High risk of cardiovascular diseases after diagnosis of multiple sclerosis

2013 ◽  
Vol 19 (10) ◽  
pp. 1336-1340 ◽  
Author(s):  
Elham Jadidi ◽  
Mohammad Mohammadi ◽  
Tahereh Moradi
Keyword(s):  
Multiple Sclerosis ◽  
Myocardial Infarction ◽  
Cardiovascular Diseases ◽  
Poisson Regression ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Matched Control ◽  
Country Of Birth ◽  
Nationwide Study

Background: Studies of the risk of cardiovascular diseases (CVDs) in patients with multiple sclerosis (MS) have the potential to improve our understanding of the etiology of and the heterogeneity of prognosis and outcomes. Objectives: To investigate the risk of myocardial infarction (MI), stroke, heart failure (HF), and atrial fibrillation (AF) or Flutter in MS patients with different ethnicity, both female and male. Methods: Using Poisson regression, we performed a nationwide study in Sweden to investigate the association between the diagnosis of MS and the risk of MI, stroke, HF, or AF/Flutter in 8281 patients who were hospitalized due to MS from 1987 through 2009, plus 76,640 matched control individuals. We performed stratified analyses by sex, age at follow-up and country of birth. Results: Among MS patients, the incidence rate ratio for MI was 1.85 (95% confidence interval (CI) 1.59 to 2.15), for stroke was 1.71 (95% CI 1.46 to 2.00), for HF was 1.97 (95% CI 1.52 to 2.56) and for AF/Flutter was 0.63 (95% CI 0.46 to 0.87), as compared with individuals without MS. The increased risks were particularly prominent for women. These associations remained after stratification by sex, age and country of birth. Conclusion: We recommend careful surveillance and preventive CVDs measures among MS patients, particularly among the women.

scholarly journals Cognitive function predicts work disability among multiple sclerosis patients

2019 ◽  
Vol 5 (1) ◽  
pp. 205521731882213 ◽  
Author(s):  
Andrius Kavaliunas ◽  
Petter Tinghög ◽  
Emilie Friberg ◽  
Tomas Olsson ◽  
Kristina Alexanderson ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Function ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Work Disability ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
One Year ◽  
Multiple Sclerosis Patients

Background In multiple sclerosis various aspects of cognitive function can be detrimentally affected. More than that, patients´ employment and social functioning is likely to be impacted. Objective To determine whether work disability among multiple sclerosis patients could be predicted by the symbol digit modalities test. Methods A register-based cohort study was conducted. Individual data on work disability, operationalised as annual net days of sickness absence and/or disability pension were retrieved at baseline, when the symbol digit modalities test was performed, after one-year and 3-year follow-up for 903 multiple sclerosis patients. The incidence rate ratios for work disability were calculated with general estimating equations using a negative binomial distribution and were adjusted for gender, age, educational level, family composition, type of living area and physical disability. Results After one year of follow-up, the patients in the lowest symbol digit modalities test quartile were estimated to have a 73% higher rate of work disability when compared to the patients in the highest symbol digit modalities test quartile (incidence rate ratio 1.73, 95% confidence interval 1.42‒2.10). This estimate after 3-year follow-up was similar (incidence rate ratio 1.68, 95% confidence interval 1.40‒2.02). Conclusion Cognitive function is to a high extent associated with multiple sclerosis patients’ future work disability, even after adjusting for other factors.

scholarly journals Prevalence and Incidence of Statin Use and 3-Year Adherence and Discontinuation Rates Among Older Adults With Dementia

2018 ◽  
Vol 33 (8) ◽  
pp. 527-534 ◽  
Author(s):  
Richard Ofori-Asenso ◽  
Jenni Ilomaki ◽  
Mark Tacey ◽  
Andrea J. Curtis ◽  
Ella Zomer ◽  
...  
Keyword(s):  
Older Adults ◽  
Poisson Regression ◽  
Rate Ratio ◽  
Annual Prevalence ◽  
People With Dementia ◽  
Proportion Of Days Covered ◽  
Adjusted Rate ◽  
Adjusted Rate Ratio ◽  
Statin Use

