Abstract 184: The 8.7-year Follow-up For Prediction Of Stroke By Enlargement Of Carotid Arteries In a General Urban Cohort: The Suita Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Yoshihiro Kokubo ◽  
Masatoshi Koga ◽  
Makoto Watanabe ◽  
Kazunori Toyoda ◽  
Kazuyuki Nagatsuka ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Proportional Hazards ◽  
Intima Media Thickness ◽  
Cox Proportional Hazards ◽  
Baseline Survey ◽  
External Carotid ◽  
Diastolic Phase ◽  
General Populations

Introduction: Carotid intima-media thickness (IMT) has been increasingly used as a subclinical marker for stroke and ischemic heart disease (IHD). However, no study has examined the association between enlargement of carotid arteries and the incidence of stroke in general populations. We assessed the hypothesis that carotid artery enlargement was a predictor for stroke events in a general urban Japanese population. Methods: We studied 5,330 Japanese individuals (mean age 55.3 years, without stroke or IHD) who completed a baseline survey and carotid ultrasonography in the Suita Study, and were then followed for 8.7 years on average. Carotid atherosclerosis was evaluated by high-resolution ultrasonography (7.5MHz transducer) with atherosclerotic indexes of IMT in the common carotid artery (CCA), carotid artery bulbs (Bulbs), and internal and external carotid arteries (ICA and ECA, respectively). The CCA-int and the CCA-adv diameters were defined as the means of the minimal lumen-intima diameters and the maximal media-adventitia diameters for both sides of the CCA, respectively, at the beginning points of dilation of the Bulbs in the diastolic phase. The ICA and the ECA diameters were defined as the means of the minimal intima-lumen diameters for both sides of the ICA and the ECA at the points where the ICA and the ECA were divided from the Bulbs in the diastolic phase, respectively. The risks of stroke across quartiles according to carotid arteries diameters were compared by the use of multivariable-adjusted Cox proportional-hazards models. Results: In 46,553 person-years of follow-up, we documented 124 cerebral infarctions, 49 hemorrhagic strokes, 12 unclassified strokes, and 125 IHD events. The multivariable-adjusted hazard ratios (HRs; 95% confidence intervals [CIs]) in the highest quartile of the CCA-int diameter (>6.65 mm) for all strokes, ischemic and hemorrhagic strokes were 2.62 (1.54 to 4.47), 2.27 (1.17 to 4.41), and 4.38 (1.51 to 12.68), respectively, compared with the lowest quartile of the CCA-int diameter (<5.7 mm). The multivariable-adjusted HRs (95% CIs) for all strokes, ischemic and hemorrhagic strokes, lacunar, and atherothrombotic infarctions were 1.61 (1.32 to 1.96), 1.51 (1.19 to 1.92), 2.12 (1.41 to 3.19), 1.31 (0.86 to 2.00), and 2.53 (1.45 to 4.41) in 1-mm increments of the CCA-int diameter, respectively. Those HRs (95% CIs) were 1.24 (1.05 to 1.47), 1.18 (0.97-1.45), 1.49 (1.07 to 2.07), 0.87 (0.62 to 1.23), and 1.97 (1.19 to 3.24) in 1-mm increments of the ICA diameter, respectively. The risks of strokes for the CCA-adv diameter were similar to those for CCA-int. No association of the ECA diameter with stroke was observed. Conclusions: Enlargement of both the CCA and the ICA is an independent risk factor for stroke and its subtypes in the general population. Carotid artery enlargement may be a good predictor for stroke in general populations.

Abstract 2456: High HDL-cholesterol Levels Are Paradoxically Associated With Increased Atherosclerosis And Increased Coronary Heart Disease (CHD) Events In Metabolic Syndrome Subjects: The Multi-ethnic Study Of Atherosclerosis (MESA)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Karol E Watson ◽  
Preethi Srikanthan ◽  
Pamela J Schreiner ◽  
Wendy Post ◽  
Gregory L Burke ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Proportional Hazards ◽  
Hdl Cholesterol ◽  
Cox Proportional Hazards ◽  
Cholesterol Levels ◽  
Inflammatory Status ◽  
Cox Proportional Hazards Models ◽  
Low Hdl ◽  
General Populations

