scholarly journals Recurrence Risk after Limited Duration of Anticoagulant Treatment for Late Second Venous Thromboembolism

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 591-591
Author(s):  
T van der Hulle ◽  
M Tan ◽  
P L den Exter ◽  
M JG van Roosmalen ◽  
F JM van der Meer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Recurrence Risk ◽  
Incidence Rates ◽  
Anticoagulant Treatment ◽  
Duration Of Treatment ◽  
Patients At Risk ◽  
Limited Duration

Abstract Introduction Patients with a second venous thromboembolism (VTE) generally receive anticoagulant treatment for indefinite duration, although it is known that the recurrence risk diminishes over time while the risk of hemorrhage persists with continued anticoagulation and increases with age. Based on these arguments and the limited evidence for indefinite duration of treatment, the Dutch guideline recommends to consider limited duration of treatment (i.e. 12-month) for a 'late' second VTE, defined as a second VTE diagnosis >1 year after discontinuing treatment for a first VTE. It is hypothesized that the risk of continued anticoagulation might outweigh the benefits in those patients. We evaluated this management in daily practice. Methods Since 2003, a limited duration of treatment was systematically considered in consecutive patients with a late second VTE at a single academic hospital in The Netherlands. Incidence rates and cumulative incidence rates for a third VTE were calculated in patients who were treated for a limited duration and for an indefinite duration separately. For patients who were treated for a limited duration, hazard ratios (HR) for a third VTE were calculated for unprovoked versus provoked second VTE and DVT or PE as second VTE diagnosis. HR were adjusted for age, sex and where possible for type of second VTE and whether the second VTE was provoked or unprovoked. Results Of 132 patients with a late second VTE, 77 patients were treated for limited duration, of whom 26 developed a symptomatic third VTE after treatment cessation during a cumulative follow-up of 277 years, resulting in an incidence rate of 9.4/100 patient-years (95%CI 6.1-14). Cumulative incidence rates were 15% (95%CI 6.1-14) and 33% (95%CI 18-49) after 1 and 5 years of follow-up (Figure 1). In patients who were treated for an indefinite duration, the incidence rate was 1.2/100 patient-years (95%CI 0.33-3.1). The incidence rates in patients with an unprovoked VTE and a VTE related to a transient provoking factor were 12 per 100 patient-years (95%CI 7.4-19) and 5.6 per 100 patient-years (95%CI 2.2-12) respectively with a HR of 2.8 (95%CI 1.1-7.2) (Figure 2). No difference was observed for patients with deep vein thrombosis as second VTE compared to patients with pulmonary embolism as second VTE, HR 0.65 (95%CI 0.29-1.5). Conclusion The incidence rate of 9.5/100 patient-years for a third VTE after a limited duration of treatment for a second VTE largely exceeds the risk of major hemorrhage associated with long-term anticoagulant treatment, which has been estimated to be 2.7/100 patient-years. Therefore, these findings strongly suggest that identifying patients with a relatively low recurrence risk based on the interval between first and second VTE is not an appropriate strategy. Only in patients with a second VTE in the presence of a transient provoking factor the recurrence risk approaches the risk of major bleeding associated with long-term anticoagulant treatment and a limited duration of treatmentmay still be considered in these patients. Follow-up started at the time of the second venous thromboembolism diagnosis for both categories. Figure 1: Figure 1:. Cumulative incidence rate of a third venous thromboembolism in patients treated for a limited duration and patients treated for an indefinite duration. Note: nrVTE: number of recurrent VTE; PAR: patients at risk Follow-up started at the time of cessation anticoagulant treatment. Figure 2: Figure 2:. Cumulative third venous thromboembolism event rate in patients with a provoked second VTE versus an unprovoked second VTE, treated for a maximum of 12 months. Note: nrVTE: number of recurrent VTE; PAR: patients at risk Disclosures No relevant conflicts of interest to declare.

