Changes in cardiovascular risk and clinical outcomes in a HIV/AIDS cohort study over a one-year period at a specialized clinic in Mexico v1 (protocols.io.mcqc2vw)

AbstractImportanceWhether earlier onset of puberty is associated with higher cardiovascular risk in early adulthood is not well understood.ObjectiveTo examine the association between puberty timing and markers of cardiovascular structure and function at age 25 years.DesignProspective birth cohort study.SettingThe Southwest region of England.ParticipantsParticipants in the Avon Longitudinal Study of Parents and Children (ALSPAC), born between April 1, 1991, and December 31, 1992.ExposureAge at peak height velocity (aPHV), an objective and validated growth-based measure of puberty onset.Main Outcomes and MeasuresCardiovascular structure and function at age 25 years: carotid intima-media thickness (CIMT), left ventricular mass index (LVMI) and relative wall thickness (RWT), pulse wave velocity (PWV) and systolic blood pressure (SBP). Multiple imputation was used to impute missing data on covariates and outcomes. Linear regression was used to examine the association between aPHV and each measure of cardiac structure and function, adjusting for maternal age, gestational age, household social class, maternal education, mother’s partner’s education, breastfeeding, parity, birthweight, maternal body mass index, maternal marital status, maternal prenatal smoking status, and height and fat mass at age 9. All analyses were stratified by sex.ResultsA total of 2752-4571 participants were included in the imputed analyses. A one-year older aPHV was not strongly associated with markers of cardiac structure and function in males and females at 25 years and most results spanned the null value. In adjusted analyses a one-year older aPHV was associated with 0.003mm (95% Confidence Interval (CI): 0.00001, 0.006) and 0.0008mm (95% CI: −0.002, 0.003) higher CIMT; 0.02m/s (95% CI: −0.05, 0.09) and 0.02m/s (95% CI: −0.04, 0.09) higher PWV; and 0.003mmHg (95% CI: −0.60, 0.60) and 0.13mmHg (95% CI: −0.44, 0.70) higher SBP, among males and females respectively. A one-year older aPHV was associated with −0.55g/m2.7 (95% CI: −0.03, −1.08) and −0.89g/m2.7 (95% CI: −0.45, −1.34) lower LVMI and −0.001 (95% CI: −0.006, 0.002) and −0.002 (95% CI: −0.006, 0.002) lower RWT among males and females.Conclusions and RelevanceEarlier puberty is unlikely to have a major impact on pre-clinical cardiovascular risk in early adulthood.Key PointsQuestionIs puberty timing associated with cardiovascular structure and function at age 25 years?FindingsAdjusted estimates from this prospective birth cohort study suggest no strong evidence of association between age at puberty (measured using age at peak height velocity) and carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), and relative wall thickness (RWT), pulse wave velocity (PWV), and systolic blood pressure (SBP) at age 25 years among males and females, with results spanning the null in all but LVMI.MeaningEarlier puberty is unlikely to have a major impact on pre-clinical cardiovascular risk in early adulthood.

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Underlying cardiovascular risk and major adverse cardiovascular events after acute respiratory infection: a population-based cohort study of over 4.2 million individuals in England, 2008-2018

10.1101/2021.03.18.21253890 ◽

2021 ◽

Author(s):

Jennifer Davidson ◽

Amitava Banerjee ◽

Liam Smeeth ◽

Helen I McDonald ◽

Daniel J Grint ◽

...

Keyword(s):

