Substitutions of Oatmeal and Breakfast Food Alternatives and the Rate of Stroke

Background and Purpose— Studies indicate that consuming breakfast every day, and particularly oatmeal, is associated with lower risk of stroke. However, few studies have considered replacement foods when considering foods usually consumed at breakfast. We, therefore, aimed to model substitutions between the breakfast food products oatmeal, eggs, yogurt, or white bread and subsequent risk of stroke. Methods— Participants from the Danish cohort study (Diet, Cancer and Health; n=55 095) were followed for 13.4 years, during which 2260 subjects experienced a first-ever stroke. Breakfast foods were assessed using a validated 192-item food-frequency questionnaire at baseline. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% CIs for associations between hypothetical substitutions of standard portion sizes of breakfast foods and stroke. Results— Modeling replacement of white bread or eggs with oatmeal was associated with a lower rate of total stroke (hazard ratio [HR]=0.96 [95% CI, 0.95–0.98]; HR=0.96 [95% CI, 0.93–0.98], respectively), total ischemic stroke (HR=0.96 [95% CI, 0.94–0.98]; HR=0.96 [95% CI, 0.94–0.99], respectively), and ischemic stroke due to small-artery occlusion (HR=0.95 [95% CI, 0.93–0.98]; HR=0.95 [95% CI, 0.91–0.99], respectively). Furthermore, modeling replacement of eggs with oatmeal was associated with a lower rate of total hemorrhagic stroke (HR=0.94 [95% CI, 0.89–0.99]). Modeling replacement of yogurt with oatmeal was not associated with stroke. Conclusions— Our findings suggest that a diet containing oatmeal instead of white bread or eggs may be associated with a lower rate of stroke.

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Use of disease-modifying antirheumatic drugs and the subsequent risk of herpes zoster in older adults

Rheumatology ◽

10.1093/rheumatology/keab538 ◽

2021 ◽

Author(s):

Jiahui Qian ◽

Marissa Nichole Lassere ◽

Anita Elizabeth Heywood ◽

Bette Liu

Keyword(s):

Herpes Zoster ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Antiviral Therapies ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Using Data ◽

Subsequent Risk

Abstract Objectives To examine the association between DMARD use and subsequent risk of herpes zoster in a large, heterogeneous, and prospective population-based cohort. Methods Using data from a cohort of adults (45 and Up Study) recruited between 2006 and 2009 and linked to pharmaceutical, hospital and death data (2004–2015), the effect of DMARD use on zoster risk was analysed using Cox proportional hazards models, adjusting for sociodemographic characteristics, comorbidities and corticosteroid use. Results Among 254 065 eligible participants, over 1,826 311 person-years follow-up, there were 6295 new DMARD users and 17 024 incident herpes zoster events. Compared with non-users, the risk of zoster was higher in those who used bDMARDs, either alone or in combination with csDMARDs than in those who only used csDMARDs (adjusted hazard ratios, aHR 2.53 [95% confidence interval, CI 2.03–3.16]) for bDMARDs vs 1.48 [95%CI 1.33–1.66] for csDMARDs, p-heterogeneity < 0.001; reference: non-users). Among users of csDMARDs, compared with non-users, zoster risks were highest in those using exclusively cyclophosphamide (aHR 2.69 [95%CI 1.89–3.83]), more moderate in those using azathioprine (aHR 1.57 [95%CI 1.07–2.30]) and hydroxychloroquine (aHR 1.43 [95%CI 1.11–1.83]) and not elevated in users of methotrexate (aHR 1.24 [95%CI 0.98–1.57]), sulfasalazine (aHR 1.00 [95%CI 0.71–1.42]) and leflunomide (aHR 0.41 [95%CI 0.06–2.88]). Conclusions The risk of zoster was high among bDMARD and cyclophosphamide users. Also, the risk was increased in those using hydroxychloroquine alone and in combination with methotrexate but not methotrexate alone. Preventative strategies such as zoster vaccination or antiviral therapies should be considered in these populations if not contraindicated.

