Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery

Objective: To determine the relationship between preoperative glucose levels and perioperative mortality in noncardiac, nonvascular surgery. Research design and methods: We performed a case–control study in a cohort of 108 593 patients who underwent noncardiac surgery at the Erasmus MC during 1991–2001. Cases were 989 patients who underwent elective noncardiac, nonvascular surgery and died within 30 days during hospital stay. From the remaining patients, 1879 matched controls (age, sex, calendar year, and type of surgery) were selected. Information was obtained regarding the presence of cardiac risk factors, medication, and preoperative laboratory results. Preoperative random glucose levels <5.6 mmol/l (110 mg/dl) were normal. Impaired glucose levels in the range of 5.6–11.1 mmol/l were prediabetes. Glucose levels ≥11.1 mmol/l (200 mg/dl) were diabetes. Results: Preoperative glucose levels were available in 904 cases and 1247 controls. A cardiovascular complication was the primary cause of death in 207 (23%) cases. Prediabetes glucose levels were associated with a 1.7-fold increased mortality risk compared with normoglycemic levels (adjusted odds ratio (OR) 1.7 and 95% confidence interval (CI) 1.4–2.1; P<0.001). Diabetes glucose levels were associated with a 2.1-fold increased risk (adjusted OR 2.1 and 95% CI 1.3–3.5; P<0.001). In cases with cardiovascular death, prediabetes glucose levels had a threefold increased cardiovascular mortality risk (adjusted OR 3.0 and 95% CI 1.7–5.1) and diabetes glucose levels had a fourfold increased cardiovascular mortality risk (OR 4.0 and 95% CI 1.3–12). Conclusions: Preoperative hyperglycemia is associated with increased (cardiovascular) mortality in patients undergoing noncardiac, nonvascular surgery.

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Addition of cystatin C predicts cardiovascular death better than creatinine in intensive care

Heart ◽

10.1136/heartjnl-2020-318860 ◽

2021 ◽

pp. heartjnl-2020-318860

Author(s):

Johanna Helmersson-Karlqvist ◽

Miklos Lipcsey ◽

Johan Ärnlöv ◽

Max Bell ◽

Bo Ravn ◽

...

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Cystatin C ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Cardiovascular Death ◽

University Hospitals ◽

Cardiovascular Mortality Risk

ObjectiveDecreased kidney function increases cardiovascular risk and predicts poor survival. Estimated glomerular filtration rate (eGFR) by creatinine may theoretically be less accurate in the critically ill. This observational study compares long-term cardiovascular mortality risk by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation; Caucasian, Asian, paediatric and adult cohort (CAPA) cystatin C equation and the CKD-EPI combined creatinine/cystatin C equation.MethodsThe nationwide study includes 22 488 intensive care patients in Uppsala, Karolinska and Lund University Hospitals, Sweden, between 2004 and 2015. Creatinine and cystatin C were analysed with accredited methods at admission. Reclassification and model discrimination with C-statistics was used to compare creatinine and cystatin C for cardiovascular mortality prediction.ResultsDuring 5 years of follow-up, 2960 (13 %) of the patients died of cardiovascular causes. Reduced eGFR was significantly associated with cardiovascular death by all eGFR equations in Cox regression models. In each creatinine-based GFR category, 17%, 19% and 31% reclassified to a lower GFR category by cystatin C. These patients had significantly higher cardiovascular mortality risk, adjusted HR (95% CI), 1.55 (1.38 to 1.74), 1.76 (1.53 to 2.03) and 1.44 (1.11 to 1.86), respectively, compared with patients not reclassified. Harrell’s C-statistic for cardiovascular death for cystatin C, alone or combined with creatinine, was 0.73, significantly higher than for creatinine (0.71), p<0.001.ConclusionsA single cystatin C at admission to the intensive care unit added significant predictive value to creatinine for long-term cardiovascular death risk assessment. Cystatin C, alone or in combination with creatinine, should be used for estimating GFR for long-term risk prediction in critically ill.

