Anthropometric indices and the risk of incident sudden cardiac death among adults with and without diabetes: over 15 years of follow-up in The Tehran Lipid and Glucose Study

Abstract Background We investigated the association of anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and hip circumference (HC) with the risk of incident sudden cardiac death (SCD) among Iranian population with and without type 2 diabetes mellitus (T2DM). Methods The study population included 9,089 subjects without and 1,185 subjects with T2DM, aged ≥ 20 years. Participants were recruited in 1999–2001 or 2001–2005, and followed for incident SCD annually, up to 20 March 2018. Multivariate Cox proportional hazard models, adjusted for traditional risk factors of cardiovascular disease, were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of anthropometric indices (as continuous and categorical variables). Results During a follow-up of over 15 years, 144 (1.58%) and 86 (7.26%) incident SCD occurred in non-T2DM and T2DM groups, respectively. Among non-T2DM group, a 1 standard deviation (SD) increase in WHtR was associated with higher risk of incident SCD by a HR of 1.23 (95% CI: 1.00–1.50) in the multivariable model. From the first quartile to the fourth quartile of WHtR, the trend of SCD risk was significant in age- and sex-adjusted analysis (P-value for trend: 0.041). Other indices did not show significant associations with SCD. Among T2DM group, a 1 SD increase in WHR had a HR of 1.36 (1.05–1.76) in the multivariable model. Considering WHR as categorical variables, the trend of SCD risk across quartiles of WHR was significant. Furthermore, a 1 SD increase in HC led to reduced risk of incident SCD with a HR of 0.75 (0.58–0.97) in multivariable analysis; this lower risk remained significant even after adjustment for WC. Compared to the first quartile, the fourth quartile of HC also showed a HR of 0.50 (0.25–0.99) (P-value for trend = 0.018). BMI, WC, and WHtR did not have significant associations with incident SCD. Conclusion In our long-term population-based study, we demonstrated central but not general obesity (as assessed by WHR in participants with T2DM, and WHtR in participants without T2DM) as a herald of incident SCD. Moreover, HC can have an inverse association with SCD among participants with T2DM.

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Association between digoxin use and sudden cardiac death in individuals with the rs10494366 variant of the NOS1AP gene

European Heart Journal ◽

10.1093/ehjci/ehaa946.3394 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Soroush ◽

A Aarnoudse ◽

F Shokri ◽

M Van Den Berg ◽

F Ahmadizar ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Smoking Status ◽

Adaptor Protein ◽

Therapeutic Window ◽

P Value ◽

Qtc Interval ◽

Total Study Population ◽

Increased Risk

Abstract Background Digoxin is one of the oldest cardiovascular medications still used to treat heart failure and atrial fibrillation. Due to its narrow therapeutic window, it is associated with life threatening intoxication and arrhythmias, and with QTc-shortening. Common genetic variation in the nitric oxide synthase-1 adaptor protein (NOS1AP) has been associated with QTc interval prolongation. Purpose We investigated whether the rs10494366 variant of the NOS1AP gene modified the risk of SCD in patients using digoxin. Methods In a prospective population-based cohort study, we included data of the three cohorts, started as of January 1st, 1991 until January 1st 2014. Digoxin current use on the date of cardiac death in cases and the same day of follow-up in the remainder of the cohort was a time-dependent exposure. The main outcome was SCD defined as sudden and unexpected death as a result of cardiac causes, according to international criteria. Identification and adjudication of SCD was performed independently, before the start of this study. We used Cox proportional hazard regression analysis to investigate the associations between NOS1AP rs10494366 variant and incident SCD among digoxin users compared to non-users. Associations were adjusted for age, sex (model 1) in addition to BMI, prevalent diabetes, myocardial infarction, baseline hypertension and smoking status (past, current, never) (model 2). Results We included 14,594 individuals, with a mean age of 65.3 (SD 10.3) years. Almost 59% were female. The cumulative incidence of SCD was 9.5% (609 cases) by the end of follow up. Among them, 98 (16%) individuals were exposed to digoxin at the time of death. In model 1, NOS1AP rs10494366 variant was not associated with SCD in the total study population. However, an interaction term of the gene with the daily dose of digoxin was significantly associated with increased risk of SCD (p-value 0.0001). In model 2, the risk of SCD in current users of digoxin was 4.2 [95% CI 1.3–13.8] for the GG genotype; 2.1 [95% CI 1.1–4.2] for the GT genotype, and 1.5 [95% CI 0.7–3.2] for the TT genotype. Conclusion NOS1AP rs10494366 variant modified the risk of sudden cardiac death in users of digoxin. Our study suggests that individuals with the homozygous minor GG allele have a fourfold increased risk of sudden cardiac death. Funding Acknowledgement Type of funding source: None

