Epidemiology of Thrombosis in Aging

Abstract Aging is an important risk factor for venous thromboembolism (VTE). Data on age-specific incidence rates of VTE from population-based studies are limited. While it is well conceived that aging likely acts through Virchow's triad to increase VTE risk, the relative contribution of the components of Virchow's triad is not understood. The objectives of this study are three-fold. First, we calculated age-specific incidence of VTE (deep vein thrombosis and/or pulmonary embolism) using data from two large, prospective cohort studies: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study. Second, we evaluated the contribution of coagulation factors VII and VIII, VWF, and activated partial thromboplastin time (aPTT) to age prediction of VTE risk. Third, we evaluated how aging influenced the prediction of VTE risk by confirmed genetic risk factors. We followed participants aged 45-64 years in ARIC (n=14,185) and ≥65 in CHS (n=5,414) at baseline visits (1987-89 in ARIC, 1989-90 and 1992-93 in CHS) for incident VTE through 2011 in ARIC and through 2001 in CHS. We computed person-years of follow-up from the date of the baseline examination to a censoring date. Genotype for the F5 Leiden and activity of coagulation factors (FVII:C and FVIII:C), VWF antigen, and aPTT were measured at baseline in ARIC. We performed proportional hazards regression to estimate the hazard ratio (HR) of VTE for baseline risk factors including age, the four hemostasis variables, and the F5 Leiden after adjusting for race and gender. The genetic analysis was stratified by race and follow-up time in both race groups, and additionally adjusted for principal components of population stratification in African Americans. ARIC participants developed 728 VTE events over 288,535 person-years of follow-up, and CHS participants developed 172 VTE events over 54,207 person-years of follow-up. Incidence rates of VTE per 1,000 person-years were 0.5, 1.0, 1.8, 2.8, 3.8, 5.4, 7.9, and 7.1 for 45-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and 85-89 years in ARIC, respectively, and 0.8, 2.7, 2.7, 3.8, 6.2, and 5.7 for 65-69, 70-74, 75-79, 80-84, 85-89, and 90-99 years in CHS, respectively. The four hemostasis variables at baseline were significantly associated with baseline age (Pearson correlation coefficients -0.09 to 0.19, p<0.05) and future risk of VTE (p<0.05). Compared to the first quartile of baseline age distribution, the HRs of VTE with increasing quartile of age were 1.13 (95% CI 0.89-1.42), 1.92 (1.55-2.39), and 2.34 (1.89-2.92) for quartiles 2 to 4; the strength of association decreased after additional adjustment for FVII:C, FVIII:C, VWF, and aPTT: HRs 1.06 (0.84-1.34), 1.69 (1.36-2.11), and 1.97 (1.58-2.46), respectively. F5 Leiden was significantly associated with VTE risk in both whites and African Americans (p<0.05). The HRs for F5 Leiden were stronger for earlier follow-up (when the cohort was younger) than later follow-up in both race groups: whites: HR=4.59 (2.91, 7.25), 2.77 (1.88, 4.09), and 1.47 (0.69, 3.13) for first 10 years, second 10 years, and remaining ~5 years of follow-up, respectively; African Americans: HR=9.09 (2.00, 41.30), 2.14 (0.52, 8.79), and 6.10 (1.40, 26.47) for the three follow-up periods. In conclusion, our data suggest that contribution of aging to VTE risk is partly mediated through the coagulation pathway, and that the increased risk of VTE with aging is pushed to younger age by the presence of strong genetic predisposition (e.g. F5 Leiden). Disclosures No relevant conflicts of interest to declare.

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Risk of Thromboembolic Events in ET and Early/Prefibrotic PMF: The Relevance of an Accurate Histological Diagnosis

Blood ◽

10.1182/blood.v120.21.1735.1735 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1735-1735

Author(s):

Serena Rupoli ◽

Gaia Goteri ◽

Picardi Picardi ◽

Lucia Canafoglia ◽

Giorgia Micucci ◽

...

