scholarly journals Improving walking speed reduces hospitalization costs in outpatients with cardiovascular disease. An analysis based on a multistrata non-parametric test

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stefano Bonnini ◽  
Gianni Mazzoni ◽  
Michela Borghesi ◽  
Giorgio Chiaranda ◽  
Jonathan Myers ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Propensity Score ◽  
Walking Speed ◽  
Permutation Test ◽  
Artery Bypass ◽  
Inverse Association ◽  
Homogeneous Groups ◽  
Hospitalization Rates ◽  
Hospitalization Costs ◽  
History Of

Abstract Background To assess the association between walking speed (WS) and its improvement on hospitalization rates and costs in outpatients with cardiovascular disease. Methods Six hundred forty-nine patients participating in an exercise-based secondary prevention program were studied. Patients were divided at baseline into two groups characterized by low and high WS based on the average WS maintained during a moderate 1-km treadmill-walking test. WS and other covariates were grouped into three domains (demographic factors, medical history and risk factors), and used to estimate a propensity score, in order to create homogeneous groups of patients. All-cause hospitalization was assessed 3 years after baseline as a function of WS. Hospitalization and related costs were also assessed during the fourth-to-sixth years after enrollment. To test whether the hospitalization costs were related to changes in WS after 36 months, a multistrata permutation test was performed by combining within strata partial tests. Results The results support the hypothesis that hospitalization costs are significantly reduced in accordance with an improvement in WS. This effect is most evident among older patients, overweight or obese, smokers, and those without a history of coronary artery bypass surgery. Conclusions The present study supports growing evidence of an inverse association between WS, risk of hospitalization and consequent health-care costs. The joint use of propensity score and multistrata permutation approaches represent a flexible and robust testing method which avoids the possible effects of several confounding factors typical of these studies.

Abstract P345: A Cross Sectional Analysis of High Depressive Symptoms and Antidepressants on Heart Rate Parameters in the Community. The Paris Prospective Study III

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Marie-Caroline Laï ◽  
Pierre Boutouyrie ◽  
Muriel Tafflet ◽  
Frédérique Tomas ◽  
Catherine Guibout ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Heart Rate ◽  
Depressive Symptoms ◽  
Propensity Score ◽  
Prospective Study ◽  
Beta Blockers ◽  
Personal History ◽  
Rr Interval ◽  
History Of ◽  
Paris Prospective Study

Background: Dysautonomy has been suggested to be a mechanism contributing to the well-established association between high depressive symptoms (HDS) and cardiovascular disease (CVD). So far however, at the population level, this question has been addressed using parameters of complex interpretation that are rarely used in the clinical setting. The aim of this study was to quantify the respective association of HDS and antidepressants (ATD) on different heart rate parameters of simple investigation. Methods: The Paris Prospective Study III included subjects recruited in a large health preventive centre in Paris (France) between 2008 and 2012. Four heart rate parameters were measured including resting heart rate (RHR), heart rate immediately after moderate effort (EHR), differences between EHR and RHR, and RR interval. A total score ≥ 7 on a 13-item standardized questionnaire defined the presence of HDS. Information on classes of ATD was obtained on a face-to-face interview with a medical doctor. The association between HDS or ATD and each of the 4 heart rate parameters were quantified in separate linear regression analysis adjusted for age, sex, body mass index, physical activity, personal history of CVD, smoking, diabetes, high blood pressure and beta blockers. To minimize indication bias, the analysis on ATD was adjusted for the propensity score of receiving ATD. Results: The mean age of the 8430 participants was 59.6 years and 39% were women. HDS were noted in 473 subjects and 383 participants were on ATD: 58 on Tricyclics, 232 on Serotonin Specific Reuptake Inhibitor (SSRI) and 80 on Serotonin Norepinephrine Reuptake Inhibitors (NSRI) respectively. Beta-blockers were used by 4.2% of the participants and only 2.1% had a personal history of cardiovascular disease. HDS were associated with slightly higher RHR (+0.9 beats per minute (bpm), p<0.05) and lower RR interval (-21.1 ms, p<0.05). ATD of any class were related to lower RR interval (-22.3 ms, p=0.007), higher EHR (+1.7 bpm, p=0.02) and higher difference between EHR and RHR (+1.5 bpm, p=0.009). While tricyclics and NSRI were both associated with significantly higher RHR (+7.0 and +2.64 bpm respectively, p<0.05), higher EHR (+6.79 and +6.94 bpm respectively, p<0.001), higher difference between EHR and RHR (+2.74, p=0.06 and +5.70, p<0.001 respectively) and lower RR interval (-98.50 ms and -50.63 ms respectively, p<0.001), SSRI was related to lower RHR (-1.81 bpm, p<0.05) and almost significantly higher RR interval (+18.61 ms, p=0.08). Neither sex nor beta-blockers modified these associations. Consistent findings were observed when other propensity score methods were used. Conclusions: Our study suggests that ATD more than HDS are associated with dysautonomy as evaluated by simple and routinely used heart rate parameters.