Contemporary Estimates of the Incidence of Venous Thromboembolism: A Population-Based Cohort Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1143-1143
Author(s):  
Vicky Tagalakis ◽  
Valerie Patenaude ◽  
Susan R. Kahn ◽  
Samy Suissa
Keyword(s):  
Venous Thromboembolism ◽  
General Population ◽  
Incidence Rate ◽  
Conflicts Of Interest ◽  
Public Health Problem ◽  
Incidence Rates ◽  
Future Research ◽  
Public Healthcare ◽  
Source Population

Abstract Abstract 1143 Background: Venous thromboembolism (VTE) is a growing public health problem due largely to the aging population and the increasing prevalence of known risk factors such as surgery and cancer-related treatments. As a result, the true burden of VTE is not fully known and more contemporary estimates of incidence are needed. Objectives: We estimated the incidence of a first VTE event in a general population. Methods: This retrospective, observational study used the linked administrative healthcare databases of the province of Québec, Canada, including the province-wide hospitalization database (MED-ÉCHO) and the healthcare services database of RAMQ which oversees all physician reimbursement claims for services provided to Québec residents. From a source population of all RAMQ beneficiaries with a physician visit or a hospitalization associated with an ICD-9-CM or ICD-10-CA diagnosis code for deep vein thrombosis (DVT) or pulmonary embolism (PE) recorded between January 1, 2000 and December 31, 2009 and without a DVT or PE code prior to January 1, 2000, we identified a cohort of Québec residents with definite incident VTE and a cohort with definite or probable incident VTE. We used a priori determined diagnostic algorithms using RAMQ and MED-ÉCHO data to identify definite and probable cases of VTE. Subjects were followed forward in time from first-time VTE occurrence until the earliest of either death or end of study period (December 31, 2009). Incidence rates of first VTE, DVT alone, and PE with or without DVT were calculated by dividing the number of new cases by the total person-years at risk in the population of Québec residents eligible for RAMQ between 2000 and 2009. Age-specific incidence rates and associated 95% confidence intervals (CI) were calculated using achieved age during follow-up, and as a result patients contributed person-time in different age categories while aging during follow-up. Crude and age-adjusted incidence rate ratios (IRR) were reported comparing rates among women and men. Results: From the 245 452 Québec residents between 2000 and 2009 with at least 1 VTE diagnosis in RAMQ or MED-ÉCHO (source population), we identified 67 410 cases with definite VTE and 35 123 cases with probable VTE. The incidence rate of definite VTE was 0.91 per 1000 person-years (95% CI: 0.90–0.91). For DVT alone, the incidence was 0.53 per 1000 person-years (95% CI: 0.52–0.52) and for PE with or without DVT it was 0.38 per 1000 person-years (95% CI: 0.38–0.38). The incidence rates increased with age, and rates in patients 70 years of age and older were more than 4 times higher than rates in patients who were 40–69 years of age (Table 1). The VTE incidence rate was 0.99 per 1000 person-years (95% CI: 0.98–1.00) in women as compared to 0.82 per 1000 person-years (95% CI: 0.81–0.83) in men. The IRR was 1.19 (95% CI: 1.17–1.22) but this sex difference was no longer seen when adjusted for age (IRR 0.98; 95% CI: 0.96–1.01). The corresponding VTE, DVT alone, and PE incidence rates per 1000 person-years for definite or probable VTE were 1.24 (95% CI: 1.23–1.24), 0.79 (95% CI: 0.78–0.79), and 0.45 (95% CI: 0.45–0.46), respectively. Conclusion: Our study provides real-world contemporary estimates of VTE incidence. The risk in the general population is about 0.9 to 1.2 per 1000 person-years and is highest in the elderly. These data may help inform public healthcare planning and future research. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Recurrence risk after anticoagulant treatment of limited duration for late, second venous thromboembolism

Haematologica ◽  
2014 ◽  
Vol 100 (2) ◽  
pp. 188-193 ◽  
Author(s):  
T. van der Hulle ◽  
M. Tan ◽  
P. L. den Exter ◽  
M. J. G. van Roosmalen ◽  
F. J. M. van der Meer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Recurrence Risk ◽  
Anticoagulant Treatment ◽  
Limited Duration

Atrial fibrillation associated with increased risk of venous thromboembolism

2015 ◽  
Vol 113 (01) ◽  
pp. 185-192 ◽  
Author(s):  
Chun-Cheng Wang ◽  
Cheng-Li Lin ◽  
Guei-Jane Wang ◽  
Chiz-Tzung Chang ◽  
Fung-Chang Sung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Incidence Rates ◽  
Vein Thrombosis ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Deep Vein