Keyword(s):

Risk Factors ◽

Conflicts Of Interest ◽

Myeloproliferative Neoplasm ◽

Primary Myelofibrosis ◽

Vascular Events ◽

Bone Marrow Trephine Biopsy ◽

Increased Risk ◽

Risk Patients ◽

Early Primary

Abstract Abstract 1735 Background: Essential Thrombocytemia (ET) is a myeloproliferative neoplasm characterized by increased risk of vascular events. Established thrombosis risk factors are age and previous vascular events. The clinical and prognostic relevance of WHO histologic criteria for ET and prefibrotic/early Primary Myelofibrosis (PMF) has been well recognized. Our aim was to evaluate the correlation between histologic interpretation and vascular events in our series of thrombocytemias. Material and methods: From our files, we retrieved all patients consecutively diagnosed as having ET with complete clinical data (N = 283) who had undergone to a bone marrow trephine biopsy before any treatment at or within 1 year of diagnosis (N= 133). The histologic slides were reviewed in order to separate true ET cases from early/prefibrotic PMF; vaso-occlusive events at diagnosis and in the follow-up were than compared in the two groups. Results: Histologic review reclassified 61 cases as ET and 72 cases as prefibrotic/early PMF. Prefibrotic/early PMF showed a significant higher prevalence of thrombosis history and thrombotic events at diagnosis, and an increased leukocyte count than ET (22% vs 8%, 15.2% vs 1.6%, 8389/mmc vs 7500/mmc, respectively); furthermore, venous thromboses (mainly atypical) were relatively common in PMF, as opposed to WHO-defined ET. During follow-up, patients with prefibrotic PMF, although younger, showed a significant higher risk of developing thrombosis: the 15-year risk of thrombosis was 48% in prefibrotic PMF (grade 0), 16% in early PMF (grade 1, 2) and 17% in ET. Multivariate analysis confirmed that age and histopathology are independent risk factors for thrombosis during follow-up. Patients older than 60 or with prefibrotic PMF are high risk patients whereas those younger and with non prefibrotic PMF or ET should be considered at low risk (20-year risk of thrombosis 47% vs 4%, p=0.005). Conclusion: The results of present study indicate prefibrotic PMF as a myloproliferative neoplasm with the highest tendency to develop vascular events compared to early PMF and ET. Therefore we suggest to include histopathology interpretation in the risk stratification of so-called ET patients. Disclosures: No relevant conflicts of interest to declare.

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Association Between Changes in Risk Factor Status and Suicidal Ideation Incidence and Recovery

Crisis ◽

10.1027/0227-5910/a000343 ◽

2015 ◽

Vol 36 (6) ◽

pp. 390-398 ◽

Cited By ~ 1

Author(s):

Yi Zhang ◽

Paul Siu Fai Yip ◽

Shu-Sen Chang ◽

Paul Wai Ching Wong ◽

Frances Yik Wa Law

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Life Events ◽

Irrational Beliefs ◽

Psychiatric Treatment ◽

Economic Status ◽

Incidence Rates ◽

Increased Risk ◽

Persistent Unemployment

Abstract. Background: Little is known about risk factors associated with the incidence of and recovery from suicidal ideation. Aims: To examine the association between potential risk factors and their change in status over the follow-up period and the incidence of and recovery from suicidal ideation. Method: A 12-month follow-up survey was conducted among 997 adults aged between 20 and 59 years living in Hong Kong. Results: The incidence rates of suicidal ideation increased in individuals who were divorced, separated, or widowed, in low economic status, had a history of psychiatric treatment, and experienced bereavement at baseline. Experiencing three or more life events and persistent unemployment over the follow-up period was associated with increased incidence of suicidal ideation. Increased levels of depression, anxiety, hopelessness, and irrational beliefs were associated with suicidal ideation incidence in men but not in women (p = .009–.067 for interactions). Among individuals who had suicidal ideation at baseline, those who had increased severity of depression, anxiety, and hopelessness over the follow-up period were less likely to recover from suicidal ideation. Conclusion: Life events and persistent unemployment were associated with increased risk of suicidal ideation. Gender differences were detected in the association between changes in the status of psychological factors and the occurrence of suicidal ideation.

