High alkaline phosphatase and low intact parathyroid hormone associate with worse clinical outcome in peritoneal dialysis patients

2020 ◽  
pp. 089686082091813 ◽  
Author(s):  
Zhimin Chen ◽  
Xiaohui Zhang ◽  
Fei Han ◽  
Xishao Xie ◽  
Zhou Hua ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Alkaline Phosphatase ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Competing Risks ◽  
Cardiovascular Mortality ◽  
Assessment Tools ◽  
Baseline Serum ◽  
All Cause Mortality

Objective: Alkaline phosphatase (ALP) is used as a biomarker to monitor the chronic kidney disease–mineral bone disorder (CKD-MBD) and high levels of parathyroid hormone (PTH) that were reported to be related to increased mortality in CKD patients. Therefore, we conducted this longitudinal cohort study to evaluate the relations between ALP and intact PTH (iPTH) and the associations with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients. Methods: In 1276 incident PD patients (median age 50 years, 56% males), baseline serum ALP, iPTH, and metabolic biomarkers potentially linked to CKD-MBD were analyzed in relation to mortality during follow-up period of up to 60 months. All-cause and cardiovascular mortality risk of ALP and iPTH were analyzed with competing-risks regression models with transplantation as competing risk adjusting for all covariates. Results: After adjustments for confounders by logistic regression model, older age, higher change level to levels of iPTH, S-albumin, calcium, alanine transaminase (ALT), and lower level of phosphorus were associated with higher ALP level (>79 U/L), and female gender, non-diabetes mellitus, younger age, lower calcium, higher ALT, total bilirubin, phosphorus, and ALP were associated with higher iPTH level (>300 pg/mL). During 60 months (median 44 months) of follow-up, the all-cause mortality rate was 16%, and 91 (46%) of the 199 deaths were caused by cardiovascular disease. In competing-risks regression analysis, “high ALP + low iPTH” was independently associated with all-cause and cardiovascular mortality after adjustment for age, gender, presence of diabetes, and cardiovascular disease, the calendar year of recruitment and vitamin D therapy in PD patients. The subhazard ratio (sHR) of group “high ALP + low iPTH” was 1.96 times and 3.35 times higher than sHR of group “low ALP + high iPTH” for all-cause mortality and cardiovascular mortality, respectively. Conclusions: The combination of high ALP and low iPTH was independently associated with increased all-cause and cardiovascular mortality in PD patients, suggesting that ALP and iPTH have the potential to predict clinical outcomes and might be useful risk assessment tools in PD patients. Further studies exploring the observed association between combination of ALP with iPTH and mortality are warranted.

FC 100ASSOCIATION OF SINGLE AND SERIAL MEASURES OF SERUM PHOSPHORUS WITH ADVERSE OUTCOMES IN PATIENTS ON PERITONEAL DIALYSIS: RESULTS FROM THE INTERNATIONAL PDOPPS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marcelo Lopes ◽  
Angelo Karaboyas ◽  
David W Johnson ◽  
Talerngsak Kanjanabuch ◽  
Martin Wilkie ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Outcomes ◽  
Serum Phosphorus ◽  
Target Range ◽  
Recent Measurement ◽  
Baseline Serum ◽  
All Cause Mortality ◽  
Serial Measurements ◽  
Phosphorus Levels

