Lower serum retinoic acid level for prediction of higher risk of mortality in ischemic stroke

Neurology ◽  
2019 ◽  
Vol 92 (15) ◽  
pp. e1678-e1687 ◽  
Author(s):  
Wen-Jun Tu ◽  
Han-Cheng Qiu ◽  
Yiqun Zhang ◽  
Jian-lei Cao ◽  
Hong Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Retinoic Acid ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Net Reclassification Improvement ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cvd Mortality

ObjectiveTo explore the association between serum retinoic acid (RA) level in patients with acute ischemic stroke (AIS) and mortality risk in the 6 months after admission.MethodsFrom January 2015 through December 2016, patients admitted to 3 stroke centers in China for first-ever AIS were screened. The primary endpoint was all-cause mortality or cardiovascular disease (CVD) mortality in the 6 months after admission. The significance of serum RA level, NIH Stroke Scale score, and established risk factors in predicting mortality were determined. The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) statistics were applied in statistical analysis.ResultsOf the 1,530 patients enrolled, 325 died within 6 months of admission, with an all-cause mortality of 21.2% and CVD-related mortality of 13.1%. In multivariable analysis, RA levels were expressed as quartiles with the clinical variables. The results of the second to fourth quartiles (Q2–Q4) were compared with the first quartile (Q1); RA levels showed prognostic significance, with decreased all-cause and CVD mortality of 55% and 63%, respectively. After RA was added to the existing risk factors, all-cause mortality could be better reclassified, in association with only the NRI statistic (p = 0.005); CVD mortality could be better reclassified with significance, in association with both the IDI and NRI statistics (p < 0.01).ConclusionsLow circulating levels of RA were associated with increased risk of all-cause and CVD mortality in a cohort of patients with first-incidence AIS, indicating that RA level could be a predictor independent of established conventional risk factors.

scholarly journals Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality

2019 ◽  
Vol 27 (9) ◽  
pp. 978-987 ◽  
Author(s):  
Kristofer Hedman ◽  
Nicholas Cauwenberghs ◽  
Jeffrey W Christle ◽  
Tatiana Kuznetsova ◽  
Francois Haddad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Exercise Testing ◽  
Lower Risk ◽  
Metabolic Equivalents ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Clinical Exercise Testing

Aims The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise. We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality. Methods and results Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan–Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects ( n = 709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (<210 mmHg) and higher SBP/MET-slope (>10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08–1.32) and 1.20 (1.10–1.31), respectively). In subjects with high fitness, a SBP/MET-slope > 6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12–1.45)). Conclusion In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality. This simple, novel metric can be considered in clinical exercise testing reports.

Multiple biomarkers covering distinct pathways for predicting outcomes after ischemic stroke

Neurology ◽  
2018 ◽  
Vol 92 (4) ◽  
pp. e295-e304 ◽  
Author(s):  
Chongke Zhong ◽  
Zhengbao Zhu ◽  
Aili Wang ◽  
Tan Xu ◽  
Xiaoqing Bu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Primary Outcome ◽  
Prognostic Significance ◽  
Complement C3 ◽  
Vascular Events ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
Multiple Biomarkers ◽  
Novel Biomarkers ◽  
Integrated Discrimination Improvement

ObjectiveTo study the prognostic significance of multiple novel biomarkers in combination after ischemic stroke.MethodsWe derived data from the China Antihypertensive Trial in Acute Ischemic Stroke, and 12 informative biomarkers were measured. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.ResultsIn 3,405 participants, 866 participants (25.4%) experienced major disability or died within 3 months. In multivariable analyses, elevated high-sensitive C-reactive protein, complement C3, matrix metalloproteinase-9, hepatocyte growth factor, and antiphosphatidylserine antibodies were individually associated with the primary outcome. Participants with a larger number of elevated biomarkers had increased risk of all study outcomes. The adjusted odds ratios (95% confidence intervals) of participants with 5 elevated biomarkers were 3.88 (2.05–7.36) for the primary outcome, 2.81 (1.49–5.33) for major disability, 5.67 (1.09–29.52) for death, and 4.00 (1.22–13.14) for vascular events, compared to those with no elevated biomarkers. Simultaneously adding these 5 biomarkers to the basic model with traditional risk factors led to substantial reclassification for the combined outcome (net reclassification improvement 28.5%, p < 0.001; integrated discrimination improvement 2.2%, p < 0.001) and vascular events (net reclassification improvement 37.0%, p = 0.001; integrated discrimination improvement 0.8%, p = 0.001).ConclusionWe observed a clear gradient relationship between the numbers of elevated novel biomarkers and risk of major disability, mortality, and vascular events. Incorporation of a combination of multiple biomarkers observed substantially improved the risk stratification for adverse outcomes in ischemic stroke patients.

