2014 CRL Build Study of Life Insurance Applicants

2016 ◽  
Vol 46 (1) ◽  
pp. 13-19
Author(s):  
Michael Fulks ◽  
Vera F. Dolan ◽  
Robert L. Stout
Keyword(s):  
Blood Pressure ◽  
Relative Risk ◽  
Laboratory Test ◽  
Primary Study ◽  
Reference Laboratory ◽  
Cox Regression Analysis ◽  
Relative Mortality ◽  
Low Bmi ◽  
The Impact ◽  
High Bmi

Objective Determine the impact of build on insurance applicant mortality accounting for smoking, laboratory test values and blood pressure. Method The study consisted of 2,051,370 applicants tested at Clinical Reference Laboratory between 1993 and 2007 with build and cotinine measurements available whose body mass index (BMI) was between 15 and 47. Vital status was determined as of September, 2011 by the Social Security Death Master File. Excluded from the primary study were applicants with HbA1c values ≥6.5%, systolic BP ≥141 mmHg, albumin values ≤3.3 g/dL or total cholesterol values ≤130 mg/dL. Relative mortality was determined by Cox regression analysis for bands of BMI split by age, sex and smoking status (urine cotinine positive). Results A majority of applicants had BMI >24 (overweight or obese by WHO criteria). After the exclusions noted above, relative mortality does not increase by >34% unless BMI is <20 (<18 for female non-smokers age 18 to 59) or BMI is >34. BMI values in the range of 22 to 24 and 25 to 29, overall, had similar and the lowest relative risks. For most nonsmokers, risk was lowest in the lower of these two BMI bands but for smokers (and non-smoking males age 60 to 89) risk was lowest in the higher BMI band. Additional analysis showed limited reduction in relative risk by accounting for all laboratory test values as well as continuing the exclusions. Eliminating the exclusions resulted in only a modest increase in relative risk because the mortality rate of the reference band increased as well. Conclusion After excluding elevated HbA1c and blood pressure (associated with high BMI) and low albumin and cholesterol (associated with low BMI) which are usually evaluated separately, mortality varies by a limited degree for BMI 20 to 34. Accounting for the mortality impact of other test values, in addition to the exclusions noted, reduced mortality associated with high BMI to a limited extent, but had little impact on mortality associated with low BMI.

Abstract 18402: Impact of Obesity on Outcomes After Percutaneous Coronary Intervention in Japanese Population: Obesity Paradox with High Waist Circumference but Not High BMI

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kenji Sakamoto ◽  
Seiji Hokimoto ◽  
Shuichi Oshima ◽  
Koichi Nakao ◽  
Kazuteru Fujimoto ◽  
...  
Keyword(s):  
Waist Circumference ◽  
Central Obesity ◽  
Japanese Patients ◽  
Coronary Intervention ◽  
Obesity Paradox ◽  
High Waist Circumference ◽  
Significant Difference ◽  
Low Bmi ◽  
The Impact ◽  
High Bmi

Introduction: Although the counterintuitive association between obesity and mortality has been termed the obesity paradox, the evaluation of obesity was inconsistent, and evidence for an obesity paradox among past studies has been also less consistent. Hypothesis: This inconsistency may be due, in part, to a discrepancy between central obesity, estimated by waist circumference (WC), and body mass index (BMI) as patterns of adiposity. Methods: To elucidate the impact of obesity, 2817 subjects with both WC and BMI data were enrolled from the data of Kumamoto Intervention Conference Study (KICS), a multicenter registry, enrolling consecutive patients undergoing PCI in 15 centers from August 2008 to March 2011 in Japan. Subjects were stratified according to patterns of adiposity (WC or BMI), utilizing NCEP-ATPIII criteria and WHO classification. Results: Subjects’ mean age was 69.8 years, and 28% were female. There were 68 deaths during 12-month follow up. Although obesity defined by WC (ObWC) was associated with lower mortality compared with non-obesity (no-ObWC, p=0.013), no difference was shown between obesity, defined by BMI (ObBMI), and non-obesity (no-ObBMI) (p=0.201). When dividing into 4 categories based on high/low of WC and BMI, subjects with high WC and high BMI had the lowest mortality (1.6%) compared to other 3 categories (high WC low BMI; 1.7%, low WC high BMI; 2.4%, or low WC and low BMI; 3.1%). Kaplan-Meier analysis for all cause mortality showed a significant difference between ObWC and no-ObWC (Log Rank p=0.010), but comparable in BMI (ObOMI vs no-ObBMI, p=0.295). This discrepancy was also observed in the analysis for cardiac death (Figure). In multivariate analysis, in addition to age and CKD, ObWC was an independent predictor for the low mortality (OR; 0.582, 95% CI; 0.342-0.991, p=0.046). Conclusions: In Japanese patients with known CAD who undergo PCI, central obesity but not BMI is associated with the paradoxical protective effect of obesity.