Abstract Background and Aims While it has been established that high serum phosphorus is associated with mortality in hemodialysis (HD) patients, there is limited evidence in the peritoneal dialysis (PD) setting. We evaluated the association of serum phosphorus with mortality and major adverse cardiovascular events (MACE) in patients on PD, and investigated various parameterizations using single and serial measurements of serum phosphorus. Method We utilized data from 7 countries in phase 1 (2014-2017) of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Australia, Canada, Japan, New Zealand, Thailand, the UK, and the US. We investigated the association of serum phosphorus and 3 outcomes: all-cause mortality, cardiovascular (CV) mortality, and MACE (CV mortality + non-fatal angina, myocardial infarction, stroke, and heart failure). We parameterized serum phosphorus using 4 different methods: (1) single measurement of baseline serum phosphorus [most recent measurement during 6-month run-in period]; (2) mean serum phosphorus over a 6-month run-in period; (3) number of months (over the past 6 months) with serum phosphorus above the target range (>4.5 mg/dL); (4) mean area-under-the-curve (AUC), calculated as the average amount of time spent with serum phosphorus >4.5 mg/dL multiplied by the extent to which this threshold was exceeded over 6 months. Cox regression was used to estimate the association between each of these 4 exposures with the time-to-event outcomes, in models thoroughly adjusted for possible confounders. Follow-up began after the 6-month run-in period and continued until the outcome occurred, 7 days after leaving the facility due to transfer or change in kidney replacement therapy modality, loss to follow-up, or end of study phase (whichever event occurred first). Results Our sample consisted of 5904 patients who were on PD. Those with higher serum phosphorus levels were younger and had lower hemoglobin levels. Compared to patients with serum phosphorus ≥3.5 to <4.5 mg/dL, we found an all-cause mortality hazard ratio (HR) of 1.62 (95% CI: 1.19, 2.20) for patients with serum phosphorus ≥ 7 mg/dL. Strong associations were also observed using serial phosphorus measures [Table]. For example, compared to the reference group of AUC=0, the HR (95% CI) of death was 1.49 (1.10, 2.00) for AUC >1 to 2; and 1.67 (1.15, 2.41) for AUC >2. Akaike Information Criteria (AIC) results showed that, among the 4 exposures, AUC was the strongest predictor of all-cause mortality, and the single phosphorus measure was the weakest predictor. Associations between serum phosphorus and adverse outcomes were generally stronger for CV death and MACE than for all-cause mortality [Table]. Conclusion As seen in HD patients, this analysis demonstrates that serum phosphorus is a strong predictor of adverse outcomes in patients on PD. When considering serial measurements of serum phosphorus, rates of adverse events began to rise at phosphorus levels >4.5 mg/dL. As recommended by KDIGO guidelines, serial measurements that consider a history of serum phosphorus excursions >4.5 mg/dL should be considered when assessing risks of adverse outcomes.

scholarly journals The Significance of Follow-Up Serum Uric Acid Levels in Predicting All-Cause Mortality and Cardiovascular Mortality in Peritoneal Dialysis Patients

2021 ◽  
Author(s):  
Pingping Ren ◽  
Qilong Zhang ◽  
Yixuan Pan ◽  
Yi Liu ◽  
Chenglin Li ◽  
...  
Keyword(s):  
Uric Acid ◽  
Peritoneal Dialysis ◽  
Serum Uric Acid ◽  
Cardiovascular Mortality ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Kaplan Meier ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background: Studies on the correlation between serum uric acid (SUA) and all-cause mortality in peritoneal dialysis (PD) patients were mainly based on the results of baseline SUA. We aimed to analyze the change of SUA level post PD, and the correlation between follow-up SUA and prognosis in PD patients. Methods: All patients who received PD catheterization and maintaining PD in our center from March 2, 2001 to March 8, 2017 were screened. Kaplan-Meier and Cox proportional-hazards regression models were used to analyze the effect of SUA levels on the risks of death. We graded SUA levels at baseline, 6 months, 12 months, 18 months and 24 months post PD by mean of SUA plus or minus a standard deviation as cut-off values, and compared all-cause and cardiovascular mortality among patients with different SUA grades. Results: A total of 1402 patients were included, 763 males (54.42%) and 639 females (45.58%). Their average age at PD start was 49.50±14.20 years. The SUA levels were 7.97±1.79mg/dl at baseline, 7.12±1.48mg/dl at 6 months, 7.05±1.33mg/dl at 12 months, 7.01±1.30mg/dl at 18 months, and 6.93±1.26mg/dl at 24 months. During median follow-up time of 31 (18, 49) months, 173 (12.34%) all-cause deaths occurred, including 68 (4.85%) cardiovascular deaths. There were no significant differences on all-cause mortality among groups with graded SUA levels at baseline, 12 months, 18 months and 24 months during follow-up or on cardiovascular mortality among groups with graded SUA levels at baseline, 6 months, 12 months, 18 months and 24 months during follow-up. At 6 months post PD，Kaplan Meier analysis showed there was significant difference on all-cause mortality among graded SUA levels (c2=11.315, P=0.010), and the all-cause mortality was lowest in grade of 5.65mg/dl≤SUA<7.13mg/dl. Conclusion: SUA level decreased during follow up post PD. At 6 months post PD, a grade of 5.65mg/dl≤SUA<7.13mg/dl was appropriate for better patients’ survival.

