Abstract 65: Identifying and Adapting a Prognostic Risk Equation for Relevant Subpopulations in a Pharmacoeconomic Model of Major Adverse Cardiovascular Event Prevention

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Rinat Ariely ◽  
Robert Klein ◽  
Weng-Kian Tham ◽  
Chris Bell ◽  
Lee Smolen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Baseline Risk ◽  
Number Needed To Treat ◽  
Additional Risk ◽  
Prognostic Equation ◽  
Pharmacoeconomic Model ◽  
The Uk

Background: Pharmacoeconomic models in cardiovascular disease (CVD) are typically developed on the basis of an assumed relative risk reduction (RRR) for new treatments which is in turn applied to estimates of baseline risk in patients subject to standard of care medications for coronary heart disease. However, baseline risk of CVD varies by relevant patient characteristics (e.g., age, gender, event history) and additional risk factors (e.g., smoking, diabetes, chronic kidney disease, lipids, blood pressure, obesity) which can be applied across diverse populations and settings. This study aimed to find and adapt a prognostic equation to adjust baseline risk of major adverse cardiovascular events (MACE=CV death, non fatal MI, Stroke), in a general pharmacoeconomic model, based on population risk factor prevalence. Methods: In order to find an equation that includes all relevant risk factors, a literature search was conducted to update a review (published 2008) of 70 pre-2005 primary cardiovascular risk equations. Once an equation was selected, a relative risk was calculated from the ratio of estimated one-year CV risks of the modeled population versus the population in the selected equation. An initial assumption of independence of risk factors was made. The resulting ratio is adapted as a risk multiplier to estimate risk when modeling specific trial populations or subpopulations. Results: None of the original 70 equations included all of the six factors of interest, and only two contained kidney disease. In addition to updates and modifications of the 70 equations, four new studies were identified, including the UK-based QRISK2 which was the only prognostic equation that uses all six factors. QRISK2 was developed using over 16 million person-years’ worth of observations with 140,000 cardiovascular events, and was validated against the UK THIN population. The adapted QRISK2 equation estimates the first-year CV risk for a population adjusted for the six additional risk factors to be 7.1%. However the subset with diabetes and/or kidney disease, which makes up about 43% of the population, has an estimated risk of about 11%. If a treatment is assumed to reduce CV risk by 15% in both the entire and subset populations, then the number needed to treat to avoid one event is reduced from 93 for the entire population to 61 for the diabetes and/or renal impairment subset. Conclusions: Estimating the ratio of absolute risks for specific populations and subsets using QRISK2 can help a model to predict the value of targeting relevant subpopulations for a new treatment. When this risk adjustment is included in a lifetime model, additional benefits from secondary prevention, and increased likelihood that a treatment is cost effective in a UK context, can also be estimated. For non-UK populations, calibration of QRISK2 is needed or an alternative equation must be used.

scholarly journals Proportion and risk factors for death by euthanasia in dogs in the UK

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Camilla Pegram ◽  
Carol Gray ◽  
Rowena M. A. Packer ◽  
Ysabelle Richards ◽  
David B. Church ◽  
...  
Keyword(s):  
Risk Factors ◽  
Poor Quality ◽  
Clinical Factors ◽  
Sampling Frame ◽  
Additional Risk ◽  
Factors Associated ◽  
Regression Modelling ◽  
The Uk ◽  
Logistic Regression Modelling

AbstractThe loss of a pet can be particularly distressing for owners, whether the method of death is euthanasia or is unassisted. Using primary-care clinical data, this study aimed to report the demographic and clinical factors associated with euthanasia, relative to unassisted death, in dogs. Method of death (euthanasia or unassisted) and clinical cause of death were extracted from a random sample of 29,865 dogs within the VetCompass Programme from a sampling frame of 905,544 dogs under UK veterinary care in 2016. Multivariable logistic regression modelling was used to evaluate associations between risk factors and method of death. Of the confirmed deaths, 26,676 (89.3%) were euthanased and 2,487 (8.3%) died unassisted. After accounting for confounding factors, 6 grouped-level disorders had higher odds in euthanased dogs (than dogs that died unassisted), using neoplasia as the baseline. The disorders with greatest odds included: poor quality of life (OR 16.28), undesirable behaviour (OR 11.36) and spinal cord disorder (OR 6.00). Breed, larger bodyweight and increasing age were additional risk factors for euthanasia. The results highlight that a large majority of owners will face euthanasia decisions and these findings can support veterinarians and owners to better prepare for such an eventuality.

Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1442-1455
Author(s):  
Pantelis Sarafidis ◽  
Christodoulos E. Papadopoulos ◽  
Vasilios Kamperidis ◽  
George Giannakoulas ◽  
Michael Doumas
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Mineralocorticoid Receptor ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
Cardiovascular Protection ◽  
Sodium Glucose Cotransporter

Chronic kidney disease (CKD) and cardiovascular disease are intimately linked. They share major risk factors, including age, hypertension, and diabetes, and common pathogenetic mechanisms. Furthermore, reduced renal function and kidney injury documented with albuminuria are independent risk factors for cardiovascular events and mortality. In major renal outcome trials and subsequent meta-analyses in patients with CKD, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) were shown to effectively retard CKD progression but not to significantly reduce cardiovascular events or mortality. Thus, a high residual risk for cardiovascular disease progression under standard-of-care treatment is still present for patients with CKD. In contrast to the above, several outcome trials with SGLT-2 (sodium-glucose cotransporter-2) inhibitors and MRAs (mineralocorticoid receptor antagonists) clearly suggest that these agents, apart from nephroprotection, offer important cardioprotection in this population. This article discusses existing evidence on the effects of SGLT-2 inhibitors and MRAs on cardiovascular outcomes in patients with CKD that open new roads in cardiovascular protection of this heavily burdened population.

Prevention of Postoperative Nausea and Vomiting

2018 ◽  
pp. 147-152
Keyword(s):  
Risk Factors ◽  
Nitrous Oxide ◽  
Relative Risk ◽  
Adverse Events ◽  
Postoperative Nausea ◽  
Volatile Anesthetic ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Baseline Risk ◽  
Maximum Reduction

This case focuses on the prevention of postoperative nausea and vomiting (PONV) by asking the question: What is the efficacy of six well-established prophylactic antiemetic strategies individually and in combination for the prevention of postoperative nausea and vomiting? Each of the three antiemetics in this study (ondansetron, dexamethasone, and droperidol) reduced the risk for PONV by approximately 26%; substituting propofol for volatile anesthetic reduced the risk by 19%; and substituting nitrogen (air) for nitrous oxide reduced the risk by 12%. A maximum reduction of 70% in the relative risk for PONV can be expected when total intravenous anesthesia is used with three antiemetics. The appropriate approach to the management of PONV depends on the patient’s baseline risk factors as well as the likelihood of adverse events and costs from the antiemetic medications.

Special conditions: kidney disease

ESC CardioMed ◽  
2018 ◽  
pp. 947-950
Author(s):  
Drazenka Pongrac Barlovic ◽  
Per-Henrik Groop
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Kidney Disease ◽  
Life Expectancy ◽  
Renal Disease ◽  
Beneficial Effect ◽  
Cardiovascular Events ◽  
Treatment Strategies ◽  
Microvascular Damage ◽  
Increased Risk

Kidney disease is one of the most common and important consequences of microvascular damage in diabetes. Its occurrence largely determines the increased risk of cardiovascular events and remarkably shortens life expectancy. Therefore, protecting the kidney is one of the main aims of patient care in diabetes and should be based on implementation of the intensive treatment of risk factors that promote its progression to prevent renal failure, and even more importantly, cardiovascular events. Very recently, some new therapies with a beneficial effect on renal disease have emerged; however, there is still plenty of room for additional innovative treatment strategies to prevent, arrest, treat, and reverse kidney disease caused by diabetes and its devastating consequences.

