scholarly journals Incidence of Venous Thromboembolism and Impact on Mortality in Patients with Primary CNS Lymphoma: A Population Based Study

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 754-754
Author(s):  
Anjlee Mahajan ◽  
Ann M Brunson ◽  
Theresa H.M. Keegan ◽  
Aaron S. Rosenberg ◽  
Ted Wun
Keyword(s):  
Major Bleeding ◽  
Proportional Hazards ◽  
Large Population ◽  
Steering Committee ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Population Based Study ◽  
Risk Of Death ◽  
Proportional Hazards Regression ◽  
Increased Risk

Abstract Background: Venous thromboembolism (VTE) is a known complication of cancer, with a high incidence in patients with both gliomas and lymphoma. Recent studies have shown a high risk of intracranial bleeding in glioma patients treated for VTE with anticoagulation. To date, there are no large, population-based studies describing the incidence of VTE in patients with primary central nervous system lymphoma (PCNSL). Methods: Using the California Cancer Registry, we identified patients with a first histologic diagnosis of PCNSL from 2005-2014 and linked these cases to the California hospitalization and emergency department databases. Patients with a VTE within 6 months prior to PCNSL diagnosis were excluded (n=11). We calculated cumulative incidence of VTE and major bleeding and associated 95% confidence intervals (CI), adjusted for the competing risk of death. Multivariable Cox proportional hazards regression models, using the methods of Fine and Gray to adjust for competing risk of death, were used to analyze factors associated with VTE and major bleeding. Models included sex, race/ethnicity, age at diagnosis, neighborhood sociodemographic status, health insurance at diagnosis, Elixhauser comorbidities, HIV status, initial treatment (chemotherapy, radiation, or CNS procedure), and prior VTE (> 6 months prior to diagnosis). The major bleeding model additionally included VTE type as a time dependent covariate. The association of VTE and major bleeding with PCNSL-specific mortality was analyzed using multivariable Cox proportional hazards regression models; VTE and major bleeding were included as time dependent covariates. Results are presented as adjusted hazard ratios (HR) and 95% CI. Results: There were 992 patients with a PCNSL identified. VTE occurred in 143 patients (14.4%). Of the VTE events, 52% were pulmonary emboli [(PE +/- deep vein thrombosis (DVT)], 23% proximal DVT and 22% distal DVT. The 3- and 12-month cumulative incidences of VTE were 10.2% (CI: 8.4-12.2%) and 13.6% (CI: 11.5-15.8%), respectively (Figure 1). Patients who received chemotherapy had over 2-fold increased risk of developing VTE (HR=2.42, CI: 1.33-4.42) compared to those who did not receive chemotherapy, and those who received radiation were also at increased risk of VTE (HR=1.56 CI: 1.07-2.27). Asian/Pacific Islanders had a decreased risk of VTE compared to non-Hispanic Whites (HR=0.37, CI: 0.21-0.66). Major bleeding occurred in 156 patients (15.7%). Of the major bleeding events, 53% were intracranial hemorrhage, 33% were gastrointestinal bleeds, 12% of patients required a transfusion and 3% had unspecified bleeding. The 3- and 12-month cumulative incidences of major bleeding were 9.8% (CI: 8.1-11.8%) and 13.2% (CI: 11.1-15.3%), respectively (Figure 2). PE and proximal DVT were associated with increased risk of major bleeding (HR=4.57, CI: 2.43-8.60 and HR=5.95, CI: 2.47-14.34, respectively). In the PCNSL specific mortality models, PE was associated with increased risk of death (HR=1.81, CI: 1.14-2.87), though DVT (proximal or distal) was not. Patients with major bleeding were at over 2-fold increased risk of PCNSL death compared to those without major bleeding (HR=2.34, CI: 1.71-3.19). Conclusions: The incidence of VTE in this large population-based study of patients with PCNSL was high at 14.4%, with most VTE events occurring within the first 3 months after diagnosis. Risk factors associated with VTE included treatment with either chemotherapy or radiation. PE and proximal DVT were associated with increased risk of major bleeding, suggesting these patients may have received anticoagulation, and as recently shown in glioma patients, are at a high risk of intracranial hemorrhage. In addition, PE and major bleeding were both independently associated with higher PCNSL mortality. Disclosures Wun: Janssen: Other: Study steering committee and research support (site PI); Pfizer: Other: Study steering committee and research support (site PI).

scholarly journals Survival of patients with rare diseases: a population-based study in Tuscany (Italy)