scholarly journals Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: the Japanese–Brazilian thyroid study

2010 ◽  
Vol 162 (3) ◽  
pp. 569-577 ◽  
Author(s):  
José A Sgarbi ◽  
Luiza K Matsumura ◽  
Teresa S Kasamatsu ◽  
Sandra R Ferreira ◽  
Rui M B Maciel
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Mortality ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Subclinical Hyperthyroidism ◽  
Cross Sectional ◽  
All Cause Mortality ◽  
Thyroid Medication ◽  
Cardiometabolic Profile

ObjectiveThe currently available data concerning the influence of subclinical thyroid disease (STD) on morbidity and mortality are conflicting. Our objective was to investigate the relationships between STD and cardiometabolic profile and cardiovascular disease at baseline, as well as with all-cause and cardiovascular mortality in a 7.5-year follow-up.DesignProspective, observational study.MethodsAn overall of 1110 Japanese–Brazilians aged above 30 years, free of thyroid disease, and not taking thyroid medication at baseline were studied. In a cross-sectional analysis, we investigated the prevalence of STD and its relationship with cardiometabolic profile and cardiovascular disease. All-cause and cardiovascular mortality rates were assessed for participants followed for up to 7.5 years. Association between STD and mortality was drawn using multivariate analysis, adjusting for potential confounders.ResultsA total of 913 (82.3%) participants had euthyroidism, 99 (8.7%) had subclinical hypothyroidism, and 69 (6.2%) had subclinical hyperthyroidism. At baseline, no association was found between STD and cardiometabolic profile or cardiovascular disease. Multivariate-adjusted hazard ratios (HRs (95% confidence interval)) for all-cause mortality were significantly higher for individuals with both subclinical hyperthyroidism (HR, 3.0 (1.5–5.9); n=14) and subclinical hypothyroidism (HR, 2.3 (1.2–4.4); n=13) than for euthyroid subjects. Cardiovascular mortality was significantly associated with subclinical hyperthyroidism (HR, 3.3 (1.4–7.5); n=8), but not with subclinical hypothyroidism (HR, 1.6 (0.6–4.2); n=5).ConclusionIn the Japanese–Brazilian population, subclinical hyperthyroidism is an independent risk factor for all-cause and cardiovascular mortality, while subclinical hypothyroidism is associated with all-cause mortality.

scholarly journals Comparative Mortality–Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis

2014 ◽  
Vol 34 (7) ◽  
pp. 732-748 ◽  
Author(s):  
Connie M. Rhee ◽  
Miklos Z. Molnar ◽  
Wei Ling Lau ◽  
Vanessa Ravel ◽  
Csaba P. Kovesdy ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Serum Alkaline Phosphatase ◽  
Reference Ranges ◽  
Cox Models ◽  
Death Risk ◽  
Entry Period ◽  
Hazard Ratios

