scholarly journals Association of fasting glucose with lifetime risk of incident heart failure: the Lifetime Risk Pooling Project

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Arjun Sinha ◽  
Hongyan Ning ◽  
Faraz S. Ahmad ◽  
Michael P. Bancks ◽  
Mercedes R. Carnethon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Black Women ◽  
Population Based ◽  
Lifetime Risk ◽  
Middle Aged ◽  
Cox Models ◽  
Individual Level ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
White Adults

Abstract Background Given the rising prevalence of dysglycemia and disparities in heart failure (HF) burden, we determined race- and sex-specific lifetime risk of HF across the spectrum of fasting plasma glucose (FPG). Methods Individual-level data from adults without baseline HF was pooled from 6 population-based cohorts. Modified Kaplan–Meier analysis, Cox models adjusted for the competing risk of death, and Irwin’s restricted mean were used to estimate the lifetime risk, adjusted hazard ratio (aHR), and years lived free from HF in middle-aged (40–59 years) and older (60–79 years) adults with FPG < 100 mg/dL, prediabetes (FPG 100–125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) across race-sex groups. Results In 40,117 participants with 638,910 person-years of follow-up, 4846 cases of incident HF occurred. The lifetime risk of HF was significantly higher among middle-aged White adults and Black women with prediabetes (range: 6.1% [95% CI 4.8%, 7.4%] to 10.8% [95% CI 8.3%, 13.4%]) compared with normoglycemic adults (range: 3.5% [95% CI 3.0%, 4.1%] to 6.5% [95% CI 4.9%, 8.1%]). Middle-aged Black women with diabetes had the highest lifetime risk (32.4% [95% CI 26.0%, 38.7%]) and aHR (4.0 [95% CI 3.0, 5.4]) for HF across race-sex groups. Middle-aged adults with prediabetes and diabetes lived on average 0.9–1.6 and 4.1–6.0 fewer years free from HF, respectively. Findings were similar in older adults except older Black women with prediabetes did not have a higher lifetime risk of HF. Conclusions Prediabetes was associated with higher lifetime risk of HF in middle-aged White adults and Black women, with the association attenuating in older Black women. Black women with diabetes had the highest lifetime risk of HF compared with other race-sex groups.

Abstract 16177: Race and Sex-specific Long-term Risk of Incident Heart Failure in Adults Stratified by Fasting Glucose Level: Lifetime Risk Pooling Project

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Arjun Sinha ◽  
Hongyan Ning ◽  
Faraz S Ahmad ◽  
Michael Bancks ◽  
Mercedes R Carnethon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Black Women ◽  
Population Based ◽  
Middle Aged ◽  
Individual Level ◽  
Kaplan Meier ◽  
Level Data ◽  
The Life Course

Introduction: While the association of diabetes with heart failure (HF) is well-established, the long-term risk (LR) of incident HF with prediabetes across the life course is not known. Furthermore, race-sex disparities in LR of HF across categories of fasting plasma glucose (FPG) has not been described. To inform HF preventive strategies, we compared the race- and sex-specific LR of HF across categories of FPG in adults. Methods: Individual-level data from adults free of baseline HF was pooled from 6 population-based cohorts stratified by baseline age (40-59, 60-79 years) and race-sex groups. We defined FPG status as normal (<100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥126 mg/dL or use of antihyperglycemic agents). Modified Kaplan-Meier analysis was performed by FPG strata to estimate the LR of HF (30-year in middle-aged and 20-year in older adults) adjusted for the competing risk of non-HF death. We estimated adjusted hazard ratios (aHR) for HF in each FPG strata using Cox proportional regression models. Results: Of the 40,117 participants, 24% were black and 56% were women. During 638,910 person-years of follow-up, there were 4,846 cases of incident HF. In middle-aged adults, the LR of HF was significantly higher among individuals with prediabetes (6.1 [4.8, 7.4] to 14.4 [9.6, 19.2]%) compared with normal FPG (3.5 [3.0, 4.1] to 11.7 [9.1, 14.3]%). In older adults with prediabetes compared with normal FPG, LR of HF was significantly higher in white men (13.5 [12.0, 14.9]% vs 10.4 [9.2, 11.6]%) and women (12.2 [10.8, 13.6]% vs 7.8 [6.9, 8.7]%) but not in black men (12.2 [9.0, 15.3]% vs 14.6 [11.6, 17.6]%) or women (13.5 [10.1, 16.8]% vs 11.7 [9.4, 14.0]%). Race-sex specific aHR for HF across FPG strata are shown in the table. Conclusions: Compared with normal FPG, prediabetes was associated with significantly greater LR of HF in middle-aged but not in older adults. Of all groups, black women with diabetes qualitatively had a disproportionately higher LR of HF.

