Identification Of Patients (pts) With Chronic Myeloid Leukemia (CML) At High Risk Of Artery Occlusive Events (AOE) During Treatment With The 2nd Generation Tyrosine Kinase Inhibitor (TKI) Nilotinib, Using Risk Stratification For Cardiovascular Diseases (CVD)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2726-2726 ◽  
Author(s):  
Delphine Rea ◽  
Tristan Mirault ◽  
Emmanuel Raffoux ◽  
Jean-Michel Miclea ◽  
Philippe Rousselot ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Median Time ◽  
Median Duration ◽  
Cumulative Incidence ◽  
Risk Estimation ◽  
Cvd Risk ◽  
Significant Difference ◽  
History Of ◽  
Very High

Background Nilotinib is approved for use in pts with CML after failure of imatinib and in newly diagnosed CP-CML. However, several studies report a nilotinib-associated risk of AOE, especially in pts with preexisting risk factors for CVD. Since CVD are a major cause of disability and death worldwide and result from complex interactions between multiple risk factors, we aimed at determining whether CVD risk estimation using the 2012 European Society of Cardiology (ESC) classification could be useful to identify patients at high risk of AOE during nilotinib therapy. Methods Pts (n=75) treated with nilotinib upfront or after failure of prior TKI at our institution were included provided that baseline risk factors for CVD and prior history of established CVD could be retrospectively collected. Risk factors included age, tobacco use, diabetes mellitus (DM), arterial hypertension (AH), dyslipidemia and increased body mass index (BMI). Patients were categorized into 2 groups according to ESC 2012 classification: low/moderate (L/M) and high/very high (H/VH) CVD risk. H/VH included pts with any of the following: established CVD, DM, severe AH, familial dysplipidemia or a SCORE (systematic coronary risk evaluation project) ≥5%. Results At nilotinib initiation, median age was 51 years (19-76), 41 pts (54.7%) were males. Nilotinib was given upfront in 28 pts (37%) and after failure of imatinib or dasatinib following imatinib in 47 pts (63%). Median time from diagnosis was 1 month (0.3-4) in the former group and 25 months (2-130) in the latter. Median duration of TKI exposure prior to nilotinib in the latter group was 22 months (0.4-91). Initial nilotinib dosing regimen was 400mg BID in 42 pts (56%) and 300mg BID in 33 pts (44%). Median duration of nilotinib treatment of 28 months (3-76) and median follow-up was 30 months (3-77). At baseline, medical history revealed H/VH risk category in 15 pts (20%) including established CVD in 6 pts (8%) (all diagnosed before CML), DM in 10 pts (13.3%), severe AH in 1 pt (1.3%), familial dyslipidemia in 1 pt (1.3%) and a SCORE ≥5% in 2 pts (2.6%). Median number of CVD risk factors was 1 (0-6) including age ≥ 45 years in men and ≥ 55 years in women in 37 pts (49.3%), active smoking or ceased during the previous year in 12 pts (16.7%), DM in 10 pts (13.3%), AH in 14 pts (18.7%), dyslipidemia in 10 pts (13.3%) and BMI ≥ 25 kg/m2in 20 pts (38.6). Nilotinib was discontinued in 23 pts (30.7%) due to adverse events (10 pts), resistance (7 pts), TKI discontinuation study (4 pts) or death (2 pts). AOE occurred in 12 pts after a median duration of nilotinib treatment of 24 months (9-47). AOE included myocardial infarction (MI) or coronary heart disease (CHD) (n=3), cerebrovascular events (CeVD) (n=3) and peripheral artery disease (PAD) (n=6). Overall, the cumulative incidence of AOE was 2.91% (95% CI: 0.74-11.42) by 12 months, 9.81% (95% CI: 4.57-21.08) by 24 months, 19.29 (95% CI: 10.77-34.56) by 36 months and 27.7% (95% CI: 16.2-47.35) by 48 months (discontinuation of nilotinib and death as competing risks). Cumulative incidence of AOE by 48 months was 72.22% (95% CI: 47.46-100) in the H/VH group and only 12.13% (95% CI: 4.32-34.08) in the L/M group. Log Rank comparison of Kaplan Meier analysis of 48-month survival without AOE showed a significant difference between the 2 groups (27.78% (95% CI: 0-58.9) versus 84.38% (95% CI: 67.04-100) p=0.0001). Sensitivity of the ESC classification in nilotinib-treated patients was 67% and specificity 89%. It is important to note that all pts with a history of AOE had recurrent AOE on nilotinib. Nilotinib was discontinued in 11 pts with AOE after a median time of 288 days (1-688), 7 pts had recurrent or worsening AOE before nilotinib discontinuation and 2 pts died from AOE. Conclusions In our retrospective study, CVD risk estimation according to the 2012 ESC classification reveals that pts who belong to the H/VH risk group at baseline are at very high risk of AOE during nilotinib therapy. These findings now need to be validated in a prospective fashion. Nevertheless, we readily recommend that assessment of CVD risk should be performed in all pts considered for nilotinib therapy. Alternative TKI may be chosen whenever possible in pts at H/VH risk of CVD. In those treated with nilotinib, CVD risk should be reassessed throughout therapy and risk factors should be tightly controlled according to current guidelines. Disclosures: Rea: BMS: Honoraria; Novartis: Honoraria; Pfizer: Honoraria; ARIAD: Honoraria; Teva: Honoraria. Messas:Novartis: Honoraria.