BackgroundIn hemodialysis (HD) patients, serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) derangements are associated with mortality, but outcome-predictability using ALP and PTH in peritoneal dialysis (PD) patients remains uncertain.MethodsIn a cohort of 9244 adult PD patients from a large national dialysis organization (entry period 2001 – 2006, with follow-up through 2009), we used multivariable Cox models adjusted for case-mix and laboratory covariates to examine the associations of time-averaged ALP and PTH with all-cause mortality. We then compared mortality-predictability using ALP and PTH in 9244 PD and 99 323 HD patients.ResultsIn PD patients, ALP concentrations exceeding 150 U/L were associated with increased mortality (reference ALP: 70 to <90 U/L). Hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.18 (1.03 to 1.36), 1.27 (1.08 to 1.50), 1.49 (1.23 to 1.79), and 1.35 (1.19 to 1.53) for ALP concentrations of 150 to <170 U/L, 170 to <190 U/L, 190 to <210 U/L, and ≥210 U/L respectively. In contrast, we observed a U-shaped association between PTH concentration and death risk in PD patients, with PTH concentrations of less than 200 pg/mL and 700 pg/mL or more associated with increased mortality (reference PTH: 200 to <300 pg/mL). Hazard ratios and 95% CIs were 1.25 (1.12 to 1.41), 1.12 (1.02 to 1.23), 1.06 (0.96 to 1.18), 1.09 (0.97 to 1.24), 1.12 (0.97 to 1.29), 1.18 (0.99 to 1.40), and 1.23 (1.09 to 1.38) for PTH concentrations of <100 pg/mL, 100 to <200 pg/mL, 300 to <400 pg/mL, 400 to <500 pg/mL, 500 to <600 pg/mL, 600 to <700 pg/mL, and ≥700 pg/mL respectively. Compared with PD patients having serum concentrations of ALP and PTH within reference ranges, patients on HD experienced increased mortality across all ALP and PTH concentrations, particularly those in the lowest and highest categories.ConclusionsIn summary, higher ALP concentrations are associated with increased mortality, and lower and higher PTH concentrations are both associated with death risk in PD patients. The utility of ALP in the management of chronic kidney disease mineral bone disorders in PD patients warrants further study.

scholarly journals Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chengyi Ding ◽  
Dara O’Neill ◽  
Steven Bell ◽  
Emmanuel Stamatakis ◽  
Annie Britton
Keyword(s):  
Cardiovascular Disease ◽  
Alcohol Consumption ◽  
Health Survey ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Polynomial Regression ◽  
De Novo ◽  
New Findings ◽  
All Cause Mortality

Abstract Background Light-to-moderate alcohol consumption has been reported to be cardio-protective among apparently healthy individuals; however, it is unclear whether this association is also present in those with disease. To examine the association between alcohol consumption and prognosis in individuals with pre-existing cardiovascular disease (CVD), we conducted a series of meta-analyses of new findings from three large-scale cohorts and existing published studies. Methods We assessed alcohol consumption in relation to all-cause mortality, cardiovascular mortality, and subsequent cardiovascular events via de novo analyses of 14,386 patients with a previous myocardial infarction, angina, or stroke in the UK Biobank Study (median follow-up 8.7 years, interquartile range [IQR] 8.0–9.5), involving 1640 deaths and 2950 subsequent events, and 2802 patients and 1257 deaths in 15 waves of the Health Survey for England 1994–2008 and three waves of the Scottish Health Survey 1995, 1998, and 2003 (median follow-up 9.5 years, IQR 5.7–13.0). This was augmented with findings from 12 published studies identified through a systematic review, providing data on 31,235 patients, 5095 deaths, and 1414 subsequent events. To determine the best-fitting dose-response association between alcohol and each outcome in the combined sample of 48,423 patients, models were constructed using fractional polynomial regression, adjusting at least for age, sex, and smoking status. Results Alcohol consumption was associated with all assessed outcomes in a J-shaped manner relative to current non-drinkers, with a risk reduction that peaked at 7 g/day (relative risk 0.79, 95% confidence interval 0.73–0.85) for all-cause mortality, 8 g/day (0.73, 0.64–0.83) for cardiovascular mortality and 6 g/day (0.50, 0.26–0.96) for cardiovascular events, and remained significant up to 62, 50, and 15 g/day, respectively. No statistically significant elevated risks were found at higher levels of drinking. In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated. Conclusions For secondary prevention of CVD, current drinkers may not need to stop drinking. However, they should be informed that the lowest risk of mortality and having another cardiovascular event is likely to be associated with lower levels of drinking, that is up to approximately 105g (or equivalent to 13 UK units, with one unit equal to half a pint of beer/lager/cider, half a glass of wine, or one measure of spirits) a week.