Abstract TP186: Incidence and Risk Factors for Stroke and All-Cause Mortality in Korean Adults Congenital Heart Diseases

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jin-Man Jung ◽  
Hong Ju Shin ◽  
Jae-Young Kim ◽  
Woo-Keun Seo
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Heart Diseases ◽  
Multivariable Analysis ◽  
Control Group ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
All Cause Mortality

Objective: To compare incidence of ischemic stroke, hemorrhagic stroke and all-cause mortality in Korean adults congenital heart disease (ACHD) to that of control and scrutinize risk factors for these outcomes. Methods: Subjects aged over 20 were collected from the Korea National Health Insurance Service from 2006 through 2017. ACHD group as case was extracted from the diagnosis records related to CHD according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD 10). Those without CHD (control group) was selected as 4 controls for each patient through random sampling. We compared incidence rate of ischemic stroke, hemorrhagic stroke and all-cause mortality. Cox proportional hazard models were used to investigate relevant risk factors for each of outcomes. Results: Case and control group were 49,445 and 249,649, respectively. Age-adjusted rates of ischemic stroke, hemorrhagic stroke and all-cause mortality in case was by about 4 times more higher than those of control. Cumulative survival plot demonstrated that ACHD was associated with ischemic stroke (HR 1.31 95% CI 1.25-1.36), hemorrhagic stroke (HR 1.49 95% CI 1.36-1.63), and all-cause mortality (HR 1.41 95% CI 1.35-1.46). Case group was associated with younger age, female, hypertension, diabetes mellitus, coronary artery disease, heart failure, atrial fibrillation (all p <.001). In Cox proportional hazard model for ischemic stroke, diabetes (HR 2.13 95% CI 1.93-2.35) and coararctation of aorta (HR 1.54 95% CI 1.13 - 2.09) carried highest risk. In multivariable analysis for hemorrhagic stroke, hypertension (HR 2.28 95% CI 1.74-2.98) was highest risk factor. Multivariable analysis for all-cause mortality showed that congestive heart failure (HR 1.78 95% CI 1.65-1.92) and Eisenmenger syndrome (HR 2.91 95% CI 2.53-3.35) was highest risk factor. Conclusions: Korean ACHD patients have significantly higher incidence of co-morbidities including hypertension, diabetes mellitus, several heart diseases. They have a higher tendency of ischemic, hemorrhagic stroke and mortality. These findings suggest that medical surveillance and risk factor management is sustainedly needed for ACHD patients to reduce stroke and mortality in the future.

scholarly journals Frailty index as a predictor of all-cause and cause-specific mortality in a Swedish population-based cohort

2017 ◽  
Author(s):  
M Jiang ◽  
AD Foebel ◽  
R Kuja-Halkola ◽  
I Karlsson ◽  
NL Pedersen ◽  
...  
Keyword(s):  
Frailty Index ◽  
Population Based ◽  
Swedish Population ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Younger Men ◽  
Cvd Mortality

AbstractBackgroundFrailty is a complex manifestation of aging and associated with increased risk of mortality and poor health outcomes. Younger individuals (under 65 years) typically have low levels of frailty and are less-studied in this respect. Also, the relationship between the Rockwood frailty index (FI) and cause-specific mortality in community settings is understudied.MethodsWe created and validated a 42-item Rockwood-based FI in The Swedish Adoption/Twin Study of Aging (n=1477; 623 men, 854 women; aged 29-95 years) and analyzed its association with all-cause and cause-specific mortality in up to 30-years of follow-up. Deaths due to cardiovascular disease (CVD), cancer, dementia and other causes were considered as competing risks.ResultsOur FI demonstrated construct validity as its associations with age, sex and mortality were similar to the existing literature. The FI was independently associated with increased risk for all-cause mortality in younger (<65 years; HR per increase in one deficit 1.11, 95%CI 1.07-1.17) and older (≥65 years; HR 1.07, 95%CI 1.04-1.10) women and in younger men (HR 1.05, 95%CI 1.01-1.10). In cause-specific mortality analysis, the FI was strongly predictive of CVD mortality in women (HR per increase in one deficit 1.13, 95%CI 1.09-1.17), whereas in men the risk was restricted to deaths from other causes (HR 1.07, 95%CI 1.01-1.13).ConclusionsThe FI showed good predictive value for all-cause mortality especially in the younger group. The FI predicted CVD mortality risk in women, whereas in men it captured vulnerability to death from various causes.