Cohort Study ◽

Cardiovascular Risk ◽

Cardiovascular Events ◽

Respiratory Infections ◽

Cardiovascular Complications ◽

Major Adverse Cardiovascular Events ◽

Mortality Data ◽

Clinical Practice Research Datalink ◽

Increased Risk ◽

One Year

Background While acute respiratory infections (ARIs) can lead to cardiovascular complications, the effect of underlying cardiovascular risk profile on ARI incidence and cardiovascular complications in those without established cardiovascular disease (CVD) is unknown. Whether to consider individuals at raised cardiovascular risk a priority group for vaccination against respiratory infections therefore remains unclear. Methods We conducted a cohort study in individuals aged 40-64 years without established CVD or a chronic health condition eligible for influenza vaccination, using Clinical Practice Research Datalink GOLD and Aurum data from 01/09/2008-31/08/2018 linked to Hospital Episode Statistics Admitted Patient Care and Office for National Statistics mortality data from England. We classified cardiovascular risk based on diagnosed hypertension and overall predicted cardiovascular risk estimated using QRISK2 score (≥10% compared with <10%). Using multivariable Poisson regression models, we obtained incidence rate ratios (IRR) for ARI. Among individuals who had an ARI, we then used multivariable Cox regression to obtain hazard ratios (HR) for the risk of major adverse cardiovascular events (MACE) within one year of infection. Findings 4,212,930 individuals were included; 12.5% had hypertension and 14.4% had a QRISK2 score ≥10%. After adjusting for confounders, patients with hypertension (IRR 1.04, 95% CI 1.03-1.05) or QRISK2 score ≥10% (IRR 1.39, 1.37-1.40) had a higher incidence of ARI. Of the 442,408 individuals with an ARI, 4,196 had a MACE within one year of infection. After adjustment, hypertension (HR 1.98, 1.83-2.15) and QRISK2 score ≥10% (HR 3.65, 3.42-3.89) were associated with substantial increased risk of a MACE after infection. Interpretation People without diagnosed CVD but who have raised cardiovascular risk, measured by diagnosed hypertension or, in particular, overall predicted cardiovascular risk, have increased incidence of both ARI and cardiovascular complications following an ARI.

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Clinical Outcomes of Tenofovir Versus Zidovudine-based Regimens Among People Living with HIV/AIDS: a Two Years Retrospective Cohort Study

The Open AIDS Journal ◽

10.2174/1874613601711010001 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Teshale Ayele ◽

Habtemu Jarso ◽

Girma Mamo

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Opportunistic Infections ◽

Average Treatment Effect ◽

People Living With Hiv ◽

Average Treatment ◽

Hiv Aids

Background: Tenofovir (TDF) based regimen is one of the first line agents that has been utilized routinely since 2013 in Ethiopia. Unfortunately, there is limited information regarding the Clinical outcomes and associated risk factors in this setting, where patients generally present late, have high rates of TB and other infectious conditions. Methods: A two year retrospective cohort study was conducted from February 10/2015 to March 10/2015 at Jimma University Specialized Hospital. A total of 280 records were reviewed by including data from September 3, 2012 to July 31, 2014. Records were selected using a simple random sampling technique. Data was collected on socio-demographic, clinical and drug related variables. Data was analyzed using STATA 13.1. Kaplan-Meier and Cox regression were used to compare survival experience and identify independent predictors. Propensity score matching analysis was conducted to elucidate the average treatment effects of each regimen over opportunistic infections. Results: Of 280 patients, 183(65.36%) were females and 93(33.32%) of females belong to Tenofovir group. Through 24 months analysis, TDF based regimen had a protective effect against death and opportunistic infections (OIs), (AHR=0.79, 95% CI [0.24, 2.62]) and (AHR=0.78, 95%CI [0.43, 1.4] respectively. The average treatment effect of TDF/3TC/EFV was (-71/1000, p=0.026), while it was (+114/1000, p=0.049) for AZT/3TC/EFV. However, TDF/3TC/NVP was associated with statistically insignificant morbidity reduction (-74/1000, p=0.377). Those with body mass-index (BMI) <18.5kg/m2 (AHR=3.21, 95%CI [0.93, 11.97]) had higher hazard of death. Absence of baseline prophylaxis (AHR=8.22, 95% CI [1.7, 39.77]), Cotrimoxazole prophylaxis alone (AHR=6.15, 95% CI [1.47, 26.67]) and BMI<18.5kg/m2 (AHR=2.06, 95% CI [1.14, 3.73]) had higher hazards of OIs. Conclusion: The survival benefit of TDF based regimen was similar to AZT based regimen and therefore can be used as an alternative for HIV/AIDS patients in resource limited setups. However, since this study was not dealt with toxicity of the regimens, we recommend to conduct high quality design on this issue.