Risk stratification and risk assessment

2015 ◽  
Author(s):  
Ian Graham ◽  
Therese Cooney ◽  
Dirk De Bacquer
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Risk Estimation ◽  
Absolute Risk ◽  
Cvd Risk ◽  
Mortality And Morbidity ◽  
Risk Factor Management ◽  
Estimation System ◽  
Very High ◽  
Apparently Healthy

Cardiovascular disease (CVD) is the biggest cause of death worldwide. The underlying atherosclerosis starts in childhood and is often advanced when it becomes clinically apparent many years later. CVD is manageable: in countries where it has reduced this is due to changes in lifestyle and risk factors and to therapy. Risk factor management reduces mortality and morbidity. In apparently healthy people CVD risk is most frequently the result of multiple interacting risk factors and a risk estimation system such as SCORE can assist in making logical management decisions. In younger people a low absolute risk may conceal a very high relative risk, and use of the relative risk chart or calculation of their ‘risk age’ may help in advising them of the need for intensive life style efforts. All risk estimation systems are relatively crude and require attention to qualifying statements.

scholarly journals Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 134
Author(s):  
Gediminas Urbonas ◽  
Lina Vencevičienė ◽  
Leonas Valius ◽  
Ieva Krivickienė ◽  
Linas Petrauskas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
High Risk ◽  
Lipid Lowering ◽  
Blood Pressure Target ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Risk Patients ◽  
Very High

Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients’ interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%–80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.

Abstract P218: Dietary Prescription in the Coronary Care Unit, Missed Opportunity to Improve Care?

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Mohammed Al-Sadawi ◽  
Muhammad Ihsan ◽  
Adekunle Kiladejo ◽  
Judith E Mitchell
Keyword(s):  
Risk Factors ◽  
Coronary Care Unit ◽  
Dietary Assessment ◽  
Clinical Status ◽  
Normal Diet ◽  
Cvd Risk ◽  
Diabetic Diet ◽  
Significant Difference ◽  
History Of ◽  
Coronary Care

Introduction: A notable portion of the excess burden of cardiovascular disease [CVD] risk factors in African Americans [AA] is believed secondary to the diet. Hypothesis: Dietary assessment and prescribed diets are inadequate in patients admitted to the coronary care unit [CCU]. Results: Cohort: 267 consecutively patients, AA 83%, male 55%, mean age 65 yrs, were assessed for cardiovascular [CV] risk factors, clinical status and appropriateness of prescribed diets. Patients were at increased CV risk as evidenced by 65% older than 60 yrs, Body Mass Index (BMI) >30 in 40% with women almost twice as likely to be obese [p<0.006], history of smoking 55%, hypertension 90%, diabetes 54%, and mean ejection fraction 43%. Established CAD acknowledged in 60%. Breakdown of diet orders: normal diet 11%, diabetic diet 38% and a form of low sodium, low cholesterol diet in 51%. CCU length of stay: 2.5 days with no significant difference by sex, diabetic or obesity status. Dietary assessment documentation was missing in 40% of the CCU admissions. A significant percentage of the patients missing this documentation were women [45%], diabetics [47%], obese--BMI>30 [42%] and older--age >60 [68%]. Incongruence is seen between the disease burden and the appropriate dietary order. For example, 54% of patients had DM. However, only 38% were given a diabetic diet. A form of low Na diet was provided to 51% of the patients yet 90% of them were hypertensive or had a history of hypertension. The statistic, dietary assessment not recorded in 40% of the patients, may have been affected by the relatively short CCU stay. One limitation of our study is that we did not examine if this decreased dietary assessment rate was affected by week-day vs. weekend stay in the CCU or by the severity of the patient’s illness. Conclusion: Dietary assessment and appropriate dietary prescription matters. Recent studies show that dietary pattern is one of the largest mediating factors for differences in the incidence of CV risks, i.e. hypertension, in blacks vs. whites accounting for some of the excess risk among blacks. Not adequately addressing nutrition in a CCU setting leads to the loss of a critical teachable moment.

