scholarly journals One-year change in plasma volume and mortality in the Japanese general population: An observational cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254665
Author(s):  
Yoichiro Otaki ◽  
Tetsu Watanabe ◽  
Tsuneo Konta ◽  
Masafumi Watanabe ◽  
Koichi Asahi ◽  
...  
Keyword(s):  
Risk Factor ◽  
General Population ◽  
Plasma Volume ◽  
Additional Risk Factor ◽  
Plasma Volume Expansion ◽  
C Statistic ◽  
Kaplan Meier ◽  
Observational Cohort ◽  
Cox Proportional Hazard Regression ◽  
One Year

Background Changes in plasma volume, a marker of plasma volume expansion and contraction, are gaining attention in the field of cardiovascular disease because of its role in the prevention and management of heart failure. However, it remains unknown whether a 1-year change in plasma volume is a risk factor for all-cause, cardiovascular, and non-cardiovascular mortality in the general population. Methods and results We used a nationwide database of 134,291 subjects (age 40–75 years) who participated in the annual “Specific Health Check and Guidance in Japan” check-up for 2 consecutive years between 2008 and 2011. A 1-year change in plasm volume was calculated using the Strauss–Davis-Rosenbaum formula. There were 220 cardiovascular deaths, 1,001 non-cardiovascular deaths including 718 cancer deaths, and 1,221 all-cause deaths during the follow-up period of 3.9 years. All subjects were divided into quintiles based on the 1-year change in plasma volume. Kaplan–Meier analysis demonstrated that the highest 5th quintile had the greatest risk among the five groups. Multivariate Cox proportional hazard regression analysis demonstrated that a 1-year change in plasma volume was an independent risk factor for all-cause, cardiovascular, non-cardiovascular, and cancer deaths. The addition of a 1-year change in plasma volume to cardiovascular risk factors significantly improved the C-statistic, net reclassification, and integrated discrimination indexes. Conclusions Here, we have demonstrated for the first time that a 1-year change in plasma volume could be an additional risk factor for all-cause, cardiovascular, and non-cardiovascular (mainly cancer) mortality in the general population.

scholarly journals Association of nephronophthisis 4 genetic variation with cardiorenal syndrome and cardiovascular events in Japanese general population: the Yamagata (Takahata) study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Otaki ◽  
T W Watanabe ◽  
J G Goto ◽  
Y S Saito ◽  
T A Aono ◽  
...  
Keyword(s):  
Risk Factor ◽  
General Population ◽  
Cardiovascular Events ◽  
Cardiorenal Syndrome ◽  
Health Study ◽  
Nucleotide Polymorphisms ◽  
Logistic Analysis ◽  
Cox Proportional Hazard Regression ◽  
Gene Variability ◽  
Stage Renal Disease

Abstract Background Nephronophthisis (NPHP) 4 gene encoding nephrocystin-4, which contributes to end-stage renal disease in children and young adults, is involved in the development of the heart and kidneys. Cardiorenal syndrome (CRS), which consists of bidirectional dysfunction of the heart and kidneys, is a risk factor for cardiovascular events. Single nucleotide polymorphisms (SNPs) within the NPHP4 gene are reportedly associated with kidney function, even in adults. However, the association of NPHP4 gene variability with CRS and cardiovascular events remains unknown. Purpose To examine whether NPHP4 gene variability is related to CRS and cardiovascular events in general population. Methods and results This prospective cohort study included 2,946 subjects who participated in a community-based health study with a 16-year follow-up period. We genotyped 11 SNPs within the NPHP4 gene whose minor allele frequency was greater than 0.1 in the Japanese population. The SNP rs12058375 was significantly associated with CRS and cardiovascular events. Multivariate logistic analysis demonstrated a significant association between the homozygous A-allele of rs12058375 with the presence of CRS. Haplotype analysis identified the haplotype with the A-allele of rs12058375 as an increased susceptibility factor for CRS. Kaplan-Meier analysis demonstrated that homozygous A-allele carriers of rs12058375 had the greatest risk of developing cardiovascular events among the NPHP4 variants. Multivariate Cox proportional hazard regression analysis revealed that the homozygous A-allele and heterozygous carriers of rs12058375 were associated with cardiovascular events after adjusting for confounding factors. The net reclassification index and integrated discrimination index were significantly improved by the addition of rs12058375 as a cardiovascular risk factor. Conclusion Genetic variations in the NPHP4 gene were associated with CRS and cardiovascular events in the general population, suggesting that it may facilitate the early identification of high-risk subjects with CRS and cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None.

Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score

2015 ◽  
Vol 114 (10) ◽  
pp. 826-834 ◽  
Author(s):  
Flemming Skjøth ◽  
Peter Nielsen ◽  
Torben Bjerregaard Larsen ◽  
Gregory Lip
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Additional Risk Factor ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors ◽  
Long Run ◽  
One Year ◽  
Net Clinical Benefit

SummaryOral anticoagulation (OAC) to prevent stroke has to be balanced against the potential harm of serious bleeding, especially intracranial haemorrhage (ICH). We determined the net clinical benefit (NCB) balancing effectiveness and safety of no antithrombotic therapy, aspirin and warfarin in AF patients with none or one stroke risk factor. Using Danish registries, we determined NCB using various definitions intrinsic to our cohort (Danish weights at 1 and 5 year follow-up), with risk weights which were derived from the hazard ratio (HR) of death following an event, relative to HR of death after ischaemic stroke. When aspirin was compared to no treatment, NCB was neutral or negative for both risk strata. For warfarin vs no treatment, NCB using Danish weights was neutral where no risk factors were present and using five years follow-up. For one stroke risk factor, NCB was positive for warfarin vs no treatment, for one year and five year follow-up. For warfarin vs aspirin use in patients with no risk factors, NCB was positive with one year follow-up, but neutral with five year follow-up. With one risk factor, NCB was generally positive for warfarin vs aspirin. In conclusion, we show a positive overall advantage (i.e. positive NCB) of effective stroke prevention with OAC, compared to no therapy or aspirin with one additional stroke risk factor, using Danish weights. ‘Low risk’ AF patients with no additional stroke risk factors (i.e. CHA2DS2-VASc 0 in males, 1 in females) do not derive any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

Abstract P016: Physical Activity as Key Risk Factors for Incident Dementiain a Thai Population: Health Checks Ubon Ratchathani (HCUR) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Parinya Chamnan ◽  
Prasert Boongird ◽  
Somsak Laptikultham ◽  
Wannee Nitiyanont ◽  
Wichai Aekplakorn ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Physical Exercise ◽  
Cox Regression ◽  
Thai Population ◽  
Cohort Study Design ◽  
Independent Risk Factors ◽  
Cox Proportional Hazard Regression ◽  
One Year ◽  
Regular Physical Exercise

Introduction: There is little evidence to describe risk factors for dementia in a Thai general population. Hypothesis: This study was aimed to examine factors associated with the risk of developing dementia in a Thai general population in Ubon Ratchathani. Methods: Data on 761,935 men and women participating in the Health Check Ubon Ratchathani (HCUR) Project in 2006-7 were merged with diagnostic information from hospital’s electronic medical records in the following 5 years (2006-2012). Using a retrospective cohort study design, we examined the incidence of physician-diagnosed dementia over 5 years. Factors independently associated with the risk of developing dementia were examined using multivariate cox proportional hazard regression. Results: Over a total time at risk of 4,407,201 person-years, 519 individuals developed dementia, the incidence rate of dementia was 0.12 (95%CI 0.11-0.13) per 1,000 person-years. Factors independently associated with the risk of developing dementia in multivariate cox regression included increasing age, diabetes and lack of physical exercise. The risk of dementia rose by 9% for every one year of age older (Hazard ratio (HR) of 1.09 (1.08-1.09), p<0.001). Diabetes increased the risk of dementia by almost 2 times (HR 1.67 (1.26-2.23), p<0.05). Compared to no physical exercise, regular physical exercise of 3-5 days/week and >5 days/week reduced the risk of dementia by 36% and 57% (HR 0.64 (0.52-0.78) and 0.43 (0.28-0.67) respectively). These associations remained significant after controlling for sex, hypertension, systolic blood pressure, smoking, body mass index, waist circumference, high salt diet and alcohol drinking. Discussion: In this Thai general population, the incidence of dementia was modest and its independent risk factors included increasing age, diabetes and lack of physical exercise. Regular physical exercise may counter balance aging process, the main drive of dementia. The more physical exercise you do, the lower risk of dementia.