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesca Gorini ◽  
Alessio Coi ◽  
Lorena Mezzasalma ◽  
Silvia Baldacci ◽  
Anna Pierini ◽  
...  
Keyword(s):  
Rare Diseases ◽  
Proportional Hazards ◽  
Large Population ◽  
Circulatory System ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Public Health Issue ◽  
Risk Of Death ◽  
Increased Risk ◽  
Circulatory System Diseases

Abstract Background Rare diseases (RDs) encompass a heterogeneous group of life-threatening or chronically debilitating conditions that individually affect a small number of subjects but overall represent a major public health issue globally. There are still limited data on RD burden due to the paucity of large population-based epidemiological studies. The aim of this research was to provide survival estimates of patients with a RD residing in Tuscany, Italy. Methods Cases collected in the Rare Diseases Registry of Tuscany with diagnosis between 1st January 2000 and 31th December 2018 were linked to the regional health databases in order to retrieve information on mortality of all subjects. Survival at 1, 5 and 10 years from diagnosis with 95% confidence intervals (CI) was estimated by sex, age class, nosological group and subgroup using the Kaplan–Meier method. The effect of sex, age and period of diagnosis (years 2000–2009 or 2010–2018) on survival was estimated using Cox proportional hazards regression. Results Survival at 1, 5 and 10 years from diagnosis was 97.3%, 88.8% and 80.8%, respectively. Respiratory diseases and peripheral and central nervous system disorders were characterized by the lowest survival at 5 and 10 years. Despite a modest higher prevalence of RDs among females (54.0% of the total), male cases had a significant increased risk of death (hazard ratio, HR 1.48, 95% CI 1.38–1.58). Cases diagnosed during 2010–2018 period had a risk of death significantly lower than those diagnosed during 2000–2009 (HR 0.81, 95% CI 0.82–0.96), especially for immune system disorders (HR 0.48, 95% CI 0.26–0.87), circulatory system diseases (HR 0.61, 95% CI 0.45–0.84) and diseases of the musculoskeletal system and connective tissue (HR 0.64, 95% CI 0.49–0.84). Conclusions An earlier diagnosis as well as the improvement in the efficacy of treatment resulted in a decreased risk of death over the years for specific RDs. The linkage between a population-based registry and other regional databases exploited in this study provides a large and accurate mass of data capable of estimating patients’ life-expectancy and increasing knowledge on the collective burden of RDs.

The Risk and Consequences of Vertebral Fracture in Patients with Ankylosing Spondylitis: A Population-based Data Linkage Study

2020 ◽  
Vol 47 (11) ◽  
pp. 1629-1636 ◽  
Author(s):  
Milica Ognjenovic ◽  
Warren D. Raymond ◽  
Charles A. Inderjeeth ◽  
Helen I. Keen ◽  
David B. Preen ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Vertebral Fracture ◽  
Proportional Hazards ◽  
Tumor Necrosis Factor Inhibitor ◽  
Population Based ◽  
Linkage Study ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Increased Risk

Objective.To compare the long-term prevalence, incidence, and outcomes of vertebral fracture (VF) between ankylosing spondylitis (AS) patients and matched controls, including the role of extraarticular manifestations (EAM) and osteoporosis.Methods.This was a statewide observational study using linked health data for 2321 patients with AS and 22,976 controls presenting to hospital from 1980 to 2015. Data were analyzed using incidence rates (per 1000 person-yrs) and ratios (IRR), multivariable Cox proportional hazards regression, and Kaplan-Meier survival curves.Results.Over a median 13.92 (interquartile range 7.58–21.67) years of follow-up, patients with AS had a greater VF prevalence and greater incidence of developing a new VF compared to controls (9.3% vs 2.5%, 6.8% vs 1.9%, respectively, all P < 0.001). Patients with AS had an increased risk of developing a VF after adjustments for age, sex, and osteoporosis (HR 2.55, 95% CI 2.11–3.09) compared to controls; this risk remained throughout the study period. Patients with AS were 5 years younger at time of first VF (P = 0.008) and had a greater likelihood of a recurrent VF (IRR 4.64; 95% CI 4.54–4.75) compared to respective controls. Mortality overall was comparable between patients with AS and controls after adjustment for age, sex, osteoporosis, and VF status (HR 0.90; 95% CI 0.80–1.01).Conclusion.The significantly increased risk of VF in patients with AS has not altered following the introduction of tumor necrosis factor inhibitor treatment. Although patients with AS experience a first VF at a younger age than controls, this does not lead to an increased risk of death.

scholarly journals Risk of primary lung cancer after adjuvant radiotherapy in breast cancer—a large population-based study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Anna-Karin Wennstig ◽  
Charlotta Wadsten ◽  
Hans Garmo ◽  
Mikael Johansson ◽  
Irma Fredriksson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Cumulative Incidence ◽  
Adjuvant Radiotherapy ◽  
Proportional Hazards ◽  
Large Population ◽  
Primary Lung Cancer ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Increased Risk