Independent, Non-traditional Risk Factors for Cardiovascular Events and Atherothrombosis in Chronic Kidney Disease and in Hemodialysis-dependent Patients

2006 ◽  
Vol 6 (3) ◽  
pp. 484-491 ◽  
Author(s):  
Mona Ezzat Madkour . ◽  
Iman William Bekheet . ◽  
Nagwa Abdel-Ghaffar . ◽  
Emam Waked . ◽  
Khaled Younes .
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Traditional Risk Factors

Hemoglobin Decline and Health Outcomes in the Elderly: the Cardiovascular Health Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3448-3448
Author(s):  
Neil A Zakai ◽  
Benjamin French ◽  
Alice Arnold ◽  
Anne Newman ◽  
Linda F. Fried ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Cardiovascular Health ◽  
The Elderly ◽  
Baseline Risk ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Logistic Regression Models ◽  
Concurrent Development ◽  
Adjusted Logistic Regression

Abstract Introduction: Anemia is associated with increased morbidity and mortality in the elderly, though the risk factors for and the consequences of hemoglobin (HGB) decline are poorly characterized. Methods: We studied 5201 men and women ≥65 participating in the Cardiovascular Health Study. The cohort was followed biannually and had baseline and repeat hemograms 3 years later. HGB decline was defined as >1g/dL HGB drop, or incident anemia at 3 years by WHO criteria. Results: 4006 participants survived to 3 years and had two HGB measures. The median HGB change was −0.2g/dL (IQR-0.8, 0.1). 961 (24%) participants had a >1g/dL HGB drop and 335 (8%) developed incident anemia. The left side of the table presents adjusted logistic regression models of baseline risk factors for HGB decline. Those with baseline cardiovascular disease (CVD), diabetes and kidney disease were more likely to develop >1g/dL HGB drop while only baseline kidney disease was associated with incident anemia. The table also shows the adjusted risk of HGB decline with concurrent development of co-morbid conditions. A >1g/dL drop in HGB was more likely in those who concurrently developed incident CVD, hypertension or inflammation. Incident anemia was more likely in participants with concurrent development of kidney disease or inflammation. Both incident anemia and a HGB drop >1g/dL were associated with subsequent 9-year mortality adjusting for age, race, gender, year 3 HGB, hypertension, CVD, diabetes, and renal disease; HRs (95% CI) 1.4 (1.2, 1.6) and 1.2 (1.1, 1.4) respectively. Discussion: Among studied factors, baseline CVD, diabetes and kidney disease were risk factors for >1g/dL HGB drop while only baseline kidney disease was a risk factor for incident anemia. Incident CVD and hypertension were associated concurrently with >1g/dL HGB drop while kidney disease was associated with concurrent incident anemia. Inflammation development was the strongest risk factor accompanying HGB decline. HGB decline, especially a 1g/dL drop, was associated with subsequent mortality irrespective of HGB concentration. These data suggest that small HGB changes not captured by the WHO anemia criteria are associated with poor health outcomes and that inflammation is a major correlate of HGB decline in the elderly. Table: Risk Factors for HGB Decline in Age-, Race-, Gender, and Baseline HGB-Adjusted Logistic Regression Models Baseline Risk Factors for HGB Decline Risk of HGB Decline with Concurrent Conditions HGB Drop >1g/dL Incident Anemia HGB Drop >1g/dL Incident Anemia CVD 1.2 (1.1, 1.4) 1.0 (0.8, 1.3) 1.3 (1.1, 1.6) 1.0 (0.7, 1.3) Hypertension 1.1 (0.99, 1.3) 1.1 (0.8, 1.2) 1.4 (1.1, 1.7) 1.1 (0.8, 1.5) Diabetes 1.3 (1.1, 1.5) 1.1 (0.8, 1.4) 0.9 (0.6, 1.4) 0.8 (0.4, 1.7) Kidney Disease (GFR <60ml/min/1.73m2) 1.2 (1.0, 1.3) 1.3 (1.1, 1.7) 1.1 (0.8, 1.4) 1.5 (1.0, 2.1) Inflammation CRP ≥10mg/dL or WBC≥15×109/mm3 1.0 (0.8, 1.3) 1.3 (0.99 1.8) 2.3 (1.8, 2.8) 2.3 (1.8, 3.0)

Assessment of Cardiovascular Events in Chronic Myeloid Leukemia Patients Treated with Tyrosine Kinase Inhibitors