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RESEARCH THE VALUE OF THE COMBINATION OF T WAVE ALTERNANS AND NT-PROBNT IN PREDICTING SUDDEN CARDIAC DEATH

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.1.10 ◽

2012 ◽

pp. 74-83

Author(s):

Anh Tien Hoang ◽

Nhat Quang Nguyen

Keyword(s):

Myocardial Infarction ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Healthy Person ◽

Treadmill Test ◽

T Wave ◽

T Wave Alternans

Background: Decades of research now link TWA with inducible and spontaneous clinical ventricular arrhythmias. This bench-to-bedside foundation makes TWA, NT-ProBNP a very plausible index of susceptibility to ventricular arrythmia, and motivates the need to define optimal combination of TWA and NT-ProBNP in predicting ventricular arrythmia in myocardial infarction patients. We research this study with 2 targets: 1. To evaluate the role of TWA in predicting sudden cardiac death in myocardial infarction patients. 2. To evaluate the role of NT-ProBNP in predicting sudden cardiac death in myocardial infarction patients 3. Evaluate the role of the combined NT-ProBNP and TWA in predicting sudden cardiac death in myocardial infarction patients. Methods: Prospective study with follow up the mortality in 2 years: 71 chronic myocardial infarction patients admitted to hospital from 5/2009 to 5/20011 and 50 healthy person was done treadmill test to caculate TWA; ECG, echocardiography, NT-ProBNP. Results: Cut-off point of NT-ProBNP in predicting sudden cardiac death is 3168 pg/ml; AUC = 0,86 (95% CI: 0,72 - 0,91); Cut-off point of TWA in predicting sudden cardiac death is 107 µV; AUC = 0,81 (95% CI: 0,69 - 0,87); NT-ProBNP can predict sudden cardiac death with OR= 7,26 (p<0,01); TWA can predict sudden cardiac death with OR= 8,45 (p<0,01). The combined NT-ProBNP and TWA in predicting ventricular arrythmia in heart failure patients: OR= 17,91 (p<0,001). Conclusions: The combined NT-ProBNP and TWA have the best predict value of sudden cardiac death in myocardial infarction patients, compare to NT-ProBNP or TWA alone

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Long-term Clinical Follow-up of Japanese Heart Failure Patients Received ICD Therapy for Primary Prevention of Sudden Cardiac Death

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2008.07.049 ◽

2008 ◽

Vol 14 (7) ◽

pp. S140-S141

Author(s):

Kenji Ando ◽

Yoshimitsu Soga ◽

Masahiko Goya ◽

Shinichi Shirai ◽

Shinya Nagayama ◽

...

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Icd Therapy ◽

Heart Failure Patients

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465 No Role for Postoperative Antibiotics in Uncomplicated Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab134.283 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

N Ayoub ◽

Y Tryliskyy ◽

M K Baig

Keyword(s):

Wound Infection ◽

P Value ◽

Nice Guidelines ◽

Uncomplicated Appendicitis ◽

Perforated Appendix ◽

Group A ◽

Preoperative Antibiotics ◽

Group B ◽

Variable Practice

Abstract Introduction Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences. Method This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection. Results 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1). Conclusions Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.

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Calcium Channel Autoantibodies Predicted Sudden Cardiac Death and All-Cause Mortality in Patients with Ischemic and Nonischemic Chronic Heart Failure

Disease Markers ◽

10.1155/2014/796075 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Haiyun Yu ◽

Juanhui Pei ◽

Xiaoyan Liu ◽

Jingzhou Chen ◽

Xian Li ◽

...