AbstractAdjuvant radiotherapy (RT) for breast cancer (BC) has been associated with an increased risk of later radiation-induced lung cancer (LC). We examined the risk of primary LC in a population-based cohort of 52300 women treated for BC during 1992 to 2012, and 253796 age-matched women without BC. Cumulative incidence of LC was calculated by the Kaplan–Meier method, and the risk of LC after BC treatment was estimated by Cox proportional hazards regression analyses. Women with BC receiving RT had a higher cumulative incidence of LC compared to women with BC not receiving RT and women without BC. This became apparent 5 years after RT and increased with longer follow-up. Women with BC receiving RT had a Hazard ratio of 1.59 (95% confidence interval 1.37–1.84) for LC compared to women without BC. RT techniques that lower the incidental lung doses, e.g breathing adaption techniques, may lower this risk.

scholarly journals A contemporary survival analysis of individuals with cystic fibrosis: a cohort study

2014 ◽  
Vol 45 (3) ◽  
pp. 670-679 ◽  
Author(s):  
Anne L. Stephenson ◽  
Melissa Tom ◽  
Yves Berthiaume ◽  
Lianne G. Singer ◽  
Shawn D. Aaron ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Previously established predictors of survival may no longer apply in the current era of cystic fibrosis (CF) care. Our objective was to identify risk factors associated with survival in a contemporary CF population.We used the Canadian CF Registry, a population-based cohort, to calculate median age of survival and summarise patient characteristics from 1990 to 2012. Clinical, demographic and geographical factors, and survival were estimated for a contemporary cohort (2000–2012) using Cox proportional hazards models.There were 5787 individuals in the registry between 1990 and 2012. Median survival age increased from 31.9 years (95% CI 28.3–35.2 years) in 1990 to 49.7 years (95% CI 46.1–52.2 years) in the most current 5-year window ending in 2012. Median forced expiratory volume in 1 s improved (p=0.04) and fewer subjects were malnourished (p<0.001) over time. Malnourished patients (hazard ratio (HR) 2.1, 95% CI 1.6–2.8), those with multiple exacerbations (HR 4.5, 95% CI 3.2–6.4) and women with CF-related diabetes (HR 1.8, 95% CI 1.2–2.7) were at increased risk of death.Life expectancy in Canadians with CF is increasing. Modifiable risk factors such as malnutrition and pulmonary exacerbations are associated with an increased risk of death. The sex gap in CF survival may be explained by an increased hazard for death in women with CF-related diabetes.

scholarly journals Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1514
Author(s):  
Hilde Espnes ◽  
Jocasta Ball ◽  
Maja-Lisa Løchen ◽  
Tom Wilsgaard ◽  
Inger Njølstad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Pressure Management ◽  
Reference Models ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

scholarly journals Burden of major gastrointestinal bleeding among oral anticoagulant-treated non-valvular atrial fibrillation patients

2021 ◽  
Vol 14 ◽  
pp. 175628482199735
Author(s):  
Steven Deitelzweig ◽  
Allison Keshishian ◽  
Amiee Kang ◽  
Amol D. Dhamane ◽  
Xuemei Luo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Proportional Hazards ◽  
Bleeding Event ◽  
Cox Proportional Hazards ◽  
High Rate ◽  
Gi Bleeding ◽  
Increased Risk ◽  
Gi Bleed

Background: Gastrointestinal (GI) bleeding is the most common type of major bleeding associated with oral anticoagulant (OAC) treatment. Patients with major bleeding are at an increased risk of a stroke if an OAC is not reinitiated. Methods: Non-valvular atrial fibrillation (NVAF) patients initiating OACs were identified from the Centers for Medicare and Medicaid Services ( CMS) Medicare data and four US commercial claims databases. Patients who had a major GI bleeding event (hospitalization with primary diagnosis of GI bleeding) while on an OAC were selected. A control cohort of patients without a major GI bleed during OAC treatment was matched to major GI bleeding patients using propensity scores. Stroke/systemic embolism (SE), major bleeding, and mortality (in the CMS population) were examined using Cox proportional hazards models with robust sandwich estimates. Results: A total of 15,888 patients with major GI bleeding and 833,052 patients without major GI bleeding were included in the study. Within 90 days of the major GI bleed, 58% of patients discontinued the initial OAC treatment. Patients with a major GI bleed had a higher risk of stroke/SE [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.42–1.74], major bleeding (HR: 2.79, 95% CI: 2.64–2.95), and all-cause mortality (HR: 1.29, 95% CI: 1.23–1.36) than patients without a major GI bleed. Conclusion: Patients with a major GI bleed on OAC had a high rate of OAC discontinuation and significantly higher risk of stroke/SE, major bleeding, and mortality after hospital discharge than those without. Effective management strategies are needed for patients with risk factors for major GI bleeding.