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Relationship between sex and cardiovascular mortality in chronic kidney disease: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0254554 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254554

Author(s):

Sultana Shajahan ◽

Janaki Amin ◽

Jacqueline K. Phillips ◽

Cara M. Hildreth

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Increased Risk ◽

The Usa ◽

The Impact ◽

Cardiovascular Mortality Risk

Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03–1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.

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Risk of Typical Diabetes-Associated Complications in Different Clusters of Diabetic Patients: Analysis of Nine Risk Factors

Journal of Personalized Medicine ◽

10.3390/jpm11050328 ◽

2021 ◽

Vol 11 (5) ◽

pp. 328

Author(s):

Michael Leutner ◽

Nils Haug ◽

Luise Bellach ◽

Elma Dervic ◽

Alexander Kautzky ◽

...

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Diabetic Patients ◽

Complication Risk ◽

Increased Risk ◽

Icd 10 ◽

Healthy Control ◽

Design And Methods ◽

The Relationship ◽

Observation Period

Objectives: Diabetic patients are often diagnosed with several comorbidities. The aim of the present study was to investigate the relationship between different combinations of risk factors and complications in diabetic patients. Research design and methods: We used a longitudinal, population-wide dataset of patients with hospital diagnoses and identified all patients (n = 195,575) receiving a diagnosis of diabetes in the observation period from 2003–2014. We defined nine ICD-10-codes as risk factors and 16 ICD-10 codes as complications. Using a computational algorithm, cohort patients were assigned to clusters based on the risk factors they were diagnosed with. The clusters were defined so that the patients assigned to them developed similar complications. Complication risk was quantified in terms of relative risk (RR) compared with healthy control patients. Results: We identified five clusters associated with an increased risk of complications. A combined diagnosis of arterial hypertension (aHTN) and dyslipidemia was shared by all clusters and expressed a baseline of increased risk. Additional diagnosis of (1) smoking, (2) depression, (3) liver disease, or (4) obesity made up the other four clusters and further increased the risk of complications. Cluster 9 (aHTN, dyslipidemia and depression) represented diabetic patients at high risk of angina pectoris “AP” (RR: 7.35, CI: 6.74–8.01), kidney disease (RR: 3.18, CI: 3.04–3.32), polyneuropathy (RR: 4.80, CI: 4.23–5.45), and stroke (RR: 4.32, CI: 3.95–4.71), whereas cluster 10 (aHTN, dyslipidemia and smoking) identified patients with the highest risk of AP (RR: 10.10, CI: 9.28–10.98), atherosclerosis (RR: 4.07, CI: 3.84–4.31), and loss of extremities (RR: 4.21, CI: 1.5–11.84) compared to the controls. Conclusions: A comorbidity of aHTN and dyslipidemia was shown to be associated with diabetic complications across all risk-clusters. This effect was amplified by a combination with either depression, smoking, obesity, or non-specific liver disease.

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Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.04.058 ◽

2014 ◽

Vol 64 (5) ◽

pp. 472-481 ◽

Cited By ~ 359

Author(s):

Duck-chul Lee ◽

Russell R. Pate ◽

Carl J. Lavie ◽

Xuemei Sui ◽

Timothy S. Church ◽

...

Keyword(s):

Mortality Risk ◽

Cardiovascular Mortality ◽

Leisure Time ◽

Cardiovascular Mortality Risk

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Relationship between Cardiovascular Disease Risk and Neck Circumference Shown in the Systematic Coronary Risk Estimation (SCORE) Risk Model

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010763 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10763

Author(s):

Serkan Asil ◽

Ender Murat ◽

Hatice Taşkan ◽

Veysel Özgür Barış ◽

Suat Görmel ◽

...