Abstract 16128: Association Between Timing of Readmission and Risk of 1-year Mortality Among Patients After Hospitalization for Heart Failure in China: Findings From the China-PEACE Prospective Heart Failure Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
YILAN Ge ◽  
Bin Wang ◽  
jing li ◽  
xin zheng
Keyword(s):  
Heart Failure ◽  
Patient Characteristics ◽  
National Sample ◽  
Cox Models ◽  
Quality Metric ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Early Readmission

Introduction: Although 30-day readmission has been used as a quality metric for treatment of patients hospitalized for heart failure (HF), the association between the timing of readmission with mortality after discharge has been scarcely investigated. Methods: We studied a national sample of 4875 patients admitted to 52 hospitals for HF between 2016 and 2018 who were discharged alive from the China PEACE-Heart Failure Study. The timing of readmission was defined as the timing of first readmission from all cause after discharge. Mortality analyses across the timing of readmission were performed using Kaplan-Meier curves and log-rank tests. The associations between the timing of readmission and 1-year all-cause mortality was determined using Cox models. Results: The median participant age was 67 (57-76) years, and 37.5% were female. The median duration from discharge to readmission was 88 (28-194) days. Kaplan-Meier analysis revealed 1-year mortality did not differ between patients admitted within 0-30 and 31-60 days, and between patients admitted within 61-90 and 91-180 days after discharge (Figure1A). Then we classified the timing of readmission as early (0-60 days), midrange (61-180 days) and late (181-365 days). The 1-year all-cause mortality for patients experiencing early, midrange and late readmission was 31.8%, 23.2% and 12.0%, respectively (Figure1B). After adjusting for patient characteristics and treatment during hospitalization, the HR for 1-year all-cause mortality was 2.89 (95% CI 2.22-3.77) for patients with early readmission, and 2.07 (95% CI 1.56-2.75) for patients with midrange readmission when compared with patients with late readmission, respectively. Conclusions: Earlier readmission are associated with increased risk for 1-year all-cause mortality. Not only 30-day readmission but also readmission within 60 days after discharge could be perceived as an alarming sign of higher risk of death in patients with hospitalized HF in China.

scholarly journals Race- and Sex-Specific Population Attributable Fractions of Incident Heart Failure

2021 ◽  
Author(s):  
Arjun Sinha ◽  
Hongyan Ning ◽  
Mercedes R. Carnethon ◽  
Norrina B. Allen ◽  
John T. Wilkins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Risk Factor ◽  
Black Women ◽  
Population Attributable Fraction ◽  
Population Based ◽  
Competing Risk ◽  
Modifiable Risk Factors ◽  
Risk Of Death ◽  
Obesity Hypertension