Accelerated aging and mortality in long-term survivors of childhood cancer: A report from the St. Jude Lifetime Cohort (SJLIFE).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10045-10045
Author(s):  
AnnaLynn M. Williams ◽  
Jeanne S. Mandelblatt ◽  
Mingjuan Wang ◽  
Kirsten K. Ness ◽  
Gregory T. Armstrong ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Proportional Hazards ◽  
Accelerated Aging ◽  
Cox Proportional Hazards ◽  
Premature Aging ◽  
Self Report ◽  
Deficit Accumulation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Survivors Of Childhood Cancer

10045 Background: Survivors of childhood cancer have functional limitations and health-related morbidity consistent with an accelerated aging phenotype. We characterized aging using a Deficit Accumulation Index (DAI) which examines the accumulation of multiple aging-related deficits readily available from medical records and self-report. DAI’s are used as surrogates of biologic aging and are validated to predict mortality in adult cancer patients. Methods: We included childhood cancer survivors (N = 3,758, mean age 30 [SD 8], 22 [9] years post diagnosis, 52% male) and community controls (N = 575, mean age 34 [10] 44% male) who completed clinical assessments and questionnaires and who were followed for mortality through December 31st, 2018 (mean follow-up 6.1 [3.1] years). Using the initial SJLIFE clinical assessment, a DAI score was generated as the proportion of deficits out of 44 items related to aging, including chronic conditions (e.g. hearing loss, hypertension), psychosocial and physical function, and activities of daily living. The total score ranged 0 to 1; scores > 0.20 are robust, while moderate and large clinically meaningful differences are 0.02 and 0.06, respectively. Linear regression compared the DAI in survivors and controls with an age*survivor/control interaction and examined treatment associations in survivors. Cox-proportional hazards models estimated risk of death associated with DAI. All models were adjusted for age, sex, and race. Results: Mean [SD] of DAI was 0.17 [0.11] for survivors and 0.10 [0.08] for controls. 32% of survivors had a DAI above the 90th percentile of the control distribution (p < 0.001). After adjustment for covariates, survivors had a statistically and clinically meaningfully higher DAI score than controls (β = 0.072 95%CI 0.062, 0.081; p < 0.001). When plotted against age, the adjusted DAI at the average age of survivors (30 years) was 0.166 (95% CI 0.160,0.171), which corresponded to 60 years of age in controls, suggesting premature aging of 30 years. The mean difference in DAI between survivors and controls increased with age from 0.06 (95% CI 0.04, 0.07) at age 20 to 0.11 (95% CI 0.08, 0.13) at age 60, consistent with an accelerated aging phenotype (p = 0.014). Cranial radiation, abdominal radiation, cyclophosphamide, platinum agents, neurosurgery, and amputation were each associated with a higher DAI (all p≤0.001). Among survivors, a 0.06 increase in DAI was associated with a 41% increased risk of all-cause mortality (HR 1.41 95%CI 1.32, 1.50; p < 0.001). Conclusions: Survivors of childhood cancer experience significant age acceleration that is associated with an increased risk of mortality; longitudinal analyses are underway to validate these findings. Given the ease of estimating a DAI, this may be a feasible method to quickly identify survivors for novel and tailored interventions that can improve health and prevent premature mortality.

Diet Inflammatory Index and Dementia Incidence: A Population-Based Study

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012973
Author(s):  
Sokratis Charisis ◽  
Eva Ntanasi ◽  
Mary Yannakoulia ◽  
Costas A Anastasiou ◽  
Mary H Kosmidis ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Dietary Interventions ◽  
Clinical Criteria ◽  
Inflammatory Index ◽  
Incident Dementia ◽  
Dementia Incidence ◽  
Increased Risk

