A dose-independent association of triglyceride levels with all-cause mortality among adults population

Abstract Background The relationship between triglyceride (TG) level and the mortality risk of all-cause and cardiovascular disease is not entirely consistent among adults. Methods The present analysis included adult participants from National Health and Nutrition Examination Surveys (NHANES) between the periods 1999–2014. The levels of TG were categorized into < 150, 150–199, 200–250 and ≥ 250 mg/dL respectively. Multivariate Cox regression analysis, stratified analysis and generalized additive model were conducted to reveal the correlation between TG and mortality risk. Results were presented in hazard ratio (HRs) and 95% confidence intervals (CIs). Results There were 18,781 (9130 males, mean age was 45.64 years) participants being included in the analysis. The average follow-up period was 8.25 years, where 1992 (10.61%) cases of all-cause and 421 (2.24%) cardiovascular death have occurred. In the multivariate Cox model, every 1 mg/dL raise in TG has significantly associated with all-cause mortality (HR: 1.08, 95% CI: 1.02, 1.15) but not cardiovascular mortality (HR: 1.10, 95% CI: 0.97, 1.24). When using TG < 150 mg/dL as reference, TG ≥ 250 mg/dL associated with death from all-cause (HR = 1.34, 95% CI: 1.12, 1.60; P = 0.0016 but not cardiovascular death (HR = 1.26, 95% CI: 0.85, 1.88; P = 0.2517). According to smoothing spline plots, the risk of all-cause was the lowest when TG was approximately 135 mg/dL. Conclusion TG might have a dose-independent association with all-cause mortality among adults in United States.

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The Non-linear Relationship Between Normal Range Systolic Blood Pressure and Cardiovascular or All-Cause Mortality Among Elderly Population

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.677189 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shuo Sun ◽

Xiao-cong Liu ◽

Guo-dong He ◽

Kenneth Lo ◽

Ying-qing Feng ◽

...

Keyword(s):

Older Adults ◽

Mortality Risk ◽

Elderly Population ◽

Cox Regression ◽

Cardiovascular Death ◽

Nutrition Examination Survey ◽

Normal Range ◽

Health And Nutrition ◽

All Cause Mortality ◽

Cardiovascular Mortality Risk

Purpose: The aim was to explore the association of normal range SBP with cardiovascular and all-cause mortality in older adults without hypertension.Methods: Participants aged ≥ 65 years without hypertension and those had an SBP level between 90 and 129 mmHg were included from the National Health and Nutrition Examination Survey (1999–2014). SBP was categorized into: 90–99, 100–109, 110–119, and 120–129 mmHg. Multivariate Cox regression was performed with hazard ratio (HR) and 95% confidence interval (CI).Results: Of the 1,074 participants, 584 were men (54.38%). Compared with participants with SBP level ranged 110 to 119 mmHg, the HRs for all-cause mortality risk was 1.83 (95% CI: 1.04, 3.23) for SBP level ranged 90 to 99 mm Hg, 0.87 (95% CI: 0.54, 1.41) for SBP level ranged 100 to 109 mmHg, and 1.30 (95% CI: 0.96, 1.75) for SBP level ranged 120 to 129 mmHg (P for trend = 0.448), and the HR for cardiovascular mortality risk was 3.30 (95% CI: 0.87, 12.54) for SBP level ranged 90 to 99 mmHg, 0.35(95% CI: 0.08, 1.56) for SBP level ranged 100 to 109 mmHg, and 1.75 (95% CI: 0.78, 3.94) for SBP level ranged 120 to 129 mm Hg (P for trend = 0.349) after confounders were adjusted.Conclusion: These were a nonlinear association of normal range SBP level with all-cause and cardiovascular death in older adults.