Objective: To examine the patterns of statin use and determine the 3-year adherence and discontinuation rates among a cohort of Australians aged ≥65 years with dementia. Methods: The yearly prevalence and incidence of statin use were compared via Poisson regression modeling using 2007 as the reference year. People with dementia were identified according to dispensing of antidementia medications. A cohort of 589 new statin users was followed longitudinally. Adherence was estimated via the proportion of days covered (PDC). Discontinuation was defined as ≥90 days without statin coverage. Results: The annual prevalence of statin use among older Australians with dementia increased from 20.6% in 2007 to 31.7% in 2016 (aged-sex adjusted rate ratio: 1.51, 95% confidence interval: 1.35-1.69). Among the new users, the proportion adherent (PDC ≥ 0.80) decreased from 60.3% at 6 months to 31.0% at 3 years. During the 3-year follow-up, 58.7% discontinued their statin. Conclusions: Despite increased use of statins among older Australians with dementia, adherence is low and discontinuation is high, which may point to intentional cessation.

Incidence of chronic immune-mediated inflammatory diseases after diagnosis with Kawasaki disease: a population-based cohort study

Rheumatology ◽  
2021 ◽  
Author(s):  
Stephen G Fung ◽  
Richard Webster ◽  
M Ellen Kuenzig ◽  
Braden D Knight ◽  
Michelle Batthish ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cohort Study ◽  
Liver Disease ◽  
Kawasaki Disease ◽  
Sclerosing Cholangitis ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Population Based ◽  
Immune Mediated ◽  
Increased Risk

Abstract Objectives Kawasaki disease (KD) is an immune-mediated vasculitis of childhood with multi-organ inflammation. We determined the risk of subsequent immune-mediated inflammatory disease (IMID), including arthritis, type 1 diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis and multiple sclerosis. Methods We conducted a matched population-based cohort study using health administrative data from Ontario, Canada. Children aged <18 years born between 1991 and 2016 diagnosed with KD (n = 3753) were matched to 5 non-KD controls from the general population (n = 18 749). We determined the incidence of IMIDs after resolution of KD. Three- and 12-month washout periods were used to exclude KD-related symptoms. Results There was an elevated risk of arthritis in KD patients compared with non-KD controls, starting 3 months after index date [103.0 vs 12.7 per 100 000 person-years (PYs); incidence rate ratio 8.07 (95% CI 4.95, 13.2); hazard ratio 8.08 (95% CI 4.95, 13.2), resulting in the overall incidence of IMIDs being elevated in KD patients (175.1 vs 68.0 per 100 000 PYs; incidence rate ratio 2.58 (95% CI 1.93, 3.43); hazard ratio 2.58, 95% CI 1.94, 3.43]. However, there was no increased risk for diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis or multiple sclerosis in KD patients. Similar results were observed using a 12-month washout period. Conclusion Children diagnosed with KD were at increased risk of arthritis following the acute KD event, but not other IMIDs. Health-care providers should monitor for arthritis in children following a diagnosis of KD.

Hyperprolactinemia and the Association with All-Cause Mortality and Cardiovascular Mortality

2017 ◽  
Vol 49 (06) ◽  
pp. 411-417 ◽  
Author(s):  
Jesper Krogh ◽  
Christian Selmer ◽  
Christian Torp-Pedersen ◽  
Gunnar Gislason ◽  
Caroline Kistorp
Keyword(s):  
Antipsychotic Medication ◽  
Cardiovascular Mortality ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
University Hospitals ◽  
All Cause Mortality ◽  
Adjusted Incidence Rate ◽  
Male Patients ◽  
Adjusted Incidence

