scholarly journals Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients

2010 ◽  
Vol 163 (4) ◽  
pp. 699-708 ◽  
Author(s):  
Caroline Sievers ◽  
Jens Klotsche ◽  
Lars Pieper ◽  
Harald J Schneider ◽  
Winfried März ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Total Testosterone ◽  
Similar Data ◽  
Testosterone Levels ◽  
All Cause Mortality

ObjectiveAlthough associations between testosterone and cardiovascular (CV) morbidity in women have been proposed, no large prospective study has evaluated potential associations between testosterone and mortality in women. The objective was to determine whether baseline testosterone levels in women are associated with future overall or CV morbidity and mortality.DesignProspective cohort study with a 4.5-year follow-up period.MethodsFrom a representative sample of German primary care practices, 2914 female patients between 18 and 75 years were analyzed for the main outcome measures: CV risk factors, CV diseases, and all-cause mortality.ResultsAt baseline, the study population was aged 57.96±14.37 years with a mean body mass index of 26.71±5.17 kg/m2. No predictive value of total testosterone for incident CV risk factors or CV diseases was observed in logistic regressions. Patients with total testosterone levels in the lowest quintile Q1, however, had a higher risk to die of any cause or to develop a CV event within the follow-up period compared to patients in the collapsed quintiles Q2–Q5 in crude and adjusted Cox regression models (all-cause mortality: Q2–Q5 versus Q1: crude hazard ratios (HR) 0.49, 95% confidence interval (CI) 0.33–0.74; adjusted HR 0.62, 95% CI 0.42–0.939; CV events: Q2–Q5 versus Q1: crude HR 0.54, 95% CI 0.38–0.77; adjusted HR 0.68, 95% CI 0.48–0.97). Kaplan–Meier curves revealed similar data.ConclusionsLow baseline testosterone in women is associated with increased all-cause mortality and incident CV events independent of traditional risk factors.

scholarly journals Depression, non-fatal stroke and all-cause mortality in old age: A prospective cohort study of primary care patients

2013 ◽  
Vol 150 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Sebastian Köhler ◽  
Frans Verhey ◽  
Siegfried Weyerer ◽  
Birgitt Wiese ◽  
Kathrin Heser ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Old Age ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Fatal Stroke ◽  
All Cause Mortality ◽  
Primary Care Patients

Follow-up care of children identified with ADHD by primary care clinicians: A prospective cohort study

2004 ◽  
Vol 145 (6) ◽  
pp. 767-771 ◽  
Author(s):  
William Gardner ◽  
Kelly J. Kelleher ◽  
Kathleen Pajer ◽  
John V. Campo
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Follow Up Care ◽  
Primary Care Clinicians

scholarly journals Vitamin D intake and risk of CVD and all-cause mortality: evidence from the Caerphilly Prospective Cohort Study

2017 ◽  
Vol 20 (15) ◽  
pp. 2744-2753 ◽  
Author(s):  
Jing Guo ◽  
John R Cockcroft ◽  
Peter C Elwood ◽  
Janet E Pickering ◽  
Julie A Lovegrove ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Cohort Study ◽  
Diastolic Blood Pressure ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cvd Risk ◽  
Vitamin D Intake ◽  
All Cause Mortality

AbstractObjectiveProspective data on the associations between vitamin D intake and risk of CVD and all-cause mortality are limited and inconclusive. The aim of the present study was to investigate the associations between vitamin D intake and CVD risk and all-cause mortality in the Caerphilly Prospective Cohort Study.DesignThe associations of vitamin D intake with CVD risk markers were examined cross-sectionally at baseline and longitudinally at 5-year, 10-year and >20-year follow-ups. In addition, the predictive value of vitamin D intake for CVD events and all-cause mortality after >20 years of follow-up was examined. Logistic regression and general linear regression were used for data analysis.SettingParticipants in the UK.SubjectsMen (n452) who were free from CVD and type 2 diabetes at recruitment.ResultsHigher vitamin D intake was associated with increased HDL cholesterol (P=0·003) and pulse pressure (P=0·04) and decreased total cholesterol:HDL cholesterol (P=0·008) cross-sectionally at baseline, but the associations were lost during follow-up. Furthermore, higher vitamin D intake was associated with decreased concentration of plasma TAG at baseline (P=0·01) and at the 5-year (P=0·01), but not the 10-year examination. After >20 years of follow-up, vitamin D was not associated with stroke (n72), myocardial infarctions (n142), heart failure (n43) or all-cause mortality (n281), but was positively associated with increased diastolic blood pressure (P=0·03).ConclusionsThe study supports associations of higher vitamin D intake with lower fasting plasma TAG and higher diastolic blood pressure.

scholarly journals Effects of cardiac rehabilitation on the two-year prognosis of patients with heart failure: a multicentre prospective cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Adachi ◽  
N Iritani ◽  
K Kamiya ◽  
K Iwatsu ◽  
K Kamisaka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Landmark Analysis ◽  
All Cause Mortality