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The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients

BMC Nephrology ◽

10.1186/s12882-019-1570-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Woong-pyo Hong ◽

Yu-Ji Lee

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Mortality Risk ◽

Cox Regression ◽

Target Range ◽

Dialysis Adequacy ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality ◽

High Bmi

Abstract Background Although hemodialysis (HD) adequacy, single-pool Kt/Vurea (spKt/V), is inversely correlated with body size, each is known to affect patient survival in the same direction. Therefore, we sought to examine the relationship between HD adequacy and mortality according to body mass index (BMI) in HD patients and explore a combination effect of BMI and HD adequacy on mortality risk. Methods We retrospectively reviewed patient data from the Korean Society of Nephrology registry, a nationwide database of medical records of HD patients, from January 2001 to June 2017. We included patients ≥18 years old who were receiving maintenance HD. Patients were categorized into three groups according to baseline BMI (< 20 (low), 20 to < 23 (normal), and ≥ 23 (high) kg/m2). Baseline spKt/V was divided into six categories. Results Among 18,242 patients on HD, the median follow-up duration was 5.2 (IQR, 1.9–8.9) years. Cox regression analysis showed that, compared to the reference (spKt/V 1.2–1.4), lower and higher baseline spKt/V were associated with greater and lower risks for all-cause mortality, respectively. However, among patients with high BMI (n = 5588), the association between higher spKt/V and lower all-cause mortality was attenuated in all adjusted models (Pinteraction < 0.001). Compared to patients with normal BMI and spKt/V within the target range (1.2–1.4), those with low BMI had a higher risk for all-cause mortality at all spKt/V levels. However, the gap in mortality risk became narrower for higher values of spKt/V. Compared to patients with normal BMI and spKt/V in the target range, those with high BMI and spKt/V < 1.2 were not at increased risk for mortality despite low dialysis adequacy. Conclusions The association between spKt/V and mortality in HD patients may be modified by BMI.

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Association of Different Physical Activity Domains on All-Cause Mortality in Adults Participating in Primary Care in the Brazilian National Health System: 4-Year Follow-up

Journal of Physical Activity and Health ◽

10.1123/jpah.2016-0067 ◽

2017 ◽

Vol 14 (1) ◽

pp. 45-51 ◽

Cited By ~ 3

Author(s):

Bruna C. Turi ◽

Jamile S. Codogno ◽

Romulo A. Fernandes ◽

Xuemei Sui ◽

Carl J. Lavie ◽

...

Keyword(s):

Physical Activity ◽

Mortality Risk ◽

Cox Regression ◽

National Health System ◽

Circulatory System ◽

Cox Regression Analysis ◽

Circulatory System Diseases ◽

All Cause Mortality ◽

Males And Females

Background:Evidence has shown that physical activity (PA) is associated with low mortality risk. However, data about reduced mortality due to PA are scarce in developing countries and the dose–response relationship between PA from different domains and all-cause mortality remains unclear. Thus, the aim of this study is to investigate the association of PA from different domains on all-cause mortality among Brazilian adults.Methods:679 males and females composed the study sample. Participants were divided into quartile groups according to PA from different domains (occupational, sports, and leisure-time). Medical records were used to identify the cause of the death. Cox regression analysis was performed to determine the independent associations of PA from different domains and all-cause mortality.Results:During the follow-up period, 59 participants died. The most prevalent cause of death was circulatory system diseases (n = 20; 33.9% [21.8%–45.9%]). Higher scores of occupational (HR= 0.45 [95% CI: 0.20–0.97]), sports (HR= 0.44 [95% CI: 0.20–0.95]) and overall PA (HR= 0.40 [95% CI: 0.17–0.90]) were associated with lower mortality, even after adjustment for confounders.Conclusions:The findings in this study showed the importance of being active in different domains to reduce mortality risk.

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Malnutrition Affects Cholesterol Paradox in Coronary Artery Disease: a 41,229 Chinese Cohort Study

10.21203/rs.3.rs-266119/v1 ◽

2021 ◽

Author(s):

Bo Wang ◽

Jin Liu ◽

Shiqun Chen ◽

Ming Ying ◽

Guanzhong Chen ◽

...