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Adherence to the EAT-Lancet Diet and Risk of Stroke and Stroke Subtypes: A Cohort Study

Stroke ◽

10.1161/strokeaha.121.036738 ◽

2021 ◽

Author(s):

Daniel B. Ibsen ◽

Anne H. Christiansen ◽

Anja Olsen ◽

Anne Tjønneland ◽

Kim Overvad ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Lower Risk ◽

Proportional Hazards ◽

National Registry ◽

Healthy Eating Index ◽

Cox Proportional Hazards ◽

Stroke Subtypes ◽

Cox Proportional Hazards Models ◽

Hazard Ratios

Background and Purpose: We investigated the association between adherence to the EAT-Lancet diet, a sustainable and mostly plant-based diet, and risk of stroke and subtypes of stroke in a Danish population. For comparison, we also investigated the Alternate Healthy Eating Index-2010 (AHEI). Methods: We used the Danish Diet, Cancer and Health cohort (n=55 016) including adults aged 50 to 64 years at baseline (1993–1997). A food frequency questionnaire was used to assess dietary intake and group participants according to adherence to the diets. Stroke cases were identified using a national registry and subsequently validated by review of medical records (n=2253). Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for associations with the EAT-Lancet diet or the AHEI and risk of stroke and stroke subtypes. Results: Adherence to the EAT-Lancet diet was associated with a lower risk of stroke, although not statistically significant (highest versus lowest adherence: hazard ratio, 0.91 [95% CI, 0.76–1.09]). A lower risk was observed for AHEI (0.75 [95% CI, 0.64–0.87]). For stroke subtypes, we found that adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid hemorrhage (0.30 [95% CI, 0.12–0.73]), and the AHEI was associated with a lower risk of ischemic stroke (0.76 [95% CI, 0.64–0.90]) and intracerebral hemorrhage (0.58 [95% CI, 0.36–0.93]). Conclusions: Adherence to the EAT-Lancet diet in midlife was associated with a lower risk of subarachnoid stroke, and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.

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Adherence to the EAT-Lancet diet and risk of stroke and stroke subtypes: A Danish cohort study

10.1101/2021.04.14.21255371 ◽

2021 ◽

Author(s):

Daniel B Ibsen ◽

Anne H Christiansen ◽

Anja Olsen ◽

Anne Tjoenneland ◽

Kim Overvad ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Lower Risk ◽

Proportional Hazards ◽

National Registry ◽

Healthy Eating Index ◽

Cox Proportional Hazards ◽

Stroke Subtypes ◽

Cox Proportional Hazards Models ◽

Hazard Ratios

Objective To investigate the association between adherence to the EAT-Lancet diet, a sustainable and mostly plant-based diet, and risk of stroke and subtypes of stroke in a Danish population. For comparison, we also investigated the Alternate Healthy Eating Index-2010 (AHEI). Methods We used the Danish Diet, Cancer and Health cohort (n=55,016) including adults aged 50-64 years at baseline (1993-1997). A food frequency questionnaire was used to assess dietary intake and group participants according to adherence to the diets. Stroke cases were identified using a national registry and subsequently validated by review of medical records (n=2253). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations with the EAT-Lancet diet or the AHEI and risk of stroke and stroke subtypes. Results Adherence to the EAT-Lancet diet was associated with a lower risk of stroke, although not statistically significant (highest vs lowest adherence: HR 0.91; 95% CI 0.76, 1.09). A lower risk was observed for the AHEI (0.75; 0.64, 0.87). For stroke subtypes we found that adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid hemorrhage (0.30; 0.12, 0.73) and the AHEI was associated with a lower risk of ischemic stroke (0.76; 0.64, 0.90) and intracerebral hemorrhage (0.58; 0.36, 0.93). Conclusions Adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid stroke and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.

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Changes in Metabolic Syndrome Status and Breast Cancer Risk: A Nationwide Cohort Study

Cancers ◽

10.3390/cancers13051177 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1177

Author(s):

In Young Choi ◽

Sohyun Chun ◽

Dong Wook Shin ◽

Kyungdo Han ◽

Keun Hye Jeon ◽

...