AbstractHyperprolactinemia has been suspected to increase mortality risk, but the available data are conflicting. The objective of this study was to estimate the association between hyperprolactinemia and all-cause and cardiovascular mortality among patients referred for assessment of prolactin. For this study, adults with no prio pituitary disease who underwent prolactin assessment at 3 university Hospitals in Denmark between 2001 and 2011 were included in a retrospective cohort study. A total of 3 633 patients with a median follow-up time of 5.3 years (IQR 2.7–5.7) were included. Mean (SD) age 39.7 (15.5) years and 78% female. 373/3 633 (10.3%) had hyperprolactinemia and during follow-up 330/3 633 (9.1%) patients died of any cause, and 113/3 633 (3.1%) patients died of cardiovascular causes. In males, hyperprolactinemia was associated with age-adjusted incidence rate ratio (IRR) of 1.86 for all-cause mortality (95% CI 1.22–2.82) and 2.55 (95% CI 1.43–4.55) for cardiovascular mortality. The IRR for all-cause mortality was reduced to 1.37 (0.90–2.08) when adjusted for the use of antipsychotic medication. The association between hyperprolactinemia and cardiovascular mortality remained after adjusting for confounders, for example, chronic renal failure, diabetes, and antipsychotic medication. In females, hyperprolactinemia was not associated with all-cause mortality (IRR 1.45; CI 0.86–2.47) or cardiovascular mortality (IRR 0.58; CI 0.14–2.39). In conclusion, hyperprolactinemia was associated with increased cardiovascular mortality in male patients. This association was not found in female patients. Focus on increased cardiovascular risk in males with hyperprolactinemia is warranted.

Comparing fatal occupational accidents in Denmark and Sweden 1993–2012

2019 ◽  
Vol 69 (4) ◽  
pp. 283-286 ◽  
Author(s):  
C D Hansen
Keyword(s):  
Work Environment ◽  
Poisson Regression ◽  
Employment Status ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Rates ◽  
Occupational Accidents ◽  
Sociodemographic Differences ◽  
The Difference ◽  
Over Time

Abstract Background Denmark and Sweden are in many respects two very similar countries with similar welfare state systems and work environment authorities. Nevertheless, marked differences in the incidence of fatal occupational accidents have been found in earlier comparisons of the two countries. Aims To investigate differences in the incidence of fatal occupational accidents in the period from 1993 to 2012 to establish to what extent characteristics of the deceased can explain some of the difference between the two countries. Methods Analyses of the accident registers of the two countries’ national work environment authorities with supplemental linkages to official registers on employment status are used to determine the incidence of fatal occupational accidents for different groups. The analysis is based on 2375 accidents (1068 in Denmark and 1307 in Sweden) over the period of 20 years. Poisson regression is used to derive incidence rates over time for specific groups. Results In the study period, the incidence of fatal occupational accidents decreased in both countries (incidence rate ratio [IRR]: 0.95), although the incidence was on average higher in Denmark (IRR: 1.20) and grew larger over time. This difference did not disappear after adjusting for age, sex and industry among the deceased (IRR: 1.12). Conclusions The incidence of fatal occupational accidents was slightly higher in Denmark in the entire period. The difference could not be explained completely by sociodemographic differences or differences related to the labour market structure in the two countries, i.e. other factors (e.g. cultural) may play a role in producing the difference.

scholarly journals Trend of Sudden Unexpected Death in Epilepsy Incidence Rate in Rural West China

2021 ◽  
Vol 12 ◽  
Author(s):  
Haijiao Wang ◽  
Deng Chen ◽  
Jun He ◽  
Yujin He ◽  
Ling Liu ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Sudden Unexpected Death ◽  
Percentage Change ◽  
Annual Percentage Change ◽  
Unexpected Death ◽  
West China ◽  
Adjusted Incidence

