scholarly journals Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maryam Kabootari ◽  
Samaneh Asgari ◽  
Seyedeh Maryam Ghavam ◽  
Hengameh Abdi ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Population Based ◽  
World Health ◽  
Incident Diabetes ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Diabetes Status ◽  
Adjusted Model

Abstract Background Fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD. Methods From a prospective population-based cohort, 408 Iranians aged  ≥  30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables. Results Over a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03–2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02–2.11), CHD (1.46,1.00–2.15) and hard CHD (1.95:0.99–3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05). Conclusions Among subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes.

scholarly journals Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study

2020 ◽  
Author(s):  
Maryam Kabootari ◽  
Samaneh Asgari ◽  
Seyedeh Maryam Ghavam ◽  
Fereidoun Azizi ◽  
Farzad Hadaegh
Keyword(s):  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Population Based ◽  
Incident Diabetes ◽  
Continuous Variables ◽  
Newly Diagnosed ◽  
History Of ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes

Abstract Background: To assess the association between fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2h-PCPG) as continuous or categorical variables with risk of recurrent cardiovascular disease (CVD) and incident diabetes among subjects with history of previous CVD. Methods: In a prospective population-based cohort, a total of 335 Iranians aged ≥30 years, with history of CVD and free of known diabetes were included. Prediabetes was defined as impaired fasting glucose (IFG) according to the criteria of the American Diabetes Association (ADA) [IFG-ADA; FPG: 5.6-6.9 mmol/L], the World Health Organization (WHO) expert group (IFG-WHO; FPG: 6.1-6.9 mmol/L) and impaired glucose tolerance [IGT: 2h-PCPG: 7.8-11.0 mmol/L]. Cox’s proportional hazard models adjusted for traditional risk factors were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) of different glucose intolerance for outcomes of interest. Results: During a median follow-up of 15.8 (IQR, 10.7-16.5) years, 178 CVD (hard event including death, myocardial infarction and stroke=69) events occurred. Regarding FPG, only IFG-ADA was associated with significant higher risk of hard CVD in the fully adjusted model (HR, 1.73, 95% CI: 1.04-2.89). Moreover, newly diagnosed diabetes (FPG≥7 mmol/L) was an independent risk of CVD (2.11: 1.22-3.66). Focusing on 2h-PCPG, subjects with newly diagnosed diabetes (2h-PCPG ≥ 11.1 mmol/L) had moderately increased risk of hard coronary heart disease (2.02:0.91-4.47, P=0.08). The multivariate HRs (95% CI) associated with 1 SD increase in FPG and 2h-PCPG was 1.16 (1.01–1.33) and 1.19 (1.02–1.38) for CVD, respectively. Among population free of diabetes at baseline (n=270), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes in multivariate analysis (all HRs > 4, P< 0.001); significant associations were also found for FPG and 2h-PCPG as continuous variables (all HRs for 1-SD increase > 2, all P < 0.001). Conclusions: Among subjects with stable CVD, both FPG and 2h-PCPG as continuous variables was associated with higher risk of recurrent CVD. However, only IFG-ADA was independent predictor of hard CVD events. Also, newly diagnosed diabetes, using FPG criteria, was associated with a significant risk of CVD. IFG-ADA, IFG-WHO and IGT were all significant predictors of incident diabetes.

scholarly journals Not performing an OGTT results in underdiagnosis, inadequate risk assessment and probable cost increases of (pre)diabetes in Han Chinese over 40 years: a population-based prospective cohort study

2018 ◽  
Vol 7 (12) ◽  
pp. 1507-1517 ◽  
Author(s):  
Xiang Hu ◽  
Qiao Zhang ◽  
Tian-Shu Zeng ◽  
Jiao-Yue Zhang ◽  
Jie Min ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cohort Study ◽  
Glucose Tolerance ◽  
Prospective Cohort Study ◽  
Plasma Glucose ◽  
Prospective Cohort ◽  
Population Based ◽  
Han Chinese ◽  
World Health ◽  
Over 40 Years