SummaryWhether atrial fibrillation (AF) is associated with an increased risk of venous thromboembolism (VTE) remains controversial. From Longitudinal Health Insurance Database 2000 (LHID2000), we identified 11,458 patients newly diagnosed with AF. The comparison group comprised 45,637 patients without AF. Both cohorts were followed up to measure the incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Univariable and multivariable competing-risks regression model and Kaplan-Meier analyses with the use of Aelon-Johansen estimator were used to measure the differences of cumulative incidences of DVT and PE, respectively. The overall incidence rates (per 1,000 person-years) of DVT and PE between the AF group and non-AF groups were 2.69 vs 1.12 (crude hazard ratio [HR] = 1.92; 95 % confidence interval [CI] = 1.54-2.39), 1.55 vs 0.46 (crude HR = 2.68; 95 % CI = 1.97-3.64), respectively. The baseline demographics indicated that the members of the AF group demonstrated a significantly older age and higher proportions of comorbidities than non-AF group. After adjusting for age, sex, and comorbidities, the risks of DVT and PE remained significantly elevated in the AF group compared with the non-AF group (adjusted HR = 1.74; 95 %CI = 1.36-2.24, adjusted HR = 2.18; 95 %CI = 1.51-3.15, respectively). The Kaplan-Meier curve with the use of Aelon-Johansen estimator indicated that the cumulative incidences of DVT and PE were both more significantly elevated in the AF group than in the non-AF group after a long-term follow-up period (p<0.01). In conclusion, the presence of AF is associated with increased risk of VTE after a long-term follow-up period.

Long-term Clinical Follow-up in 265 Patients with Deep Venous Thrombosis Initially Treated with either Unfractionated Heparin or Dalteparin: A Retrospective Analysis

1999 ◽  
Vol 82 (10) ◽  
pp. 1222-1226 ◽  
Author(s):  
W. Åberg ◽  
D. Lockner ◽  
C. Paul ◽  
M. Holmström
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Unfractionated Heparin ◽  
Malignant Disease ◽  
Duration Of Treatment ◽  
Post Thrombotic Syndrome ◽  
Recurrent Vte

SummaryThe primary objective of this retrospective study was to describe the frequency of a post-thrombotic syndrome in 265 patients previously treated for deep venous thrombosis (DVT). The secondary objectives were to document the frequency of recurrent venous thromboembolism (VTE) and mortality, especially from malignant disease. The patients were evaluated 5-14 years after inclusion in three randomized trials comparing continuous intravenous (i. v.) infusion of unfractionated heparin (UFH) (n = 85) with a low molecular weight heparin (LMWH), dalteparin (n = 180). The median post-thrombotic score at follow-up was 2 (range 0-8). In a multiple step-wise regression analysis the post-thrombotic score was significantly higher among patients with initial proximal DVT (p = 0,0001) as compared with those who had distal DVT. A recurrent venous thromboembolic event was diagnosed in 29,4% of the patients treated with dalteparin and in 23,5% of the patients treated with UFH (ns). A secondary risk factor for venous thromboembolism and a longer duration of treatment with oral anticoagulants (OAC) were significantly associated with a lower risk for recurrent VTE, whereas malignant disease diagnosed during follow-up was associated with a higher risk. During follow-up a total of 40,7% of patients had died. No difference in total mortality or mortality from malignant disease was demonstrated between the two drugs. In conclusion, a severe post-thrombotic syndrome occured relatively infrequent. considering the long observation period. Proximal DVT was significantly associated with a more severe post-thrombotic syndrome. After 14 years follow-up, no significant differences were observed in overall mortality, mortality from malignant disease or recurrent VTE between UFH- and dalteparin-treated patients. Malignant disease was a risk factor for recurrent VTE, the presence of a secondary risk factor and a longer duration of treatment with OAC decreased the risk for recurrent VTE.