Self-Reported Cardiac Risk Factors in Emergency Department Nurses and Paramedics

2000 ◽  
Vol 15 (2) ◽  
pp. 14-17 ◽  
Author(s):  
Tyler W. Barrett ◽  
Valerie C. Norton ◽  
Matthew Busam ◽  
Julie Boyd ◽  
David J. Maron ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Emergency Department ◽  
High Risk ◽  
Cardiac Disease ◽  
Cardiac Risk ◽  
Smoking History ◽  
Cardiac Risk Factors ◽  
History Of ◽  
Very High

AbstractStudy Objective:Our objective was to assess the prevalence of cardiac risk factors in a sample of urban paramedics and emergency department (ED) nurses.Methods:We asked 175 paramedics and ED nurses working at a busy, urban ED to complete a cardiovascular risk assessment. The survey asked subjects to report smoking history, diet, exercise habits, weight, stress levels, medication use, history of hypertension or cardiac disease, family history of cardiovascular disease (CVD), and cholesterol level (if known)Results:129 of 175 surveys were returned (74% return rate) by 85 paramedics and 44 nurses. The percentages of paramedics and nurses at high or very high risk for cardiac disease were 48% and 41%, respectively. Forty-one percent of female respondents and 46% of male respondents were at high or very high risk. Cigarette smoking was reported in 19% of the paramedics and 14% of the nurses. The percentages of paramedics and nurses who reported hypertension were 13% and 11%, respectively. High cholesterol was reported in 31% of paramedics and 16% of nurses.Conclusions:Forty-eight percent of paramedics and 41% of ED nurses at this center are at high or very high risk for cardiovascular disease, by self-report. Efforts should be made to better educate and intervene in this population of health-care providers in order to reduce their cardiac risk.

scholarly journals Obstetric Thromboprophylaxis: The Swedish Guidelines

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Pelle G. Lindqvist ◽  
Margareta Hellgren
Keyword(s):  
Risk Factors ◽  
Cost Effectiveness ◽  
High Risk ◽  
Risk Score ◽  
Risk Estimation ◽  
Lifestyle Advice ◽  
Estimation Model ◽  
Increased Risk ◽  
History Of ◽  
The Cost

Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism). We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment.

Allogeneic Transplantation (HCT) for Myelodysplastic Syndrome:Recent MDACC Experience.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1131-1131
Author(s):  
Uday Popat ◽  
Marcos J de Lima ◽  
Touch Ativitavas ◽  
Gabriela Rondon ◽  
Leandro de Padua Silva ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Cumulative Incidence ◽  
Risk Group ◽  
Conditioning Regimen ◽  
Disease Free Survival ◽  
High Risk Group ◽  
Hla Typing ◽  
Unrelated Donor ◽  
Very High