A meta-analysis of anticoagulants as cancer treatment: Impact on survival and bleeding complications

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9071-9071
Author(s):  
N. M. Kuderer ◽  
A. A. Khorana ◽  
G. H. Lyman ◽  
C. W. Francis
Keyword(s):  
Relative Risk ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Bleeding Complications ◽  
Primary Study ◽  
Bleeding Events ◽  
Impact On Survival ◽  
The Impact ◽  
Overall Mortality

9071 Background: There is substantial laboratory evidence that anticoagulants, in particular the low-molecular-weight heparins (LMWH), exert an antitumor effect, while clinical trials have reported conflicting results. This study represents the first comprehensive systematic review and meta-analysis of the evidence from randomized controlled trials (RCTs) evaluating specifically the impact of anticoagulants on survival and safety in cancer patients without venous thromboembolism (VTE). Methods: An exhaustive systematic literature review of RCTs was performed without language restrictions, including a comprehensive search of electronic databases through May 2006 with subsequent weekly updates to the end of 2006 (Medline, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, DARE, and major conference proceedings) and relevant article references. Two reviewers extracted the data independently. Primary study outcomes were 1-year overall mortality and all bleeding complications. Major and fatal bleeding complications were secondary outcomes. The meta- analysis was performed utilizing the Mantel-Haenszel method. Results: All identified 11 RCTs were performed in solid tumor patients. Anticoagulation significantly decreased overall mortality across all studies with a relative risk (RR) of 0.905 (95%CI: 0.847–0.967; p=0.003). The survival improvement appears not to be due to the prevention of fatal VTE. All bleeding complications (RR=2.309; 95%CI: 1.928–2.764; p<0.0001) and major bleeding events (RR=2.598; 95%CI; 1.936–3.488; p<0.0001) occurred more frequently with anticoagulation. The relative risk for mortality was 0.877 (95%CI: 0.789–0.975; p=0.015) with LMWH, compared to warfarin (RR=0.942; 95%CI: 0.854–1.040; p=0.239). Warfarin resulted in higher rates for all and major bleeding complications compared to LMWH (p<0.0001, respectively). Conclusions: Anticoagulants significantly improved overall survival in cancer patients while increasing the risk of bleeding complications. Despite these encouraging findings, given limitations of available data and the potential for life-threatening complications, the use of anticoagulants as antineoplastic therapy cannot be recommended until additional RCTs confirm these results. No significant financial relationships to disclose.

scholarly journals Impact of Prior Cerebrovascular Disease and Glucose Status on Incident Cerebrovascular Disease in Japanese

2021 ◽  
Author(s):  
Momoko Oe ◽  
Kazuya Fujihara ◽  
Mayuko Harada Yamada ◽  
Taeko Osawa ◽  
Masaru Kitazawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glucose Tolerance ◽  
Cerebrovascular Disease ◽  
Systolic Blood Pressure ◽  
Cox Regression ◽  
Drug Prescription ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
The Impact ◽  
Glucose Status

Abstract Background: Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. Methods: This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. Results: The subjects’ mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD+ conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR) , 8.77; 95% CI, 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI, 5.97-9.17; diabetes: HR, 5.73, 95% CI, 4.52-7.25). Compared with the normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI, 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, HDL cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD+/diabetes.Conclusions: Prior CVD had a greater impact on risk of CVD than glucose tolerance and glycemic control. In diabetes with prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategy should consider glucose tolerance status and prior CVD.