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Risk Factors for Incident Carotid Artery Revascularization among Older Adults: The Cardiovascular Health Study

Cerebrovascular Diseases Extra ◽

10.1159/000452426 ◽

2016 ◽

Vol 6 (3) ◽

pp. 129-139 ◽

Cited By ~ 1

Author(s):

Parveen K. Garg ◽

Willam J.H. Koh ◽

Joseph A. Delaney ◽

Ethan A. Halm ◽

Calvin H. Hirsch ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Carotid Artery ◽

Cardiovascular Health ◽

Multivariable Analysis ◽

Population Based ◽

Health Study ◽

Cardiovascular Health Study ◽

Increased Risk

Background: Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults. Methods: Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), 5,107 participants without a prior history of carotid endarterectomy (CEA) or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization. Results: Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23), peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93), and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46). Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77) and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86). Conclusions: Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.

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Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/0363546519876054 ◽

2019 ◽

Vol 47 (13) ◽

pp. 3229-3237 ◽

Cited By ~ 3

Author(s):

Melissa Hornbæk Pedersen ◽

Liv Riisager Wahlsten ◽

Henrik Grønborg ◽

Gunnar Hilmar Gislason ◽

Michael Mørk Petersen ◽

...

Keyword(s):

Risk Factors ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Nonoperative Treatment ◽

Incidence Rates ◽

Factors Associated ◽

Increased Risk ◽

Male Sex

Background: Venous thromboembolism (VTE) is a well-known complication of Achilles tendon rupture (ATR) and carries a high risk of morbidity and mortality. Although routine thromboprophylaxis for patients with ATR is not recommended, sparse knowledge is available regarding risk factors associated with VTE in patients with ATR. Purpose: To use Danish nationwide registers to identify incidence rates for symptomatic VTE and risk factors associated with increased risk of developing VTE in patients with ATR. Study Design: Cohort study; Level of evidence, 3. Methods: By crosslinking nationwide registers, we identified all patients with diagnosed ATR in Denmark from 1997 to 2015. We stratified patients into 4 groups by age and treatment modality (ie, operative vs nonoperative treatment). The main outcome was VTE within 180 days. We calculated crude incidence rates and considered age, sex, year, comorbidities, and medications as risk factors for VTE in Poisson regression models. Results: We identified 28,546 patients with ATR, of whom 389 (1.36%) were hospitalized with VTE during the follow-up period: 278 due to deep vein thromboses and 138 due to pulmonary embolism. Incidence rates were highest during the first month and ranged from 4.6 to 14.6 events per 100 person-years. VTEs were most frequent among nonoperatively treated patients aged ≥50 years. In Poisson regression analyses, having had VTE beforehand was associated with an increased risk of VTE, as was male sex in the nonoperative treatment group aged ≥50 years; among women <50 years of age, hormonal contraceptives led to a 4- to 6-fold higher risk of VTE compared with patients in the same group without the equivalent risk factor. Conclusion: In this nationwide cohort of patients with ATR, 1.36% developed symptomatic VTE during follow-up. Hormonal contraception, previous VTE, older age group, and male sex increased the risk of VTE. Taken together, the results of the present study suggest that focus on risk stratification and initiatives to prevent VTE might be warranted. A randomized controlled trial could answer this question.

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Abstract 005: Cumulative Stress Exposure is Associated With Incident Hypertension in African Americans: Findings From the Jackson Heart Study

Circulation ◽

10.1161/circ.137.suppl_1.005 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Tanya M Spruill ◽

Mark J Butler ◽

S J Thomas ◽

Gabriel S Tajeu ◽

Sheila F Castaneda ◽

...

