoriasis, and the concomitant use of glucocorticosteroids, conventional and biologic disease-modifying anti-rheumatic drugs (cDMARDs and bDMARDs, respectively) were extracted from the database.We estimated the attributable fraction of the various causes of death in PsA patients and compared it to the proportionate mortality rate (PMR) of the leading causes of death in Israel during 2014-2016 based on a recently published report by the Central Bureau of Statistics. Cox proportional hazard regression models were used to estimate the crude and the multivariate adjusted hazard ratio (HR) for the association between PsA and all-cause mortality, as well as for factors associated with mortality within the PsA group.Results:A total of 5275 PsA patients were identified between 2003 and 2018 and where matched to 21,011 controls based on age, sex, and ethnicity. The mean age was 51.7 ± 15.4 years of whom 53% were females. More individuals in the PsA group were smokers, obese, with diabetes, hypertension, and dyslipidemia, as well as with a history of ischemic heart disease, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure and cirrhosis than patients in the control group, and 38.2% of PsA patients were on b-DMARDS. Overall 471 (8.9%) patients died in the PsA group compared to 1,668 (7.9%) in the control group during a mean follow-up of 7.2 ± 4.4 years. The crude HR for the association of PsA and all-cause mortality was 1.16 (95% CI, 1.042-1.29). However, the association was not significant on multivariate analysis with HR of 1.096 (95% CI, 0.977-1.229).In PsA patients, malignancy was the leading cause of death, constituting 26% of all deaths, followed by ischemic heart disease 15.8%, diabetes 6.2%, cerebrovascular diseases 5.5% and septicemia 5.5%, in keeping with the order of the leading causes of death in the general population of Israel during 2014-2016 as recently reported by the Central Bureau of Statistics.On multivariate model Cox regression analysis, male sex, increased body mass index, increased Charlson comorbidity index scores and history of hospitalization in a year prior to death were associated with higher mortality, whereas treatment bDMARDs and cDMARDs were associated with a lower relative risk of death.Conclusion:No clinically relevant increase in mortality rate was observed in PsA patients from the period 2003-2018. The most common causes of specific proportionate mortality rates in our cohort were similar to those in the general population.Disclosure of Interests:None declared

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Abstract 9690: Does Testosterone Therapy Increase Risk of Cardiovascular Event Among Men? A Meta-Analysis

Circulation ◽

10.1161/circ.130.suppl_2.9690 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

nader makki ◽

Wassef Karrowni ◽

Wassef Karrowni

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Cardiovascular Events ◽

Meta Analysis ◽

Ischemic Heart ◽

Sensitivity Analyses ◽

Industry Funding ◽

Testosterone Therapy ◽

Increased Risk ◽

All Cause Mortality

Background: Testosterone therapy has been increasingly promoted and prescribed over the past decade. However, there is rising concern about its safety, and randomized data adequately powered to assess its effect on cardiovascular outcomes is not available. Aim: We conducted a meta-analysis and systematic review of published randomized and observational studies to examine the overall risk of cardiovascular events associated with testosterone therapy. Methods: We searched Medline (1966-2014), Embase (1966-2014), and Cochrane central (2000-2014). Data was collected and analyzed using random and fixed effect model, as appropriate, with inverse variance weighting. Results: Of 2,800 studies identified, 34 were eligible including 76,270 patients with a mean follow up of 11.7 months. Testosterone therapy was associated with increased risk of cardiovascular events (adjusted HR=1.41, 95% CI = 1.18-1.70, p<0.05), all-cause mortality (adjusted HR=1.51, 95% CI = 1.05-2.18, p<0.05), and ischemic heart disease (adjusted HR=1.32, 95% CI = 1.11-1.57, p<0.05), but not cerebrovascular events (adjusted HR=1.22, 95% CI = 0.98-1.53, p=0.08). Using meta-regression and sensitivity analyses to account for factors such as baseline cardiovascular disease, timing of testosterone collection, and industry funding did not change the results of our main analysis. Conclusions: Our meta-analysis demonstrates that testosterone therapy may be associated with increased risk of all-cause mortality, cardiovascular events, and ischemic heart disease.