Background : In population studies high HDL is associated with fewer CHD events, however in certain people high HDL does not appear to protect and recent work suggests that HDL can become dysfunctional in settings of inflammation. Since Metabolic Syndrome (MetSyn) patients often have systemic inflammation, we hypothesized that high HDL might not be protective in this group. Methods : We analyzed data from 6,814 subjects in MESA; 2,362 of whom had MetSyn. Subjects were stratified by HDL into low (< 40), mid (40 –59) and high (≥ 60 mg/dL) groups. Outcomes were cIMT, coronary calcium (CAC), and CHD events over 3 years of follow up. Cox proportional hazards models assessed the association of HDL with CHD events. Results : In non-MetSyn subjects, outcomes were worst in the low HDL group and improved as HDL increased. In MetSyn subjects, however, an unexpected U-shaped relationship was seen. The most favorable results were in MetSyn subjects with mid HDL (40 –59), while worse outcomes were seen with either low (< 40) or high (≥ 60) HDL. cIMT was 1.23, 1.14 and 1.26 mm for low, mid and high HDL respectively (p mid vs. high = 0.04). Log e CAC was 4.63, 4.37 and 4.66 for low, mid and high HDL (p = 0.09). CHD rates were 3.7%, 1.8% and 4.1% for low, mid and high HDL (p = 0.027). In multivariate analysis, high (vs. mid) HDL remained associated with CHD events in MetSyn (HR 2.44 [1.03–5.82]). Conclusion : Although HDL is associated with decreased CHD in general populations, in certain people HDL doesn’t protect. In our data MetSyn subjects with HDL ≥ 60 had poorer outcomes than those with HDL 40 –59, which suggests that HDL-C is a complex marker that must be interpreted in light of a person’s metabolic profile and inflammatory status.

scholarly journals Prevalence of atherosclerosis and association with 5-year outcome: The Norwegian Stroke in the Young Study

2021 ◽  
pp. 239698732110594
Author(s):  
Beenish Nawaz ◽  
Annette Fromm ◽  
Halvor Øygarden ◽  
Geir E Eide ◽  
Sahrai Saeed ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Proportional Hazards ◽  
Young Patients ◽  
Intima Media Thickness ◽  
Arterial Disease ◽  
Cox Proportional Hazards ◽  
Middle Aged ◽  
Stroke Patients ◽  
Female Patients

Objectives: We studied the prevalence of atherosclerosis among ischaemic stroke patients ≤60 years and controls at the time of the index stroke, and its association with occurrence of new cardiovascular events (CVEs) and mortality at a 5-year follow-up. Methods: Prevalent atherosclerosis was assessed for 385 patients and 260 controls in seven vascular areas by electrocardiogram (ECG), ankle–arm index (AAI) and measurement of right and left carotid and femoral intima-media thickness (cIMT and fIMT) and abdominal aorta plaques (AAP). Clinical end-points were any new CVE (stroke, angina, myocardial infarction or peripheral arterial disease) or death from any cause at 5-year follow-up. All results were sex- and age-adjusted; logistic regression and Cox proportional hazards models were applied. Results: Young patients ≤49 years had prevalent atherosclerosis in 1/2 of males and 1/3 of females. Compared with controls, young female patients showed significantly higher prevalent atherosclerosis, p = 0.024. Ischaemic ECG and mean cIMT were higher in young and middle-aged female patients ( p = 0.044, p = 0.020, p = 0.023 and p <0.001, respectively). Mean fIMT was higher in middle-aged female patients ( p <0.001). Cardiovascular events were associated with ischaemic ECG; AAI ≤0.9, fIMT ≥0.9 mm and increased number of areas with atherosclerosis (NAA) among patients, and with AAP, cIMT ≥0.9 mm, fIMT ≥0.9 mm and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA among patients, and cIMT ≥0.9 mm among controls. Conclusion: Atherosclerosis is highly prevalent even in young stroke patients. Some areas and increasing NAA are associated with CVEs and death.

scholarly journals Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 1034
Author(s):  
Vincenza Gianfredi ◽  
Annemarie Koster ◽  
Anna Odone ◽  
Andrea Amerio ◽  
Carlo Signorelli ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Dietary Patterns ◽  
Proportional Hazards ◽  
A Priori ◽  
Preventive Measure ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Healthy Diet ◽  
Patient Health

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

scholarly journals Risk factors associated with major adverse cardiac and cerebrovascular events following percutaneous coronary intervention: a 10-year follow-up comparing random survival forest and Cox proportional-hazards model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Farhadian ◽  
Sahar Dehdar Karsidani ◽  
Azadeh Mozayanimonfared ◽  
Hossein Mahjub
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Coronary Intervention ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Cerebrovascular Events ◽  
Long Term Follow Up ◽  
Stent Length