Keyword(s):

Mortality Risk ◽

Cardiovascular Mortality ◽

Risk Model ◽

Disease Risk ◽

Neck Circumference ◽

Anthropometric Measurements ◽

Cvd Risk ◽

Cardiovascular Mortality Risk ◽

Very High ◽

Score Risk

Introduction: The most important way to reduce CVD-related mortality is to apply appropriate treatment according to the risk status of the patients. For this purpose, the SCORE risk model is used in Europe. In addition to these risk models, some anthropometric measurements are known to be associated with CVD risk and risk factors. Objectives: This study aimed to investigate the association of these anthropometric measurements, especially neck circumference (NC), with the SCORE risk chart. Methods: This was planned as a cross-sectional study. The study population were classified according to their SCORE risk values. The relationship of NC and other anthropometric measurements with the total cardiovascular risk indicated by the SCORE risk was investigated. Results: A total of 232 patients were included in the study. The patients participating in the study were analysed in four groups according to the SCORE ten-year total cardiovascular mortality risk. As a result, the NC was statistically significantly lower among the SCORE low and moderate risk group than all other SCORE risk groups (low-high and very high 36(3)–38(4) (IQR) p: 0.026, 36(3)–39(4) (IQR) p < 0.001, 36(3)–40(4) (IQR) p < 0.001), (moderate-high and very high 38(4) vs. 39(4) (IQR) p: 0.02, 38(4) vs. 40(4) (IQR) p < 0.001, 39(4) vs. 40(4) (IQR) p > 0.05). NC was found to have the strongest correlation with SCORE than the other anthropometric measurements. Conclusions: Neck circumference correlates strongly with the SCORE risk model which shows the ten-year cardiovascular mortality risk and can be used in clinical practice to predict CVD risk.

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Cardiovascular Mortality Risk in Chronic Kidney Disease

JAMA ◽

10.1001/jama.293.14.1737 ◽

2005 ◽

Vol 293 (14) ◽

pp. 1737 ◽

Cited By ~ 464

Author(s):

Michael G. Shlipak ◽

Linda F. Fried ◽

Mary Cushman ◽

Teri A. Manolio ◽

Do Peterson ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Cardiovascular Mortality Risk

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Abstract 13619: Major Electrocardiographic Abnormalities in Brazilian Adults: Prognostic Value and Potential Use in Primary Prevention (from the Elsa-Brasil Cohort Study)

Circulation ◽

10.1161/circ.142.suppl_3.13619 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Marcelo M Pinto Filho ◽

Luisa C Brant ◽

Sandhi M Barreto ◽

JOSE GERALDO MILL ◽

Paulo A Andrade Lotufo ◽

...

Keyword(s):

Primary Prevention ◽

Cardiovascular Mortality ◽

Risk Model ◽

Independent Predictor ◽

Cardiovascular Death ◽

Noncommunicable Diseases ◽

Adult Health ◽

Increased Risk ◽

Electrocardiographic Abnormality ◽

Electrocardiogram Ecg

Introduction: Cardiovascular diseases (CVD) are the most preventable noncommunicable diseases. Accurate risk stratification is paramount for identifying patients for whom interventions should be offered. The electrocardiogram (ECG) is a potential tool for CVD primary prevention. Our aim is to evaluate the ECG role as an independent predictor of all-cause and cardiovascular mortality Methods: Participants from the Longitudinal Study of Adult Health (ELSA-Brasil), who were free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008-2010).Participants were followed up to 2018 by annual interviews.Deaths and hospitalizations were independently reviewed. Cox and Fine and Gray competitive risk regressions were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA) at baseline, defined according to de Minnesota Code system (MC), would predict total and cardiovascular deaths in multivariable models Results: The 13,437 participants (mean age 51.8 years, 55% women) were followed for 8±1 years. Baseline prevalence of MEA was 7.2% for men, 5.8% for women. All-cause and cardiovascular mortality occurred in 5.7% and 1.2% of men, and 3.1% and 1.2% of women, respectively. Prevalent MEA was an independent predictor of overall mortality after adjustments for age, race, education and traditional cardiovascular risk factors (HR:2.2; 95%CI 1.6-2.9 for men and HR:2.3; 95%CI 1.6-3.4 for women). [LB1] In the competitive risk model for cardiovascular death, the increased risk attributable to MEA was even higher (HR4.1, 95%CI 2.47-6.81 in men and 5.37, 95%CI 2.54-11.36 in women). Conclusions: Presence of MEA was a strong and independent predictor of overall and cardiovascular death for both sexes. ECG may have a role in improving risk assessment for death in primary care

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