scholarly journals Plasma N-terminal Prosomatostatin and Risk of Incident Cardiovascular Disease and All-Cause Mortality in a Prospective Observational Cohort: the PREVEND Study

2017 ◽  
Vol 63 (1) ◽  
pp. 278-287 ◽  
Author(s):  
Ali Abbasi ◽  
Lyanne M Kieneker ◽  
Eva Corpeleijn ◽  
Ron T Gansevoort ◽  
Rijk O B Gans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Net Reclassification Improvement ◽  
Framingham Risk ◽  
Potential Association ◽  
Increased Risk ◽  
All Cause Mortality ◽  
End Stage

Abstract BACKGROUND Somatostatin is a component of the well-known insulin-like growth factor-1/growth hormone (GH) longevity axis. There is observational evidence that increased GH is associated with an increased risk of cardiovascular disease (CVD). We aimed to investigate the potential association of plasma N-terminal fragment prosomatostatin (NT-proSST) with incident CVD and all-cause mortality in apparently healthy adults. METHODS We studied 8134 participants without history of CVD (aged 28–75 years; women, 52.6%) from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study in Groningen, the Netherlands. Plasma NT-proSST was measured in baseline samples. Outcomes were incidence of CVD and all-cause mortality. RESULTS In cross-sectional analyses, NT-proSST [mean (SD), 384.0 (169.3) pmol/L] was positively associated with male sex and age (both P &lt; 0.001). During a median follow-up of 10.5 (Q1-Q3: 9.9–10.8) years, 708 (8.7%) participants developed CVD and 517 (6.4%) participants died. In univariable analyses, NT-proSST was associated with an increased risk of incident CVD and all-cause mortality (both P &lt; 0.001). In multivariable analyses, these associations were independent of the Framingham risk factors, with hazard ratios (95% CI) per doubling of NT-proSST of 1.17 (1.03–1.34; P = 0.02) for incident CVD and of 1.28 (1.09–1.49; P = 0.002) for all-cause mortality. Addition of NT-proSST to the updated Framingham Risk Score improved reclassification (integrated discrimination improvement (P &lt; 0.001); net reclassification improvement was 2.5% (P = 0.04)). CONCLUSIONS Plasma NT-proSST is positively associated with increased risk of future CVD and all-cause mortality, partly independent of traditional CVD risk factors. Further research is needed to address the nature of associations.

scholarly journals Independent and Combined Effects of Telomere Shortening and mtDNA4977 Deletion on Long-term Outcomes of Patients with Coronary Artery Disease

2019 ◽  
Vol 20 (21) ◽  
pp. 5508 ◽  
Author(s):  
Cecilia Vecoli ◽  
Andrea Borghini ◽  
Silvia Pulignani ◽  
Antonella Mercuri ◽  
Stefano Turchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Reference Model ◽  
Disease Risk ◽  
Major Adverse Cardiovascular Events ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Artery Disease

