Abstract 19: Pericardial Fat Volume is Associated with Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Susan R Heckbert ◽  
Kerri L Wiggins ◽  
Chad Blackshear ◽  
Benjamin F Banahan ◽  
Yi Yang ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Cox Regression ◽  
Renin Angiotensin System ◽  
Fee For Service ◽  
Pericardial Fat ◽  
Adjusted Risk ◽  
Race Ethnicity ◽  
Underlying Mechanisms ◽  
Fat Volume

Introduction: Obesity is associated with higher risk of incident AF, but the underlying mechanisms are not well understood. Increased pericardial fat deposition may lead to atrial fibrosis and renin-angiotensin system activation due to free diffusion of cytokines into the thin atrial wall, promoting AF development. Little is known about the association of pericardial fat volume with incident AF. Hypothesis: We assessed the hypothesis that greater pericardial fat volume is associated with higher AF risk in MESA and JHS, overall and in four race/ethnic groups. Methods: Pericardial fat volume was measured on chest CT scans (performed 2000-02 in MESA, 2007-09 in JHS) in 18 2.5-mm slices, from 1.5 cm above to 3.0 cm below the superior extent of the left main coronary artery, using Volume Analysis software (GE Healthcare, Waukesha, WI). Data were combined across the 2 studies. Participants with prevalent AF before the scan were excluded. Incident AF was identified by hospital discharge diagnosis codes for AF or atrial flutter, by study ECG at a follow-up visit, or, for those enrolled in fee-for-service Medicare, by an inpatient or outpatient claim with an AF diagnosis in any position. We used Cox regression to estimate adjusted hazard ratios for incident AF. Results: A total of 8056 participants (6681 in MESA; 1375 in JHS) had pericardial fat volume measured and were followed for clinical events. Among MESA participants, 1855 were AA, 2568 white, 1470 Hispanic, and 788 Chinese; all JHS participants were AA. In the combined data, the average age was 62 years; 55% were women. Greater pericardial fat volume was associated with male sex, older age, white or Hispanic race/ethnicity, greater BMI and systolic blood pressure (SBP), treated hypertension (HTN), impaired fasting glucose, and diabetes mellitus. Despite more obesity, AA participants had on average the lowest pericardial fat volume. During an average of 9 years of follow-up in MESA and 4 years in JHS, a total of 614 cases of incident AF were identified. Whites had the highest unadjusted AF incidence and AA the lowest. In all 4 race/ethnic groups, pericardial fat volume was positively associated with unadjusted AF incidence. After adjustment for age, sex, race/ethnicity, and study, greater pericardial fat volume was associated with higher risk of incident AF (HR=1.17 per SD pericardial fat volume [41 ml], 95% CI 1.09-1.26). After further adjustment for BMI, height, diabetes, SBP, and treated HTN, the association was attenuated (HR 1.06 per SD, 95% CI 0.97-1.16). Associations did not differ in subgroups defined by sex, race/ethnicity, or study. Conclusion: Greater deposition of fat in the pericardium is associated with higher AF incidence and higher adjusted risk of incident AF. Much of this association appears to be related to obesity, diabetes, and HTN. Lower average pericardial fat volume may explain in part the observed lower AF incidence in AA than in whites.

Abstract 50: Persistent Racial/Ethnic Disparities Despite Declining Rates of Ischemic Stroke Hospitalizations Among Medicare Beneficiaries, 2001-2013

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Tatjana Rundek ◽  
Larry B Goldstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ethnic Groups ◽  
Mixed Model ◽  
Systems Of Care ◽  
Ethnic Disparities ◽  
Fee For Service ◽  
Hospitalization Rates ◽  
The Us ◽  
Race Ethnicity ◽  
Racial Ethnic