Keyword(s):

Cox Regression ◽

Cox Model ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Kaplan Meier ◽

All Cause Mortality ◽

Chinese Cohort ◽

Artery Disease

Abstract Background: Several studies found that baseline low LDL-C concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which was called “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. We objected to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.Method: A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018, and divided into two groups (LDL-C < 1.8 mmol/L, n=4,863; LDL-C ≥ 1.8 mmol/L, n = 36,366). We used Kaplan-Meier method and Cox regression analyses to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result: In this real-world cohort (mean age 62.94 years; 74.94% male), there were 5257 incidents of all-cause death during a median follow-up of 5.20 years [Inter-quartile range (IQR): 3.05-7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low LDL-C level (<1.8mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment of nutritional status, risk of all-cause mortality of patients with low LDL-C level decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).Conclusion: Our results demonstrate that the cholesterol paradox persisted in CAD patients, but disappeared after accounting for the effects of malnutrition.

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Nocturia as a Risk Factor for All-Cause and Cardiovascular Disease Mortality

10.21203/rs.3.rs-1055538/v1 ◽

2021 ◽

Author(s):

Shinje Moon ◽

Yoon Jung Kim ◽

Hye Soo Chung ◽

Jae Myung Yu ◽

Il In Park ◽

...

Keyword(s):

Cardiovascular Disease ◽

Mortality Risk ◽

Cox Regression ◽

Baseline Survey ◽

Mortality Data ◽

Cox Regression Analysis ◽

Health And Nutrition ◽

Disease Mortality ◽

Confounding Variables ◽

Cox Proportional Hazard Regression

Abstract This study aimed to evaluate the relationship between nocturia and mortality risk using the National Health and Nutrition Examination Survey database 2005–2010, given that only few studies have investigated nocturia or its association with mortality using this database. Data were obtained from the database, and nocturia was defined based on the symptom questionnaire. We categorized patients into two groups: mild nocturia (2–3 voids/night) and moderate-to severe nocturia (≥4 voids/night). Mortality data were obtained by linking the primary database to death certificate data found in the National Death Index with mortality follow-up up to December 31, 2015. Multiple Cox proportional hazard regression analyses were performed with adjustment for confounding variables at the baseline survey. We included 9,892 adults (4,758 men, 5,134 women) in this study. Nocturia occurred in 3,314 individuals (33.5%). In the multiple Cox regression analysis (results presented as hazard ratio, 95% confidence interval), nocturia was significantly associated with all-cause (1.21, 1.08–1.35, p=0.001) and cardiovascular disease (1.45, 1.13–1.85, p=0.003) mortality. Both mild and moderate-to-severe nocturia were significantly associated with all-cause (1.14, 1.02–1.28, p=0.021 and 1.62, 1.34–1.98, p<0.001, respectively) and cardiovascular disease (1.43, 1.11–1.84, p=0.006 and 1.58, 1.01–2.45, p=0.043, respectively) mortality. Nocturia was significantly associated with mortality in men and women after adjustments for major confounding factors. Moreover, the mortality risk increased with increasing nocturia severity.

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Waist Circumference and All-Cause Mortality among Older Adults in Rural Indonesia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010116 ◽

2019 ◽

Vol 16 (1) ◽

pp. 116 ◽

Cited By ~ 5

Author(s):

Cahya Utamie Pujilestari ◽

Lennarth Nyström ◽

Margareta Norberg ◽

Nawi Ng

Keyword(s):

Older Adults ◽

Waist Circumference ◽

Abdominal Obesity ◽

Mortality Risk ◽

Cox Regression ◽

Public Health Intervention ◽

World Health ◽

Men And Women ◽

Cox Regression Analysis ◽

All Cause Mortality

Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

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1444Metabolically healthy obesity (MHO) in the Malmo Diet Cancer Study - epidemiology and prospective risks

European Heart Journal ◽

10.1093/eurheartj/ehz748.0079 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

J Korduner ◽

E Bachus ◽

A Jujic ◽

M Magnusson ◽

P M Nilsson

Keyword(s):