Aging is one of the main risk factors for cardiovascular disease, resulting in a progressive organ and cell decline. This study evaluated a possible joint impact of two emerging hallmarks of aging, leucocyte telomere length (LTL) and common mitochondrial DNA deletion (mtDNA4977), on major adverse cardiovascular events (MACEs) and all-cause mortality in patients with coronary artery disease (CAD). We studied 770 patients (673 males, 64.8 ± 8.3 years) with known or suspected stable CAD. LTL and mtDNA4977 deletion were assessed in peripheral blood using qRT-PCR. During a median follow-up of 5.4 ± 1.2 years, MACEs were 140 while 86 deaths were recorded. After adjustments for confounding risk factors, short LTLs and high mtDNA4977 deletion levels acted independently as predictors of MACEs (HR: 2.2, 95% CI: 1.2–3.9, p = 0.01 and HR: 1.7, 95% CI: 1.1–2.9, p = 0.04; respectively) and all-cause mortality events (HR: 2.1, 95% CI: 1.1–4.6, p = 0.04 and HR: 2.3, 95% CI: 1.1–4.9, p = 0.02; respectively). Patients with both short LTLs and high mtDNA4977 deletion levels had an increased risk for MACEs (HR: 4.3; 95% CI: 1.9–9.6; p = 0.0006) and all-cause mortality (HR: 6.0; 95% CI: 2.0–18.4; p = 0.001). The addition of mtDNA4977 deletion to a clinical reference model was associated with a significant net reclassification improvement (NRI = 0.18, p = 0.01). Short LTL and high mtDNA4977 deletion showed independent and joint predictive value on adverse cardiovascular outcomes and all-cause mortality in patients with CAD. These findings strongly support the importance of evaluating biomarkers of physiological/biological age, which can predict disease risk and mortality more accurately than chronological age.

Abstract 2733: The Comparative Importance of `Shared' Risk Factors for Ischemic Stroke and Intracerebral Hemorrhage in Patients with Atrial Fibrillation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Emer R McGrath ◽  
Moira K Kapral ◽  
Jiming Fang ◽  
Martin J O'Donnell ◽  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Renal Impairment ◽  
Intracerebral Hemorrhage ◽  
Vascular Disease ◽  
Multivariable Analysis ◽  
Increased Risk ◽  
History Of ◽  
Shared Risk

Background: Optimal prescribing of oral anticoagulants, for the prevention of stroke in patients with atrial fibrillation, requires clinicians to estimate the competing risk of ischemic stroke and intracerebral hemorrhage (ICH). However, a number of risk factors increase the risk of both ischemic stroke and ICH (e.g. age, hypertension and chronic renal disease), and it is unclear how these ‘shared’ risk factors should influence decisions on antithrombotic therapy. Objective: To determine the comparative importance of risk factors for ischemic stroke and ICH in patients with atrial fibrillation, focusing primarily on risk factors included in the CHA2DS2VASC (risk of ischemic stroke) and HAS-BLED (risk of major bleeding) scores. Methods: Prospective registry of 3,197 patients admitted with acute ischemic stroke or ICH and atrial fibrillation included in the Registry of the Canadian Stroke Network (Jul 03-Mar 08; 11 Regional Stroke Centers in Ontario, Canada). Multivariable analysis was used to determine the association between baseline risk factors (age, sex, history of hypertension, previous stroke or transient ischemic attack, history of congestive heart failure, history of vascular disease, hepatic impairment, current alcohol intake, history of diabetes mellitus, history of gastro-intestinal bleeding, renal impairment, admission INR and antiplatelet therapy) and risk of ischemic stroke versus ICH. Results: Of 3,197 patients with atrial fibrillation and acute stroke, 2,806 (87.8%) presented with an ischemic stroke and 391 (12.2%) presented with an ICH. Of the ‘shared’ risk factors, age (OR 1.17; 95% CI 1.04-1.31 per decade) and previous history of stroke (OR 1.40; 95% CI 1.09-1.81) were associated with an increased risk of ischemic stroke relative to ICH, while a history of hypertension (OR 0.90; 95% CI 0.69-1.18) and renal impairment (OR 1.29; 0.96-1.72) were not associated with either stroke subtype, on multivariable analyses. Of the ‘non-shared’ risk factors, alcohol consumption of <2 units/day vs. no consumption (OR 1.61; 95% CI 1.24-2.09), female sex (OR 1.53; 95% CI 1.20-1.96) and a history of vascular disease (OR 1.73; 95% CI 1.30- 2.30) were associated with an increased risk of ischemic stroke relative to ICH. Elevated INR at the time of admission was a significant predictor of ICH, relative to ischemic stroke. Conclusion: None of the ‘shared’ risk factors were stronger predictors of ICH compared to ischemic stroke, which has obvious implications for clinical practice. In particular, older age was more strongly associated with ischemic stroke than ICH in patients with atrial fibrillation, and therefore, should be considered as a factor favoring a decision to commence anticoagulant therapy.