Keyword(s):

Heart Failure ◽

Multivariate Analysis ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Cardiac Death ◽

Independent Predictor ◽

All Cause Mortality ◽

Patient Prognosis ◽

The Relationship

The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. A total of 2096 patients with CHF (841 DCM patients and 1255 ICM patients) and 834 control subjects were recruited. CC-AAbs were detected and the relationship between CC-AAbs and patient prognosis was analyzed. During a median follow-up time of 52 months, there were 578 deaths. Of these, sudden cardiac death (SCD) occurred in 102 cases of DCM and 121 cases of ICM. The presence of CC-AAbs in patients was significantly higher than that of controls (bothP<0.001). Multivariate analysis revealed that positive CC-AAbs could predict SCD (HR 3.191, 95% CI 1.598–6.369 for DCM; HR 2.805, 95% CI 1.488–5.288 for ICM) and all-cause mortality (HR 1.733, 95% CI 1.042–2.883 for DCM; HR 2.219, 95% CI 1.461–3.371 for ICM) in CHF patients. A significant association between CC-AAbs and non-SCD (NSCD) was found in ICM patients (HR = 1.887, 95% CI 1.081–3.293). Our results demonstrated that the presence of CC-AAbs was higher in CHF patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients.

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Comparable Efficacy of Terbinafine and Itraconazole in the Treatment of Tinea Pedis

Bangladesh Journal of Medicine ◽

10.3329/bjmed.v21i2.13615 ◽

2013 ◽

Vol 21 (2) ◽

pp. 74-79

Author(s):

Md Abdul Wahab ◽

Mohammad Jamal Uddin ◽

Biswas Shahen Hassan ◽

Md Zafrul Islam ◽

Ishrat Bhuiyan ◽

...

Keyword(s):

Fungal Infection ◽

Tinea Pedis ◽

Comparable Efficacy ◽

P Value ◽

Mycological Cure ◽

Efficacy Analysis ◽

Group A ◽

Group B

Background: Tinea pedis (athlets foot) is the most common fungal infection. Relapse is common in tinea pedis and may be result of recurrence following inadequate treatment or reinfection. Objective: To evaluate the comparable efficacy of terbinafine and itraconazole in the treatment of tinea pedis. Methods: 120 patients of tinea pedis confirmed by KOH microscopy were included in the study. The study was carried out in three different Hospitals and Private Chambers for a period of 3 years from July 2006 to June 2009. Mean age of the patients was 40.28±10.23. The patients were devided into 2 equal group:A & B. Group- A was given terbinafine 250 mg/day and group-B was given intraconazole 200 mg/day for 2 weeks. Results: Follow up 2 weeks after cessation of therapy revealed clinical and mycological cure of 93.3% in terbinafine group and 86.6% in itraconazole group. Conclusion: Efficacy analysis revealed that terbinafine is superior than itraconazole in the treatment of tinea pedis (P value 0.224). DOI: http://dx.doi.org/10.3329/bjmed.v21i2.13615 Bangladesh J Medicine 2010; 21: 74-79

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Effect of Isoniazid Preventive Therapy on the Incidence of Tuberculosis among Seropositive Children Attending HIV/AIDS Care in Two General Hospitals, Northwest Ethiopia, 2021

Journal of Tropical Medicine ◽

10.1155/2021/9996953 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Fassikaw Kebede ◽

Birhanu Kebede ◽

Tsehay Kebede ◽

Melaku Agmasu

Keyword(s):

Cox Regression ◽

Data Entry ◽

Concomitant Administration ◽

Preventive Therapy ◽

Northwest Ethiopia ◽

Isoniazid Preventive Therapy ◽

Categorical Variables ◽

P Value ◽

Human Immune Deficiency Virus

The human immune deficiency virus (HIV) is the strongest risk factor for the incidence of tuberculosis (TB) by way of reactivation of latent or new infection. The provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB. To date, there have been limited clinical data regarding the effectiveness of isoniazid preventive therapy (IPT) on TB incidence. This study aimed to assess the effect of isoniazid preventive therapy on the incidence of tuberculosis for seropositive children in Northwest Ethiopia. Methods. A facility-based retrospective follow-up was employed for reviewing 421 files from 1 January 2015 up to 30 December 2019. EpiData version 3.2 and Stata/14 software were used for data entry and analysis, respectively. Categorical variables at bivariable Cox regression were assessed for candidates transferred at P value <0.25 for multivariable Cox regression to claiming predictors associated with TB incidence rate at 95% CI at P < 0.005 . Result. The overall incidence of TB was found to be 4.99 cases per 100 person-years at 95% CI (3.89–6.53). Missed IPT (AHR = 7.45, 95% CI: 2.96, 18.74, P < 0.001 ), missed cotrimoxazole preventive therapy (CPT) (AHR = 2.4, 95% CI: 1.84–4.74, P < 0.022 ), age ≥ 11 years (AHR = 4.2, 95% CI: 1.04–7.03, P < 0.048 ), MUAC ≤ 11.5 cm (AHR = 4.36, 95% CI: 1.97–9.97, P < 0.001 ), WHO stages III and IV (AHR = 2.04, 95% CI: 1.12–3.74, P < 0.022 ), and CD4 count ≤100 cells/μl (AHR = 3.96, 95% CI: 1.52–10.34, P < 0.005 ) were significantly associated with TB incidence. Conclusion. Concomitant administration of ART with IPT had demoted more than ninety-six percent of new TB incidences for this report. Undertaking in-depth TB screening and frequent follow-up among all these children is critical in order to prevent and control tuberculosis.