Keyword(s):

Breast Cancer ◽

Metabolic Syndrome ◽

Proportional Hazards ◽

Screening Program ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Increased Risk ◽

Health Screening Program ◽

Design And Methods

Objective: To our knowledge, no studies have yet looked at how the risk of developing breast cancer (BC) varies with changes in metabolic syndrome (MetS) status. This study aimed to investigate the association between changes in MetS and subsequent BC occurrence. Research Design and Methods: We enrolled 930,055 postmenopausal women aged 40–74 years who participated in a biennial National Health Screening Program in 2009–2010 and 2011–2012. Participants were categorized into four groups according to change in MetS status during the two-year interval screening: sustained non-MetS, transition to MetS, transition to non-MetS, and sustained MetS. We calculated multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for BC incidence using the Cox proportional hazards models. Results: At baseline, MetS was associated with a significantly increased risk of BC (aHR 1.11, 95% CI 1.06–1.17) and so were all of its components. The risk of BC increased as the number of the components increased (aHR 1.46, 95% CI 1.26–1.61 for women with all five components). Compared to the sustained non-MetS group, the aHR (95% CI) for BC was 1.11 (1.04–1.19) in the transition to MetS group, 1.05 (0.96–1.14) in the transition to non-MetS group, and 1.18 (1.12–1.25) in the sustained MetS group. Conclusions: Significantly increased BC risk was observed in the sustained MetS and transition to MetS groups. These findings are clinically meaningful in that efforts to recover from MetS may lead to reduced risk of BC.

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Effects of antiarrhythmic drugs on atrioventricular conduction in patients with preexisting bundle branch block

European Heart Journal ◽

10.1093/ehjci/ehaa946.3358 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Kochav ◽

R.C Chen ◽

J.M.D Dizon ◽

J.A.R Reiffel

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

Class I ◽

Class Iii ◽

Bundle Branch Block ◽

Kaplan Meier ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

History Of ◽

Propensity Score Stratification

Abstract Background Theoretical concern exists regarding AV block (AVB) with class I antiarrhythmics (AADs) when bundle branch block (BBB) is present. Whether this is substantiated in real-world populations is unknown. Purpose To determine the relationship between type of AAD and incidence of AVB in patients with preexisting BBB. Methods We retrospectively studied all patients with BBB who received class I and III AADs between 1997–2019 to compare incidence of AVB. We defined index time as first exposure to either drug class and excluded patients with prior AVB or exposed to both classes. Time-at-risk window ended at first outcome occurrence or when patients were no longer observed in the database. We estimated hazard ratios for incident AVB using Cox proportional hazards models with propensity score stratification, adjusting for over 32,000 covariates from the electronic health record. Kaplan-Meier methods were used to determine treatment effects over time. Results Of 40,120 individuals with BBB, 148 were exposed to a class I AAD and 2401 to a class III AAD. Over nearly 4,200 person-years of follow up, there were 22 and 620 outcome events in the class I and class III cohorts, respectively (Figure). In adjusted analyses, AVB risk was markedly lower in patients exposed to class I AADs compared with class III (HR 0.48 [95% CI 0.30–0.75]). Conclusion Among patients with BBB, exposure to class III AADs was strongly associated with greater risk of incident AVB. This likely reflects differences in natural history of patients receiving class I vs class III AADs rather than adverse class III effects, however, the lack of worse outcomes acutely with class I AADs suggests that they may be safer in BBB than suspected. Funding Acknowledgement Type of funding source: None

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Adverse Effect of Older Age on the Recurrence of Soft Tissue Sarcoma of the Extremities and Trunk

Journal of Clinical Oncology ◽

10.1200/jco.2010.34.0711 ◽

2011 ◽

Vol 29 (30) ◽

pp. 4029-4035 ◽

Cited By ~ 32

Author(s):

David J. Biau ◽

Peter C. Ferguson ◽

Robert E. Turcotte ◽

Peter Chung ◽

Marc H. Isler ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcoma ◽

Older Patients ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Age At Surgery ◽