Abstract P9: Mid-Regional Pro-Adrenomedullin as a Novel Biomarker of Transient Ischemic Attack

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Satoshi Hosoki ◽  
Kazuo Washida ◽  
Yuriko Nakaoku ◽  
Teruhide Koyama ◽  
Hiroyuki Ishiyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Multivariable Analysis ◽  
Population Based ◽  
Blood Levels ◽  
Net Reclassification Improvement ◽  
Cerebrovascular Risk Factors ◽  
Cerebrovascular Risk ◽  
Ischemic Attack

Background: Transient ischemic attack (TIA) is often a warning sign for ischemic stroke within a couple of months and should be treated as an emergency disease. However, the symptoms often disappear within a few hours, making the diagnosis of TIA difficult. The peptide hormone adrenomedullin (AM) increases during the acute phase of ischemic stroke because AM is produced by vascular endothelial cells as a biological defense mechanism against hypoxia and oxidative stress during cerebral ischemia. Therefore, we hypothesized that the blood levels of mid-regional pro-adrenomedullin (MR-pro-AM), half-life of which is several hours and much longer than AM, in patients with TIA could be a useful biomarker for the diagnosis of TIA. Method: We retrospectively compared the blood levels of MR-pro-AM using stored peripheral blood samples of the TIA cohort within 14 days from onset in the National Cerebral and Cardiovascular Center from April 1, 2016 to March 30, 2019, and those of the population-based cohort of the Kyoto Prefectural University of Medicine. Results: The TIA cohort (n = 39) was significantly older (73 vs. 58 years old) and showed higher frequency of cerebrovascular risk factors and higher levels of MR-pro-AM (0.584 vs. 0.418 nmol/l) than the population-based cohort (n = 1298). The MR-pro-AM level was significantly associated with TIA: odds ratio (OR) per 0.1 nmol/l MR-pro-AM increment was 2.8 (95% confidence interval (CI) = 2.2-3.6) in univariable analysis and 1.5 (95% CI = 1.1-2.1) in multivariable analysis with sex, age, chronic kidney disease and cerebrovascular risk factors as covariates. The cutoff value of MR-pro-AM was 0.523 nmol/l based on receiver operating characteristic curve analysis for TIA, with a sensitivity of 69% and a specificity of 88% (area under the curve = 0.78). Moreover, the model with the blood level of MR-pro-AM in addition to the prediction model the ABCD 2 score predicted TIA more accurately (net reclassification improvement = 1.14, p < 0.001). The MR-pro-AM level was found significantly higher in the TIA cohort than the population-based cohort after propensity score-matching (0.665 vs. 0.525 nmol/l, p = 0.047). Conclusion: MR-pro-AM may be a promising diagnostic biomarker for TIA.

Abstract P268: Serum Lipids, Apolipoproteins, and Mortality among Coronary Artery Disease Patients

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Ding Ding ◽  
Xinrui Li ◽  
Jian Qiu ◽  
Rui Li ◽  
Yuan Zhang ◽  
...  
Keyword(s):  
Ldl Cholesterol ◽  
Prognostic Significance ◽  
Hdl Cholesterol ◽  
Study Cohort ◽  
Cvd Risk ◽  
Apo B ◽  
Hazard Ratios ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cvd Mortality