Abstract BACKGROUND: Many recent advances have occurred in the field of MDS including hypomethylating agents, lenalidomide, and WHO classification. Likewise the field of HCT has also undergone major new developments including non ablative conditioning, better supportive care, better HLA typing, selection of unrelated donors and development of reduced toxicity ablative regimens like Busulfan and Fludarabine. The role of HCT therefore needs to be redefined in light of these developments. The purpose of this study is to report our recent results. PATIENTS AND METHODS: 89 consecutive patients with MDS as defined by WHO criteria treated at our institution between Jan 2002 and April 2008 are included in this report. There were 60 males and 29 female with a median age of 54 (23–67). There were 5(6%) patients with RA, 1(1%) RARS, 9(10%) RCMD, 22(25%) RAEB 1, 17(19%) RAEB 2, and 35(39%) therapy related MDS(t MDS). Their IPSS scores were 25(28%) patients with Intermediate 1, 49(55%) Intermediate 2, 15(17%) high. Their WPSS categories were 5(6%) patients Low, 9(10%) Intermediate, 49(55%) high, and 26(29%) very high. 51(57%) patients had a matched related donor and 38(43%) had an unrelated donor. Conditioning regimen were Flu/Bu in 56(63%) patients, Bu/Cy 1(1%), Flu/Mel 32(36%). According to HCT-CI index, the comorbidity scores were 0 in 16(18%) patients, 1 or 2 in 19(21%) and greater then 2 in 54(61%). Median time from diagnosis to transplant was 8 months (range 1–51 months). RESULTS: With a median follow up of 28 (3–73) months, 2 year overall(OS) and disease free survival were 54%(95% CI; 42%–66%) and 52%(95% CI; 40%–64%) respectively. Cumulative incidence of non relapse mortality at 2 years was 23% (95% CI; 16%–35%). Cumulative incidence of relapse mortality at 2 years was 23% (95% CI; 15%–34%). As per WHO grouping, OS was 63%, 60%, 46% and 48% in patients with Low blast count (RA, RARS, RAMD), RAEB1, RAEB2 and t MDS( p=0.46) respectively. WPSS score was significantly(P=0.01) predictive of overall survival (see fig): 27% surviving in very high risk group, 61% in high risk group and 78% in Low and intermediate risk group. Likewise cytogenetic risk group and IPSS were significantly predictive of survival. Donor type or graft source did not predict outcome. Five patients developed primary(3) or secondary(2) graft failure. Median time to neutrophil engraftment was 13 days (8–26 days) and to platelet engraftment was 16 days (9–89 days). CONCLUSION: These results in patients with comorbidities and with a median age of 54 years are promising. Cytogenetics and prognostic scores based on cytogenetics predict outcome after HCT. Figure Figure

Non-Myeloablative Conditioning with Total Lymphoid Irradiation and ATG and Allogeneic Transplantation for Patients with Myelodysplastic Syndrome, Therapy-Related Myeloid Neoplasms, and Myeloproliferative Neoplasms.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3087-3087
Author(s):  
Jonathan Benjamin ◽  
Saurabh Chhabra ◽  
Holbrook E Kohrt ◽  
Ginna G Laport ◽  
Sally Arai ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Cumulative Incidence ◽  
Dna Methyltransferase ◽  
Hematopoietic Cell Transplantation ◽  
De Novo ◽  
Myeloproliferative Neoplasms ◽  
Risk Scores ◽  
Dna Methyltransferase Inhibitors ◽  
Very High