Abstract Background Cardiac rehabilitation (CR) is a comprehensive disease management program highly recommended by heart failure (HF) guidelines. However, the prognostic effects of outpatient CR are inconsistent among recent meta-analyses which enrolled mainly younger HF with reduced ejection fraction (HFrEF). With an aging population, an increased importance of CR has been put on patients with HF with preserved ejection fraction (HFpEF). Purpose This study aimed to examine the prognostic effects of regularly undergoing CR for 6 months after discharge analysing nationwide cohort data including older population with HFrEF and HFpEF. Methods We analysed 2876 patients who hospitalised for acute HF or worsening chronic HF and capable of walking at discharge in the multicentre prospective cohort study. Frequency of outpatient CR participation of each patient was collected using medical records. We assessed CR frequency within 6 months of discharge since most collaborating hospitals conducted final follow-up examinations at 6 months. The CR group was defined as patients who underwent outpatient CR once or more per week for 6 months after discharge. The main study endpoint was a composite of all-cause mortality and HF rehospitalisation during a 2-year follow-up. We performed a propensity score-matched analysis to compare survival rates between the CR and non-CR groups. Propensity scores for each patient were produced by a logistic regression analysis with the CR group as the dependent variable and 33 potential confounders as independent variables. To evaluate events beyond 6 months, we also conducted landmark analyses at 6 months. Results Of the 2876 enrolled patients, 313 underwent CR for 6 months. After propensity score matching using confounding factors, 626 patients (313 pairs) were included in the survival analysis (median age: 74 years, men: 59.6%, median left ventricular ejection fraction [LVEF]: 42%). During 1006.1 person-years of follow-up, 137 patients were rehospitalised due to HF exacerbation, and 50 patients died in the matched cohort. In Cox proportional hazards model (Figure 1), CR was associated with a reduced risk of composite outcomes (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.48–0.91), all-cause mortality (HR 0.53; 95% CI 0.30–0.95), and HF rehospitalisation (HR 0.66; 95% CI 0.47–0.92). A subgroup analysis showed similar CR effects in patients with HFpEF (LVEF ≥50%) and HFrEF (LVEF <40%). However, in a landmark analysis, CR did not reduce the adverse outcomes beyond 6 months after discharge (Figure 2). Conclusions The findings of this study demonstrate the needs that CR should become a standard treatment for HF regardless of HF type and the necessity of periodical follow-up after completing CR program to maintain its prognostic effects. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science Figure 1. Prognostic effects of CR Figure 2. Landmark analysis

scholarly journals Disability Trajectories in Patients With Complaints of Arm, Neck, and Shoulder (CANS) in Primary Care: Prospective Cohort Study

2016 ◽  
Vol 96 (7) ◽  
pp. 972-984 ◽  
Author(s):  
Harald S. Miedema ◽  
Anita Feleus ◽  
Sita M.A. Bierma-Zeinstra ◽  
Trynke Hoekstra ◽  
Alex Burdorf ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Latent Class ◽  
Diagnostic Category ◽  
Prognostic Indicators ◽  
Multinomial Regression ◽  
Poor General Health

Abstract Background Nontraumatic complaints of arm, neck, and shoulder (CANS) represent an important health issue, with a high prevalence in the general working age population and huge economic impact. Nevertheless, only few prospective cohort studies for the outcome of CANS are available. Objectives The purpose of this study was to identify disability trajectories and associated prognostic factors during a 2-year follow-up of patients with a new episode of CANS in primary care. Design This was a prospective cohort study. Methods Data of 682 participants were collected through questionnaires at baseline and every 6 months thereafter. Disability was measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Latent class growth mixture (LCGM) modeling was used to identify clinically meaningful groups of patients who were similar in their disability trajectory during follow-up. Multivariate multinomial regression analysis was used to evaluate associations between sociodemographic, complaint-related, physical, and psychosocial variables and the identified disability trajectories. Results Three disability trajectories were identified: fast recovery (67.6%), modest recovery (23.6%), and continuous high disability (8.8%). A high level of somatization was the most important baseline predictor of continuous high disability. Furthermore, poor general health, widespread complaints, and medium level of somatization were associated with this trajectory and >3 months complaint duration, musculoskeletal comorbidity, female sex, history of trauma, low educational level, low social support, and high complaint severity were associated with both continuous high disability and modest recovery. Age, kinesiophobia, and catastrophizing showed significant associations only with modest recovery. Limitations Loss to follow-up ranged from 10% to 22% at each follow-up measurement. Disabilities were assessed only with the DASH and not with physical tests. Misclassification by general practitioners regarding specific or nonspecific diagnostic category might have occurred. The decision for optimal LCGM model, resulting in the disability trajectories, remains arbitrary to some extent. Conclusions Three trajectories described the course of disabilities due to CANS. Several prognostic indicators were identified that can easily be recognized in primary care. As some of these prognostic indicators may be amenable for change, their presence in the early stages of CANS may lead to more intensive or additional interventions (eg, psychological or multidisciplinary therapy). Further research focusing on the use of these prognostic indicators in treatment decisions is needed to further substantiate their predictive value.

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