scholarly journals The association between transfer coefficient of the lung and the risk of exacerbation in asthma-COPD overlap: an observational cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroaki Ogata ◽  
Katsuyuki Katahira ◽  
Aimi Enokizu-Ogawa ◽  
Yujiro Jingushi ◽  
Akiko Ishimatsu ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Risk Factor ◽  
Confidence Interval ◽  
Transfer Coefficient ◽  
Severe Exacerbation ◽  
National Hospital ◽  
Increased Risk ◽  
Observational Cohort ◽  
One Year ◽  
Low K

Abstract Background Asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) patients experience exacerbations more frequently than those with asthma or COPD alone. Since low diffusing capacity of the lung for carbon monoxide (DLCO) is known as a strong risk factor for severe exacerbation in COPD, DLCO or a transfer coefficient of the lung for carbon monoxide (KCO) is speculated to also be associated with the risk of exacerbations in ACO. Methods This study was conducted as an observational cohort survey at the National Hospital Organization Fukuoka National Hospital. DLCO and KCO were measured in 94 patients aged ≥ 40 years with a confirmed diagnosis of ACO. Multivariable-adjusted hazard ratios (HRs) for the exacerbation-free rate over one year were estimated and compared across the levels of DLCO and KCO. Results Within one year, 33.3% of the cohort experienced exacerbations. After adjustment for potential confounders, low KCO (< 80% per predicted) was positively associated with the incidence of exacerbation (multivariable-adjusted HR = 3.71 (95% confidence interval 1.32–10.4)). The association between low DLCO (< 80% per predicted) and exacerbations showed similar trends, although it failed to reach statistical significance (multivariable-adjusted HR = 1.31 (95% confidence interval 0.55–3.11)). Conclusions Low KCO was a significant risk factor for exacerbations among patients with ACO. Clinicians should be aware that ACO patients with impaired KCO are at increased risk of exacerbations and that careful management in such a population is mandatory.

Improved Risk Stratification With Addition Of Male Sex (S) To The Elderly International Prognostic Index (S-EIPI) For DLBCL Patients > 60 Years Treated With R-CHOP: An International Collaboration Of The US Intergroup, German High-Grade Non-Hodgkin Lymphoma Study Group and Groupe d’Etude De Lymphome d’Adultes

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3045-3045
Author(s):  
Ranjana H. Advani ◽  
Fangxin Hong ◽  
Thomas M. Habermann ◽  
Hailun Li ◽  
Brad S. Kahl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Stratification ◽  
Risk Group ◽  
International Prognostic Index ◽  
Risk Groups ◽  
Additional Risk Factor ◽  
Excellent Outcome ◽  
C Statistic ◽  
Kaplan Meier ◽  
Male Sex

Abstract Background We have previously reported and validated that the E-IPI, provided better discrimination of overall survival (OS) than the IPI for DLBCL patients > 60 years of age treated with R-CHOP (Advani et al., BJH 2010 and 12-ICML 2013 Abstract 222). Recent reports suggest that males > 60 years treated with R-CHOP have worse outcomes likely related to differences in rituximab clearance (Muller et al., Blood 2012). In this study, we explored if the addition of male sex to the E-IPI further improved risk stratification. Methods DLBCL patients > 60 years treated with R-CHOP on the E4494, RICOVER-60 and GELA 98-5 trials were included. A multivariate analysis was performed to assess whether male sex is an independent prognostic factor for OS in addition to the five E-IPI risk factors, E-IPI score, and E-IPI risk group. Male sex (S) was added as an additional risk factor to the E-IPI (S-EIPI, 0-6) and patients regrouped according to the number of risk factors: low (L)=0-1, low intermediate (LI)=2, high intermediate (HI)=3 and high (H)=4-6 based on the observed OS using Kaplan-Meier curves. C-statistic was used to compare the discrimination ability. The 5 year OS was estimated using the Kaplan-Meier method. Results 1079 patients (E4494, n=267; RICOVER-60, n=610; GELA 98-5, n=202) with a median follow-up of 8.9 years were included. In multivariate analyses, male sex was a significant independent predictor for OS adjusting for all five E-IPI factors, (HR 1.5, p < 0.0001), E-IPI score (HR 1.42, p < 0.001), and E-IPI risk group (HR 1.42, p < 0.001) (Table 1). C-statistic was 0.66 for S-EIPI and 0.64 for EIPI. Incorporation of sex into the E-IPI shifted 35% patients to higher risk groups, including 110 patients into the highest risk group (Table 2). The estimated 5 year OS for the S-EIPI L, LI, HI, and H risk groups was 87%, 70%, 58%, and 40%, respectively (Table 3). Compared to E-IPI, the 95% C.I. did not overlap among S-EIPI risk groups. Conclusion For DLBCL patients >60 years treated with R-CHOP, our results suggest the addition of male sex to the E-IPI may improve categorization of patients into well-defined clinically relevant risk groups. Patients with low risk S-EIPI have an excellent outcome (5 year OS 87%). Patients with high risk S-EIPI have a 5 year OS of only 40% and therapies beyond standard R-CHOP need to be explored. Disclosures: Horning: Genentech: Employment; Roche: Equity Ownership.