Background: Stroke hospitalizations in the US have declined over the last decade, but little is known about whether decreases are similar across racial/ethnic groups. We compared ischemic stroke hospitalization rates and geographic patterns across the US from 2001-2013 for elderly Hispanics, Blacks, Whites, and those of other race/ethnicity. Methods: Ischemic stroke hospitalizations (ICD-9 primary discharge codes 433, 434, 436) were identified among Medicare fee-for-service beneficiaries aged ≥65y in 2001-2003 and 2011-2013. National annualized rates for each period were calculated per 100,000 person-years (PY). A spatial mixed model with a Poisson link function and adjustment for age and sex was fit to calculate and map county-specific risk-standardized stroke hospitalization rates for each racial/ethnic group. Results: National annualized stroke hospitalization rates decreased by 15% between 2001-2003 and 2011-2013 (1298/100,000 PY to 1103/100,000 PY). County-level risk-standardized hospitalization rates varied across the US and among the four racial/ethnic groups (figure). Regardless of time period, Blacks had the highest rates, followed by Whites, Hispanics, and other races. The absolute and relative declines in risk-standardized hospitalization rates were smallest for Hispanics (173/100,000 PY; 15%) and Blacks (196/100,000 PY; 12%) compared to Whites (243/100,000 PY; 19%) and other races (273/100,000 PY; 33%). Conclusions: Although national hospitalization rates for ischemic stroke among those aged ≥65y decreased between 2001 and 2013, the decline varied by race/ethnicity, with persistent disparities between groups. Despite the declines in US stroke hospitalizations, these racial/ethnic differences call for greater prioritization of prevention intervention programs to reduce stroke disparities. AHA/ASA efforts to expand stroke systems of care also need to address these disparities.

Abstract MP57: Lactation Duration is Associated With Lower Visceral and Pericardial Fat Volumes in Parous Women: 25-year Follow-up in the Cardia Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Duke Appiah ◽  
Cora E Lewis ◽  
Jeff Carr ◽  
Myron D Gross ◽  
David R Jacobs ◽  
...  
Keyword(s):  
Body Weight ◽  
Linear Regression Models ◽  
Weight Changes ◽  
Pericardial Fat ◽  
Incident Type ◽  
Computed Tomographic ◽  
Pericardial Adipose Tissue ◽  
Underlying Mechanisms ◽  
Lactation Duration

Introduction: Lactation has been associated with a lower risk of incident type 2 diabetes mellitus and cardiovascular disease (CVD) in women. However, the underlying mechanisms for these associations are not well understood. The longitudinal association between lactation and maternal fat volume has rarely been investigated. Hypothesis: We tested the hypothesis that lactation duration is inversely associated with maternal visceral and pericardial fat volumes. Methods: Data were obtained from 910 women enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study (1985-86) without diabetes prior to pregnancy who had ≥1 birth during 25 years of follow-up. Cumulative lactation duration across all births since baseline was calculated from self-reports collected at each exam. Volumes of visceral and pericardial adipose tissue were measured from computed tomographic scans at the Year 25 exam in 2010-2011. Methods: At baseline, the average age of women (48% black, 52% white) was 24 years (range: 18-30 years). During 25 years of follow-up, 76% of women reported lactation duration of ≥ 1 month. In adjusted linear regression models, lactation duration was inversely associated with visceral fat (p=0.021) and pericardial fat (p=0.001) volumes (Table). There was a significant interaction between race and lactation on visceral (p=0.035) and pericardial fat (p=0.027) volumes (Table). Formal mediation analysis showed a significant indirect effect of lactation duration on visceral (p=0.001) and pericardial fat (p=0.002) volumes through body weight change between the first postbaseline birth and the end of follow-up. Changes in body weight mediated 29.4% and 26.0% of the association between lactation duration and visceral and pericardial fat volumes. Conclusions: In this prospective study, the associations of longer lactation duration with lower visceral and pericardial fat volumes were partially mediated by body weight changes.

scholarly journals Donepezil Adherence, Persistence and Time to First Discontinuation in a Three-Year Follow-Up of Older People