Effect Of Age

Purpose To examine the effect of age on the recurrence of soft tissue sarcoma in the extremities and trunk. Patients and Methods This was a multicenter study that included 2,385 patients with median age at surgery of 57 years. The end points considered were local recurrence and metastasis. Cox proportional hazards models were used to estimate hazard ratios across the age ranges with and without adjustment for known confounding factors. Results Older patients presented with tumors that were larger (P < .001) and of higher grade (P < .001). The proportion of positive margins increased significantly as patients age (P < .001), but radiation therapy was relatively underused in patients older than age 60 years. The 5-year cumulative incidences of local recurrence were 7.2% (95% CI, 4% to 11.7%) for patients age 30 years or younger and 12.9% (95% CI, 9.1% to 17.5%) for patients age 75 years or older. The corresponding 5-year cumulative incidences of metastasis were 17.5% (95% CI, 12.1% to 23.7%) and 33.9% (95% CI, 28.1% to 39.8%) for the same groups. Regression models showed that age was significantly associated with local recurrence (P < .001) and metastasis (P < .001) in nonadjusted models. After adjusting for imbalance in presentation and treatment variables, age remained significantly associated with local recurrence (P = .031) and metastasis (P = .019). Conclusion Older patients have worse outcomes because they tend to present with worse tumors and are treated less aggressively. However, there remained a significant increase in the risk of both local and systemic recurrence associated with increasing age that could not be explained by tumor or treatment characteristics.

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NHSR 155: Comparative Analysis of the National Health and Nutrition Examination Survey Public-Use and Restricted-Use Linked Mortality Files - Production Schedule

10.15620/cdc:104774 ◽

2021 ◽

Author(s):

Lisa Mirel

Keyword(s):

Comparative Analysis ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

The Public ◽

Health And Nutrition ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Specific Mortality ◽

Standard Set ◽

Restricted Use

This report describes a comparative analysis of the public-use and restricted-use NHANES LMFs. Cox proportional hazards models were used to estimate relative hazard ratios for a standard set of sociodemographic covariates for all-cause as well as cause-specific mortality, using the public-use and restricted-use NHANES LMFs.

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Abstract P005: Comparative Effectiveness of Rivaroxaban versus Warfarin for the Treatment of Patients with Non-valvular Atrial Fibrillation

Circulation ◽

10.1161/circ.133.suppl_1.p005 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Faye L Norby ◽

Lindsay G Bengtson ◽

Lin Y Chen ◽

Richard F MacLehose ◽

Pamela L Lutsey ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Real World ◽

Proportional Hazards ◽

Large Population ◽

Population Based ◽

Cox Proportional Hazards ◽

Gi Bleeding ◽

Cox Proportional Hazards Models ◽

The Us

Background: Rivaroxaban is a novel oral anticoagulant approved in the US in 2011 for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Information on risks and benefits among rivaroxaban users in real-world populations is limited. Methods: We used data from the US MarketScan Commercial and Medicare Supplemental databases between 2010 and 2013. We selected patients with a history of NVAF and initiating rivaroxaban or warfarin. Rivaroxaban users were matched with up to 5 warfarin users by age, sex, database enrollment date and drug initiation date. Ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding outcomes were defined by ICD-9-CM codes in an inpatient claim after drug initiation date. Cox proportional hazards models were used to assess the association between rivaroxaban vs. warfarin use and outcomes adjusting for age, sex, and CHA2DS2-VASc score. Separate models were used to compare a) new rivaroxaban users with new warfarin users, and b) switchers from warfarin to rivaroxaban to continuous warfarin users. Results: Our analysis included 34,998 rivaroxaban users matched to 102,480 warfarin users with NVAF (39% female, mean age 71), in which 487 ischemic strokes, 179 ICB, 647 MI, and 1353 GI bleeds were identified during a mean follow-up of 9 months. Associations of rivaroxaban vs warfarin were similar in new users and switchers; therefore we pooled both analyses. Rivaroxaban users had lower rates of ICB (hazard ratio (HR) (95% confidence interval (CI)) = 0.72 (0.46, 1.12))) and ischemic stroke (HR (95% CI) = 0.88 (0.68, 1.13)), but higher rates of GI bleeding (HR (95% CI) = 1.15 (1.01, 1.33)) when compared to warfarin users (table). Conclusion: In this large population-based study of NVAF patients, rivaroxaban users had a non-significant lower risk of ICB and ischemic stroke than warfarin users, but a higher risk of GI bleeding. These real-world findings are comparable to results reported in published clinical trials.