Abstract Abstract 3087 Background: The Myelodysplastic Syndromes (MDS) and Myeloproliferative Neoplasms (MPN) are hematopoietic malignancies primarily affecting older patients. Myeloablative allogeneic hematopoietic cell transplantation (allo HCT) is potentially curative for MDS and MPN, but has traditionally been limited to younger patients because of the toxicity associated with high-dose chemoradiotherapy. The preparative regimen of Total Lymphoid Irradiation (TLI) and Anti-Thymocyte Globulin (ATG) permits the gradual establishment of donor hematopoiesis that is necessary for the graft versus malignancy effect. However, TLI-ATG is protective against acute Graft versus Host Disease (aGVHD), presumably due to the enrichment of tolerogenic recipient NK-T cells (Lowsky et al., NEJM 2005, Kohrt et al, Blood 2009). Here we report the outcomes of patients with MDS and MPN treated with TLI-ATG and allo HCT. Patients and Methods: Between August 2004 and December 2010, 51 patients were treated on an IRB approved Phase II trial. The median age was 63 years (range 50–73). The initial diagnosis was de novo MDS (n=24), CMML (n=6), MPN (n=8), and therapy-related MDS (t-MDS, n=13). The median time from diagnosis to HCT was 11 months (range 3–160). Among all patients, 41% had progressed to AML at some point preceding HCT. Most patients had received treatment beyond growth factor or transfusion support, including cytotoxic chemotherapy (29%), DNA methyltransferase inhibitors and/or immunomodulatory agents (41%), or cytotoxic chemotherapy and DNA methyltransferase inhibitors (14%). Among the patients with de novo MDS, the IPSS-R score (Greenberg et al., Blood 2012) at the time of HCT was Very High or High (17%), Intermediate (23%), Low or Very Low (53%) or unknown/indeterminate (7%). At the time of HCT, 40% of patients had abnormal marrow cytogenetics. Following provision of informed consent, patients were treated with 10 fractions of TLI (cumulative dose1200 cGy) and ATG (Thymoglobulin, Genzyme, 7.5 mg/kg divided in 5 doses). Primary GVHD prophylaxis consisted of Cyclosporine A and Mycophenolate Mofetil. Patients received G-CSF mobilized peripheral blood progenitor cells from matched related (45%), 10/10 matched unrelated (45%), or mismatched unrelated donors (10%). Results: The median follow up for living patients was 3.2 years (range 1.5–7) and for all patients was 1.4 years (range 0.1–7). The three-year overall survival (OS), non-relapse mortality (NRM), and event-free survival (EFS) were 42% (95% CI 28–56%), 8% (0.3–15%), and 31% (18–44%), respectively. The cumulative incidence of aGVHD Grades II-IV was 14% (95% CI 4–23%) and Grades III-IV 4% (0–9%) and did not differ according to allograft source. The three-year cumulative incidence of Chronic GVHD was 33% (20–47%) with median time of onset of 199 days (range 112–475 days). The three-year cumulative incidence of progression was 61% (47–74%) and the median time to progression was 136 days (range 13–292). Rates of progression were not significantly different for patients with MDS (60%, 95%CI 44–73%), MPN (88%, 71–95%), and t-MDS (45%, 15–70%). The presence of abnormal cytogenetics at the time of HCT did not impact risk of progression (p=0.54). However, patients with IPSS-R Very High and High Risk scores all had progressive disease within the first 100 days. In contrast, patients with Intermediate Risk scores had equivalent progression and progression-free survival rates when compared with those in the Very Low and Low risk groups (Hazard Ratio for progression 1.25, 95% CI 0.36–4.32). CD15 chimerism at day 28 was the most predictive of progression at any subsequent time point. Those with donor CD15>90% donor at day 28 (40% of patients) defined a group with a low likelihood of disease progression (Odds Ratio 0.20, p=.01). Conclusions: For patients with MDS and MPN, nonablative TLI/ATG conditioning prior to allo HCT was safe and associated with low rates of acute GVHD and NRM. Patients whose IPSS-R scores at the time of HCT were Intermediate, Low, and Very Low had significantly better outcomes than those with High or Very High risk scores. Analysis of CD15 chimerism at Day 28 may identify patients at high risk of progression and offers an early time point for intervention. These data suggest that for patients with MDS, earlier transplantation may result in better long-term outcomes due to lower transplant related risks. Disclosures: Off Label Use: ATG (Thymoglobulin, Genzyme) for conditioning prior to allogeneic hematopoietic cell transplantation.

Real world cardiovascular risk assessment using reduced DAD, SCORE and Framingham equations in a German HIV cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Q Zhou ◽  
S Usadel ◽  
W Kern ◽  
A Zirlik ◽  
M.C Mueller
Keyword(s):  
High Risk ◽  
Statin Therapy ◽  
Median Time ◽  
Real World ◽  
Hiv Care ◽  
Risk Scores ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Statin Medication ◽  
Very High