Comparison of incidence rates and risk factors of heart failure between two male cohorts born 30 years apart

Heart ◽  
2020 ◽  
Vol 106 (21) ◽  
pp. 1672-1678
Author(s):  
Constantinos Ergatoudes ◽  
Per-Olof Hansson ◽  
Kurt Svärdsudd ◽  
Annika Rosengren ◽  
Erik Östgärd Thunström ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Physical Inactivity ◽  
Cox Regression ◽  
Incidence Rates ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
The Impact

ObjectiveTo compare two cohorts of middle-aged men from the general population born 30 years apart for incidence and predictors of heart failure (HF).MethodsTwo population samples of men, born in 1913 (n=855) and in 1943 (n=797), were examined at 50 years of age and followed up for 21 years (1963–1994 and 1993–2014). Cox regression analysis was used to examine the impact of different factors on the risk of developing HF.ResultsEighty men born in 1913 (9.4%) and 42 men born in 1943 (5.3%) developed HF during follow-up; adjusted HRs comparing the two cohorts (born 1943 vs 1913) were: 0.46 (95% CI 0.28 to 0.74, p=0.002). In both cohorts, higher body mass index, higher diastolic blood pressure, treatment for hypertension, onset of either atrial fibrillation (AF), ischaemic heart disease and diabetes mellitus were associated with higher risk of HF. Higher heart rate was associated with an increased risk only in men born in 1913, whereas higher systolic blood pressure (SBP), smoking, higher glucose, higher cholesterol and physical inactivity were associated with an increased risk in men born in 1943. AF contributed higher risk of incident HF, whereas SBP and physical inactivity contributed lower risk in men born in 1943 compared with men born in 1913.ConclusionsMen born in 1943 had half the risk of HF after their 50s than those born 30 years earlier. AF, obesity, ischaemic heart disease, diabetes and hypertension remain important precursors of HF.

scholarly journals Proteinuria as an independent predictor of stroke: Systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
pp. 29-38 ◽  
Author(s):  
Dearbhla M Kelly ◽  
Peter M Rothwell
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Relative Risk ◽  
Cohort Studies ◽  
Stroke Risk ◽  
Independent Predictor ◽  
Adjusted Relative Risk ◽  
Vascular Risk ◽  
The Impact

Background Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined. Aim We aimed to determine if proteinuria remains an independent predictor of stroke after more complete adjustment for blood pressure. Summary of review We performed a systematic review, searching MEDLINE and EMBASE (to February 2018) for cohort studies or randomized controlled trials that reported stroke incidence in adults according to baseline proteinuria ± glomerular filtration rate. Study and participant characteristics and relative risks were extracted. Estimates were combined using a random effects model. Heterogeneity was assessed by χ 2 statistics and I2, and by subgroup strata and meta-regression, with a particular focus on the impact of more complete adjustment for blood pressure on the association. The quality of cohort studies and post hoc analyses was assessed using the Newcastle–Ottawa Scale. We identified 38 studies comprising 1,735,390 participants with 26,405 stroke events. Overall, the presence of any level of proteinuria was associated with greater stroke risk (18 studies; pooled crude relative risk 2.00, 95%CI 1.63–2.46; p < 0.001) even after adjustment for established cardiovascular risk factors (33 studies; pooled adjusted relative risk 1.72, 1.51–1.95; p < 0.001), albeit with considerable heterogeneity between studies (p < 0.001; I2 = 77.3%). Moreover, the association did not substantially attenuate with more thorough adjustment for hypertension: single baseline blood pressure measure (10 studies; pooled adjusted relative risk = 1.92, 1.39–2.66; p < 0.001); history or treated hypertension (four studies; pooled adjusted relative risk = 1.76, 1.13–2.75, p = 0.013); multiple blood pressure measurements over months to years (four studies; relative risk = 1.68, 1.33–2.14; p < 0.001). Conclusions Even after extensive adjustment for hypertension, proteinuria is strongly and independently associated with incident stroke risk, possibly indicating a shared renal and cerebral susceptibility to vascular injury that is not fully explained by traditional vascular risk factors.