2015 ◽  
Vol 5 (3) ◽  
pp. 482-491 ◽  
Author(s):  
Henry C. Ndukwe ◽  
Prasad S. Nishtala
Keyword(s):  
Cox Regression ◽  
Cumulative Probability ◽  
Inception Cohort ◽  
Cox Regression Analysis ◽  
Adjusted Risk ◽  
Kaplan Meier ◽  
Moderate Dementia ◽  
The Mean ◽  
Minimum Dataset

Background: Donepezil is indicated for the management of mild to moderate dementia, particularly in Alzheimer's disease. Several studies have described low adherence rates with donepezil. Aim: To examine and measure donepezil adherence, persistence and time to first discontinuation in older New Zealanders. Methods: An inception cohort of 1,999 new users of donepezil, aged 65 years or older, were identified from the Pharmaceutical Collections and National Minimum Dataset from 1 November 2010 to 31 December 2013. Kaplan-Meier curves and Cox regression analysis were used to estimate the cumulative probability and risk of time to first discontinuation of donepezil therapy. Results: The mean age of the cohort was 79.5 ± 6.4 years and included 42.7% females. Adherence was high (89.0%), while the proportion of donepezil dispensings (81.0-32.5%) declined between 6 and 36 months. Persistence between the 1st and 6th dispensing visit decreased by 19.0%, and 11.0% of the total cohort had a gap of 31 days or more. The adjusted risk of time to first discontinuation in the non-adherent group was 2.2 times (95% CI 1.9-2.6) that of the adherent group. Conclusions: The non-adherent new donepezil users, on average, discontinued faster than the adherent group. Time to first discontinuation in this study was higher compared to discontinuation rates observed in clinical trials.

scholarly journals Risk of clinical severity by age and race/ethnicity among adults hospitalized for COVID-19 — United States, March–September 2020

2020 ◽  
Author(s):  
Audrey F Pennington ◽  
Lyudmyla Kompaniyets ◽  
April D Summers ◽  
Melissa L Danielson ◽  
Alyson B Goodman ◽  
...  
Keyword(s):  
Older Adults ◽  
Ethnic Groups ◽  
Invasive Mechanical Ventilation ◽  
Clinical Severity ◽  
Adjusted Risk ◽  
Icu Admission ◽  
Risk Of Death ◽  
Race Ethnicity ◽  
Poor Outcomes ◽  
The Impact

Abstract Background Older adults and people from certain racial and ethnic groups are disproportionately represented in COVID-19 hospitalizations and deaths. Methods Using data from the Premier Healthcare Database on 181,813 hospitalized adults diagnosed with COVID-19 during March–September 2020 we applied multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], and death); and determine whether the impact of age on clinical severity differs by race/ethnicity. Results Overall, 84,497 (47%) patients were admitted to the ICU, 29,078 (16%) received IMV, and 27,864 (15%) died in the hospital. Increased age was strongly associated with clinical severity when controlling for underlying medical conditions and other covariates; the strength of this association differed by race/ethnicity. Compared with non-Hispanic White patients, risk of death was lower among non-Hispanic Black patients (adjusted risk ratio [95% CI]: 0.96 [0.92, 0.99]), and higher among Hispanic/Latino patients (RR [95% CI]: 1.15 [1.09, 1.20]), non-Hispanic Asian patients (RR [95% CI]: 1.16 [1.09, 1.23]), and patients of other racial and ethnic groups (RR [95% CI]: 1.13 [1.06, 1.21]). Risk of ICU admission and IMV was elevated among some racial and ethnic groups. Conclusions These results indicate that age is a driver of poor outcomes among hospitalized persons with COVID-19. Additionally, clinical severity may be elevated among patients of some racial and ethnic minority groups. Public health strategies to reduce SARS-CoV-2 infection rates among older adults and racial and ethnic minorities are essential to reduce poor outcomes.