Abstract Background Due to the limited number of studies with long term follow-up of patients undergoing Percutaneous Coronary Intervention (PCI), we investigated the occurrence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) during 10 years of follow-up after coronary angioplasty using Random Survival Forest (RSF) and Cox proportional hazards models. Methods The current retrospective cohort study was performed on 220 patients (69 women and 151 men) undergoing coronary angioplasty from March 2009 to March 2012 in Farchshian Medical Center in Hamadan city, Iran. Survival time (month) as the response variable was considered from the date of angioplasty to the main endpoint or the end of the follow-up period (September 2019). To identify the factors influencing the occurrence of MACCE, the performance of Cox and RSF models were investigated in terms of C index, Integrated Brier Score (IBS) and prediction error criteria. Results Ninety-six patients (43.7%) experienced MACCE by the end of the follow-up period, and the median survival time was estimated to be 98 months. Survival decreased from 99% during the first year to 39% at 10 years' follow-up. By applying the Cox model, the predictors were identified as follows: age (HR = 1.03, 95% CI 1.01–1.05), diabetes (HR = 2.17, 95% CI 1.29–3.66), smoking (HR = 2.41, 95% CI 1.46–3.98), and stent length (HR = 1.74, 95% CI 1.11–2.75). The predictive performance was slightly better by the RSF model (IBS of 0.124 vs. 0.135, C index of 0.648 vs. 0.626 and out-of-bag error rate of 0.352 vs. 0.374 for RSF). In addition to age, diabetes, smoking, and stent length, RSF also included coronary artery disease (acute or chronic) and hyperlipidemia as the most important variables. Conclusion Machine-learning prediction models such as RSF showed better performance than the Cox proportional hazards model for the prediction of MACCE during long-term follow-up after PCI.

scholarly journals Elevated plasma growth and differentiation factor 15 predicts incident anemia in older adults aged 60 years and older

2020 ◽  
Author(s):  
Yuko Yamaguchi ◽  
Marta Zampino ◽  
Toshiko Tanaka ◽  
Stefania Bandinelli ◽  
Yusuke Osawa ◽  
...  
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Differentiation Factor ◽  
Hazards Model ◽  
Increased Risk ◽  
The Relationship

Abstract Background Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. Methods We examined the relationship between plasma GDF-15 concentrations at baseline in 708 non-anemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. Results During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased risk of developing anemia (Hazards Ratio 1.15, 95% Confidence Interval 1.09, 1.21, P&lt;.0001) compared to those in the lower three quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Conclusions Circulating GDF-15 is an independent predictor for the development of anemia in older adults.

scholarly journals Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1514
Author(s):  
Hilde Espnes ◽  
Jocasta Ball ◽  
Maja-Lisa Løchen ◽  
Tom Wilsgaard ◽  
Inger Njølstad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Pressure Management ◽  
Reference Models ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

scholarly journals Influence of Smoking Habits on the Prevalence of Dental Caries: A Register-Based Cohort Study

2021 ◽  
Author(s):  
Miguel A. de Araújo Nobre ◽  
Ana M. Sezinando ◽  
Inês C. Fernandes ◽  
Andreia C. Araújo
Keyword(s):  
Dental Caries ◽  
Proportional Hazards ◽  
Smoking Habit ◽  
Cox Proportional Hazards ◽  
Radiographic Examination ◽  
Rank Test ◽  
Significance Level ◽  
Cumulative Survival ◽  
Caries Lesions

Abstract Objective The study aimed to evaluate the influence of smoking habit on the prevalence of dental caries lesions in a follow-up study. Materials and Methods A total of 3,675 patients (2,186 females and 1,489 males) with an average age of 51.4 years were included. Outcome measures were the incidence of dental caries defined as incipient noncavitated, microcavitated, or cavitated lesions which had been diagnosed through clinical observation with mouth mirror and probe examination evaluating change of texture, translucency, and color; radiographic examination through bitewing radiographs; or secondary caries through placement of a new restoration during the follow-up of the study. Statistical Analysis Cumulative survival (time elapsed with absence of dental caries) was estimated through the Kaplan–Meier product limit estimator with comparison of survival curves (log-rank test). A multivariable Cox proportional hazards regression model was used to evaluate the effect of smoking on the incidence of dental caries lesions when controlled to age, gender, systemic status, frequency of dental hygiene appointments, and socioeconomic status. The significance level was set at 5%. Results Eight hundred sixty-three patients developed caries (23.5% incidence rate). The cumulative survival estimation was 81.8% and 48% survival rate for nonsmokers and smokers, respectively (p < 0.001), with an average of 13.5 months between the healthy and diseased state diagnosis. Smokers registered a hazard ratio for dental caries lesions of 1.32 (p = 0.001) when controlled for the other variables of interest. Conclusion Within the limitations of this study, it was concluded that smoking habit might be a predictor for dental caries.