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Clinical Outcomes of Bariatric Surgery Among Military Retirees and Beneficiaries: A Retrospective Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa063_075 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1677-1677

Author(s):

Joshua Roe ◽

Brenda Bustillos ◽

Adam Kieffer

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Cohort Study ◽

Clinical Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Military Retirees ◽

Student’S T ◽

One Year

Abstract Objectives Obesity prevalence is estimated at 34% in U.S. military retirees and 28% in beneficiaries of military healthcare, with common comorbidities being type 2 diabetes (T2D), hypertension, and hyperlipidemia. Stressors experienced during active duty service result in higher risk for disabling musculoskeletal injuries, psychological trauma, and alcohol abuse; all of which debilitate healthy weight loss efforts. No literature exists on the demographics and clinical outcomes of military retirees who elect bariatric surgery. The purpose of this study was to assess demographics and determine clinical outcomes of retirees and beneficiaries following bariatric surgery. It was hypothesized that pre-operative weights and comorbidity remission would be higher in the military retiree group. Methods A retrospective cohort study assessed military retirees and beneficiaries who underwent sleeve gastrectomy or gastric bypass surgery at a military treatment facility in 2014. Percent total weight loss (%TWL) and remission of pre-existing comorbidities (T2D, hypertension, and hyperlipidemia) at one year follow-up were primary outcomes and compared using Student's T tests and chi-squared contingency analysis. Additional statistical analyses included a Wilcoxon-Mann-Whitney test and backwards stepwise regression. Results Ninety-eight patients (64 beneficiaries and 34 retirees) were included with mean ages of 48 and 52 years, respectively. Student's T test and Wilcoxon-Mann-Whitney test confirmed that beneficiaries achieved greater %TWL at one year follow-up, 30.2% vs. 25.8% (p < 0.05) and 55.5 vs. 38.2 mean rank (p < 0.01), respectively. Beneficiaries and retirees achieved similar remission of T2D, hypertension, and hyperlipidemia. Patient's sex and surgery type were significant predictors of %TWL variation between groups at one year follow-up. These variables accounted for 9% of the %TWL variance. Conclusions Retirees who elect bariatric surgery lose less weight than their beneficiary counterparts. Etiology of this poorer outcome remains unclear, but further research may demonstrate need for improving healthcare resources provided to military retirees. Funding Sources No funding was received to support this study.

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Implications of Vitamin D Levels in COVID-19 Morbidity and Mortality

Sciential - McMaster Undergraduate Science Journal ◽

10.15173/sciential.v1i5.2548 ◽

2020 ◽

pp. 2-3

Author(s):

Seyedeh Niki Sadat Afjeh ◽

Nahal Emami Fard ◽

Paniz Poursharif

Keyword(s):

Vitamin D ◽

Cohort Study ◽

Clinical Outcomes ◽

Vitamin D Insufficiency ◽

T Regulatory Cell ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

Randomized Controlled Studies ◽

Vitamin D Levels ◽

One Year

Vitamin D is a steroid hormone known for maintaining bone health. Vitamin D deficiency is a 25-hydroxyvitamin D (25(OH)D) serum concentration below 25 nmol/L. In contrast, vitamin D insufficiency occurs at levels below 75 nmol/L. Vitamin D insufficiency and deficiency affect 70% and 30% of the US population, respectively. Emerging evidence associates optimal vitamin D levels with better clinical outcomes in COVID-19. This literature review analyzed three preliminary articles that explored associations between vitamin D levels, COVID-19 mortality, and risk of adverse clinical outcomes in adult hospitalized patients. Google Scholar was used to find studies that diagnosed COVID-19 with reverse transcription (RT-PCR). In a cross-sectional analysis, Maghbooli et al. (2020) reported that vitamin D sufficient patients had a significantly lower chance (9.7%, n=77, p=0.01) of severe COVID-19 complications than deficient patients (32.8%, n=158, p=0.01). This study is under review for diagnosis accuracy and sample size. A retrospective cohort study by Raharusun et al. (2020), which included active and expired cases (n=780), found that 98.9% (p<0.001) of vitamin D deficient COVID-19 patients and 88% (p<0.001) with insufficiency died, but only 4% of sufficient individuals died. Lastly, a retroactive cohort study by Meltzer et al. (2020) reported higher rates of COVID-19 infection, 21.6% (95% CI, 14.0-29.2%), in vitamin D deficient groups (n=172), compared to 12.2% (95% CI, 8.5-15.4%) in sufficient groups (n=327). The 25(OH)D levels were measured within one year of COVID-19 testing. All studies controlled for age, sex, and comorbidities, while the first controlled for BMI and smoking, and the third controlled for race. Vitamin D sufficiency may activate the innate and adaptive immune systems, leading to an antiviral response. Receptor binding of vitamin D on neutrophils and macrophages stimulates cathelicidin expression, an antibacterial peptide. Macrophage and T-regulatory cell quantities also increase. These results reveal the need for randomized controlled studies of vitamin D sufficiency as a potential mitigator in COVID-19 outcomes.

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