Objective To explore the influence by not performing an oral glucose tolerance test (OGTT) in Han Chinese over 40 years. Design Overall, 6682 participants were included in the prospective cohort study and were followed up for 3 years. Methods Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2h-PG), FPG and 2h-PG (OGTT), and HbA1c testing using World Health Organization (WHO) or American Diabetes Association (ADA) criteria were employed for strategy analysis. Results The prevalence of diabetes is 12.4% (95% CI: 11.6–13.3), while the prevalence of prediabetes is 34.1% (95% CI: 32.9–35.3) and 56.5% (95% CI: 55.2–57.8) using WHO and ADA criteria, respectively. 2h-PG determined more diabetes individuals than FPG and HbA1c. The testing cost per true positive case of OGTT is close to FPG and less than 2h-PG or HbA1c. FPG, 2h-PG and HbA1c strategies would increase costs from complications for false-positive (FP) or false-negative (FN) results compared with OGTT. Moreover, the least individuals identified as normal by OGTT at baseline developed (pre)diabetes, and the most prediabetes individuals identified by HbA1c or FPG using ADA criteria developed diabetes. Conclusions The prevalence of isolated impaired glucose tolerance and isolated 2-h post-load diabetes were high, and the majority of individuals with (pre)diabetes were undetected in Chinese Han population. Not performing an OGTT results in underdiagnosis, inadequate developing risk assessment and probable cost increases of (pre)diabetes in Han Chinese over 40 years and great consideration should be given to OGTT in detecting (pre)diabetes in this population. Further population-based prospective cohort study of longer-term effects is necessary to investigate the risk assessment and cost of (pre)diabetes.

scholarly journals OP0271 REAL-WORLD CLINICAL BURDEN AND GLUCOCORTICOID USE IN PATIENTS WITH POLYMYALGIA RHEUMATICA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 169.1-169
Author(s):  
R. Punekar ◽  
P. Lafontaine ◽  
J. H. Stone
Keyword(s):  
Cardiovascular Disease ◽  
Health Plan ◽  
Polymyalgia Rheumatica ◽  
Data Availability ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Rank Tests ◽  
Medical Claim ◽  
Diagnosis Codes

Background:Polymyalgia rheumatica (PMR) is a chronic inflammatory condition characterized by aching and morning stiffness in the neck, shoulders and pelvic girdle. It is a common inflammatory rheumatic disease in patients age >50 years, particularly women. While giant cell arteritis (GCA) is present in 9–21% of PMR cases, many PMR patients have symptoms independent of GCA. Current treatment options are limited to long-term glucocorticoid (GC), however, with risks of GC-related complications, including cardiovascular disease, osteoporosis, and diabetes mellitus.Objectives:To compare GC use and subsequent GC-related complications in patients with PMR vs a general population (GnP) cohort.Methods:This retrospective, observational cohort study was based on Optum’s de-identified Clinformatics®Data Mart Database (study period 01Jan2006-30June2018). The PMR cohort included patients with ≥1 inpatient or ≥2 outpatient claims ≥30 days apart with PMR related diagnosis codes (ICD-9: 725.xx or ICD-10: M35.3x) between 01Jan2006–30June2017 (patient identification period) during which first occurrence of a PMR-related medical claim was set as the index date (ID). Patients with ≥1 medical claim related to rheumatoid arthritis (RA) or GCA during the study period were excluded. The GnP cohort included patients without any RA, GCA or PMR diagnosis codes during the study period, with their ID set as 12 months from the start of continuous health plan enrollment. Patients in both cohorts were required to be age ≥50 years (on ID) with continuous health plan enrollment ≥12 months pre- and post-ID. Cohorts were 1:1 propensity score matched. GC use and incidence of GC-related complications were assessed from GC initiation, starting from the baseline period (12-months pre-ID) through to the end of GC use during the post-index period (i.e. the end of data availability, end of the study period or death [whichever occurred first]). Mean, standard deviation (SD) and median values for continuous variables, and frequency (n and %) for categorical variables were compared between the matched cohorts. Wilcoxon sum rank tests andt-tests on continuous variables and Chi-square tests or Fisher’s exact tests on categorical variables between matched cohorts were conducted. Duration of GC use was analyzed using the Kaplan-Meier method and compared between matched cohorts using log-rank tests.Results:In each of the PMR and GnP cohorts, 16,865 patients were included. In both matched cohorts, median age was 76 years, median Elixhauser comorbidity index score was 2.0, and the majority (~65%) were women. The median follow-up duration was 45 months and 51 months in the PMR and GnP cohorts, respectively. A higher proportion of patients in the PMR cohort than the matched GnP cohort (90.4% vs 62.8%;p<0.001) used GC. The mean (SD) duration of GC therapy was significantly longer in the PMR cohort than in the matched GnP cohort (242.1 [±317.2] days vs 35.5 [±124.6] days;p<0.001). Although patients in the PMR cohort had a lower average daily dose of GC (prednisone equivalent) vs the GnP cohort (mean [SD] mg 16.3 [± 21.9] vs 27.8 [±24.5], respectively [p<0.0001)], the cumulative GC dose was significantly higher in the PMR cohort than the GnP cohort (2125.4 [±3689.5] mg vs 476.6 [±1450.9] mg;p<0.001). This indicates PMR patients used chronic low dose GC while the GnP patients utilized higher dose GC burst therapy less frequently. The number of incident complications associated with GC use were significantly greater in the PMR cohort, and included hypertension, diabetes, skin toxicity, infections, neuropsychiatric effects, endocrine abnormalities, renal dysfunction/ failure, ocular effects, and cardiovascular disease (p<0.05).Conclusion:The overall GC burden in patients with PMR is high. With a higher incidence of GC-related comorbidities among PMR patients, early onset of these complications may be a significant contributor to long-term healthcare costs in these patients.Acknowledgments:This study was funded by Sanofi, Inc. Medical writing, under the direction of authors, was provided by Gauri Saal, MA Economics, Prime, Knutsford, UK, and funded by Sanofi.Disclosure of Interests:Rajeshwari Punekar Shareholder of: Sanofi, Employee of: Sanofi, Patrick LaFontaine Shareholder of: Sanofi, Employee of: Sanofi, John H. Stone Grant/research support from: Roche, Consultant of: Roche