Keyword(s):

Risk Factors ◽

African Americans ◽

Chronic Stress ◽

Cumulative Exposure ◽

Stress Exposure ◽

Jackson Heart Study ◽

Incident Hypertension ◽

Heart Study ◽

Increased Risk

Introduction and Hypothesis: Chronic stress has been associated with incident hypertension but evidence is mixed, particularly in African Americans. We tested the hypothesis that higher cumulative exposure to stress would be associated with increased risk of developing hypertension in the Jackson Heart Study (JHS), a prospective study of cardiovascular disease in African Americans. Methods: Analyses included 1,442 JHS participants free of hypertension at baseline (2000-2004) who completed at least 3 annual follow-up telephone interviews. Incident hypertension was defined as systolic blood pressure (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg or use of antihypertensive medications at Exam 2 (2005-2008) or Exam 3 (2009-2013). A single-item measure of stress (“How much stress have you experienced over the past year?”) was completed during annual interviews, and the percentage of assessments in each measurement interval (i.e., between Exams 1 and 2, between Exams 2 and 3) in which high stress was reported was categorized as No Chronic Stress (0%), Low Chronic Stress (1-33.3%) or High Chronic Stress (>33.3%). Chronic stress exposure in each interval was used to predict incident hypertension at the following exam among participants free of hypertension at the start of the interval using repeated measures Poisson regression models with progressive adjustment for age, sex, years between exams and other relevant risk factors (education, marital status, parental history of hypertension, baseline SBP and DBP, body mass index, diabetes, chronic kidney disease). Results: The 1,442 participants in this analysis contributed data to 1,987 measurement intervals. The mean age was 49±0.26 years and 41% were male. During follow-up (median, 8 years), 44.0% of participants developed hypertension. The percentage of intervals with No, Low and High chronic stress was 62.3%, 9.2% and 28.6%, respectively. Multivariable-adjusted risk ratios (95% confidence interval) for incident hypertension associated with Low (vs. No) and High (vs. No) chronic stress were 1.11 (0.90-1.37) and 1.21 (1.06-1.38), respectively ( P trend=0.005). This association remained statistically significant after further adjustment for baseline stress ( P trend=0.014) and potential behavioral mediators (smoking, alcohol use, physical activity, diet; P trend=0.03). In stratified analyses, the association was present in women ( P trend=0.002), younger participants (<50 years old; P trend=0.007) and those with normal BP at baseline ( P trend=0.001). Conclusion: We found that African Americans reporting higher chronic stress over time are at increased risk of developing hypertension, independent of baseline stress levels and cardiovascular and behavioral risk factors. Future studies should evaluate the use of stress management interventions to support primary prevention of hypertension in this high risk population.

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Late Cardiovascular Events in Survivors of Hematopoietic Cell Transplantation (HCT).

Blood ◽

10.1182/blood.v114.22.2252.2252 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2252-2252

Author(s):

Saro Armenian ◽

Can-Lan Sun ◽

George Mills ◽

Jennifer Berano Teh ◽

Liton Francisco ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Hematopoietic Cell Transplantation ◽