Surgical Management of Heterotaxy Syndrome: Current Challenges and Opportunities

2020 ◽  
Vol 11 (2) ◽  
pp. 166-176
Author(s):  
Ashlyn M. Alongi ◽  
James K. Kirklin ◽  
Luqin Deng ◽  
Luz Padilla ◽  
Jozef Pavnica ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Management ◽  
Major Risk Factor ◽  
Right Atrial ◽  
Heterotaxy Syndrome ◽  
Cardiac Operation ◽  
Early Repair ◽  
Kaplan Meier ◽  
One Year ◽  
Atrial Isomerism

Introduction: Heterotaxy syndrome presents a unique challenge in surgical management, even in the current era. We hypothesized that certain anatomic subsets merit novel strategies. Methods: We analyzed morphologic details, surgeries, comorbidities, subsequent admissions, and survival using Kaplan-Meier methods and multivariable risk models from a single-institution experience of 103 consecutive patients with heterotaxy who underwent cardiac surgery between January 1, 1990, and May 31, 2016. Results: Of the 103 patients (50 males and 53 females), 31 had left atrial isomerism, 64 had right atrial isomerism (RAI), and 8 patients’ isomerism was indeterminate (IND), with first cardiac operation at a mean 1.0 year (standard deviation ±3.0 years) of age. Kaplan-Meier overall survival estimate was 83.1% at six months, 77.8% at one year, 65.9% at five years, and 52.1% at ten years. Survival was particularly low among RAI following repair of total anomalous pulmonary venous connection (TAPVC) at first operation, with one- and five-year survival of 57% and 46%, respectively. By multivariable analysis, the only risk factor for death during the early phase (hazard model) was repair of TAPVC at the first cardiac operation (hazard ratio [HR]: 4.4, P = .01), and risk factors during the longer term constant phase were atrioventricular valve (AVV) regurgitation (HR: 4.2, P < .01), male gender (HR: 3.7, P < .01), and two-ventricle repair (HR: 3.0, P = .02). Patients with heterotaxy undergoing the Fontan procedure had excellent subsequent survival (85% at ten years). Conclusions: This analysis of over 100 patients with heterotaxy identified TAPVC requiring initial repair as the major risk factor for early death and important AVV regurgitation as the major risk factor in the longer term. Survival with RAI and early repair of TAPVC were poor, with one-year mortality exceeding 40%. Patients with single ventricle completing the Fontan operation enjoyed outstanding ten-year survival (85%). Initial management of RAI requiring early repair of TAPVC remains challenging. For this high-risk subset, alternative strategies such as early referral for cardiac transplantation evaluation warrant consideration.

scholarly journals Observed and Expected Survival in Men and Women after Suffering a STEMI

2020 ◽  
Vol 9 (4) ◽  
pp. 1174
Author(s):  
Isaac Pascual ◽  
Daniel Hernandez-Vaquero ◽  
Marcel Almendarez ◽  
Rebeca Lorca ◽  
Alain Escalera ◽  
...  
Keyword(s):  
Risk Factor ◽  
General Population ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Reference Population ◽  
Men And Women ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Similar Survival ◽  
One Year

Introduction: Mortality caused by ST elevation myocardial infarction (STEMI) has declined because of greater use of primary percutaneous coronary intervention (PCI). It is unknown if patients >75 have similar survival as peers. We aim to know it stratifying by sex and assessing how the sex may impact the survival. Methods: We retrospectively selected all patients >75 who suffered a STEMI treated with primary PCI at our institution. We compared their survival with that of the reference population (general population matched by age, sex, and geographical region). A Cox-regression analysis controlling for clinical factors was performed to know if sex was a risk factor. Results: Total of 450 patients were studied. Survival at 1, 3, and 5 years of follow-up for patients who survived the first 30 days was 91.22% (CI95% 87.80–93.72), 79.71% (CI95% 74.58–83.92), and 68.02% (CI95% 60.66–74.3), whereas in the reference population it was 93.11%, 79.10%, and 65.01%, respectively. Sex was not a risk factor, Hazard Ratio = 1.02 (CI95% 0.67-1.53; p = 0.92). Conclusions: Life expectancy of patients suffering a STEMI is nowadays intimately linked to survival in the first 30 days. After one year, the risk of death for both men and women seems similar to that of the general population.

