scholarly journals The Effect of Ethnicity on Preterm Birth and its Influence on the Risk Factors for Prematurity

2019 ◽  
pp. 180-192
Author(s):  
P Bachkangi ◽  
AH Taylor ◽  
JC Konje
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Preterm Birth ◽  
High Risk ◽  
Risk Groups ◽  
Individual Risk ◽  
Individual Risk Factor ◽  
Increased Risk ◽  
Gestational Age At Delivery ◽  
Very High

Preterm birth (PTB) affects 9.6% of pregnancies worldwide and is associated with a very high perinatal mortality that depends on the gestational age at delivery. As a result, PTB has a significant health and financial impact on health systems, families and societies. Its aetiology is not fully understood, but in most cases it is multifactorial, with several maternal, paternal, and epidemiological factors associated with increased risk. Other factors include parental ethnicity, maternal age and body mass index, socioeconomic status, and where the families live. This review examines the influence of ethnicity as an individual risk factor for PTB. It also explores its influence on the epidemiology of PTB and demonstrates that data on certain ethnicities are lacking, despite the fact that these ethnic clusters are within the very ‘high-risk groups’ that are adequately represented in some Western societies. This review examines the influence of ethnicity as an individual risk factor for PTB and also explores its influence on the different epidemiological aspects. A thorough revisit of the ethnic epidemiology unveiled other unnoticed risk factors that if addressed appropriately prematurity can be prevented. Moreover, certain ethnicities were not within the attention of researchers, despite the facts that they are very ‘high-risk groups’ and are also adequately represented in some Western societies.

Abstract 15941: Derivation of Risk-Scores That Stratify Risk of Hospitalization and Death in SARS-CoV-2 Positive Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kirk U Knowlton ◽  
Heidi T May ◽  
Stacey Knight ◽  
Tami L Bair ◽  
Viet T Le ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Risk Groups ◽  
Risk Scores ◽  
Individual Risk ◽  
Variable Intensity ◽  
Intermountain Healthcare ◽  
Demographic Risk ◽  
Demographic Risk Factor

Introduction: It is well-documented that COVID-19 patients with pre-existing cardiovascular-related disorders are at higher risk of a complicated course. It would be valuable to integrate individual risk factors into overall risk scores for hospitalization and death from COVID-19. Methods: The Intermountain Healthcare medical record database was searched for all individuals tested for SARS-CoV-2 infection up to June 8, 2020. Data from test-positive patients (pts) was analyzed to determine the characteristics of pts requiring hospitalization. From these data, 2 risk scores for hospitalization were derived using multi-variable modeling: of only demographic and risk-factor data, or also including concurrent medications. The risk scores were also applied to predict the risk of dying from COVID-19. Results: Of 104,018 people tested at Intermountain Healthcare for SARS-CoV-2, 5505 (5.3%) were positive. Of test-positive pts, 451 (8.2%) were hospitalized, and 37 (0.7%) died. Using a demographic/risk factor only score, 1.4, 7.0, and 36.6% of low-, moderate-, and high-risk groups, respectively, were hospitalized (AUC=0.826). Using demographic risk-factors and medications, 1.4, 5.6, and 40.3% of low-, moderate-, and high-risk patients were hospitalized (AUC=0.854, Table 1). The demographic/risk factor-score was also predictive of the risk of dying, with 0%, 0.9% and 4.5% in low-, moderate-, and high-risk groups dying (AUC=0.918). Adding medications to the risk-factors model further improved the prediction of death with 0.1, 0.04, and 4.9% in the low-, moderate-, and high-risk groups dying (AUC=0.942, Table 2). Conclusions: We demonstrate the derivation of highly predictive risk scores for COVD-19 patients at low, moderate, and high risks of hospitalization or death. Pending appropriate validation in another cohort, application of these risk-scores may allow healthcare systems to risk-stratify COVID-19 patients requiring variable intensity of care.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

Estimation of risk factors associated with difficult birth in ewes

2018 ◽  
Vol 58 (6) ◽  
pp. 1125 ◽  
Author(s):  
B. J. Horton ◽  
R. Corkrey ◽  
G. N. Hinch
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Litter Size ◽  
Low Birthweight ◽  
Condition Score ◽  
Cause Of Deaths ◽  
Ease Score ◽  
Very High ◽  
Australian Merino