scholarly journals Asthma and risk of glioma: a population-based case–control study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025746 ◽  
Author(s):  
Harsheen Kaur ◽  
Daniel H Lachance ◽  
Conor S Ryan ◽  
Youn Ho Sheen ◽  
Hee Yun Seol ◽  
...  
Keyword(s):  
Propensity Score ◽  
Index Date ◽  
Case Control Study ◽  
Population Based ◽  
Case Control ◽  
Inverse Association ◽  
Asthma Status ◽  
History Of ◽  
Community Controls ◽  
Control Study

ObjectivesLiterature suggests an inconsistent, but largely inverse, association between asthma and risk of glioma, which is primarily due to methodological inconsistency in sampling frame and ascertainment of asthma. The objective of the study was to clarify the association between asthma and risk of glioma by minimising methodological biases (eg, recall and detection bias).DesignA population-based case–control study.SettingGeneral population in Olmsted County, Minnesota, USA.ParticipantsAll eligible biopsy-proven incident glioma cases (1995–2014) and two sets of controls among residents matched to age and sex (first set: community controls without glioma; second set: MRI-negative controls from the same community).MethodsThe predetermined asthma criteria via medical record review were applied to ascertain asthma status of cases and controls. History of asthma prior to index date was compared between glioma cases and their matched controls using conditional logistic regression models. Propensity score for asthma status was adjusted for multivariate analysis.ResultsWe enrolled 135 glioma cases (median age at index date: 53 years) and 270 controls. Of the cases, 21 had a history of asthma (16%), compared with 36 of MRI controls (27%) (OR (95% CI) 0.48 (0.26 to 0.91), p=0.03). With MRI controls, an inverse association between asthma and risk of glioma persisted after adjusting for the propensity score for asthma status, but did not reach statistical significance probably due to the lack of statistical power (OR (95% CI) 0.48 (0.21 to 1.09); p=0.08). Based on comparison of characteristics of controls and cases, community controls seem to be more susceptible to a detection bias.ConclusionsWhile differential detection might account for the association between asthma and risk of glioma, asthma may potentially pose a protective effect on risk of glioma. Our study results need to be replicated by a larger study.

Abstract P301: Age Differences in the Association between Waist-to-height Ratio and Risk of Cardiovascular Disease: The Suita Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Yukako Tatsumi ◽  
Makoto Watanabe ◽  
Yoshihiro Kokubo ◽  
Kunihiro Nishimura ◽  
Tomonori Okamura ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Waist Circumference ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Age Groups ◽  
Population Based ◽  
Drinking Status ◽  
History Of ◽  
The Impact