scholarly journals Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register

2011 ◽  
Vol 70 (4) ◽  
pp. 583-589 ◽  
Author(s):  
Moetaza M Soliman ◽  
Darren M Ashcroft ◽  
Kath D Watson ◽  
Mark Lunt ◽  
Deborah P M Symmons ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
British Society ◽  
Concomitant Disease ◽  
Treatment Persistence ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
Observational Cohort ◽  
One Year ◽  
Biologics Register

ObjectiveTo evaluate the effect of different concomitant disease modifying antirheumatic drugs (DMARDs) on the persistence with antitumour necrosis factor (anti-TNF) therapies in patients with rheumatoid arthritis (RA).MethodThis analysis included 10 396 patients with RA registered with the British Society for Rheumatology Biologics Register, a prospective observational cohort study, who were starting their first anti-TNF therapy and were receiving one of the following DMARD treatments at baseline: no DMARD (n=3339), methotrexate (MTX) (n=4418), leflunomide (LEF) (n=610), sulfasalazine (SSZ) (n=308), MTX+SSZ (n=902), MTX+ hydroxychloroquine (HCQ) (n=401) or MTX+SSZ+HCQ (n=418). Kaplan–Meier survival analysis was used to study the persistence with anti-TNF therapy in each DMARD subgroup up to 5 years. Multivariate Cox proportional hazard models, stratified by anti-TNF used and start year and adjusted for a number of potential confounders, were used to compare treatment persistence overall and according to the reason for discontinuation between each of the DMARD subgroups, using MTX as reference.ResultsOne-year drug survival (95% CI) for the first anti-TNF therapy was 71% (71% to 72%) but this dropped to 42% (41% to 43%) at 5 years. Compared with MTX, patients receiving no DMARD, LEF or SSZ were more likely to discontinue their first anti-TNF therapy while patients receiving MTX in combination with other DMARDs showed better treatment persistence.ConclusionsThese results support the continued use of background DMARD combinations which include MTX. Consideration should be given to the discontinuation of LEF and SSZ monotherapy at the time anti-TNF therapies are started, with the possible exception of the SSZ+ETN combination.

scholarly journals Diabetes Mellitus as a Risk Factor for Trigger Finger –a Longitudinal Cohort Study Over More Than 20 Years

2021 ◽  
Vol 2 ◽  
Author(s):  
Jin Persson Löfgren ◽  
Malin Zimmerman ◽  
Lars B. Dahlin ◽  
Peter M. Nilsson ◽  
Mattias Rydberg
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Cohort Study ◽  
Population Based ◽  
Trigger Finger ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Kaplan Meier ◽  
National Patient ◽  
Cox Proportional Hazard Regression

Background and AimTrigger finger (TF) or stenosing tenosynovitis has been associated with diabetes mellitus (DM), although today’s knowledge is mostly based on cross-sectional and case-control studies. Thus, the aim of the present population-based cohort study over more than 20 years was to investigate DM as a risk factor for TF.MethodsData from Malmö Diet and Cancer Study (MDCS), including 30,446 individuals, were analysed with regards to baseline DM and known or potential confounders. Information regarding TF diagnosis until study end date of Dec 31st, 2018, was retrieved from the Swedish National Patient Register (NPR) using ICD-codes. Survival probability was investigated in Kaplan-Meier plots. Cox proportional hazard regression model was used to evaluate DM as risk factor for TF, adjusted for several confounders and presented as Hazard Ratio (HR) with 95% confidence intervals (CI).ResultsAt baseline, 4.6% (1,393/30,357) participants had DM. In total, 3.2% (974/30,357) participants were diagnosed with TF during the study period. Kaplan-Meier plot showed that the probability for incident TF was significantly higher in participants with baseline DM compared with individuals without baseline DM. Adjusted HR for DM as risk factor for TF was 2.0 (95% CI: 1.5-2.6, p&lt;0.001).ConclusionThis longitudinal study showed that DM is an important risk factor for developing TF. When adjusting for sex, age, BMI, manual work, statin use, smoking and alcohol consumption, DM remained the main risk factor for TF.

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