In eight closely recorded Australian Merino and crossbred sheep flocks, all lamb deaths were examined and the cause of deaths identified if possible. Dystocia was identified as one of the major causes of lamb death and this study examined factors that could be used to identify ewes at high risk of dystocia, either to avoid dystocia or to assist with early intervention where possible. Dystocia was least common in lambs of ~4.8 kg, but there was a higher risk at both lower and higher birthweights. Dystocia with both low and high birthweight was more common in older ewes, ranging from negligible low birthweight dystocia in ewes less than 3 years old at lambing, to 5% in older ewes. Low birthweight dystocia increased with increasing litter size, with 40% dystocia in ewes at least 4 years of age with triplets. In contrast, high birthweight dystocia was not affected by litter size. A previous record of low birthweight dystocia was a risk factor for future low birthweight dystocia, but the same relationship was not observed for high birthweight dystocia. A high lambing ease score (difficult birth) with high birthweight was a risk factor for future high birthweight dystocia, but this was not the case for low birthweight dystocia. These differences between the risk factors for low and high birthweight dystocia suggest that they have different causes. High ewe liveweight and condition score during pregnancy may be additional indicators of the risk of dystocia, particularly for ewes with high liveweight in the first 60 days of pregnancy. For most ewes dystocia was difficult to predict, but there was a small proportion of ewes with a very high risk of dystocia and if these could be identified in advance they could be monitored much more closely than the rest of the flock.

Abstract P275: Demographic and Clinical Profile of Patients with Risk Factors for Coronary Heart Disease (CHD) Defined by National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Guidelines

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
David M Kern ◽  
Sanjeev Balu ◽  
Ozgur Tunceli ◽  
Swetha Raparla ◽  
Deborah Anzalone
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Groups ◽  
Lipid Lowering ◽  
High Risk Patients ◽  
Low Hdl ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High ◽  
Statin Use

Introduction: This study aimed to compare the demographic and clinical characteristics of patients with different risk factors for CHD as defined by NCEP ATP III guidelines. Methods: Dyslipidemia patients (≥1 medical claim for dyslipidemia, ≥1 pharmacy claim for a statin, or ≥1 LDL-C value ≥100 mg/dL [index date]) aged ≥18 y were identified from the HealthCore Integrated Research Environment from 1/1/2007-7/31/2012. Patients were classified as low risk (0 or 1 risk factor): hypertension, age ≥45 y [men] or ≥55 y [women], or low HDL-C), moderate/moderately high risk (≥2 risk factors), high risk (having CHD or CHD risk equivalent), or very high risk (having ACS or other established cardiovascular disease plus diabetes or metabolic syndrome). Demographics, comorbidities, medication use and lipid levels during the 12 months prior, and statin use during the 6 months post-index date were compared across risk groups (very high vs each other risk group). Results: There were 1,524,351 low-risk (mean age: 47 y; 45% men), 242,357 moderate-risk (mean age: 58 y; 59% men), 188,222 high-risk (mean age: 57 y; 52% men), and 57,469 very-high-risk (mean age: 63 y; 61% men) patients identified. Mean Deyo-Charlson comorbidity score differed greatly across risk strata: 0.20, 0.33, 1.26, and 2.22 from low to very high risk (p<.0001 for each). Compared with high-risk patients, very-high-risk patients had a higher rate of ischemic stroke: 5.4% vs 4.1%; peripheral artery disease: 17.1% vs 11.6%; coronary artery disease: 8.5% vs 8.2%; and abdominal aortic aneurysm: 2.3% vs 2.0% (p<.05 for each). Less than 1% of the total population had a prior prescription for each non-statin lipid-lowering medication (bile acid sequestrants, fibrates, ezetimibe, niacin, and omega-3). Very-high-risk patients had lower total cholesterol (very-high-risk mean: 194 mg/dL vs 207, 205, and 198 mg/dL for low-, moderate-/moderately-high-, and high-risk patients, respectively) and LDL-C (very-high-risk mean: 110 mg/dL vs 126, 126, and 116 mg/dL for the other risk groups; p<.0001 for each); higher triglycerides (TG) (very-high-risk mean: 206 mg/dL vs 123, 177, and 167 mg/dL for the other groups; p<.0001 for each); and lower HDL-C (very-high-risk mean: 45 mg/dL vs 57 [p<.0001], 45 [p=.006], and 51 mg/dL [p<.0001]). Statin use was low overall (15%), but higher in the very-high-risk group (45%) vs the high- (29%), moderate-/moderately-high- (18%), and low- (12%) risk groups (p<.0001 for each). Conclusions: Despite a large proportion of patients having high lipid levels, statin use after a dyslipidemia diagnosis was low: ≥80% of all patients (and more than half at very high risk) failed to receive a statin, indicating a potentially large population of patients who could benefit from statin treatment. Prior use of non-statin lipid-lowering medications was also low considering the high TG and low HDL-C levels among high-risk patients.