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Abstract P029: Racial Differences in Sudden Cardiac Death: Findings From the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽

10.1161/circ.137.suppl_1.p029 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Di Zhao ◽

Eliseo Guallar ◽

Elena Blasco-Colmenares ◽

Nona Sotoodehnia ◽

Wendy Post

Keyword(s):

Risk Factors ◽

African Americans ◽

Sudden Cardiac Death ◽

Racial Differences ◽

Cardiac Death ◽

Large Scale ◽

Community Dwelling ◽

Mediation Effect ◽

P Value ◽

Expert Committee

Background: In hospital-based studies and in studies of participants with pre-existing conditions, African Americans have a higher risk of in- and out-of-hospital sudden cardiac death (SCD) compared with Whites. However, the risk of SCD of African Americans and Whites has never been compared in large-scale community-based cohort studies. Objective: To compare the risk of SCD among African Americans and Whites, and to evaluate the risk factors that may explain racial differences in incidence. Methods: Cohort study of 3,838 African Americans and 11,245 Whites participating in ARIC. Race was self-reported. SCD cases were defined as a sudden pulseless condition from a cardiac cause in a previously stable individual and adjudicated by an expert committee. Mediation effect of covariates was calculated using boot-strapping method. Cox proportional hazards models were adjusted for demographics, social economic status, cardiovascular (CVD), and electrocardiographic risk factors. Results: The mean (SD) age was 53.6 (5.8) for African Americans and 54.4 (5.7) years for Whites. During 25.3 years of follow-up, 215 African Americans and 332 Whites experienced SCD. In multivariable-adjusted models, the HRs (95% CI) for SCD comparing African Americans and Whites were 1.70 (1.37, 2.10) overall, 2.00 (1.40, 2.84) in women, and 1.46 (1.10, 1.92) in men (p-value for race by sex interaction 0.02; Table ). CVD and electrocardiographic risk factors explained 36.6% (21.4, 51.8%) of the excess risk of SCD in African Americans, with a large proportion of racial differences unexplained. Conclusions: The risk of SCD in community-dwelling African Americans was significantly higher than in Whites, particularly among women. CVD risk factors, including higher prevalence of obesity, diabetes, hypertension and LV hypertrophy in African Americans, explained only a small fraction of this difference. Further research is needed to identify factors responsible for race differences in SCD and to implement prevention strategies in high-risk minorities.

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Abstract MP57: A South Asian Mediterranean-style Diet Pattern Is Associated With Favorable Measures Of Adiposity And A Lower Risk Of Incident Diabetes: Findings From The Masala Study

Circulation ◽

10.1161/circ.143.suppl_1.mp57 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Sharan K Rai ◽

Alka M Kanaya ◽

Namratha Kandula ◽

Qi Sun ◽

Shilpa N Bhupathiraju

Keyword(s):