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4031-4031
Author(s):  
Katia B.B. Pagnano ◽  
Paola Morelato Assunção ◽  
Roberto Zullli ◽  
Marcia T Delamain ◽  
Gislaine OLIVEIRA Duarte ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cardiovascular Events ◽  
Kinase Inhibitors ◽  
Risk Groups ◽  
Arterial Disease ◽  
Baseline Risk ◽  
Advisory Committees ◽  
Coronary Arterial Disease ◽  
Very High

Abstract Introduction : Treatment with tyrosine kinase inhibitors (TKIs) has dramatically increased the overall survival of patients with chronic myeloid leukemia (CML) but second generation TKI has been associated with an increased risk of cardiovascular events. Objectives: The aim of this study was to evaluate the incidence of cardiovascular adverse events (CVE) in CML patients treated with TKIs and to correlate with the cardiovascular (CV) risk of the patients. Methods: this is a retrospective analysis of consecutive CML patients treated with TKIs between 2005 and 2013at our Institution. Baseline risk factors for CV diseases were collected at baseline and included age, arterial hypertension (AH), dyslipidemia, obesity, hypothireoidism, smoking, diabetes mellitus (DM), coronary artery disease and chronic renal failure. Cardiovascular events during TKI treatment were collected and included: myocardial infarction, unstable angina, peripheral arterial disease, stroke, arrythmia,hypertension and cardiac failure. Cardiovascular risk was calculated using the SCORE chart of the European Society of Cardiology and patients were classified in low, moderate, high and very high risk. Results: We analyzed CML patients treated with imatinib (n=117), dasatinib (n=91) and nilotinib (n=60). The median time of follow-up was 748, 519 and 851 days, respectively. Baseline risk factors: 90 patients (38,5%) had hypertension, 34 (14,5%) DM, 67 (28,6%) dyslipidemia, 51 (21,8%) obesity, 22 (9,4%) hypothyroidism, 14 (6%) coronary arterial disease, 21 (9%) systolic cardiac dysfunction, 4 (1,7%) stroke, 20 (8,5%) chronic kidney failure and 36 (15,4%) were smokers. SCORE chart classification: 106 patients (39,5%) were in the low-risk category, 70 (26%) in the moderate risk, 46 (17,2%) in the high risk, 46 (17,2%) in the very high risk group. Overall, the cumulative incidence of CVE was 4.1%. Five (5.5%) events occurred during dasatinib treatment (P=0.015), 6 (10%) events during nilotinib and no events during imatinib treatment (P=0.001). The incidence of CVE was 10.8% in the high and very high-risk groups and 0.52% in moderate and low risk group (P≤0.001). The incidence of arterial ischemic events (AIE) was 10% (n=6) in patients treated with nilotinib, 2.2% (n=2) with dasatinib and 0% with imatinib (P≤0.001). Arterial events were exclusively observed in high and very high-risk groups (8 events, 8.7%) (P≤0.001). The risk factors associated with a higher risk of CVE were hypertension (P≤0.001), dyslipidemia (P≤0.001), coronary arterial disease (P=0.003), congestive heart failure (P=0.002) and chronic renal failure (P=0.011). Disease progression was the main cause of death in all groups. Conclusions: CVE were more frequent in patients treated with second generation TKIs. AIE were more frequent in patients treated with nilotinib, in those having a high or very high risk SCORE. The CV risk stratification of CML patients before and during TKI therapy can help in TKI selection and to identify patients at high risk, in order to reduce the morbidity and mortality associated with CVE. Disclosures Pagnano: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bristol Miers-Squibb: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

scholarly journals Are there benefits of low doses of ACE inhibitors, MRAs, diuretics and statins in the treatment of heart failure?