Background: The proatherogenic effect of LDL cholesterol and antiatherogenic effect of HDL cholesterol have been confirmed in general population. But controversy arises on the protective role of HDL cholesterol and predictive superiority of apolipoprotein (apo)B among CAD patients. Objectives: This study was to identify the association of different lipid measurements with CAD prognosis and compare their prognostic significance. Methods: The study cohort included 1916 CAD patients who were 40-85 years of age. Cox proportional hazards regression models were used to estimate the association of baseline 6 lipid factors (HDL cholesterol, LDL cholesterol, total cholesterol, non-HDL cholesterol, apoA-I, and apoB) and 3 ratios with all-cause and CVD mortality. Results: During a median follow-up of 3.1 years, 147 deaths were recorded, 113 of which were due to CVD. When lipid factors were categorized, HDL cholesterol showed a U-shape association with all-cause and CVD mortality after adjustment for major CVD risk factors. The multivariable-adjusted hazard ratios in HDL cholesterol<40 mg/dL and ≥70 mg/dL groups were 2.09 (95% CI 1.37-3.20) and 3.06 (95% CI 1.08-8.70) for all-cause mortality, and 2.59 (95% CI 1.53-4.38) and 4.83 (95% CI 1.47-15.8) for CVD mortality, compared with HDL cholesterol between 40 and 49 mg/dL group. ApoA-I level was inversely associated with the risk of all-cause and CVD mortality. The multivariable-adjusted hazard ratios across quartiles of apoA-I were 1.00, 0.59 (95% CI 0.38-0.92), 0.43 (95% CI 0.26-0.70), and 0.56 (95% CI 0.35-0.88) for all-cause mortality (P for trend =0.004), and 1.00, 0.55 (95% CI 0.33-0.91), 0.39 (95% CI 0.22-0.70), and 0.57 (95% CI 0.34-0.95) for CVD mortality (P=0.007). Serum LDL cholesterol, apoB, LDL/HDL ratio, and apoB/apoA-I ratio were positively associated with the risk of CVD mortality. Patients with LDL cholesterol ≥190 mg/dL had a 4.35-fold risk of CVD mortality (95% CI 1.34-14.2) compared with patients with LDL cholesterol<70 mg/dL. Patients with apoB ≥110 mg/dL had a 2.06-fold risk of CVD mortality (95% CI 1.10-3.85) compared with patients with apoB<90 mg/dL. The multivariable-adjusted hazard ratios in highest quartiles of LDL/HDL ratio and apoB/apoA-I ratio were 1.61 (95% CI 1.01-2.56) and 2.00 (95% CI 1.21-3.31) for all-cause mortality, and 1.74 (95% CI 1.02-2.96) and 2.33 (95% CI 1.32-4.14) for CVD mortality compared with the lowest quartiles. After further pair-wise comparison, LDL/HDL ratio and LDL cholesterol had stronger associations with all-cause and CVD mortality than other proatherogenic measurements. Conclusions: There was a U-shape association between HDL cholesterol and CVD mortality among CAD patients. High levels of LDL cholesterol and apoB, high LDL/HDL ratio and apoB/apoA-I ratio, and low level of apoA-I were independently associated with an increased risk of CVD mortality among Chinese CAD patients.

scholarly journals Association of Serum Magnesium and Calcium - Magnesium Ratio with Mortality in Patients with Coronary Artery Disease (P18-090-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Li Qing ◽  
Ling Wenhua
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Serum Magnesium ◽  
Inverse Association ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Low Serum ◽  
Cvd Mortality

Abstract Objectives Low serum magnesium (Mg) and high serum calcium (Ca) levels have been linked to increased mortality and cardiovascular disease (CVD) in the general population. This prospective study assessed whether there were independent associations of serum Mg levels and Ca-Mg ratio with all-cause and CVD mortality among patients with coronary artery disease (CAD). Methods A prospective cohort study of 3380 CAD patients was conducted. Cox regression models were used to estimate the association of serum Mg levels and Ca-Mg ratio with the risk of mortality. Results During a median follow-up of 7.59 years, there were 562 deaths recorded and 331 of them were CVD deaths. Spline plots displayed U-shaped associations between serum Mg levels and Ca-Mg ratio and all-cause as well as CVD mortality among CAD patients. Patients in the low serum Mg group had a 1.63-fold (95% confidence interval [CI] 1.32–2.00) risk of all-cause mortality and a 1.82-fold (95% CI 1.40–2.36) risk of CVD mortality compared with those in medium serum Mg group. Patients in high Ca-Mg ratio group had a 1.30-fold (95% CI 1.05–1.61) risk of all-cause mortality and a 1.50-fold (95% CI 1.13–1.98) risk of CVD mortality compared with those in medium Ca-Mg group. This inverse association between serum Mg and the risk of mortality did not change when participants were stratified by sex, age, types of CHD, history of diabetes and estimated glomerular filtration rate. Conclusions Low serum Mg concentrations and high Ca-Mg ratio were significantly associated with an increased risk of all-cause and CVD mortality in Chinese patients with CAD, independent of traditional CVD risk factors. Funding Sources The National Natural Science Fund.

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