South Asian ◽

South Asians ◽

Subclinical Atherosclerosis ◽

Cultural Beliefs ◽

P Value ◽

Inverse Association ◽

Processed Meats ◽

Lower Likelihood ◽

Diet Pattern

Introduction: South Asians are at a disproportionately high risk for cardiometabolic disease. The Mediterranean diet is associated with reduced risks of type 2 diabetes (T2D) and cardiovascular disease in certain populations, although data among South Asians are lacking. Therefore, we evaluated the association between a novel South Asian Mediterranean style (SAM) diet pattern and a broad panel of cardiometabolic markers from the MASALA study, an ongoing prospective cohort of South Asians in the US. Methods: We included 891 participants who completed the baseline visit (2010-13) with reliable responses to a validated ethnic-specific food frequency questionnaire (mean age 55 y; 47% female). We created the SAM score by grouping foods including those specific to this population’s cuisine into 9 pre-defined categories (vegetables, fruits, legumes, nuts, whole grains, red/processed meats, fish, alcohol, and monounsaturated to saturated fat ratio). Participants above the median intake received 1 point per category; red/processed meats were reverse scored and those with alcohol intake 5-25 g/d received 1 point. We summed these for a score from 0-9, with higher scores reflecting greater adherence to a Mediterranean style diet. Participants underwent a clinical exam, carotid ultrasound, cardiac and abdominal CT, and fasting blood tests. We used multivariable linear and logistic regression to examine cross-sectional associations between the SAM score and cardiometabolic risk, adjusting for age, sex, calories, physical activity, smoking status, medical history, income, education level, and cultural beliefs. We additionally adjusted for body mass index (BMI) in the full model. Finally, we examined the association between the SAM score and incident T2D at follow-up (~5 y later). Results: Participants with higher SAM scores tended to be older, more likely to have a bachelor’s degree, less likely to report experiences of discrimination, and less likely to be smokers. At baseline, the SAM score was inversely associated with pericardial fat volume (-1.22 ± 0.55 cm 3 per 1-unit increase in SAM score; p value=0.03) in the fully adjusted model. We observed an inverse association between the SAM score and visceral fat, but it was attenuated after additionally adjusting for BMI. There were no associations with subclinical atherosclerosis, glycemia measures, lipids, inflammatory markers, or uric acid. The SAM score was associated with a lower likelihood of obesity (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.79 to 0.98) and fatty liver (OR 0.82, 95% CI 0.68 to 0.98), but not with hypertension. Finally, the SAM score was associated with lower odds of incident T2D (OR 0.75, 95% CI 0.59 to 0.95) at follow-up. Conclusion: A greater intake of a Mediterranean style diet that incorporates traditional South Asian foods was associated with favorable measures of adiposity and a lower likelihood of incident T2D.

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Pitfalls of the S-ICD therapy: experiences from a large tertiary centre

Clinical Research in Cardiology ◽

10.1007/s00392-020-01767-x ◽

2020 ◽

Author(s):

Kevin Willy ◽

Florian Reinke ◽

Benjamin Rath ◽

Christian Ellermann ◽

Julian Wolfes ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Large Scale ◽

P Wave ◽

Subcutaneous Icd ◽

Lead Failure ◽

Tertiary Centre ◽

Expected Benefits ◽

Myopotential Oversensing

Abstract Aim The subcutaneous ICD (S-ICD) has evolved to a potential first option for many patients who have to be protected from sudden cardiac death. Many trials have underlined a similar performance regarding its effectiveness in relation to transvenous ICDs and have shown the expected benefits concerning infective endocarditis and lead failure. However, there have also been problems due to the peculiarities of the device, such as oversensing and myopotentials. In this study, we present patients from a large tertiary centre suffering from complications with an S-ICD and propose possible solutions. Methods and results All S-ICD patients who experienced complications related to the device (n = 40) of our large-scale single-centre S-ICD registry (n = 351 patients) were included in this study. Baseline characteristics, complications occurring and solutions to these problems were documented over a mean follow-up of 50 months. In most cases (n = 23), patients suffered from oversensing (18 cases with T wave or P wave oversensing, 5 due to myopotentials). Re-programming successfully prevented further oversensing episode in 13/23 patients. In 9 patients, generator or lead-related complications, mostly due to infectious reasons (5/9), occurred. Further problems consisted of ineffective shocks in one patient and need for antibradycardia stimulation in 2 patients and indication for CRT in 2 other patients. In total, the S-ICD had to be extracted in 10 patients. 7 of them received a tv-ICD subsequently, 3 patients refused re-implantation of any ICD. One other patient kept the ICD but had antitachycardic therapy deactivated due to inappropriate shocks for myopotential oversensing. Conclusion The S-ICD is a valuable option for many patients for the prevention of sudden cardiac death. Nonetheless, certain problems are immanent to the S-ICD (limited re-programming options, size of the generator) and should be addressed in future generations of the S-ICD. Graphic abstract

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