A Risk Score to Predict CMV Viremia within the First 100 Days after Allogeneic Stem Cell Transplantation Based on Pre-Transplant Parameters

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3877-3877
Author(s):  
Feras Alfraih ◽  
John Kuruvilla ◽  
Naheed Alam ◽  
Anna Lambie ◽  
Vikas Gupta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
High Risk ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Cmv Infection ◽  
Allogeneic Hsct ◽  
Very High

Abstract Introduction: Cytomegalovirus (CMV) is a major infectious complication following allogeneic hematopoietic stem cell transplantation (HSCT). Risk of CMV infection varies between patients and individualized strategies for monitoring and therapy for CMV are needed. In this study, we attempted to establish a clinical score based on patient and transplant characteristics in order to predict the probability for early CMV viremia (CMV-V) within the first 100 days after HSCT. Methods: A total of 548 patients were evaluated after receiving HSCT between 2005 and 2012 at Princess Margaret Cancer Centre. CMV sero-negative recipients with CMV sero-negative donors (R-D-) were excluded. CMV-V was diagnosed in peripheral blood samples obtained on two occasions either by PCR (>200 IU/ml) or antigenemia testing (>2 positive cells/100000). A total of 378 patients were included into the study. Uni- and multivariable analyses were performed to identify risk factors for CMV-V. A weighted score was assigned to each factor based on the odds ratios determined by the multivariable analysis. A total score was calculated for each patient and used for assignment into one of 4 risk categories, the low risk (score 0-1), the intermediate (score 2-3), the high (score 4-5) and the very high (score 6-8). Median age for all patients was 51 years (range 17-71) and 173 (46%) were female. Matched related donors were used for two hundred fifteen patients (57%). Two hundred forty-three patients (64%) were transplanted for myeloid and 108 (29%) for lymphoid malignancies. One hundred thirteen patients (30%) were CMV sero-positive with a negative donor (R+D-) while 191 (51%) were recipient and donor CMV sero-positivity (R+D+). Graft versus host disease (GVHD) prophylaxis included CSA/MMF (n=200, 52%), and CSA/MTX (n=178, 48%). Myeloablative conditioning regimens were administered to 220 patients (58%), 158 patients (42%) were treated with a reduced intensity regimen. Three hundred-thirty seven patients (89%) received peripheral blood stem cells as a stem cell source. In vivo T cell depletion (TCD) with alemtuzumab was used in 138 (37%). Results: CMV-V occurred in 246 (64%) patients by day 100 post HSCT. The impact of patient and HSCT characteristics on the risk of CMV-V was assessed by multivariable analysis. The significant factors were CMV sero-status R+D- and R+D+, TCD, GVHD prophylaxis with MMF administration of myeloablative preparative regimens (Table 1). Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT CMV-V rates on the 4 new risk categories amounted to 93% in the very high-risk, 78% in high-risk, 41% in intermediate-risk and 11% in low-risk group (Fig 1). The risk score was also predictive for the occurrence of multiple CMV-V reactivations with rates of 71%, 45%, 19% and 4% for the very high, high, intermediate and low-risk groups, respectively. The overall survival (OS) rate at 2 years was 33%(n=56) in the very high-risk group compared to 50% in other-risk groups (n=147) (P=0.01) (Fig 2). Non-relapse mortality (NRM) was 53% in the very high-risk versus 33% in other-risk groups (P<0.001). However, there was no difference on cumulative incidence of relapse between the groups (P=0.3). The cumulative incidence of grades 1-4 acute GVHD, grades 2-4, grades 3-4 at day 120 and overall chronic GVHD at 2 years was 68%, 47%, 25% and 39% in very high-risk group versus 65%, 52%, 21% and 52% in other-risk groups, suggesting slightly lower incidence of chronic GVHD in very high-risk vs other-risk groups. Conclusion: We present a new clinical scoring system to stratify the risk of early CMV viremia after allogeneic HSCT based on patients and HSCT characteristics. Identifying the risk for each patient would facilitate decision making with respect to strategies including CMV prophylaxis, pre-emptive treatment or inclusion into clinical trials, as well directing the CMV monitoring policy post-transplant. In addition, the risk score was associated with higher risk of overall mortality and NRM in the very high-risk versus other-risk groups. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Assessment of Cardiovascular Events in Chronic Myeloid Leukemia Patients Treated with Tyrosine Kinase Inhibitors