scholarly journals Association between Intimate Partner Violence with Quality of Life

2021 ◽  
Author(s):  
NV Roopesh Gopal ◽  
SV Sathish Kumar ◽  
Kiran S Bhat
Keyword(s):  
Quality Of Life ◽  
Intimate Partner Violence ◽  
Partner Violence ◽  
Intimate Partner ◽  
World Health ◽  
Categorical Variables ◽  
Early Interventions ◽  
Continuous Variables ◽  
Cross Sectional

Introduction: An intimate relationship is an interpersonal relationship that involves physical or emotional intimacy. Those who are in such a relationship may experience violence from partners which may affect their day-to-day quality of life and thus cause a burden on the family. Aim: To assess the relationship between Intimate Partner Violence (IPV) with Quality of life and to provide early interventions. Materials and Methods: Hospital-based, cross-sectional study was conducted at the Department of Psychiatry, Kodagu Institute of Medical Sciences (KoIMS) teaching hospital Madikeri, Karnataka. The subjects were recruited by purposive sampling method. A total of 5810 consecutive subjects who visited the psychiatry OPD from March 2017 to June 2019 were assessed and among them, 82 subjects both men and women in the age group of 18 to 60 years were recruited. All of them reported IPV on the Hurt, Insulted, Threatened, and Screamed (HITS) scale and were further assessed for Quality of life using the World Health Organisation Quality of Life BREF (WHOQOL-BREF) scale. Descriptive statistics were used for continuous variables. A Nonparametric Chi-square test was applied for categorical variables and Mann-Whitney U scores were used for quality of life variables. The correlation was done using Pearson’s correlation. Results: Mean age was 36.04 in years (SD±11.28) having a mean of 7.5 years of schooling (SD±4.5). The majority belonged to the rural background and lower socioeconomic status. Out of 82 subjects, 21 subjects reported IPV score less than 10 (25.60%) and among the rest of the 61 (74.39%) subjects, 80.32% were females and 19.67% were males who had IPV scores of more than 10. The study subjects reported poor and very poor scores in their overall quality of life and very dissatisfied and dissatisfied in their health domain. IPV also correlated with reduced quality of life, which was statistically significant. Conclusion: People that experience IPV has an overall reduced quality of life. Routine clinical assessment needs to be done to provide early interventions.