Mortality Risk ◽

Cox Regression ◽

University Hospital ◽

Cross Sectional ◽

Cox Regression Analysis ◽

Cancer Study ◽

All Cause Mortality ◽

Prospective Risk ◽

Morbidity Risk

Abstract Background/Aims Metabolically healthy obesity (MHO) is a controversial topic, since the underlying mechanisms and contributing factors behind this phenotype remain unclear. Here we aimed to investigate the characteristics of MHO, as well as prospective mortality risk. Method A cross-sectional analysis was carried out in a subsample of 3,812 obese subjects (BMI ≥30 kg/m2) selected from the Malmo Diet Cancer Study (MDCS) cohort (n=28,403). Subjects with MHO (n=1182; mean age 58±7 years) were defined by having no records of hospitalization in the national Swedish Hospital Discharge Register prior to the baseline examination, other than hospitalization due to normal deliveries or external injuries. MHO subjects were further compared to subjects with metabolically unhealthy obesity, MUO (n=2,630; mean age 60±7 years), and all non-obese individuals (n=24,591; mean age 58±8 years) in the cohort study. Moreover, prospective risk analyses for incident morbidity and mortality were carried out by Cox regression. Results Compared to MOU individuals (one-way ANOVA), MHO individuals were younger (58±7 years vs. 60±7 years, p=0.001) and more likely to be male (41.2% vs 37.1%, p=0.016). MHO individuals reported a significantly lower proportion of sedentary life style than MUO (17.4% vs. 21.9%, p=0.009), and were more likely to hold a university degree (13.4% vs. 9.4%, p=0.003). Furthermore, MHO individuals had significantly lower HbA1c (p=0.012), fasting plasma glucose (p=0.001) and triglyceride levels (p=0.011) as compared to their MOU counterparts. Cox-regression analysis adjusted for age, sex, smoking and blood pressure (follow-up time 20±6 years) showed both a significantly lower all-cause mortality risk for MHO individuals as compared to MUO (HR 0.74, 95% CI: 0.66–0.82; p=0.001), as well as lower total incident cardiovascular (CV) morbidity risk (HR 0.69, 95% CI: 0.60–0.80; p=0.001). Interestingly, when comparing MHO individuals to all non-obese individuals in the MDCS, there were no significant differences in neither mortality risk (p=0.9), nor incident CV morbidity risk (p=0.7). All-cause mortality risk Conclusion Compared to MUO individuals, MHO individuals presented with a higher level of education- and physical activity together with a more favorable lipid- and glucose profile. MHO individuals were at significantly lower prospective risk of total- and cardiovascular mortality during 20-years follow-up, as compared to MOU individuals. Notably, no significant differences could be seen in mortality and CV morbidity risks when comparing MHO subjects to all non-obese individuals in the total cohort. Acknowledgement/Funding The Research Council of Sweden and Skane University Hospital Funds and Foundations (Sweden)

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Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study

Lipids in Health and Disease ◽

10.1186/s12944-021-01460-6 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Bo Wang ◽

Jin Liu ◽

Shiqun Chen ◽

Ming Ying ◽

Guanzhong Chen ◽

...

Keyword(s):

Cox Regression ◽

Cox Model ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Kaplan Meier ◽

All Cause Mortality ◽

Chinese Cohort ◽

Artery Disease

Abstract Background Several studies have found that a low baseline low -density lipoprotein cholesterol (LDL-C) concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which is called the “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. The aim of this study was to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition. Method A total of 41,229 CAD patients admitted to Guangdong Provincial People’s Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (LDL-C < 1.8 mmol/L, n = 4863; LDL-C ≥ 1.8 mmol/L, n = 36,366). The Kaplan-Meier method and Cox regression analyses were used to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result In this real-world cohort (mean age 62.9 years; 74.9% male), there were 5257 cases of all-cause death during a median follow-up of 5.20 years [interquartile range (IQR): 3.05–7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with a worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that a low LDL-C level (< 1.8 mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96–1.24). After adjustment for nutritional status, the risk of all-cause mortality in patients with low LDL-C levels decreased (adjusted HR, 0.90; 95% CI, 0.83–0.98). In the final multivariate Cox model, a low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84–0.99). Conclusion This study demonstrated that the cholesterol paradox existed in CAD patients but disappeared after accounting for the effects of malnutrition.