Insomnia among elderly men and risk of prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 78-78 ◽  
Author(s):  
Lara Sigurdardottir ◽  
Unnur Anna Valdimarsdottir ◽  
Lorelei Mucci ◽  
Katja Fall ◽  
Jennifer R. Rider ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sleep Disturbances ◽  
Potential Role ◽  
Cox Regression ◽  
Positive Association ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Biological Explanation ◽  
Underlying Mechanisms

78 Background: While a large number of studies have reported a positive association between sleep disruption and breast cancer, little is known about its potential role in prostate cancer. Methods: Within the prospective AGES-Reykjavik cohort study, we followed 2102 men from 2002-2006 until the end of 2009. The men answered questions on sleep disturbances, which were combined in various ways to reflect onset and/or maintenance insomnia. Information on the occurrence of prostate cancer was obtained through record-linkages across the Icelandic Cancer and Causes of Death Registers. We used Cox regression models with 95% confidence intervals [CIs] to estimate age- and multivariable adjusted hazard ratios [HR] of prostate cancer by symptoms of insomnia. Results: During follow-up, 135 men (6,4%) were diagnosed with prostate cancer. Compared to men without insomnia, men with severe onset and maintenance insomnia and very severe insomnia were at increased risk of total prostate cancer with HR 1.9 (CI 1.2, 3.0) and 2.2 (CI 1.3, 3.8), respectively. For advanced prostate cancer, the corresponding HRs were 2.3 (CI 0.9-6.2) and 3.7 (CI 1.4-9.9), respectively. Conclusions: These data suggest that insomnia may confer an increased risk of prostate cancer. Reduced melatonin levels represent a plausible biological explanation, although additional studies using biomarkers and longer follow-up times are needed to further clarify the underlying mechanisms.

scholarly journals Urinary Taurine Excretion and Risk of Late Graft Failure in Renal Transplant Recipients

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2212
Author(s):  
Adrian Post ◽  
M. Yusof Said ◽  
Antonio W. Gomes-Neto ◽  
Jennifer van der Krogt ◽  
Pim de Blaauw ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Failure ◽  
Cox Regression ◽  
Low Risk ◽  
Renal Transplant Recipients ◽  
Regression Analyses ◽  
Transplant Recipients ◽  
Taurine Supplementation ◽  
Underlying Mechanisms

Taurine is a sulfur containing nutrient that has been shown to protect against oxidative stress, which has been implicated in the pathophysiology leading to late graft failure after renal transplantation. We prospectively investigated whether high urinary taurine excretion, reflecting high taurine intake, is associated with low risk for development of late graft failure in renal transplant recipients (RTR). Urinary taurine excretion was measured in a longitudinal cohort of 678 stable RTR. Prospective associations were assessed using Cox regression analyses. Graft failure was defined as the start of dialysis or re-transplantation. In RTR (58% male, 53 ± 13 years old, estimated glomerular filtration rate (eGFR) 45 ± 19 mL/min/1.73 m2), urinary taurine excretion (533 (210–946) µmol/24 h) was significantly associated with serum free sulfhydryl groups (β = 0.126; P = 0.001). During median follow-up for 5.3 (4.5–6.0) years, 83 (12%) patients developed graft failure. In Cox regression analyses, urinary taurine excretion was inversely associated with graft failure (hazard ratio: 0.74 (0.67–0.82); P < 0.001). This association remained significant independent of potential confounders. High urinary taurine excretion is associated with low risk of late graft failure in RTR. Therefore, increasing taurine intake may potentially support graft survival in RTR. Further studies are warranted to determine the underlying mechanisms and the potential of taurine supplementation.

scholarly journals Socioeconomic position and risk of atrial fibrillation: a nationwide Danish cohort study