Abstract Introduction People living with HIV are at increased risk for cardiovascular disease (CVD). Therefore, prevention of CVD should be integrated in HIV care. Although several risk scores exist to predict the risk of developing CVD, none of this specifically addresses the fact of HIV. Previously, the reduced Data Collection on Adverse Events of Anti-HIV Drug score (D:A:D-R) model has been proposed to assess the CVD risk for HIV patients. However, this score has not been validated in an independent cohort, or compared to traditional CVD prediction models established in the non-HIV population. Purpose We aim to compare the predictive value of the CVD risk scores D:A:D-R, SCORE and Framingham CVD in a German HIV population and evaluate their CVD risk in a real world setting. Methods This is a prospective, cross-sectional, single center study. Patients with HIV and older than 30 years were enrolled between January 2018 and December 2019. Exclusion criteria were preexisting CVD and statin therapy. CVD risk estimates were calculated using the D:A:D-R, Framingham CVD (FRS), and SCORE models. Agreement between estimates was assessed using Cohen's kappa coefficient. The indication for statin therapy was calculated using the AHA and EACS guidelines. Results 488 patients with HIV and a median age of 47.8 years were included. Median time since HIV diagnosis was 9.9 years. All, but one Patient were on ART for a median time of 5.9 years. 61% were female. Using the D:A:D-R score, the highest proportion of patients with high or very high risk for CVD were identified (17.8%). In comparison, using SCORE and FRS only 4.7% and 13.7% of patients were identified as high or very high risk, respectively. There was a poor agreement between D:A:D-R and SCORE (k=0.11), and D:A:D-R and FRS (k=0.33). Based on the calculated CVD risk using the three models, indication for primary statin medication varied between 34.8% to 92%. Conclusion Our data demonstrate that standard CVD risk scores underestimate the CVD risk in patients with HIV. Using SCORE and FRS, a high proportion of patients with HIV and at high risk for CVD would be underestimated and miss the indication for statin medication. Therefore, using scores including HIV specific parameters should be considered in this patient population. Funding Acknowledgement Type of funding source: None

scholarly journals Peripherally Inserted Central Catheters (PICCs), the Leading Cause of Central Venous Catheter Associated Thrombosis in Children

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 139-139 ◽  
Author(s):  
Julie Jaffray ◽  
Sarah H. O'Brien ◽  
Char M Witmer ◽  
Rosa Diaz ◽  
Lingyun Ji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Median Time ◽  
Cumulative Incidence ◽  
Univariate Analysis ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Increased Risk ◽  
History Of ◽  
Record Review ◽  
Central Catheters