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Integrating Sleep, Physical Activity, and Diet Quality to Estimate All-Cause Mortality Risk: A Combined Compositional Clustering and Survival Analysis of the National Health and Nutrition Examination Survey 2005–2006 Cycle

American Journal of Epidemiology ◽

10.1093/aje/kwaa057 ◽

2020 ◽

Vol 189 (10) ◽

pp. 1057-1064 ◽

Cited By ~ 3

Author(s):

Borja del Pozo Cruz ◽

Duncan E McGregor ◽

Jesús del Pozo Cruz ◽

Matthew P Buman ◽

Javier Palarea-Albaladejo ◽

...

Keyword(s):

Physical Activity ◽

National Health ◽

Diet Quality ◽

Mortality Risk ◽

Cox Regression ◽

Nutrition Examination Survey ◽

Activity Profile ◽

Health And Nutrition ◽

All Cause Mortality ◽

Log Ratio

Abstract We aimed to compare all-cause mortality risk across clusters of adults ≥50 years of age (n = 1,035) with common lifestyle behaviors patterns, enrolled in the US National Health and Nutrition Examination Survey (2005–2006). Log-ratio coordinates of 24-hour movement pattern and z scores of diet quality were used as input into a model-based clustering analysis. A Cox regression model was fitted to ascertain the all-cause mortality risk associated with each cluster. Participants were clustered into 4 groups: 1) a group characterized by a better physical activity profile and longer sleep duration coupled with an average diet quality (cluster 1); 2) a group with the poorest activity profile and shortest sleep but also the best diet quality (cluster 2); 3) another group featuring lower levels of activity of either intensity and higher levels of sedentary behavior and also a poor diet quality score (cluster 3); and 4) a group with an average diet quality and the best activity profile in the sample (cluster 4). A combination of a poorer diet and activity profile increased the prospective risk of all-cause mortality. Our findings emphasize the importance of considering the combination of diet quality and 24-hour movement patterns when developing interventions to reduce the risk of premature mortality.

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Higher premature atrial complex burden from the Holter examination predicts poor cardiovascular outcome

Scientific Reports ◽

10.1038/s41598-021-91800-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ting-Chun Huang ◽

Po-Tseng Lee ◽

Mu-Shiang Huang ◽

Pei-Fang Su ◽

Ping-Yen Liu

Keyword(s):

Risk Factor ◽

Dose Response ◽

Cox Model ◽

Significant Risk ◽

Significant Risk Factor ◽

Cardiovascular Death ◽

Specific Model ◽

Distribution Model ◽

All Cause Mortality ◽

Quartile Group

AbstractPremature atrial complexes (PACs) have been suggested to increase the risk of adverse events. The distribution of PAC burden and its dose–response effects on all-cause mortality and cardiovascular death had not been elucidated clearly. We analyzed 15,893 patients in a medical referral center from July 1st, 2011, to December 31st, 2018. Multivariate regression driven by ln PAC (beats per 24 h plus 1) or quartiles of PAC burden were examined. Older group had higher PAC burden than younger group (p for trend < 0.001), and both genders shared similar PACs distribution. In Cox model, ln PAC remained an independent risk factor for all-cause mortality (hazard ratio (HR) = 1.09 per ln PAC increase, 95% CI = 1.06‒1.12, p < 0.001). PACs were a significant risk factor in cause-specific model (HR = 1.13, 95% CI = 1.05‒1.22, p = 0.001) or sub-distribution model (HR = 1.12, 95% CI = 1.04‒1.21, p = 0.004). In ordinal PAC model, 4th quartile group had significantly higher risk of all-cause mortality than those in 1st quartile group (HR = 1.47, 95% CI = 1.13‒1.94, p = 0.005), but no difference in cardiovascular death were found in competing risk analysis. In subgroup analysis, the risk of high PAC burden was consistently higher than in low-burden group across pre-specified subgroups. In conclusion, PAC burden has a dose response effect on all-cause mortality and cardiovascular death.

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