Background: Race- and sex-specific differences in heart failure (HF) risk may be related to differential burden and effect of risk factors. We estimated the population attributable fraction (PAF), which incorporates both prevalence and excess risk of HF associated with each risk factor (obesity, hypertension, diabetes, current smoking, and hyperlipidemia), in specific race-sex groups. Methods: A pooled cohort was created using harmonized data from 6 US longitudinal population-based cohorts. Baseline measurements of risk factors were used to determine prevalence. Relative risk of incident HF was assessed using a piecewise constant hazards model adjusted for age, education, other modifiable risk factors, and the competing risk of death from non-HF causes. Within each race-sex group, PAF of HF was estimated for each risk factor individually and for all risk factors simultaneously. Results: Of 38 028 participants, 55% were female and 22% Black. Hypertension had the highest PAF among Black men (28.3% [18.7–36.7]) and women (25.8% [16.3%–34.2%]). In contrast, PAF associated with obesity was the highest in White men (21.0% [14.6–27.0]) and women (17.9% [12.8–22.6]). Diabetes disproportionately contributed to HF in Black women (PAF, 16.4% [95% CI, 12.7%–19.9%]). The cumulative PAF of all 5 risk factors was the highest in Black women (51.9% [39.3–61.8]). Conclusions: The observed differences in contribution of risk factors across race-sex groups can inform tailored prevention strategies to mitigate disparities in HF burden. This novel competing risk analysis suggests that a sizeable proportion of HF risk may not be associated with modifiable risk factors.

Abstract P489: Association of Fasting Triglyceride Levels With Long-Term Competing Risks for Cause-Specific Cardiovascular Disease Events Among Middle-aged White and Black Men and Women

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sadiya S Khan ◽  
Hongyan Ning ◽  
Norrina B Allen ◽  
Mercedes R Carnethon ◽  
Donald M Lloyd-jones ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Competing Risks ◽  
White Women ◽  
Hdl Cholesterol ◽  
Population Based ◽  
Middle Aged ◽  
Cox Models ◽  
Men And Women ◽  
Individual Level

Introduction: Hypertriglyceridemia is common and reflects poor metabolic health, but conflicting data exist regarding the independent association of triglycerides (TG) and cardiovascular disease (CVD). In addition, whether elevated TG are associated with differential long-term risks for CVD subtypes and whether this varies by sex and race, is not well-established. Therefore, we sought to examine the incidence of coronary heart disease, stroke, or heart failure in white and black US men and women by baseline TG levels. Methods: We included individual-level pooled data from 5 population-based cohorts and stratified middle-aged participants (index ages 40-59 years) who were free of CVD at baseline by sex and race. We categorized fasting TG levels as optimal (<100 mg/dL), intermediate (100 to 150 mg/dL), or elevated (>150mg/dL). We performed 1) Irwin’s restricted mean to estimate years lived free of and with CVD and 2) competing Cox models (adjusted for age, education, smoking, obesity, hypertension, diabetes, total cholesterol, and HDL-cholesterol) to estimate joint cumulative risks for CVD events (overall and by subtype) and non-CVD death. Results: Among the 20,406 participants, 26% were black and 55% were women. Elevated TG was associated with significantly fewer healthy years lived free of CVD in all race-sex groups (p<0.05 compared with optimal TG). Overall, competing cumulative incidence of CVD as well as non-CVD death was higher in intermediate and elevated TG subgroups compared with the optimal TG group. After adjustment for other risk factors, elevated TG were not associated with risks for any CVD subtype in black adults; among whites, elevated TG were associated with risk for stroke as a first event in men, and with all CVD subtypes in women (TABLE) . Discussion: Using pooled individual-level data from 5 large cohorts of middle-aged individuals, we observed differential competing risks by sex and race group for CVD subtypes associated with elevated TG. White women especially may have independent risk from elevated TG.

scholarly journals Lifetime risk of cardiovascular-renal disease in type 2 diabetes: a population-based study in 473399 individuals

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zhang ◽  
J Mamza ◽  
T Morris ◽  
G Godfrey ◽  
F Asselbergs ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Disease ◽  
Population Based ◽  
Lifetime Risk ◽  
Disease Stage ◽  
Renal Diseases ◽  
Funding Source ◽  
Private Company ◽  
Risk Of Death