(A Clinicopathological Aspects of Resectable Pancreatic Neoplasm)

2021 ◽  
Vol 6 (15) ◽  
pp. 39-44
Author(s):  
Şeref Dokcu ◽  
Mehmet Ali Çaparlar ◽  
Salim Demirci
Keyword(s):  
Pancreatic Cancer ◽  
Survival Analysis ◽  
Survival Rates ◽  
Pancreatic Neoplasm ◽  
Population Based ◽  
Clinicopathological Features ◽  
Categorical Variables ◽  
Malignant Neoplasms ◽  
Continuous Variables ◽  
Common Diagnosis

Aim Pancreatic cancer is one of the deadliest malignant neoplasms. As with many malignant neoplasms, survival rates depend on the histopathological type of cancer, its stage, tumor size, and treatment. In this study, we aimed to classify pancreatic cancer according to clinicopathological features and histological subtypes. Material and method The data of all adult patients diagnosed and treated for pancreatic neoplasm in our clinic were collected retrospectively from the hospital's computerized database and medical files. Patients were categorized according to their clinicopathological features. Chi-square test and Fisher's exact test were used for between-group comparisons, and t-test was used for independent samples for quantitative data. Data were expressed as mean ± SD for continuous variables and numbers and percentages for categorical variables. A value of p<0.05 was considered significant. Results The mean age of the patients was 60.5 years, 70.8% were male. There were five types of tumors defined histopathologically, and the most common diagnosis was adenocarcinoma (76.9%). The most common localization of the tumor was head and neck (44.4%). Whipple surgery was performed predominantly in 69.2% of patients, and distal pancreatectomy in 29.0%. Postoperative complications were observed in more than one third (34%) of the patients. The main complications were pancreatic cyst (16.3%). In the survival analysis performed with the Kaplan-Meier test, median survival of 30.5 months, and overall survival (OS) at 1.2 and 5 years were 67.8%, 40.5%, and 16.6%, respectively. Discussion However, survival analysis results were optimistic compared to population-based studies as all patients had resectable tumors.

Variability of Capillary Plasma Glucose in Healthy Individuals in Repeated 75 g Oral Glucose Tolerance Tests

1988 ◽  
Vol 25 (6) ◽  
pp. 634-637 ◽  
Author(s):  
S T Cummings ◽  
C G Fraser
Keyword(s):  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Population Based ◽  
Oral Glucose ◽  
Optimal Conditions ◽  
Oral Glucose Tolerance ◽  
Healthy Individuals ◽  
Oral Glucose Tolerance Tests ◽  
Glucose Tolerance Tests ◽  
Apparently Healthy

A series of ten 75g oral glucose tolerance tests was carried out on each of 14 apparently healthy subjects. The analytical, intra-individual and inter-individual components of variation were calculated by nested ANOVA following duplicate analyses of capillary plasma glucose under optimal conditions. The analyses met the objectively set analytical goal of CV ≤2·2%. There was considerable intra-individual variation, but no subject was ever classified as diabetic or having impaired glucose tolerance. Recent criteria for interpretation of results must be used since conventional population-based reference values are not adequate. Serial results from an individual must differ by more than 0·7 mmol/L for fasting specimens and at least 1·6 mmol/L for other specimens for a statistically significant ( P ≤ 0·05) change to have occurred.

scholarly journals The Association of Retinopathy and Plasma Glucose and HbA1c: A Validation of Diabetes Diagnostic Criteria in a Chinese Population

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Rui Zhang ◽  
Yufeng Li ◽  
Simin Zhang ◽  
Xiaoling Cai ◽  
Xianghai Zhou ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Plasma Glucose ◽  
Chinese Population ◽  
High Specificity ◽  
Population Based ◽  
World Health ◽  
Who Criteria ◽  
Receiver Operating Characteristic Curves ◽  
Health Organization ◽  
Low Sensitivity

Aims. This study aimed to evaluate the associations of diabetic retinopathy (DR) with fasting plasma glucose (FPG), 2-hour postload plasma glucose (2hPG), and glycated hemoglobin A1c (HbA1c) in a Chinese population.Materials and Methods. A total of 3124 participants, identified from a population-based survey in Pinggu district, were examined by retinal photography (45°). DR was classified according to the Early Treatment Diabetic Retinopathy Study scale. FPG, 2hPG, and HbA1c were tested and categorized by deciles, with the prevalence of DR calculated in each decile.Results. The prevalence of DR increased sharply in the 10th deciles, when FPG exceeded 7.03 mmol/L and HbA1c exceeded 6.4%. Analysis of the receiver operating characteristic curves showed that the optimal cutoffs for detecting DR were 6.52 mmol/L and 5.9% for FPG and HbA1c, respectively. The World Health Organization (WHO) criteria for diagnosing diabetes showed high specificity (90.5–99.5%) and low sensitivity (35.3–65.0%). Further, 6 individuals with retinopathy had normal plasma glucose; however, their characteristics did not differ from those without retinopathy.Conclusions. Thresholds of FPG and HbA1c for detecting DR were observed, and the WHO criteria of diagnosing diabetes were shown to have high specificity and low sensitivity in this population.