Emotional states and future risk of venous thromboembolism

2012 ◽  
Vol 107 (03) ◽  
pp. 485-493 ◽  
Author(s):  
Sigrid K. Brækkan ◽  
Ida J. Hansen-Krone ◽  
John-Bjarne Hansen ◽  
Kristin F. Enga
Keyword(s):  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Population Based ◽  
Emotional States ◽  
Depressive Feelings ◽  
Increased Risk ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence ◽  
Reduced Risk

SummaryEmotional states of depression and loneliness are reported to be associated with higher risk and optimism with lower risk of arterial cardiovascular disease (CVD) and death. The relation between emotional states and risk of venous thromboembolism (VTE) has not been explored previously. We aimed to investigate the associations between self-reported emotional states and risk of incident VTE in a population-based, prospective study. The frequency of feeling depressed, lonely and happy/optimistic were registered by self-administered questionnaires, along with major co-morbidities and lifestyle habits, in 25,964 subjects aged 25–96 years, enrolled in the Tromsø Study in 1994–1995. Incident VTE-events were registered from the date of inclusion until September 1, 2007. There were 440 incident VTE-events during a median of 12.4 years of follow-up. Subjects who often felt depressed had 1.6-fold (95% CI:1.02–2.50) higher risk of VTE compared to those not depressed in analyses adjusted for other risk factors (age, sex , body mass index, oes-trogens), lifestyle (smoking, alcohol consumption, educational level) and co-morbidities (diabetes, CVD, and cancer). Often feeling lonely was not associated with VTE. However, the incidence rate of VTE in subjects who concurrently felt often lonely and depressed was higher than for depression alone (age-and sex-adjusted incidence rate: 3.27 vs. 2.21). Oppositely, subjects who often felt happy/optimistic had 40% reduced risk of VTE (HR 0.60, 95% CI: 0.41–0.87). Our findings suggest that self-reported emotional states are associated with risk of VTE. Depressive feelings were associated with increased risk, while happiness/ optimism was associated with reduced risk of VTE.

scholarly journals Betahistine in the Treatment of Peripheral Vestibular Vertigo: Results of a Real-Life Study in Primary Care

2019 ◽  
Vol 99 (6) ◽  
pp. 356-360
Author(s):  
Guillermo Sanchez-Vanegas ◽  
Carlos Castro-Moreno ◽  
Diana Buitrago
Keyword(s):  
Primary Care ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Primary Care Physicians ◽  
Real Life ◽  
Global Improvement ◽  
Life Study ◽  
Observational Prospective Cohort Study ◽  
Vestibular Vertigo

The present research was carried out with the objective to establish the clinical effect and safety of betahistine (48 mg daily), for the management of peripheral vestibular vertigo, in patients treated by primary care physicians in Colombia. An observational prospective cohort study was conducted including patients older than 15 years with clinical diagnosis of peripheral vestibular vertigo who were candidates to be treated with betahistine (48 mg daily). A sample size of 150 individuals was calculated, and weekly follow-ups were planned for 12 weeks. Rotatory movement sensation, loss of balance, and global improvement scale from 0 to 100 points were evaluated. Complete improvement was defined when the patient reached a level of 100 points. We calculated average weekly improvement, cumulative incidence of complete improvement, incidence rate of complete improvement, and the probability of complete improvement as a function of time. After the first week, the average improvement was 56.6 points (95% confidence interval [CI]: 50.4-62.7). At the end of week 12, it was 89.3 points (95% CI: 86.5-92.2). Sixty-one percent of the patients had achieved complete improvement at the end of the second week. After the sixth week, the percentage of cumulative improvement was 72%, and after 12 weeks of follow-up, the cumulative incidence of complete improvement was 73% (95% CI: 65%-80%). Based on the follow-up times, a complete improvement incidence rate of 16 cases per 100 people/week was calculated (95% CI: 13-19). We concluded that Betahistine (48 mg daily) has a positive effect, controlling the symptoms associated with benign paroxysmal vertigo, with an adequate safety profile.

scholarly journals Incidence of extra-articular manifestations in ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis: results from a national register-based cohort study

Rheumatology ◽  
2020 ◽  
Author(s):  
Karin Bengtsson ◽  
Helena Forsblad-d'Elia ◽  
Anna Deminger ◽  
Eva Klingberg ◽  
Mats Dehlin ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Incidence Rates ◽  
The Other ◽  
Population Register ◽  
Swedish Population ◽  
National Patient Register ◽  
National Patient ◽  
Rate Ratios ◽  
Strength Of Association