scholarly journals Association of Brain Natriuretic Peptide With Mortality in Exceptionally Long-Lived Families

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 211-211
Author(s):  
Allison Kuipers ◽  
Robert Boudreau ◽  
Mary Feitosa ◽  
Angeline Galvin ◽  
Bharat Thygarajan ◽  
...  
Keyword(s):  
Older Adults ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Sex Education ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Time To Event ◽  
Healthy Older Adults ◽  
Secondary Analyses

Abstract Natriuretic peptides are produced within the heart and released in response to increased chamber wall tension and heart failure (HF). N-Terminal prohormone Brain Natriuretic Peptide (NT-proBNP) is a specific natriuretic peptide commonly assayed in persons at risk for HF. In these individuals, NT-proBNP is associated with future disease prognosis and mortality. However, its association with mortality among healthy older adults remains unknown. Therefore, we determined the association of NT-proBNP with all-cause mortality over a median follow-up of 10 years in 3253 individuals free from HF at baseline in the Long Life Family Study, a study of families recruited for exceptional longevity. We performed cox proportional hazards analysis (coxme in R) for time-to event (mortality), adjusted for field center, familial relatedness, age, sex, education, smoking, alcohol, physical activity, BMI, diabetes, hypertension, and cancer. In addition, we performed secondary analyses among individuals (N=2457) within the normal NT-proBNP limits at baseline (&lt;125pg/ml aged &lt;75 years; &lt;450pg/ml aged ≥75 years). Overall, individuals were aged 32-110 years (median 67 years; 44% male), had mean NT-proBNP of 318.5 pg/ml (median 91.0 pg/ml) and 1066 individuals (33%) died over the follow-up period. After adjustment, each 1 SD greater baseline NT-proBNP was associated with a 1.30-times increased hazard of mortality (95% CI: 1.24-1.36; P&lt;0.0001). Results were similar in individuals with normal baseline NT-proBNP (HR: 1.21; 95% CI: 1.11-1.32; P&lt;0.0001). These results suggest that NT-proBNP is a strong and specific biomarker for mortality in older adults independent of current health status, even in those with clinically-defined normal NT-proBNP.

scholarly journals Replacement of potatoes with other vegetables and risk of myocardial infarction in the Danish Diet, Cancer and Health cohort

2021 ◽  
pp. 1-21
Author(s):  
Anne Mette L. Würtz ◽  
Mette D. Hansen ◽  
Anne Tjønneland ◽  
Eric B. Rimm ◽  
Erik B. Schmidt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Similar Pattern ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Heterogeneous Group ◽  
Dietary Guidelines ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Root Vegetables

ABSTRACT Intake of vegetables is recommended for the prevention of myocardial infarction (MI). However, vegetables make up a heterogeneous group, and subgroups of vegetables may be differentially associated with MI. The aim of this study was to examine replacement of potatoes with other vegetables or subgroups of other vegetables and the risk of MI. Substitutions between subgroups of other vegetables and risk of MI were also investigated. We followed 29,142 women and 26,029 men aged 50-64 years in the Danish Diet, Cancer and Health cohort. Diet was assessed at baseline by using a detailed validated FFQ. Hazards ratios (HR) with 95% CI for the incidence of MI were calculated using Cox proportional hazards regression. During 13.6 years of follow-up, 656 female and 1,694 male cases were identified. Among women, the adjusted HR for MI was 1.02 (95% CI: 0.93, 1.13) per 500 g/week replacement of potatoes with other vegetables. For vegetable subgroups, the HR was 0.93 (95% CI: 0.77, 1.13) for replacement of potatoes with fruiting vegetables and 0.91 (95% CI: 0.77, 1.07) for replacement of potatoes with other root vegetables. A higher intake of cabbage replacing other vegetable subgroups was associated with a statistically non-significant higher risk of MI. A similar pattern of associations was found when intake was expressed in kcal/week. Among men, the pattern of associations was overall found to be similar to that for women. This study supports food-based dietary guidelines recommending to consume a variety of vegetables from all subgroups.

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