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Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database

Neurosurgery ◽

10.1093/neuros/nyz377 ◽

2019 ◽

Vol 87 (1) ◽

pp. 63-70

Author(s):

Haruhisa Fukuda ◽

Daisuke Sato ◽

Yoriko Kato ◽

Wataro Tsuruta ◽

Masahiro Katsumata ◽

...

Keyword(s):

Linear Models ◽

Proportional Hazards ◽

National Level ◽

Cox Proportional Hazards ◽

National Database ◽

Healthcare Expenditures ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Unruptured Intracranial Aneurysms ◽

Economic Perspectives

Abstract BACKGROUND Flow diverters (FDs) have marked the beginning of innovations in the endovascular treatment of large unruptured intracranial aneurysms, but no multi-institutional studies have been conducted on these devices from both the clinical and economic perspectives. OBJECTIVE To compare retreatment rates and healthcare expenditures between FDs and conventional coiling-based treatments in all eligible cases in Japan. METHODS We identified patients who had undergone endovascular treatments during the study period (October 2015-March 2018) from a national-level claims database. The outcome measures were retreatment rates and 1-yr total healthcare expenditures, which were compared among patients who had undergone FD, coiling, and stent-assisted coiling (SAC) treatments. The coiling and SAC groups were further categorized according to the number of coils used. Retreatment rates were analyzed using Cox proportional hazards models, and total expenditures were analyzed using multilevel mixed-effects generalized linear models. RESULTS The study sample comprised 512 FD patients, 1499 coiling patients, and 711 SAC patients. The coiling groups with ≥10 coils and ≥9 coils had significantly higher retreatment rates than the FD group with hazard ratios of 2.75 (1.30-5.82) and 2.52 (1.24-5.09), respectively. In addition, the coiling group with ≥10 coils and SAC group with ≥10 coils had significantly higher 1-year expenditures than the FD group with cost ratios (95% CI) of 1.30 (1.13-1.49) and 1.31 (1.15-1.50), respectively. CONCLUSION In this national-level study, FDs demonstrated significantly lower retreatment rates and total expenditures than conventional coiling with ≥ 9 coils.

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Dietary selenium intake and mortality in two population-based cohort studies of 133 957 Chinese men and women

Public Health Nutrition ◽

10.1017/s1368980016001130 ◽

2016 ◽

Vol 19 (16) ◽

pp. 2991-2998 ◽

Cited By ~ 7

Author(s):

Jiang-Wei Sun ◽

Xiao-Ou Shu ◽

Hong-Lan Li ◽

Wei Zhang ◽

Jing Gao ◽

...

Keyword(s):

Cancer Mortality ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Health Study ◽

Chinese Populations ◽

Urban City ◽

Cox Proportional Hazards Models ◽

Hazard Ratios

AbstractObjectiveTo investigate the potential influence of dietary Se intake on mortality among Chinese populations.DesignWe prospectively evaluated all-cause, CVD and cancer mortality risks associated with dietary Se intake in participants of the Shanghai Women’s Health Study (SWHS) and the Shanghai Men’s Health study (SMHS). Dietary Se intake was assessed by validated FFQ during in-person interviews. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95 % CI.SettingUrban city in China.SubjectsChinese adults (n 133 957).ResultsDuring an average follow-up of 13·90 years in the SWHS and 8·37 years in the SMHS, 5749 women and 4217 men died. The mean estimated dietary Se intake was 45·48 μg/d for women and 51·34 μg/d for men, respectively. Dietary Se intake was inversely associated with all-cause mortality and CVD mortality in both women and men, with respective HR for the highest compared with the lowest quintile being 0·79 (95 % CI 0·71, 0·88; Ptrend<0·0001) and 0·80 (95 % CI 0·66, 0·98; Ptrend=0·0268) for women, and 0·79 (95 % CI 0·70, 0·89; Ptrend=0·0001) and 0·66 (95 % CI 0·54, 0·82; Ptrend=0·0002) for men. No significant associations were observed for cancer mortality in both women and men. Results were similar in subgroup and sensitivity analyses.ConclusionsDietary Se intake was inversely associated with all-cause and cardiovascular mortality in both sexes, but not cancer mortality.

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