Abstract Objectives To estimate the incidence and strength of association of extra-articular manifestations [EAMs, here: anterior uveitis (AU), IBD and psoriasis] in patients with AS, undifferentiated SpA (uSpA) and PsA, compared with controls. Methods Three mutually exclusive cohorts of patients aged 18–69 years with AS (n = 8517), uSpA (n = 10 245) and PsA (n = 22 667) were identified in the Swedish National Patient Register 2001–2015. Age-, sex- and geography-matched controls were identified from the Swedish Population Register. Follow-up began 1 January 2006, or six months after the first SpA diagnosis, whichever occurred later, and ended at the first date of the EAM under study, death, emigration, 70 years of age, and 31 December 2016. Incidence rates (IRs) and incidence rate ratios were calculated for each EAM, and stratified by sex and age. Results Incidence rate ratios for incident AU, IBD and psoriasis were significantly increased in AS (20.2, 6.2, 2.5), uSpA (13.6, 5.7, 3.8) and PsA (2.5, 2.3, n.a) vs controls. Men with AS and uSpA had significantly higher IRs per 1000 person-years at risk for incident AU than women with AS (IR 15.8 vs 11.2) and uSpA (IR 10.1 vs 6.0), whereas no such sex difference was demonstrated in PsA or for the other EAMs. Conclusions AU, followed by IBD and psoriasis, is the EAM most strongly associated with AS and uSpA. Among the SpA subtypes, AS and uSpA display a largely similar pattern of EAMs, whereas PsA has a considerably weaker association with AU and IBD.

Assessment of Late Thromboembolic Complications Post–Fontan Procedure in Relation to Different Antithrombotic Regimens: 30-Years’ Follow-up Experience

2019 ◽  
Vol 53 (8) ◽  
pp. 786-793
Author(s):  
Abdulrazaq S. Al-Jazairi ◽  
Hana A. Al Alshaykh ◽  
Giovanni Di Salvo ◽  
Edward B. De Vol ◽  
Zohair Y. Alhalees
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Fontan Procedure ◽  
Incidence Rates ◽  
Drug Selection ◽  
Thromboembolic Complications ◽  
Inclusion Criteria ◽  
Duration Of Therapy ◽  
The Difference

Background: The current CHEST guidelines recommend the use of antithrombotic therapy, either aspirin or warfarin, as a primary thromboembolic complications (TECs) prophylaxis in patients who undergo Fontan procedure, without specification on drug selection or duration of therapy. Objective: To investigate the incidence rate of late TECs, occurring after 1-year post–Fontan procedure and to assess the difference in rate of late TECs between warfarin and aspirin. Methods: A retrospective cohort study included patients who had Fontan procedures between 1985-2010 at our institution. Patients were stratified according to the antithrombotic regimen—warfarin, aspirin, or no therapy—at the time of TECs. Results: We screened 499 patients who underwent Fontan procedures; 431 procedures met the inclusion criteria. Over a median follow-up of 13.6 years (IQR= 8.7), freedom from late TECs at 5, 10, 15, and 20 years was 97.54%, 96.90%, 90.78%, and 88.07%, respectively. There was no difference in late TEC incidence rates per 1000 patient-years between warfarin and aspirin: 7.82 and 5.83 events, respectively; rate ratio= 1.34 (95% CI= 0.68-2.60). Warfarin was associated with a higher major bleeding incidence rate per 1000 patient-years: 3.70 versus 2.91 events with aspirin; rate ratio= 1.27 (95% CI= 0.49 to 3.29). Conclusion and Relevance: The incidence rate of late clinical TECs post–Fontan procedure in our population is low. Warfarin was not superior to aspirin for prevention of late TECs. Yet warfarin was associated with a higher rate of bleeding. This finding suggests a simpler antithrombotic regimen for prevention of TEC after 1-year post-Fontan procedure.

Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors

Neurosurgery ◽  
2018 ◽  
Vol 85 (5) ◽  
pp. 708-716 ◽  
Author(s):  
Alexander L Chin ◽  
Dylann Fujimoto ◽  
Kiran A Kumar ◽  
Laurie Tupper ◽  
Salma Mansour ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cumulative Incidence ◽  
Standard Of Care ◽  
Incidence Rates ◽  
Spinal Tumors ◽  
Secondary Malignancy ◽  
Intracranial Tumors ◽  
Symptom Response

Abstract BACKGROUND Stereotactic radiosurgery (SRS) for benign intracranial tumors is an established standard of care. The widespread implementation of SRS for benign spinal tumors has been limited by lack of long-term data. OBJECTIVE To update our institutional experience of safety and efficacy outcomes after SRS for benign spinal tumors. METHODS We performed a retrospective cohort study of 120 patients with 149 benign spinal tumors (39 meningiomas, 26 neurofibromas, and 84 schwannomas) treated with SRS between 1999 and 2016, with follow-up magnetic resonance imaging available for review. The primary endpoint was the cumulative incidence of local failure (LF), with death as a competing risk. Secondary endpoints included tumor shrinkage, symptom response, toxicity, and secondary malignancy. RESULTS Median follow-up was 49 mo (interquartile range: 25-103 mo, range: 3-216 mo), including 61 courses with >5 yr and 24 courses with >10 yr of follow-up. We observed 9 LF for a cumulative incidence of LF of 2%, 5%, and 12% at 3, 5, and 10 yr, respectively. Excluding 10 tumors that were previously irradiated or that arose within a previously irradiated field, the 3-, 5-, and 10-yr cumulative incidence rates of LF were 1%, 2%, and 8%, respectively. At last follow-up, 35% of all lesions had decreased in size. With a total of 776 patient-years of follow-up, no SRS-related secondary malignancies were observed. CONCLUSION Comparable to SRS for benign intracranial tumors, SRS provides longer term local control of benign spinal tumors and is a standard-of-care alternative to surgical resection.

scholarly journals Increase in Adiponectin Level Prevents the Development of Type 2 Diabetes in Japanese Men With Low Adiponectin Levels

2018 ◽  
Vol 2 (7) ◽  
pp. 753-764 ◽  
Author(s):  
Risa Kashiwagi ◽  
Yuya Yamada ◽  
Yoshito Ito ◽  
Yuto Mitsui ◽  
Takaaki Sakaue ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Large Scale ◽  
Adiponectin Level ◽  
Incidence Rates ◽  
Japanese Men ◽  
Baseline Serum ◽  
Cumulative Incidence Rate

Abstract Context Low serum adiponectin (Ad) level is an important risk factor for the development of type 2 diabetes mellitus (T2DM). Objective To determine whether the changes in Ad in subjects with low baseline serum Ad levels can reduce the rate of development of T2DM. Design/Setting/Participants We performed a large-scale longitudinal study of 7052 healthy Japanese men who underwent general health checkups more than twice between April 2007 and May 2015 at the Physical Check up Center, Sumitomo Hospital. The participants were divided into quartile groups according to baseline Ad level. Subjects of the lowest baseline Ad group (≤5.2 μg/mL) were subdivided into quartile subgroups according to the percent change in Ad (%ΔAd) and into two subgroups according to endpoint Ad (&gt;5.2 and ≤5.2 μg/mL). Main Outcome Measures The cumulative incidence rate of T2DM. Results The cumulative incidence rate of T2DM of the lowest baseline Ad group (≤5.2 μg/mL) was significantly higher than the other quartile groups. The cumulative incidence rates of T2DM were significantly lower in the largest (≥21.5%) and the second largest (9.3% to 21.4%) %ΔAd-increased subgroups compared with the %ΔAd-decreased subgroup (P &lt; 0.001 and P = 0.005, respectively). The cumulative incidence rates of T2DM were significantly lower in the endpoint Ad &gt;5.2 μg/mL subgroup than in the ≤5.2 μg/mL subgroup (P &lt; 0.001). Conclusions Increases in serum Ad levels of at least ~10% or &gt;5.2 μg/mL can potentially reduce the risk of development of T2DM in Japanese men with low baseline Ad levels who are at a high risk of developing T2DM.

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