2019 ◽  
Vol 74 (1) ◽  
pp. 7-13
Author(s):  
Elin Danielsen Lunde ◽  
Albert Marni Joensen ◽  
Søren Lundbye-Christensen ◽  
Kirsten Fonager ◽  
Søren Paaske Johnsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Socioeconomic Position ◽  
Cox Regression ◽  
Risk Difference ◽  
Age Group ◽  
Adjusted Risk ◽  
Age Cohort ◽  
Observation Method ◽  
Incident Cases

AimTo examine the association between socioeconomic position and the risk of atrial fibrillation (AF) in different stages of life in a population of Danish citizens.MethodsRegister-based study. We followed all individuals turning 35, 50, 65 or 80 years from 1 January 1996 to 31 December 2005 until AF, death, emigration or the end of study period (31 December 2015). Exposure was education and income. We used Cox regression for the HRs (95% CI) and the pseudo-observation method for the adjusted risk difference (RD) (%).ResultsA total of 2 173 857 participants were enrolled and 151 340 incident cases of AF occurred over a median of 13.6 years of follow-up. Adjusted HR (95% CI) of incident AF for the youngest age group with the highest education (ref lowest) was 0.62 (0.50 to 0.77) (women) and 0.85 (0.76 to 0.96) (men). The associations attenuated with increasing age, that is, HRs for the oldest age group were 1.04 (0.97 to 1.10) and 0.98 (0.96 to 1.04), respectively. The corresponding adjusted RDs (%) were: −0.28 (−0.43 to −0.14), −0.18 (−0.36 to −0.01), 3.04 (−0.55 to 6.64) and −0.74 (−3.38 to 2.49), respectively. Similar but weaker associations were found for income.ConclusionHigher level of education and income was associated with a lower risk of being diagnosed with AF in young individuals but the association decreased with increasing age and was almost absent for the oldest age cohort. However, since AF is relatively rare in the youngest the RDs were low.

scholarly journals Shared Physiologic Pathways Among Comorbidities for Adults With Cerebral Palsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel G. Whitney ◽  
Mary Schmidt ◽  
Edward A. Hurvitz
Keyword(s):  
Cerebral Palsy ◽  
Cox Regression ◽  
Principal Component ◽  
Fee For Service ◽  
Electrolyte Disorders ◽  
And Function ◽  
Medicare Database ◽  
Adjusted Model ◽  
Underlying Pathophysiology

Objective: Aging with cerebral palsy is accompanied by a declining health and function status across neurological and non-neurological systems. There is a need to understand the shared pathophysiology among comorbidities for adults with cerebral palsy, to inform clinical assessment and guidelines for interventions to improve healthful aging. To begin defining multimorbidity, this study identified the most common comorbidity combinations and their association with mortality among a representative sample of adults with cerebral palsy.Methods: Data from 2016 to 2018 were used from a random 20% sample from the fee-for-service Medicare database. Adults ≥18 years with cerebral palsy and 25 neurological and non-neurological comorbidities were obtained from 2016. Principal component (PC) analysis identified the most common comorbidity combinations, defined as individual PCs. Cox regression estimated the hazard ratio (HR) of 2-year mortality including all PCs and demographics in a single model. To facilitate comparisons, PC scores were transformed into quintiles (reference: lowest quintile).Results: Among the 16,728 adults with cerebral palsy, the most common comorbidity combinations (PCs) in order were: cardiorespiratory diseases, dysphagia, and fluid/electrolyte disorders; metabolic disorders (e.g., diabetes, renal disease, hypertension); neurologic-related disorders (e.g., dementia, cerebrovascular disease); gastrointestinal issues; and orthopedic-related disorders. During the 2-year follow-up, 1,486 (8.9%) died. In the adjusted model, most PCs were associated with an elevated mortality rate, especially the first PC (5th quintile HR = 3.91; 95%CI = 3.29–4.65).Discussion: This study identified the most common comorbidity combinations for adults with cerebral palsy, many of them were deadly, which may inform on the underlying pathophysiology or shared characteristics of multimorbidity for this population.