scholarly journals Sex hormones, inflammation and the metabolic syndrome: a population-based study

2003 ◽  
pp. 601-608 ◽  
Author(s):  
DE Laaksonen ◽  
L Niskanen ◽  
K Punnonen ◽  
K Nyyssonen ◽  
TP Tuomainen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Body Mass ◽  
Sex Hormones ◽  
Free Testosterone ◽  
Population Based ◽  
World Health ◽  
Inverse Association ◽  
The Metabolic Syndrome

OBJECTIVE: Mild hypoandrogenism in men is associated with features of the metabolic syndrome, but the association with the metabolic syndrome itself using an accepted definition has not been described. DESIGN: Men with the metabolic syndrome were identified and testosterone and sex hormone-binding globulin (SHBG) levels were determined in a population-based cohort of 1896 non-diabetic middle-aged Finnish men. RESULTS: Calculated free testosterone and SHBG were 11% and 18% lower (P<0.001) in men with the metabolic syndrome (n=345, World Health Organisation definition). After categorisation by tertiles and adjusting for age and body mass index, total and free testosterone and SHBG were inversely associated with concentrations of insulin, glucose, triglycerides, C-reactive protein (CRP) and CRP-adjusted ferritin and positively associated with high-density lipoprotein cholesterol. Men with free testosterone levels in the lowest third were 2.7 (95% confidence interval (CI) 2.0-3.7) times more likely to have the metabolic syndrome in age-adjusted analyses, and 1.7 (95% CI 1.2-2.4) times more likely even after further adjusting for body mass index. Exclusion of men with cardiovascular disease did not alter the association. The inverse association of SHBG with the metabolic syndrome was somewhat stronger. CONCLUSIONS: Low testosterone and SHBG levels were strongly associated not only with components of the metabolic syndrome, but also with the metabolic syndrome itself, independently of body mass index. Furthermore, sex hormones were associated with inflammation and body iron stores. Even in the absence of late-stage consequences such as diabetes and cardiovascular disease, subtle derangements in sex hormones are present in the metabolic syndrome, and may contribute to its pathogenesis.

scholarly journals COVID-19 associated hospitalization in 571 patients with fibromyalgia—A population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261772
Author(s):  
Mor Amital ◽  
Niv Ben-Shabat ◽  
Howard Amital ◽  
Dan Buskila ◽  
Arnon D. Cohen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Multivariable Analysis ◽  
Population Based ◽  
Female Dominance ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Multivariable Logistic Regression Model ◽  
Population Based Study

Objective To identify predicators of patients with fibromyalgia (FM) that are associated with a severe COVID-19 disease course. Methods We utilized the data base of the Clalit Health Services (CHS); the largest public organization in Israel, and extracted data concerning patients with FM. We matched two subjects without FM to each subject with FM by sex and age and geographic location. Baseline characteristics were evaluated by t-test for continuous variables and chi-square for categorical variables. Predictors of COVID-19 associated hospitalization were identified using univariable logistic regression model, significant variables were selected and analyzed by a multivariable logistic regression model. Results The initial cohort comprised 18,598 patients with FM and 36,985 matched controls. The mean age was 57.5± 14.5(SD), with a female dominance of 91%. Out of this cohort we extracted the study population, which included all patients contracted with COVID-19, and consisted of 571 patients with FM and 1008 controls. By multivariable analysis, the following variables were found to predict COVID-19 associated hospitalization in patients with FM: older age (OR, 1.25; CI, 1.13–1.39; p<0.001), male sex (OR, 2.63; CI, 1.18–5.88; p<0.05) and hypertension (OR, 1.75; CI, 1.04–2.95; p<0.05). Conclusion The current population-based study revealed that FM per se was not directly associated with COVID-19 hospitalization or related mortality. Yet classical risk factors endangering the general population were also relevant among patients with FM.

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