Introduction: Waist-to-heightratio (WHtR) has been shown to be useful global screening tool forcardiovascular disease (CVD) in the recent meta-analysis. The impact of WHtR on the risks of CVD by age is not well known. Hypothesis: We assessed whether the association between WHtR and the risks of CVD was different by age categories. Methods: This study is a population-based cohort study in an urban area of Japan. Study participants comprised 5,488 Japanese urban residents (2,600 men and 2,888 women) aged 30-83 years with no history of CVD. At baseline (1989&#8211;1994), waist circumference was measured at the umbilical level and height with bare feet was measured. WHtR was calculated as waist circumference (cm) divided by height (cm). The criteria of myocardial infarction were based on the WHO Monitoring of Trends and Determinants in Cardiovascular Disease Projects. In addition to myocardial infarction, we also evaluated coronary angioplasty, coronary artery bypass grafting and sudden cardiac death, all of which were defined as coronary heart disease (CHD). A stroke was defined according to criteria from the US National Survey of Stroke and confirmed by computed tomography. We stratified participants by sex and age groups (30&#8211;49, 50&#8211;69 and 70&#8211;83 years). The Cox proportional hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CVD according to the quartiles of WHtR were calculated after adjustment for age, smoking and drinking status. Results: During the follow-up period (13.0 years in average), 428 CVD events (184 CHD and 244 strokes) were observed. Men with the highest quartile of WHtR aged 50&#8211;69 years had significantly increased the risks of CVD and CHD, compared with the lowest quartile; the HRs (95% CIs) were 1.81 (1.13&#8211;2.90) and 2.47 (1.17&#8211;5.20), respectively. There were statistically significant linear increases in the HRs of CVD ( p for trend =0.01), CHD ( p for trend =0.02) and cerebral infarction ( p for trend =0.03) in this group. Women with the highest quartile of WHtR aged 50&#8211;69 years had significantly increased the risks of stroke; the HRs (95% CIs) was 2.43 (1.01&#8211;5.84). There were statistically significant linear increases in the HRs of CVD ( p for trend =0.04) and stroke ( p for trend =0.04) in this group. However, the similar results were not observed in the other age groups in both sexes. We observed a significant interaction between age groups and WHtR categories for the risks of CVD in men ( p for interaction=0.02). Conclusions: The association between WHtR and CVD was different among age groups. WHtR could be useful to predict the risks of CVD in middle aged men and women.

Abstract P386: Pregnancy-related Risk Factors May Signal Additional Risk For Future Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Shivani M Reddy ◽  
Tamy H Moraes Tsujimoto ◽  
Wanda Nicholson ◽  
Jason Fine
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Health ◽  
Prediction Models ◽  
Inverse Association ◽  
Cvd Risk ◽  
Related Factors ◽  
Survival Analyses ◽  
History Of ◽  
Traditional Risk Factors

Introduction: Emerging data suggest that pregnancy may be a window on the future of women’s cardiovascular health. Cardiovascular disease (CVD) guidelines recommend using the Pooled Cohort Equation (PCE) to assess 10-year CVD risk based on traditional risk factors. Less is known about the role of pregnancy-related factors, such as a history of small for gestational age (SGA) infants or breastfeeding, and the risk of CVD events in addition to the PCE. Hypothesis: We hypothesize that pregnancy-related complications and breastfeeding can affect the risk of future CVD risk in addition to traditional risk factors currently accounted for by the PCE. Methods: Using NHANES 1999-2006, a weighted sample of 3,913 women (representing 27,102,057 women in the US population), ages 40-79, with a history of pregnancy, but no prior CVD, was identified. Variables for SGA infants and breastfeeding were abstracted along with traditional risk factors. Less than 5% of women were missing data on these variables. CVD outcomes were defined as a composite of (1) CVD death and (2) surrogates for CVD death, in which diabetes or hypertension were a secondary cause of death. CVD outcomes and survival time were obtained from the NHANES Linked Mortality File. The PCE was used to estimate 10-year CVD risk. Bivariate and survival analyses using Cox proportional hazards models adjusting for PCE risk score were performed. For survival analysis, the cause-specific hazard function was estimated considering the time of death as censoring for women dying from causes other than CVD outcomes, as well as the time of follow-up for women that did not present the death event. Results: Among the sample, 504 (11.8%) women had a SGA infant and 2133 (54.5%) reported a history of breastfeeding. 198 (5.1%) women had the composite CVD death outcome. CVD outcomes were lower in women with a history of breastfeeding (97 of 2133) compared to those who did not breastfeed (96 of 1629). (2.6% vs. 4.2%, p=0.002) The opposite relationship was observed for women with a history of SGA infant (4.2% (29 of 504) vs. 3.2% (161 of 3232), p=0.2). PCE scores were associated with breastfeeding and SGA, potentially confounding those effects. Survival analyses, adjusting for continuous PCE risk scores, showed an inverse association of breastfeeding and CVD outcomes (HR 0.7, 95% CI 0.5 to 1.0) and a positive association of history of SGA infant and CVD outcomes. (HR 1.4, 95% CI 0.8 to 2.2) Conclusion: Specific pregnancy-related complications and breastfeeding may provide additional, relevant information about the risk of CVD risk events beyond traditional risk factors. While further research is needed to incorporate pregnancy outcomes into risk prediction models, it may be helpful for clinicians to counsel women about the potential impact of pregnancy-related factors and breastfeeding on future cardiovascular health.