Background and objectives:Aging is characterized by a functional shift of the immune system towards a proinflammatory phenotype. This derangement has been associated with cognitive decline and has been implicated in the pathogenesis of dementia. Diet can modulate systemic inflammation; thus, it may be a valuable tool to counteract the associated risks for cognitive impairment and dementia. The present study aimed to explore the associations between the inflammatory potential of diet, assessed using an easily applicable, population-based, biomarker-validated diet inflammatory index (DII), and the risk for dementia in community-dwelling older adults.Methods:Individuals from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present cohort study. Participants were recruited through random population sampling, and were followed for a mean of 3.05 (SD=0.85) years. Dementia diagnosis was based on standard clinical criteria. Those with baseline dementia and/or missing cognitive follow-up data were excluded from the analyses. The inflammatory potential of diet was assessed through a DII score which considers literature-derived associations of 45 food parameters with levels of pro- and anti-inflammatory cytokines in the blood; higher values indicated a more pro-inflammatory diet. Consumption frequencies were derived from a detailed food frequency questionnaire, and were standardized to representative dietary intake normative data from 11 different countries. Analysis of dementia incidence as a function of baseline DII scores was performed by Cox proportional hazards models.Results:Analyses included 1059 individuals (mean age=73.1 years; 40.3% males; mean education=8.2 years), 62 of whom developed incident dementia. Each additional unit of DII was associated with a 21% increase in the risk for dementia incidence [HR=1.21 (1.03 – 1.42); p=0.023]. Compared to participants in the lowest DII tertile, participants in the highest one (maximal pro-inflammatory diet potential) were 3 [(1.2 – 7.3); p=0.014] times more likely to develop incident dementia. The test for trend was also significant, indicating a potential dose-response relationship (p=0.014).Conclusions:In the present study, higher DII scores (indicating greater pro-inflammatory diet potential) were associated with an increased risk for incident dementia. These findings might avail the development of primary dementia preventive strategies through tailored and precise dietary interventions.

scholarly journals Alpha-1 blocker use increased risk of subsequent renal cell carcinoma: A nationwide population-based study in Taiwan

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242429
Author(s):  
Shian-Ying Sung ◽  
Trang Thi Huynh Le ◽  
Jin- Hua Chen ◽  
Teng-Fu Hsieh ◽  
Chia-Ling Hsieh
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
Antihypertensive Medications ◽  
Increased Risk ◽  
Underlying Mechanisms

Elevated Renal cell carcinoma (RCC) risk has been associated with the use of several antihypertensive medications but has not yet been elucidated in the populations prescribed alpha-1 blockers that are commonly used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). The aim of the present study was to investigate the association between alpha-1 blocker use and the risk of developing RCC using a nationwide population-based database in Taiwan. Patients who were treated with alpha-1 blockers for at least 28 days were identified through the Taiwan National Health Insurance Research Database from 2000 to 2010. The unexposed participants were matched with the exposed cases according to age, sex, and index year at a ratio of 3:1. Cox proportional hazards regression, stratified by sex and comorbidities and adjusted for age, was performed to estimate hazard ratios (HRs) for the risk of subsequent RCC. Among 2,232,092 subjects, patients who received alpha-1 blocker treatment had a higher risk of RCC than the unexposed group. Taking into account hypertension and BPH, the adjusted HR was significantly higher in male alpha-1 blocker users who had no BPH and either the presence (HR: 1.63, 95% confidence interval [CI] = 1.22–2.18) or absence (HR: 2.31, 95% CI = 1.40–3.81) of hypertension than in men not receiving these drugs. Taken together, male alpha-1 blocker users who had no comorbidity of BPH exhibited an increased risk for developing RCC independent of hypertension. Further study is warranted to elucidate the underlying mechanisms of this association.

scholarly journals Treatment of Sleep Disturbance May Reduce the Risk of Future Probable Alzheimer’s Disease

2018 ◽  
Vol 31 (2) ◽  
pp. 322-342 ◽  
Author(s):  
Shanna L. Burke ◽  
Tianyan Hu ◽  
Christine E. Spadola ◽  
Aaron Burgess ◽  
Tan Li ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sleep Disturbance ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Data Set ◽  
Proportional Hazards Regression ◽  
Increased Risk ◽  
Research Questions

Objective: This study explored two research questions: (a) Does sleep medication neutralize or provide a protective effect against the hazard of Alzheimer’s disease (AD)? (b) Do apolipoprotein (APOE) e4 carriers reporting a sleep disturbance experience an increased risk of AD? Method: This study is a secondary analysis of the National Alzheimer’s Coordinating Center’s Uniform Data Set ( n = 6,782) using Cox proportional hazards regression. Results: Sleep disturbance was significantly associated with eventual AD development. Among the subset of participants taking general sleep medications, no relationship between sleep disturbance and eventual AD was observed. Among individuals not taking sleep medications, the increased hazard between the two variables remained. Among APOE e4 carriers, sleep disturbance and AD were significant, except among those taking zolpidem. Discussion: Our findings support the emerging link between sleep disturbance and AD. Our findings also suggest a continued need to elucidate the mechanisms that offer protective factors against AD development.

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