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Effects of Hormone Therapy on survival, cancer, cardiovascular and dementia risks in 1.5 million women over age 65: a retrospective observational study

10.22541/au.161873076.60547427/v1 ◽

2021 ◽

Author(s):

Seo Baik ◽

Clement McDonald

Keyword(s):

Observational Study ◽

Hormone Therapy ◽

Heart Diseases ◽

Significant Risk ◽

Ischemic Heart ◽

Retrospective Observational Study ◽

High Dose ◽

Ischemic Heart Diseases ◽

Increased Risk ◽

All Cause Mortality

Objectives: To examine the effects of estrogen on all-cause mortality, cancers, cardiovascular (CV) conditions, and dementia. Design: Retrospective observational study Setting: United States 2007-2018 Population: 1.5 million women aged over 65 in Medicare. Method: Cox regression with time-varying estrogen type, route, and strength as well as patient’s characteristics. Main Outcome(s): all-cause mortality; 5 cancers- breast, lung, endometrial, colorectal, ovarian cancers; 6 CV conditions- ischemic heart diseases, heart failure, venous thromboembolism, stroke, atrial fibrillation, acute myocardial infarction; and dementia. Results: Compared to counterparts, estrogen monotherapy (ET) exhibited a significant, 21% (HR=0.79; 95% CI 0.77-0.81), reduction in mortality risk. The reduction was greater with estradiol (HR=0.76; 95% CI 0.73-0.78) than conjugated estrogen (HR=0.83; 95% CI 0.80-0.86), and with topical (HR=0.69; 95% CI 0.66-0.71) than oral preparations (HR=0.86; 95% CI 0.83-0.89). ET also exhibited significant risk reductions for all study cancers, breast (HR=0.83; 95% CI 0.80-0.85), lung (HR=0.89; 95% CI 0.85-0.93), endometrial (HR=0.68; 95% CI 0.63-0.73), colorectal (HR=0.87; 95% CI 0.82-0.92) and ovarian (HR=0.86; 95% CI 0.80-0.92). Different dose levels exhibited similar risk reduction in mortality and cancers. ET slightly increased the overall CV risk, mostly risks of ischemic heart diseases and stroke. However, such risks occurred with CEE, oral, and high dose ET. Both combination therapy (HR=1.19; 95% CI 1.08-1.31) and progestogen monotherapy (HR=1.16; 95% CI 1.08-1.26) exhibited a significantly increased risk of breast cancer. No HT exhibited an increased risk of dementia. Conclusions: Among senior female Medicare beneficiaries, the effect of hormone therapy varies by type, route, and strength of estrogen.

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The Association between Sarcoidosis and Ischemic Heart Disease—A Healthcare Analysis of a Large Israeli Population

Journal of Clinical Medicine ◽

10.3390/jcm10215067 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5067

Author(s):

Tal Gonen ◽

Daphna Katz-Talmor ◽

Howard Amital ◽

Doron Comaneshter ◽

Arnon D. Cohen ◽

...

Keyword(s):

Survival Analysis ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Ischemic Heart ◽

Rank Test ◽

Increased Risk ◽

All Cause Mortality ◽

Long Term Follow Up

(1) Background: Inflammation plays a pivotal role in atherosclerosis, and the association between chronic inflammatory states and ischemic heart disease (IHD) has been shown in several rheumatic diseases. Persistent inflammation might also be a risk factor for IHD in sarcoidosis patients. (2) Methods: Demographic and clinical data of 3750 sarcoidosis patients and 18,139 age- and sex-matched controls were retrieved from the database of Clalit Health Services, Israel’s largest healthcare organization. Variables associated with IHD were assessed by a logistic regression model. To assess for variables that were related to increased risk of all-cause mortality, the Cox proportional hazards method was used, and a log-rank test was performed for survival analysis. (3) Results: Both groups were composed of 64% females with a median age of 56 years. An association between sarcoidosis and IHD was demonstrated by a multivariate analysis (adjusted odds ratio (OR) 1.5; 95% confidence interval (CI) 1.36–1.66). Long-term follow-up revealed increased mortality among sarcoidosis patients: 561 (15%) deaths compared to 1636 (9%) deaths among controls (p < 0.001). Survival analysis demonstrated that sarcoidosis patients were also at increased risk for all-cause mortality compared to controls (multivariate model, adjusted HR 1.93; 95% CI 1.76–2.13).

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Role of depressive symptoms in cardiometabolic diseases and subsequent transitions to all-cause mortality: an application of multistate models in a prospective cohort study

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000693 ◽

2021 ◽

pp. svn-2020-000693

Author(s):

Yanan Qiao ◽

Siyuan Liu ◽

Guochen Li ◽

Yanqiang Lu ◽

Ying Wu ◽

...