Association between Mediterranean diet and functional status in older adults: a longitudinal study based on the Washington Heights Inwood Community Aging Project (WHICAP)

2022 ◽  
Author(s):  
Jing Guo ◽  
Nicole Schupf ◽  
Emily Cruz ◽  
Yaakov Stern ◽  
Richard P Mayeux ◽  
...  
Keyword(s):  
Older Adults ◽  
Mediterranean Diet ◽  
Daily Living ◽  
Cox Regression ◽  
Current Evidence ◽  
Food Frequency ◽  
Race Ethnicity ◽  
Adl Disability ◽  
Washington Heights

Abstract Background Current evidence on the association between Mediterranean diet (MeDi) intake and activities of daily living (ADL) is limited and inconsistent in older adults. Methods This study included 1696 participants aged ≥ 65 years in the Washington Heights-Inwood Community Aging Project (WHICAP) study. The MeDi score was calculated based on data collected from the Willett’s semi-quantitative food frequency questionnaire. The multivariable-adjusted Cox regression model was applied to examine the association of MeDi score with risks of disability in basic (BADL) and instrumental ADL (IADL), as well as the overall ADL (B-IADL). Results 832 participants with incident ADL disability were identified over a median follow-up of 5.39 years. The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.91 to 0.99, p = 0.018) in a model adjusted for age, sex, race/ethnicity, educational level, and dietary calories intake but was no longer significant after additionally adjusted for multiple comorbidities and physical activities (0.97 [0.93, 1.01], p = 0.121). The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (0.92 [0.85, 1.00], p = 0.043) and BADL (0.90 [0.82, 0.99], p = 0.030) in non-Hispanic Whites, but not in non-Hispanic Blacks and Hispanics (p &gt; 0.05 for all). Conclusions Higher MeDi score was associated with decreased risk of ADL disability, particularly in non-Hispanic Whites.

scholarly journals Urinary PGE-M in Men with Prostate Cancer

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4073
Author(s):  
Maeve Kiely ◽  
Ginger L. Milne ◽  
Tsion Z. Minas ◽  
Tiffany H. Dorsey ◽  
Wei Tang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Case Control Study ◽  
Cox Regression ◽  
Population Based ◽  
Cancer Specific Survival ◽  
The Past ◽  
All Cause Mortality ◽  
Race Ethnicity ◽  
Control Study

Urinary PGE-M is a stable metabolite of prostaglandin E2 (PGE2). PGE2 is a product of the inflammatory COX signaling pathway and has been associated with cancer incidence and metastasis. Its synthesis can be inhibited by aspirin. We investigated the association of PGE-M with lethal prostate cancer in a case–control study of African American (AA) and European American men. We measured urinary PGE-M using mass-spectrometry. Samples were obtained from 977 cases and 1022 controls at the time of recruitment. We applied multivariable logistic and Cox regression modeling to examine associations of PGE-M with prostate cancer and participant survival. Median survival follow-up was 8.4 years, with 246 deaths among cases. Self-reported aspirin use over the past 5 years was assessed with a questionnaire. Race/ethnicity was self-reported. Urinary PGE-M levels did not differ between men with prostate cancer and population-based controls. We observed no association between PGE-M and aggressive disease nor prostate-cancer-specific survival. However, we observed a statistically significant association between higher (>median) PGE-M and all-cause mortality in AA cases who did not regularly use aspirin (HR = 2.04, 95% CI 1.23–3.37). Among cases who reported using aspirin, there was no association. Our study does not support a meaningful association between urinary PGE-M and prostate cancer. Moreover, PGE-M levels were not associated with aggressive prostate cancer. However, the observed association between elevated PGE-M and all-cause mortality in AA non-aspirin users reinforces the potential benefit of aspirin to reduce mortality among AA men with prostate cancer.

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