Conflicts Of Interest ◽

Therapeutic Option ◽

Sampling Frame ◽

Mediastinal Radiation ◽

Increased Risk

Abstract Abstract 2252 Poster Board II-229 Introduction: HCT is increasingly offered as a therapeutic option for hematological malignancies. Improvement in therapeutic and supportive care strategies has resulted in a growing population of long-term survivors. These survivors are at a substantial risk of morbidity, contributed to by therapeutic exposures, and development of comorbidities. For example, HCT survivors are potentially at increased risk of atherosclerotic disease of large and small vessels, due to the higher risk of dyslipidemia, diabetes, and hypertension in HCT survivors (Blood 2007;109:1765-72) as well as prior exposures to atherogenic therapeutic exposures (pre-HCT, during conditioning and post-HCT). However, cardiovascular disease (CVD) has not been well-characterized in HCT survivors, in part because of the long latency of clinically overt disease, requiring extended follow-up of large cohorts. The current report addresses this gap in literature by comprehensively evaluating the role of pre- and post-HCT therapeutic exposures (chemotherapy, radiation), transplant-related conditioning regimens, and comorbidities (pre- and post-HCT) in the development of late CVD after HCT. Methods: Utilizing a nested case-control design, individuals with late CVD (diagnosed ≥1 year after HCT) were identified from a cohort of 3,287 1+ year survivors who underwent HCT at a single institution. This cohort formed the sampling frame for selecting controls (without CVD) matched for age and year of HCT, donor source (allogeneic vs. autologous), and length of follow-up. All episodes of CVD (cases) were clinically validated, and included coronary artery disease (CAD) or cerebrovascular events (stroke). Results: Sixty-three patients with late CVD were identified; 44 (69.8%) had CAD and 19 (30.2%) had stroke. Median age at HCT was 49.0 years (range, 18.6 to 78.9 years); median time to CVD was 4.1 years (range, 1.15 to 19.45 years); 66.7% received autologous HCT. Compared to matched controls (N=183), patients with late CVD were more likely to be male (68.3% vs. 51.6%; p=0.02), had greater body mass index at HCT (28.5 vs. 26.6 kg/m2; p=0.03), and were more likely to have multiple comorbidities after HCT (47.6% vs. 13.4%; p<0.01). Conditioning with total body irradiation (TBI), cyclophosphamide, and TBI + cyclophosphamide were associated with incremental increased risk (Odds Ratio [OR]=1.2, 2.5, 2.9, respectively; p for trend=0.04). Multivariate logistic regression revealed that having 2 of 4 cardiovascular risk factors (obesity, dyslipidemia, hypertension, and diabetes) was independently associated with a 5-fold risk of developing late CVD (OR=5.2; p<0.01). Multivariate analyses restricted to CAD cases and their matched controls revealed the following risk factors: pre-HCT exposure to mediastinal radiation (OR=9.3; p=0.04), and presence of 2 of 4 cardiovascular risk factors (OR=4.6, p=<0.01). No interactions were observed between therapeutic exposures and presence of comorbidities. Conclusions: The current study represents the most comprehensive experience to date describing risk factors for late CVD following HCT, and demonstrates that mediastinal radiation and presence of comorbidities are primarily responsible for the risk of late CVD. These data form the basis for identifying high-risk individuals for targeted surveillance, as well as developing preventive strategies in the form of aggressive management of comorbidities. Disclosures: No relevant conflicts of interest to declare.

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POS1015 ANTI-TNF DRUGS AND CARDIOVASCULAR EVENTS IN PATIENTS WITH SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4133 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 775.2-776

Author(s):

C. W. S. Chan ◽

P. H. LI ◽

C. S. Lau ◽

H. Y. Chung

Keyword(s):