Keyword(s):

Heart Disease ◽

Depressive Symptoms ◽

Depression Scale ◽

European Population ◽

Multistate Models ◽

Cardiometabolic Diseases ◽

Increased Risk ◽

All Cause Mortality ◽

Patients With Diabetes

Background and purposeThe role of depression in the development and outcome of cardiometabolic diseases remains to be clarified. We aimed to examine the extent to which depressive symptoms affect the transitions from healthy to diabetes, stroke, heart disease and subsequent all-cause mortality in a middle-aged and elderly European population.MethodsA total of 78 212 individuals aged ≥50 years from the Survey of Health Ageing and Retirement in Europe were included. Participants with any baseline cardiometabolic diseases including diabetes, stroke and heart disease were excluded. Depressive symptoms were measured by the Euro-Depression scale at baseline. Participants were followed up to determine the occurrence of cardiometabolic diseases and all-cause mortality. We used multistate models to estimate the transition-specific HRs and 95% CIs after adjustment of confounders.ResultsDuring 500 711 person-years of follow-up, 4742 participants developed diabetes, 2173 had stroke, 5487 developed heart disease and 7182 died. Depressive symptoms were significantly associated with transitions from healthy to diabetes (HR: 1.12, 95% CI: 1.05 to 1.20), stroke (HR: 1.31, 95% CI: 1.18 to 1.44), heart disease (HR: 1.26, 95% CI: 1.18 to 1.34) and all-cause mortality (HR: 1.41, 95% CI: 1.34 to 1.49). After cardiometabolic diseases, depressive symptoms were associated with the increased risk of all-cause mortality in patients with diabetes (HR: 1.54, 95% CI: 1.25 to 1.89), patients who had stroke (HR: 1.29, 95% CI: 1.03 to 1.61) and patients with heart disease (HR: 1.21, 95% CI: 1.02 to 1.44).ConclusionsDepressive symptoms increase the risk of diabetes, stroke and heart disease, and affect the risk of mortality after the onset of these cardiometabolic conditions. Screening and treatment of depressive symptoms may have profound implications for the prevention and prognosis of cardiometabolic diseases.

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Hemodialysis patients with better coronary flow reserve and nutrition status have surprising prognosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1269 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Imaoka ◽

N Umemoto ◽

S Oshima

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Coronary Flow Reserve ◽

Coronary Flow ◽

Ischemic Heart ◽

Nutrition Status ◽

Flow Reserve ◽

All Cause Mortality ◽

Conventional Risk Factors

Abstract Background In clinical setting, ischemic heart disease is a challenging problem in hemodialysis (HD) population. Coronary flow reserve (CFR) measured by 13 ammonia positron emitting tomography (13NH3PET) is an established and reliable modality for detecting coronary artery disease. Furthermore, some prior studies show CFR is an important and independent predictor for cardiovascular event and mortality. On the other hand, HD patients with malnutrition status have poor prognosis. We have reported about the relationship between cardiovascular events and geriatric nutrition risk index (GNRI). Now, we wonder the predictability of combination of CFR and GNRI. Methods and result We collected 438 consecutive HD patients who received 13NH3PET in our hospital suspected for ischemic heart disease. 29 patients were excluded due to undergoing coronary revascularization within 60 days, 103 patients were excluded due to incomplete database. In total, 306 HD patients were classified into 4 group according the median value of CFR (1.99) and GNRI (97.73); Low CFR Low GNRI group (n=77), High CFR and Low GNRI group (n=76), Low CFR High GNRI group (n=78) and High CFR High GNRI group (n=75). We collected their follow up data up to 1544 days (median 833 days) about all-cause mortality and cardiovascular (CV) mortality. Surprisingly, there is no mortality event in High CFR High GNRI group. We analyzed about all-cause mortality, CV mortality. Kaplan-Meyer analysis shows there are statistically intergroup differences in each (all-cause mortality; log rank p<0.01, CV mortality; log rank p=0.02). Furthermore, we calculated area under the curve (AUC) analysis, net reclassification improvement (NRI) and integrated discrimination improvement (IDI)m adding GNRI and CFR on conventional risk factors. There are intergroup differences for all-cause mortality in AUC [conventional risk factors, +GNRI, +GNRI+CFR; 0.70, 0.72 (p=0.29), 0.79 (p<0.01)], NRI [+GNRI; 0.32 (p=0.04), +GNRI+CFR 0.82 (p<0.01)] and IDI [+GNRI; 0.01 (p=0.05), +GNRI+CFR 0.09 (p<0.01)]. Conclusion HD patients with low CFR and malnutrition status has statistically significant poorer prognosis comparing HD patients with high CFR and without malnutrition status. Adding combination of GNRI and CFR on conventional risk factors improves the predictability of HD population's prognosis. Funding Acknowledgement Type of funding source: None

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