2021 ◽  
Vol 14 (2) ◽  
pp. 226-231
Author(s):  
V. А. Lysenko
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Relative Risk ◽  
Ace Inhibitors ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Scientific Data ◽  
Rank Test ◽  
Coronary Syndrome

Treatment of chronic heart failure (CHF) is very controversial. The issue of optimal doses of beta-blockers, ACE inhibitors, aldosterone receptor antagonists, statins in patients with CHF has not been conclusively addressed. Achieving the maximum tolerated doses of drugs, though related to reduced mortality, but is accompanied by an increase in adverse drug reactions. The aim. To present and discuss our own clinical and scientific data concerning the role of beta-blockers and inhibitors of the renin-angiotensin aldosterone system, diuretics, statins in the treatment of CHF patients and optimization of dosage schemes. Material and methods. The study included 88 patients with CHF of ischemic origin, with sinus rhythm, stage II AB, NYHA FC II–IV, 58 – with reduced LV EF (HFrEF) and 30 – with preserved LV EF (HFpEF). The mean age of patients was 69.18 ± 9.97 years, men 52 % (n = 46). The median follow-up of the CHF patients was 396 days, the maximum number of follow-up days was 1302. During the observation period, 14 endpoints were registered, which accounted for 15.91 % of events: 7 deaths (8.0 %), 2 strokes (2.3 %), 2 cases of acute coronary syndrome (2.3 %), 3 progressive heart failure cases (3.4 %). Kaplan–Mayer curves were drawn to assess survival rate, and the significance of difference between groups was calculated by the criteria of Gehan–Wilcoxon, Cox–Mantel and log-rank test. Risk factors were determined, and prognostic uni- and multi-variant Cox proportional hazards regression models were used. The cut-off values of quantitative risk factors were obtained by ROC analysis. Results. The increase in the relative risk of adverse cardiovascular events in the CHF patients regardless of LV EF was associated with a daily carvedilol dose of more than 25 mg (HR = 1.05; 95 % CI 1.009–1.093; P = 0.0171); eplerenone – more than 12.5 mg (HR = 1.073; 95 % CI 1.005–1.144; P = 0.034), torasemide – more than 5 mg (HR = 1.13; 95 % CI 1.021–1.255; P = 0.019); rosuvastatin – more than 10 mg (HR = 1.107; 95 % CI 1.007–1.203; P = 0.035), and the trend in using atorvastatin at a dose of less than 10 mg (HR = 1.05; 95 % CI 0.951–1.165; P = 0.327). The use of ramipril in a daily dose of less than 2.5 mg was accompanied by a trend towards the 22 % reduced relative risk of adverse cardiovascular events (HR = 0.78; 95 % CI 0.384–1.580; P = 0.491). Conclusions. Positive treatment outcomes in the CHF patients, regardless of the phenotype, were associated with low daily doses of ramipril (<2.5 mg), eplerenone/spironolactone (<12.5 mg), torasemide (<5.0 mg), rosuvastatin (<10.0 mg), but with high doses of atorvastatin (>10.0 mg).

scholarly journals A Pilot Randomized Crossover Trial Assessing the Safety and Short-Term Effects of Walnut Consumption by Patients with Chronic Kidney Disease

2019 ◽  
Author(s):  
Pilar Sanchis ◽  
Marilisa Molina ◽  
Francisco Berga ◽  
Elena Muñoz ◽  
Regina Fortuny ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dietary Supplement ◽  
Cardiovascular Events ◽  
Inositol Phosphates ◽  
Control Diet ◽  
Fibroblast Growth Factor 23 ◽  
Short Term ◽  
Daily Consumption

The aim of this study of patients with chronic kidney disease (CKD) is to assess the safety of daily consumption of walnuts on the physiological levels of phosphorous, potassium, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF23), and to assess the short-term benefits of this intervention on risk factors associated with cardiovascular events. This led us to perform a prospective, randomized, cross-over, pilot clinical trial examined 13 patients with chronic kidney disease (CKD). Subjects were randomly assigned to a diet of 30 g of walnuts per day or the control diet. After 30 days, each group was given a 30-day washout period, and then switched to the alternate diet for 30 days. Urinary and serum levels of phosphorous and potassium, multiple vascular risk factors, and urinary inositol phosphates (InsPs) were measured at baseline and at the end of the intervention period. Our results showed that the walnut dietary supplement led to reduced blood pressure, LDL cholesterol, and serum albumin, but had no effect on the physiological levels of phosphorous, potassium, PTH, and FGF23. This is the first report to show that daily consumption of walnuts by patients with CKD does not alter their physiological levels of phosphorous, potassium, PTH, and FGF23. Consequently, this dietary supplement may prevent cardiovascular events in patients with CKD.

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