Risk Factors ◽

Psoriatic Arthritis ◽

Cardiovascular Events ◽

Clinical Information ◽

Incidence Rates ◽

Major Adverse Cardiovascular Events ◽

Cross Sectional ◽

Cerebrovascular Events ◽

Cardiovascular Morbidity And Mortality

Background:Cardiovascular (CVS) diseases are the leading cause of death worldwide and patients with rheumatic diseases have an increased CVS risk including stroke and myocardial infarction (MI) (1-3). CVS risk factors and CVS events are common in SpA (4). Delineating the CVS risk and the association with medications in patients with SpA would be useful.Objectives:The objective of this study was to delineate the CVS risk and the association with medications in patients with SpA.Methods:Patients with SpA and patients with non-specific back pain (NSBP) were identified in rheumatology and orthopedics clinics respectively. Clinical information and CVS events were retrieved. Incidence rates were calculated. Association analysis was performed to determine the CVS risk of SpA and other modifiable risk factors.Results:A total of 5046 patients (SpA 2616 and NSBP 2430) were included from eight centers. Over 56 484 person-years of follow-up, 160 strokes, 84 MI and 262 major adverse cardiovascular events (MACE) were identified. Hypercholesterolemia was more prevalent in SpA (SpA 34.2%, NSBP 28.7%, P<0.01). Crude incidence rates of stroke and MI were higher in SpA patients. SpA was associated with a higher risk of MACE (HR 1.66, 95%CI 1.22-2.27, P<0.01) and cerebrovascular events (HR 1.42, 95%CI 1.01-2.00, p=0.04). The use of anti-tumor necrosis factor (TNF) drugs was associated with a reduced risk of MACE (HR 0.37, 95%CI 0.17-0.80, P=0.01) and cerebrovascular events (HR 0.21, 95%CI 0.06-0.78, P=0.02).Conclusion:SpA is an independent CVS risk factor. Anti-TNF drugs were associated with a reduced CVS risk in these patients.References:[1]Crowson CS, Liao KP, Davis JM, 3rd, Solomon DH, Matteson EL, Knutson KL, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013;166(4):622-8 e1.[2]Verhoeven F, Prati C, Demougeot C, Wendling D. Cardiovascular risk in psoriatic arthritis, a narrative review. Joint Bone Spine. 2020;87(5):413-8.[3]Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32(3):369-89.[4]Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016-23.Disclosure of Interests:None declared.

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Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study

Sleep And Breathing ◽

10.1007/s11325-020-02287-8 ◽

2021 ◽

Author(s):

Maria Värendh ◽

Christer Janson ◽

Caroline Bengtsson ◽

Johan Hellgren ◽

Mathias Holm ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Health ◽

Smoking Status ◽

Northern Europe ◽

Nasal Breathing ◽

Nasal Symptoms ◽

Increased Risk ◽

Study Population ◽

Independent Risk Factors

Abstract Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.

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Cumulative incidence and risk factors for radiation induced leukoencephalopathy in high grade glioma long term survivors

Scientific Reports ◽

10.1038/s41598-021-89216-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Robert Terziev ◽

Dimitri Psimaras ◽

Yannick Marie ◽

Loic Feuvret ◽

Giulia Berzero ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

High Grade Glioma ◽

High Grade ◽

Nucleotide Polymorphisms ◽

Increased Risk ◽

Radiation Induced ◽

Long Term Survivors

AbstractThe incidence and risk factors associated with radiation-induced leukoencephalopathy (RIL) in long-term survivors of high-grade glioma (HGG) are still poorly investigated. We performed a retrospective research in our institutional database for patients with supratentorial HGG treated with focal radiotherapy, having a progression-free overall survival > 30 months and available germline DNA. We reviewed MRI scans for signs of leukoencephalopathy on T2/FLAIR sequences, and medical records for information on cerebrovascular risk factors and neurological symptoms. We investigated a panel of candidate single nucleotide polymorphisms (SNPs) to assess genetic risk. Eighty-one HGG patients (18 grade IV and 63 grade III, 50M/31F) were included in the study. The median age at the time of radiotherapy was 48 years old (range 18–69). The median follow-up after the completion of radiotherapy was 79 months. A total of 44 patients (44/81, 54.3%) developed RIL during follow-up. Twenty-nine of the 44 patients developed consistent symptoms such as subcortical dementia (n = 28), gait disturbances (n = 12), and urinary incontinence (n = 9). The cumulative incidence of RIL was 21% at 12 months, 42% at 36 months, and 48% at 60 months. Age > 60 years, smoking, and the germline SNP rs2120825 (PPARg locus) were associated with an increased risk of RIL. Our study identified potential risk factors for the development of RIL (age, smoking, and the germline SNP rs2120825) and established the rationale for testing PPARg agonists in the prevention and management of late-delayed radiation-induced neurotoxicity.

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Atrial fibrillation associated with increased risk of venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th14-05-0405 ◽

2015 ◽

Vol 113 (01) ◽

pp. 185-192 ◽

Cited By ~ 23

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.

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