Impact of Early Nephrology Referral on Mortality and Hospitalization in Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Kai Ming Chow ◽  
Cheuk Chun Szeto ◽  
Man Ching Law ◽  
Bonnie Ching-Ha Kwan ◽  
Chi Bon Leung ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiovascular Mortality ◽  
Univariate Analysis ◽  
Maintenance Hemodialysis ◽  
All Cause Mortality ◽  
Poor Outcomes ◽  
The Relationship ◽  
Late Referral ◽  
Relevant Factors

Objectives Several studies have examined the possible association between late referral to a nephrologist and mortality on maintenance hemodialysis. However, we lack information on the benefit of early nephrologist referral in patients receiving peritoneal dialysis (PD). Patients and Methods In an inception cohort of 102 consecutive PD patients identified in a single center between 2003 and 2004, we sought to determine whether late nephrologist referral was associated with poor outcomes. The primary end point was all-cause mortality. The effects of early referral to a multidisciplinary low clearance clinic on cardiovascular mortality and length of hospitalization were also evaluated. Results Of 102 incident PD patients, 61 subjects (59.8%) were referred early to the nephrologist (more than 3 months) before dialysis initiation. During the study period of 284.9 patient-years (median follow-up period 36.8 months), 25 patients died, 12 due to cardiovascular causes. Both cardiovascular and all-cause mortality were significantly increased among PD patients with late referral, but the relationship between late referral and all-cause mortality was mitigated substantially by adjusting for relevant factors. In univariate analysis, late nephrology referral was associated with increased cardiovascular mortality, with a hazard ratio of 5.43 (95% confidence interval 1.46 – 20.21, p = 0.012). Annual adjusted days of hospitalization were similar between the early and late nephrology referral groups. Conclusions A comprehensive analysis of incident PD subjects confirmed the significant relationship between late nephrology referral and all-cause and cardiovascular mortality. A causal relationship remains to be established and validated.

scholarly journals Low serum parathyroid hormone is a risk factor for peritonitis episodes in incident peritoneal dialysis patients: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuqi Yang ◽  
Jingjing Da ◽  
Yi Jiang ◽  
Jing Yuan ◽  
Yan Zha
Keyword(s):  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Proportional Hazard ◽  
Serum Parathyroid Hormone ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression ◽  
Gram Negative Organisms ◽  
Serum Pth

Abstract Background Serum parathyroid hormone (PTH) levels have been reported to be associated with infectious mortality in peritoneal dialysis (PD) patients. Peritonitis is the most common and fatal infectious complication, resulting in technique failure, hospital admission and mortality. Whether PTH is associated with peritonitis episodes remains unclear. Methods We examined the association of PTH levels and peritonitis incidence in a 7-year cohort of 270 incident PD patients who were maintained on dialysis between January 2012 and December 2018 using Cox proportional hazard regression analyses. Patients were categorized into three groups by serum PTH levels as follows: low-PTH group, PTH < 150 pg/mL; middle-PTH group, PTH 150-300 pg/mL; high-PTH group, PTH > 300 pg/mL. Results During a median follow-up of 29.5 (interquartile range 16–49) months, the incidence rate of peritonitis was 0.10 episodes per patient-year. Gram-positive organisms were the most common causative microorganisms (36.2%), and higher percentage of Gram-negative organisms was noted in patients with low PTH levels. Low PTH levels were associated with older age, higher eGFR, higher hemoglobin, calcium levels and lower phosphate, alkaline phosphatase levels. After multivariate adjustment, lower PTH levels were identified as an independent risk factor for peritonitis episodes [hazard ratio 1.643, 95% confidence interval 1.014–2.663, P = 0.044]. Conclusions Low PTH levels are independently associated with peritonitis in incident PD patients.

scholarly journals Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999–2015

2020 ◽  
Author(s):  
Kosuke Inoue ◽  
Roch Nianogo ◽  
Donatello Telesca ◽  
Atsushi Goto ◽  
Vahe Khachadourian ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Regression Models ◽  
Machine Learning Algorithms ◽  
Logistic Regression Models ◽  
Health And Nutrition ◽  
Increased Risk ◽  
The Us ◽  
All Cause Mortality ◽  
Hba1c Levels

Abstract Objective It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. Methods This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999–2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to &lt;5.0%; mid-level, 5.0 to &lt;5.7%; prediabetes, 5.7 to &lt;6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. Results Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. Conclusions Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.

scholarly journals Multi-trajectories of lipid indices with incident cardiovascular disease, heart failure, and all-cause mortality: 23 years follow-up of two US cohort studies