Objectives: To explore the trend of sudden unexpected death in epilepsy (SUDEP) incidence rate over time in rural west China.Methods: We scanned probable SUDEP patients from the epilepsy program between 2010 and 2019 in rural West China and performed a verbal autopsy for each eligible patient. We calculated the crude and sex-adjusted incidence rate of SUDEP per person-year over a calendar year and the year of follow-up. We calculated the incidence rate ratio with the Poisson model in STATA 12.0 and calculated the annual percentage change (APC) and average annual percentage change in Joinpoint Trend Analysis Software 4.8.0.1 to analyze the trend of SUDEP incidence rate.Results: In 2010–2019, 44 probable SUDEPs were identified from 10,128 patients with a total person-year of 31,347. The crude and sex-adjusted incidence rates of SUDEP were 1.40 and 1.45%0. Twenty-five (56.8%) of the 44 probable SUDEPs had no generalized tonic-clonic seizure 3 months before their death. The incidence of probable SUDEP decreased significantly in the calendar year [APC = −11.7, 95% confidence interval (CI): −21.7 to −0.3] and in time of follow-up (average annual percentage change = −21.2, 95% CI: −34.3 to −5.4). Comparing the first 5 years in follow-up with the subsequent 3 years, the incidence rate of SUDEP decreased significantly (estimated incidence rate ratio = 0.4, 95% CI: 0.2 to 0.8).Significance: SUDEP happened to 1.4 cases per thousand patient-years in convulsive epilepsy in rural west China between 2010 and 2019. The incidence rate of SUDEP presented a downward trend over the time of follow-up.

scholarly journals The Impact of Large-scale Social Restriction on COVID-19 Incidence: A Case Study of Four Regions in Indonesia

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Izza Suraya ◽  
Mochamad Iqbal Nurmansyah ◽  
Emma Rachmawati ◽  
Badra Al Aufa ◽  
Ibrahim Isa Koire
Keyword(s):  
Incidence Rate ◽  
Government Policy ◽  
Poisson Regression ◽  
Rate Ratio ◽  
Large Scale ◽  
Incidence Rate Ratio ◽  
Interaction Model ◽  
Social Restriction ◽  
The Impact

The Indonesian government has chosen to implement large-scale social restrictions, or Pembatasan Sosial Berskala Besar (PSBB), to minimize the spread of COVID-19. PSBB is a government policy aimed at restricting the internal movement of people in a bid to reduce the spread of SARS-CoV-2. This study aims to assess the impact of such large-scale social restriction measures on the incidence of COVID-19 cases in four provinces of Indonesia. Time series analysis was used to describe trends in COVID-19 cases by using surveillance data from the Ministry of Health of Indonesia. Quasi-Poisson regression with an interaction model was used to estimate the incidence rate ratio (IRR), and this was calculated to compare the incidence rate before and during PSBB implementation. The trend in COVID-19 cases in the provinces of West Java, East Java, Banten, and Jakarta has continued to fluctuate. These four provinces have continued to experience a significant increase in the COVID-19 incidence rate ratio after the implementation of the first and second PSBB periods compared to the  period before PSBB implementation. Lack of proper implementation of the large-scale social restrictions has led to PSBB’s ineffectiveness in reducing the number of COVID-19 cases in each of the provinces.

scholarly journals Long-term outcome and predictors of long-term disease activity in natalizumab-treated patients with multiple sclerosis: real life data from the Austrian MS Treatment Registry

2021 ◽  
Author(s):  
Michael Guger ◽  
◽  
Christian Enzinger ◽  
Fritz Leutmezer ◽  
Franziska Di Pauli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Activity ◽  
Rate Ratio ◽  
Disease Duration ◽  
Treatment Initiation ◽  
Incidence Rate Ratio ◽  
Real Life ◽  
Life Data ◽  
Real Life Data