The impact of hyperuricemia on all patients and low-BMI patients after endovascular treatments: from I-PAD registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Nagae ◽  
T Kato ◽  
S Ebisawa ◽  
T Saigusa ◽  
A Okada ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Overall Survival ◽  
Secondary Prevention ◽  
Endovascular Treatment ◽  
Secondary Endpoint ◽  
Funding Source ◽  
Long Time ◽  
Low Bmi ◽  
The Impact ◽  
High Bmi

Abstract Background Hyperuricemia (≥7.0 mg / dl) is known to be one of the risks of arteriosclerosis. For a long time, it has been said that metabolic syndrome and high-BMI has been implicated to hyperuricemia and also that it's a consequence of those patient background, not a cause of arteriosclerosis. Now, the accumulation of data about hyperurisemia is still not enough. Also the importance of secondary prevention for patients after endovascular treatment (EVT) is still unclear too. Purpose To investigate the impact of hyperuricemia on prognosis of all patients and low-BMI patients after EVT. Methods From July 2015 to July 2016, 335 consecutive PAD patients who performed EVT were enrolled in I-PAD registry. And we divided them into 2 groups; with hyperuricemia or not, and analyzed them. In addition to that, among them, we selected 245 low-BMI patients (&lt;25) and divided them into 2 groups; with hyperuricemia or not, and analyzed them. The primary end point was all-cause-death and the secondary endpoint was MACLE (Major Adverse Cardiovascular and limbs Events) at 3-years. Result At 3 years in the patients group with hyperuricemia, overall survival and freedom from MACLE were significantly lower (57.7% vs 83.4% P=0.0012; 30.3% vs 68.6% P=0.0095) than the group without hyperuricemia. Even among the low-BMI patients, in the patients with hyperuricemia, overall survival and freedom from MACLE were significantly lower (55.2% vs 77.1% P=0.003; 48.2% vs 69.9% P=0.002) than the patients without hyperuricemia at 3 years. Conclusion In this study, the prognosis of patients after EVT with hyperuricemia was worse than the patient without. And even among the low-BMI patients, The prognosis after EVT with hyperuricemia was worse than the patient without. Funding Acknowledgement Type of funding source: None

scholarly journals Impact of prior cerebrovascular disease and glucose status on incident cerebrovascular disease in Japanese

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Momoko Oe ◽  
Kazuya Fujihara ◽  
Mayuko Harada-Yamada ◽  
Taeko Osawa ◽  
Masaru Kitazawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glucose Tolerance ◽  
Cerebrovascular Disease ◽  
Systolic Blood Pressure ◽  
Cox Regression ◽  
Drug Prescription ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
The Impact ◽  
Glucose Status

Abstract Background Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. Methods This is a retrospective cohort study including 363,627 men aged 18–72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. Results Participants’ mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96–11.05; borderline glycemia: HR, 7.40, 95% CI 5.97–9.17; diabetes: HR, 5.73, 95% CI 4.52–7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34–1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes. Conclusions Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.

scholarly journals Circulating Leptin: A Marker of Health in Female Students

2002 ◽  
Vol 30 (2) ◽  
pp. 109-115 ◽  
Author(s):  
T Kondo ◽  
A Yoshida ◽  
R Okada ◽  
T Kanda ◽  
I Kobayashi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Nursing Students ◽  
Physical Fitness ◽  
Total Cholesterol ◽  
Healthy Lifestyle ◽  
Serum Triglyceride ◽  
Good Health ◽  
Serum Leptin ◽  
Low Bmi ◽  
High Bmi

We studied the relationship between serum leptin concentration and lifestyle factors in female nursing students. Serum leptin was estimated by radioimmunoassay and the correlation between these concentrations with serum lipids, physical fitness and Health-promoting Lifestyle Profile score was investigated. A total of 247 students took part in the study: mean age, 19.0 ± 2.0 years; mean body mass index (BMI), 21.7 ± 2.9 kg/m2; and mean serum leptin concentration, 10.8 ± 11.5 ng/ml. Serum leptin was positively correlated with BMI, systolic and diastolic blood pressure, total cholesterol and serum triglyceride. Serum leptin level concentration inversely correlated with physical fitness score and lifestyle score. When the subjects were grouped according to BMI, the high-BMI group (BMI: ≥ 24 kg/m2; n = 40) showed significantly lower fitness and lifestyle scores than the low-BMI group (BMI ≤ 20 kg/m2; n = 70). Higher leptin, blood pressure, total cholesterol and triglyceride were seen in high-BMI compared with low-BMI subjects. We suggest that leptin is a useful marker for monitoring good health and may be useful as a motivational aid towards achieving and maintaining a healthy lifestyle.

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