Abstract Background Lifetime risks of cardiovascular (CV) and renal diseases are high, particularly in type 2 diabetes (T2D), but rarely studied together, and relative disease contributions are unknown. Knowledge of lifetime risk of cardiovascular-renal disease (CVRD) will better reflect disease burden in T2D. Purpose To investigate the lifetime risks (LTRs) of composite and individual components of major adverse reno-cardiovascular events, MARCE in T2D patients. Method In a population-based cohort study using national electronic health records, we studied 473399 individuals aged 45–99 years with T2D in England 2007–2018. The LTR of composite and individual components of MARCE (including CV death and CVRD: heart failure, HF; chronic kidney disease stage 3 and above, CKD; myocardial infarction, MI; stroke or peripheral artery disease, PAD) were estimated. LTRs by baseline CVRD comorbidity status were compared with individuals free from CVRD at baseline, accounting for the competing risk of death. Results Among T2D patients aged ≥45 years, the LTR of MARCE was 80% for individuals free from CVRD at baseline. LTR of MARCE was 97%, 93%, 98%, 89% and 91% for individuals with specific CVRD comorbidities for HF, CKD, MI, stroke and PAD, respectively at baseline. Within the CVRD-free cohort, LTR of CKD was highest at 54%, followed by CV death (41%), HF (29%), stroke (20%), MI (19%) and PAD (9%). Compared to CVRD-free, HF, MI and CKD at baseline were associated with the highest LTR of MARCE and its component diseases (Table). Conclusion The lifetime risk of CV disease and CKD in T2D patients is estimated to be over 60% and 50% respectively (1–3). When considered together, the LTR of MARCE is 80% in CVRD-free T2D patients, while nearly all those with T2D and HF will develop MARCE over their lifetime. Of the individual components of MARCE, LTR of CKD and HF were the highest among CVRD-free T2D patients. Preventive measures in T2D patients should be a priority in clinical practice to mitigate the burden of these complications. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

scholarly journals Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319129
Author(s):  
Marios Rossides ◽  
Susanna Kullberg ◽  
Johan Grunewald ◽  
Anders Eklund ◽  
Daniela Di Giuseppe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
General Population ◽  
Strong Predictor ◽  
Strong Association ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Clinical Predictors ◽  
Cox Models ◽  
Classification Of Diseases

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

scholarly journals Colorectal cancer survival among Ministry of National Guard-Health Affairs (MNG-HA) population 2009–2017: retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mesnad Alyabsi ◽  
Fouad Sabatin ◽  
Majed Ramadan ◽  
Abdul Rahman Jazieh
Keyword(s):  
Colorectal Cancer ◽  
Distant Metastasis ◽  
Cancer Survival ◽  
National Guard ◽  
Population Based ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Abstract Background Colorectal cancer (CRC) is the most diagnosed cancer among males and third among females in Saudi Arabia, with up to two-third diagnosed at advanced stage. The objective of our study was to estimate CRC survival and determine prognostic factors. Methods Ministry of National Guard- Health Affairs (MNG-HA) registry data was utilized to identify patients diagnosed with CRC between 2009 and 2017. Cases were followed until December 30th, 2017 to assess their one-, three-, and five-year CRC-specific survivals. Kaplan-Meier method and Cox proportional hazard models were used to assess survival from CRC. Results A total of 1012 CRC patients were diagnosed during 2009–2017. Nearly, one-fourth of the patients presented with rectal tumor, 42.89% with left colon and 33.41% of the cases were diagnosed at distant metastasis stage. The overall one-, three-, and five-year survival were 83, 65 and 52.0%, respectively. The five-year survival was 79.85% for localized stage, 63.25% for regional stage and 20.31% for distant metastasis. Multivariate analyses showed that age, diagnosis period, stage, nationality, basis of diagnosis, morphology and location of tumor were associated with survival. Conclusions Findings reveal poor survival compared to Surveillance, Epidemiology, and End Results (SEER) population. Diagnoses at late stage and no surgical and/or perioperative chemotherapy were associated with increased risk of death. Population-based screening in this population should be considered.

Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit

2016 ◽  
Vol 26 (9) ◽  
pp. 1615-1623 ◽  
Author(s):  
Simona Sobrero ◽  
Eva Pagano ◽  
Elisa Piovano ◽  
Lorenzo Bono ◽  
Manuela Ceccarelli ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Surgical Treatment ◽  
Clinical Guidelines ◽  
Clinical Audit ◽  
Population Based ◽  
Pattern Of Care ◽  
Curative Intent ◽  
Adherence To Guidelines ◽  
Cox Models ◽  
Risk Of Death

BackgroundIn the northwestern Italian region of Piedmont, current statistics on hospitalizations show that surgical treatment for ovarian cancer (OC) is taking place in many small hospitals, as opposed to a more centralized approach. A population-based clinical audit was promoted to investigate whether OC is being managed according to clinical guidelines, identify determinants of lack of adherence to guidelines, and evaluate the association between adherence to guidelines and survival.Patients and MethodsResidents diagnosed with OC in 2009 were identified in the regional hospital discharge records database. All hospitalizations within 2 years from diagnosis were reviewed. Patients were classified according to their initial pattern of care, defined as “with curative intent” (CIPC) if including debulking surgery aimed at maximal cytoreduction. Adherence to guidelines for surgery and chemotherapy and the effects of this adherence on OC survival were investigated with logistic regression and Cox models.ResultsThe final study sample consisted of 344 patients with OC, 215 (62.5%) of whom received CIPC. Increasing age, comorbidities, and metastases were negatively associated with receiving CIPC. In the CIPC group, surgical treatment was adherent to guidelines in 35.2%, whereas chemotherapy was adherent in 87.8%. Surgical treatment that was adherent to guidelines [hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.45–1.15] and absence of residual tumor (HR, 0.55; 95% CI, 0.32–0.94) were associated with better survival in the CIPC group, and chemotherapy that was adherent to guidelines was associated with a significant reduction in the risk of death (HR, 0.49; 95% CI, 0.28–0.87).ConclusionsResults support the need to reorganize the clinical pathway of patients with OC in the Piedmont Region and the need for better adherence to current guidelines.

scholarly journals Cardiovascular Health Score and Lifetime Risk of Cardiovascular Disease

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Joshua D. Bundy ◽  
Hongyan Ning ◽  
Victor W. Zhong ◽  
Amanda E. Paluch ◽  
Donald M. Lloyd-Jones ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Black Women ◽  
Black Men ◽  
White Women ◽  
Cardiovascular Health ◽  
United States Public Health ◽  
The United States ◽  
Lifetime Risk ◽  
Men And Women ◽  
Risk Of Death

Background: Long-term risks of cardiovascular disease (CVD) according to levels of cardiovascular health (CVH) have not been characterized in a diverse, representative population. Methods and Results: We pooled individual-level data from 30 447 participants (mean [SD] age, 55.0 [13.9] years; 60.6% women; 31.8% black) from 7 US cohort studies. We defined CVH based on levels of 7 American Heart Association health metrics, scored as ideal (2 points), intermediate (1 point), or poor (0 points). The total CVH score was used to quantify overall CVH as high (12–14 points), moderate (9–11 points), or low (0–8 points). We used a modified Kaplan-Meier analysis, accounting for the competing risk of death, to estimate the lifetime risk of CVD (composite of incident myocardial infarction, stroke, heart failure, or CVD death) separately in white and black men and women free of CVD at index ages of <40, 40 to 59, and ≥60 years. High CVH was more prevalent among women compared with men, white compared with black participants, and in younger compared with older participants. During 538 477 person-years of follow-up, we observed 6546 CVD events. In women aged 40 to 59 years, those with high CVH had lower lifetime risk (95% CI) of CVD (white women, 12.6% [2.6%–22.6%]; black women, 0.0%) compared with moderate (white women, 16.6% [13.0%–20.2%]; black women, 12.7% [6.8%–18.5%]) and low (white women, 33.8% [30.6%–37.1%]; black women, 34.7% [30.4%–39.0%]) CVH strata. Patterns were similar for men and individuals <40 and ≥60 years of age. Conclusions: Higher baseline CVH at all ages in adulthood is associated with substantially lower lifetime risk for CVD compared with moderate and low CVH, in white and black men and women in the United States. Public health and healthcare efforts aimed at maintaining and restoring higher CVH throughout the life course could provide substantial benefits for the population burden of CVD.

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