Coronary Artery Bypass Grafting in a Patient with Organophosphate Poisoning

2015 ◽  
Vol 18 (4) ◽  
pp. 167 ◽  
Author(s):  
Rajeeva R. Pieris ◽  
Ravindra Fernando
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Previous History ◽  
Organophosphate Poisoning ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Excellent Health ◽  
History Of

A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

Have we learnt all from IMPROVE-IT? Part II. Subanalyses on the ef- fects of ezetimibe added to statin therapy on selected clinical and laborato- ry outcomes, cost effectiveness, guideline and clinical implications

2020 ◽  
Vol 18 ◽  
Author(s):  
Zlatko Fras ◽  
Dimitri P. Mikhailidis
Keyword(s):  
Statin Therapy ◽  
Artery Bypass ◽  
Low Density Lipoprotein ◽  
Bypass Graft ◽  
Density Lipoprotein ◽  
Drug Discontinuation ◽  
Atherosclerotic Cardiovascular Disease ◽  
History Of ◽  
Risk Cost ◽  
Cardiovascular Biomarkers

: In this second part of a review of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), we discuss the findings in relation to patients with stroke, the ACS phenotype, history of coronary artery bypass graft surgery, heart failure, concurrent polyvascular atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus, and different levels of expression of selected cardiovascular biomarkers. The combination therapy was proven safe, and drug discontinuation rates were not increased by adding ezetimibe. Since both statins and ezetimibe are now almost globally generically available, we can conclude that for secondary prevention of ASCVD, adding ezetimibe to high-intensity statin therapy further reduces low-density lipoprotein cholesterol (LDL-C) and cardiovascular risk cost-effectively.

The burden of cardiovascular disease risk factors in the Middle East: A systematic review and meta-analysis focusing on primary prevention

2020 ◽  
Vol 18 ◽  
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Abdullah Shehab ◽  
Anhar Ullah ◽  
Jamal Rahmani
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Disease ◽  
Family History ◽  
Primary Prevention ◽  
Middle East ◽  
Disease Risk ◽  
Meta Analysis ◽  
Middle Eastern ◽  
History Of

Background: The increasing incidence of cardiovascular disease (CVD) threatens the Middle Eastern population. Several epidemiological studies have assessed CVD and its risk factors in terms of the primary prevention of CVD in the Middle East. Therefore, summarizing the information from these studies is essential. Aim: We conducted a systematic review to assess the prevalence of CVD and its major risk factors among Middle Eastern adults based on the literature published between January 1, 2012 and December 31, 2018 and carried out a meta-analysis. Methods: We searched electronic databases such as PubMed/Medline, ScienceDirect, Embase and Google Scholar to identify literature published from January 1, 2012 to December 31, 2018. All the original articles that investigated the prevalence of CVD and reported at least one of the following factors were included: hypertension, diabetes, dyslipidaemia, smoking and family history of CVD. To summarize CVD prevalence, we performed a random-effects meta-analysis. Results: A total of 41 potentially relevant articles were included, and 32 were included in the meta-analysis (n=191,979). The overall prevalence of CVD was 10.1% (95% confidence interval (CI): 7.1-14.3%, p<0.001) in the Middle East. A high prevalence of CVD risk factors, such as dyslipidaemia (43.3%; 95% CI: 21.5-68%), hypertension (26.2%; 95% CI: 19.6-34%) and diabetes (16%; 95% CI: 9.9-24.8%), was observed. The prevalence rates of other risk factors, such as smoking (12.4%; 95% CI: 7.7-19.4%) and family history of CVD (18.7%; 95% CI: 15.4-22.5%), were also high. Conclusion: The prevalence of CVD is high (10.1%) in the Middle East. The burden of dyslipidaemia (43.3%) in this region is twice as high as that of hypertension (26.2%) and diabetes mellitus (16%). Multifaceted interventions are urgently needed for the primary prevention of CVD in this region.

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