Abstract Introduction Central venous catheters (CVC) are necessary for medically complex and acutely ill children, but come with the risk of venous thromboembolism (VTE) or central line associated blood stream infection (CLABSI). The rate of VTE in pediatrics has increased, most likely due to the increased use and placement of CVCs, and questions remain regarding VTE risk factors for CVC associated thrombosis. Methods This prospective, multi-center study compared the incidence and risk factors for VTE between peripherally inserted central catheters (PICCs) and centrally inserted tunneled lines (TLs) in patients 6 months to <18 years from 4 pediatric hospitals from September 2013 to April 2018. Data were collected through medical record review regarding demographics, medical history and specific CVC data including insertion technique and catheter specifications. Subjects were prospectively monitored via medical record review for CVC complications including VTE, CLABSI or malfunction (use of tissue plasminogen activator, malposition, blockage, etc). Cumulative incidence rates of VTE, CLABSI, CVC malfunction and removal were estimated and compared between PICCs and TLs. These analyses focused on the first 6 months from CVC insertion using parametric survival models assuming a Weibull survival distribution. The association between occurrence of VTE and subject/CVC characteristics was first assessed in univariate analyses, and then assessed by a minimal multivariable model. Results A total of 1,969 CVCs from 1,744 unique patients were included. Median age at CVC insertion was 6.4 years (range: 0.6-17.9) with the majority, 1048 (53%) placed in males. PICCs made up 1,259 (64%) of the CVCs and 710 (36%) were TLs. Among 1,969 CVCs, 100 had a VTE with a cumulative incidence rate of 5.4±0.5%, and median time to VTE from CVC insertion was 0.6 months (range 0-5.8 months). Eighty percent of the VTEs were in PICCs and median time to VTE was 0.5 months (range 0-5.3 months) in PICCs compared to TLs with a median time to VTE of 1.4 months (range 0-5.8 months). The incidence rate of VTE was 2.9±0.6% for TLs, and 6.8±0.7% for PICCs (Figure 1). In univariate analysis, subjects with TLs had a significantly lower risk of developing a VTE than patients with PICCs (HR=0.14, 95%CI: 0.05-0.4, p<0.001). The incidence of CLABSI was 14±1.3% for TLs compared to 7.9±0.9% for PICCs and in univariate analysis CVCs with a CLABSI were 4 times (95%CI: 1.3-13) as likely to develop a VTE. The cumulative incidence of malfunction in all CVCs was 25±1.0%, and univariate analysis revealed CVCs with a malfunction were 10 times (95%CI: 3.6, 28) as likely to develop a VTE. In the multivariable analyses (Table 1), subjects with TLs were significantly less likely to develop a VTE compared to PICCs (HR=0.16, 95%CI: 0.06-0.4, p<0.001); subjects with leukemia were more likely to have a VTE than subjects without cancer or other cancer diagnosis (HR=3.6, 95%CI: 1.3-9.9, p=0.050); subjects with a previous history of VTE were significantly more likely to develop a new VTE (HR=36, 95%CI: 6.3-210, p<0.001); and compared to CVCs with 1 lumen, CVCs with 2-3 lumens resulted in a higher risk of developing a VTE (HR=4.4, 95%CI: 1.9-10, p=0.002). Diagnosis of a CLABSI (HR=6.3, 95%CI: 2.1-18, p<0.001) as well as CVC malfunction (HR=5.7, 95%CI: 2.3-14, p<0.001) were also associated with higher risk of developing a VTE. Conclusion This study represents the first prospective evaluation of the incidence and risk factors of VTE for TLs and PICCs placed in children. Almost 2,000 CVCs are included in this final analysis, which revealed a significant increase in VTE risk for children who have a PICC placed compared to a TL. The greatest risk factor for CVC associated VTE was a prior history of VTE. Additional risk factors included CLABSI, CVC malfunction, leukemia and having a multi-lumen CVC. Even though the ease of placing a PICC is enticing to avoid repeat peripheral intravenous (PIV) insertions or surgical intervention with TL placement, the increased risk of VTE in PICCs should give practitioners pause. When CVC placement is unavoidable, limiting the number of lumens is a modifiable VTE risk factor and efforts to prevent CLABSI may reduce VTE incidence. Interestingly, no insertion characteristics (e.g. placement vein, access side, catheter brand or material, tip location, insertion attempts) were associated with an increased risk of VTE. Disclosures Jaffray: Octapharma: Consultancy; CSL Behring: Consultancy, Research Funding; Bayer: Consultancy. Young:Kedrion: Consultancy; Genentech/Roche: Consultancy, Honoraria; CSL Behring: Consultancy, Honoraria; Bioverativ: Consultancy, Honoraria; Bayer: Consultancy; Novo Nordisk: Consultancy, Honoraria; Shire: Consultancy, Honoraria.

scholarly journals Risk assessment for type 2 diabetes mellitus in Muttanallur village, Bangalore, India

2019 ◽  
Vol 8 (1) ◽  
pp. 48
Author(s):  
Suma Dasaraju ◽  
Sudeepa D. ◽  
Debasish Barik ◽  
Lalitha D. Hiremath
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
P Value ◽  
Cross Sectional ◽  
High Blood Glucose ◽  
Type 2 Dm ◽  
History Of ◽  
Vegetables And Fruits ◽  
Very High

Background: Diabetes is a major cause of morbidity and mortality worldwide. There are certain risk factors involved in the development of type 2 DM. Affordable, quick and easily available validated tools are required for assessment of risk factors for type 2 DM. Using one such questionnaire, Finnish Diabetes Risk Score [FINDRISK], we have conducted an observational study in a rural area to identify and assess the risks for the development of type 2 DM.Methods: This cross sectional, observational, community-based study was undertaken, in Muttanallur Village, Bangalore. After the application of inclusion and exclusion criteria, 487 subjects were included. According to the final score obtained with the FINDRISK questionnaire, the individuals were classified into mild, moderate, high and very high-risk groups.Results: After the analysis of the variables, 253 individuals (52%) came under moderate risk with a score of (7-14) and 6 (1.2%) were categorized as having very high risk. Females, subjects above the age group of 45 years, having BMI ≥30 kg/m2, waist circumference of ≥37 inches, not having 30 minutes of daily physical activity and consumption of vegetables and fruits, with history of hypertension, high blood glucose during pregnancy or in the past, were having higher moderate to high risk prevalence and had more chances of developing type 2 DM (p value <0.001).Conclusions: As per the results of this study authors concluded that there was a statistically significant association between certain clinical variables with the development of future type 2 DM.

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