Abstract Objectives To evaluate long-term effectiveness of natalizumab (NTZ) and to determine demographic, clinical, and radiological predictors regarding long-term disease activity (≥ 7 years) in a nationwide observational cohort, using data collected prospectively in a real-life setting. Materials and methods We analysed data from 230 patients from the Austrian Multiple Sclerosis Treatment Registry (AMSTR), who had started treatment with NTZ at any time since 2006 and stayed on NTZ for at least 7 years without treatment gap of more than three months. Results Estimated mean annualised relapse rates (ARR) over a mean treatment period of 9.3 years were 0.07 for NTZ. Sustained EDSS progression for 12 weeks was observed in 36 (19%) patients and for 24 weeks in 31 (16.3%) cases. Sustained EDSS regression for 12 and 24 weeks was seen in 45 (23.7%) and 42 (22.1%) cases. The baseline parameters ≥ 1 Gadolinium-enhancing MRI lesion(s) [incidence rate ratio (IRR) of 0.409 (95% CI 0.283–0.593), p = 0.001], ARR ≤ 1 in the prior 12 month before treatment initiation with NTZ [IRR of 0.353 (95% CI 0.200–0.623), p = 0.001] and EDSS ≤ 1 [incidence rate ratio (IRR) of 0.081 (95% CI 0.011–0.581), p = 0.012] were significantly associated with a reduced relapse risk, whereas a disease duration ≤ 5 years increased significantly the ARR [IRR of 1.851 (95% CI 1.249–2.743), p = 0.002]. The only predictive baseline parameter for experiencing EDSS progression (sustained for 12 and 24 weeks) was age > 35 years [HR of 2.482 (95% CI 1.110–5.549), p = 0.027, and HR of 2.492 (95% CI 1.039–5.978), p = 0.041, respectively]. Conclusions These real-life data show a stable disease course regarding relapse activity and disease progression under NTZ treatment for more than 7 years. The main predictors for disease activity were higher relapse rate before treatment initiation, higher disability, shorter disease duration and absence of Gadolinium-enhancing MRI lesions at baseline. Older age at NTZ start was the only significant risk factor for disease progression over long-term.

scholarly journals Trends in incident acute myocardial infarction in Norway: An updated analysis to 2014 using national data from the CVDNOR project

2018 ◽  
Vol 25 (10) ◽  
pp. 1031-1039 ◽  
Author(s):  
Gerhard Sulo ◽  
Jannicke Igland ◽  
Stein Emil Vollset ◽  
Marta Ebbing ◽  
Grace M Egeland ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Age Groups ◽  
Incidence Rates ◽  
Myocardial Infarctions ◽  
Men And Women

Background We updated the information on trends of incident acute myocardial infarction in Norway, focusing on whether the observed trends during 2001–2009 continued throughout 2014. Methods All incident (first) acute myocardial infarctions in Norwegian residents age 25 years and older were identified in the Cardiovascular Disease in Norway 1994–2014 project. We analysed overall and age group-specific (25–64 years, 65–84 years and 85 + years) trends by gender using Poisson regression analyses and report the average annual changes in rates with their 95% confidence intervals. Results During 2001–2014, 221,684 incident acute myocardial infarctions (59.4% men) were identified. Hospitalised cases accounted for 79.9% of all incident acute myocardial infarctions. Overall, incident acute myocardial infarction rates declined on average 2.6% per year (incidence rate ratio 0.974, 95% confidence interval 0.972–0.977) in men and 2.8% per year (incidence rate ratio 0.972, 95% confidence interval 0.971–0.974) in women, contributed by declining rates of hospitalisations (1.8% and 1.9% per year in men and women, respectively) and deaths (6.0% and 5.8% per year in men and women, respectively). Declining rates were observed in all three age groups. The overall acute myocardial infarction incidence rates continued to decline from 2009 onwards, with a steeper decline compared to 2001–2009. During 2009–2014, gender-adjusted acute myocardial infarction incidence among adults age 25–44 years declined 5.3% per year, contributed mostly by declines in hospitalisation rates (5.1% per year). Conclusion Acute myocardial infarction incidence rates continued to decline after 2009 in Norway in both men and women. The decline started to involve individuals aged 25–44 years, marking a turning point in the previously reported stagnation of rates during 2001–2009.

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