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Fatemeh Koohi ◽  
Davood Khalili ◽  
Mohammad Ali Mansournia ◽  
Farzad Hadaegh ◽  
Hamid Soori
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cohort Studies ◽  
Significant Risk ◽  
Density Lipoprotein ◽  
Lipid Levels ◽  
Cvd Risk ◽  
All Cause Mortality ◽  
Over Time

Abstract Background Understanding the distinct patterns (trajectories) of variation in blood lipid levels before diagnosing cardiovascular disease (CVD) might carry important implications for improving disease prevention or treatment. Methods We investigated 14,373 participants (45.5% men) aged 45–84 from two large US prospective cohort studies with a median of 23 years follow-up. First, we jointly estimated developmental trajectories of lipid indices, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations using group-based multi-trajectory modeling. Then, the association of identified multi-trajectories with incident CVD, heart failure, and all-cause mortality were examined using Cox proportional hazard model. Results Seven distinct multi-trajectories were identified. The majority of participants (approximately 80%) exhibited decreasing LDL-C but rising TG levels and relatively stable HDL-C levels. Compared to the individuals with healthy and stable LDL-C, HDL-C, and TG levels, those in other groups were at significant risk of incident CVD after adjusting for other conventional risk factors. Individuals with the highest but decreasing LDL-C and borderline high and rising TG levels over time were at the highest risk than those in other groups with a 2.22-fold risk of CVD. Also, those with the highest and increased triglyceride levels over time, over optimal and decreasing LDL-C levels, and the lowest HDL-C profile had a nearly 1.84 times CVD risk. Even individuals in the multi-trajectory group with the highest HDL-C, optimal LDL-C, and optimal TG levels had a significant risk (HR, 1.45; 95% CI 1.02–2.08). Furthermore, only those with the highest HDL-C profile increased the risk of heart failure by 1.5-fold (95% CI 1.07–2.06). Conclusions The trajectories and risk of CVD identified in this study demonstrated that despite a decline in LDL-C over time, a significant amount of residual risk for CVD remains. These findings suggest the impact of the increasing trend of TG on CVD risk and emphasize the importance of assessing the lipid levels at each visit and undertaking potential interventions that lower triglyceride concentrations to reduce the residual risk of CVD, even among those with the optimal LDL-C level.

Abstract WP226: The Association of Green Tea and Coffee Consumption With Mortality From Cardiovascular Disease and All Causes Among Persons With and Without History of Stroke or Myocardial Infarction: The JACC Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Masayuki Teramoto ◽  
Isao Muraki ◽  
Kokoro Shirai ◽  
Akiko Tamakoshi ◽  
Hiroyasu Iso
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
General Population ◽  
Green Tea ◽  
Coffee Consumption ◽  
Tea Consumption ◽  
Food Frequency ◽  
All Cause Mortality ◽  
History Of

Background: Both green tea and coffee consumption have been associated with lower risks of mortality from cardiovascular disease (CVD) and all causes in general population, but little is known about those impact on persons with history of CVD. We examined the association of those consumption with these mortalities among persons with and without history of stroke or myocardial infarction in general population. Methods: The study subjects were 60,664 participants (896 stroke and 1751 myocardial infarction survivors and 58,017 persons with no history of stroke or myocardial infarction), aged 40-79 years at the baseline (1988-1990), who completed a lifestyle and medical history questionnaire including self-administered food frequency under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). Results: During the median follow-up of 18.5 years, a total of 12,745 (7,458 men and 5,287 women) deaths including 3,737 CVD deaths were documented. Green tea and coffee consumption were inversely associated with CVD and all-cause mortality among myocardial infarction survivors as well as persons without history of stroke or myocardial infarction. After adjustment for known cardiovascular risk factors, the lower risks of mortality from CVD and all-causes associated with frequent green tea consumption (5-6 and ≥7 cups/day) or coffee consumption (≥2 cups/day) remained statistical. Conclusions: Both green tea and coffee consumption were inversely associated with risks of CVD and all-cause mortality among myocardial infarction survivors and persons without history of stroke or myocardial infarction.

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