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4031-4031
Author(s):  
Katia B.B. Pagnano ◽  
Paola Morelato Assunção ◽  
Roberto Zullli ◽  
Marcia T Delamain ◽  
Gislaine OLIVEIRA Duarte ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cardiovascular Events ◽  
Kinase Inhibitors ◽  
Risk Groups ◽  
Arterial Disease ◽  
Baseline Risk ◽  
Advisory Committees ◽  
Coronary Arterial Disease ◽  
Very High

Abstract Introduction : Treatment with tyrosine kinase inhibitors (TKIs) has dramatically increased the overall survival of patients with chronic myeloid leukemia (CML) but second generation TKI has been associated with an increased risk of cardiovascular events. Objectives: The aim of this study was to evaluate the incidence of cardiovascular adverse events (CVE) in CML patients treated with TKIs and to correlate with the cardiovascular (CV) risk of the patients. Methods: this is a retrospective analysis of consecutive CML patients treated with TKIs between 2005 and 2013at our Institution. Baseline risk factors for CV diseases were collected at baseline and included age, arterial hypertension (AH), dyslipidemia, obesity, hypothireoidism, smoking, diabetes mellitus (DM), coronary artery disease and chronic renal failure. Cardiovascular events during TKI treatment were collected and included: myocardial infarction, unstable angina, peripheral arterial disease, stroke, arrythmia,hypertension and cardiac failure. Cardiovascular risk was calculated using the SCORE chart of the European Society of Cardiology and patients were classified in low, moderate, high and very high risk. Results: We analyzed CML patients treated with imatinib (n=117), dasatinib (n=91) and nilotinib (n=60). The median time of follow-up was 748, 519 and 851 days, respectively. Baseline risk factors: 90 patients (38,5%) had hypertension, 34 (14,5%) DM, 67 (28,6%) dyslipidemia, 51 (21,8%) obesity, 22 (9,4%) hypothyroidism, 14 (6%) coronary arterial disease, 21 (9%) systolic cardiac dysfunction, 4 (1,7%) stroke, 20 (8,5%) chronic kidney failure and 36 (15,4%) were smokers. SCORE chart classification: 106 patients (39,5%) were in the low-risk category, 70 (26%) in the moderate risk, 46 (17,2%) in the high risk, 46 (17,2%) in the very high risk group. Overall, the cumulative incidence of CVE was 4.1%. Five (5.5%) events occurred during dasatinib treatment (P=0.015), 6 (10%) events during nilotinib and no events during imatinib treatment (P=0.001). The incidence of CVE was 10.8% in the high and very high-risk groups and 0.52% in moderate and low risk group (P≤0.001). The incidence of arterial ischemic events (AIE) was 10% (n=6) in patients treated with nilotinib, 2.2% (n=2) with dasatinib and 0% with imatinib (P≤0.001). Arterial events were exclusively observed in high and very high-risk groups (8 events, 8.7%) (P≤0.001). The risk factors associated with a higher risk of CVE were hypertension (P≤0.001), dyslipidemia (P≤0.001), coronary arterial disease (P=0.003), congestive heart failure (P=0.002) and chronic renal failure (P=0.011). Disease progression was the main cause of death in all groups. Conclusions: CVE were more frequent in patients treated with second generation TKIs. AIE were more frequent in patients treated with nilotinib, in those having a high or very high risk SCORE. The CV risk stratification of CML patients before and during TKI therapy can help in TKI selection and to identify patients at high risk, in order to reduce the morbidity and mortality associated with CVE. Disclosures Pagnano: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bristol Miers-Squibb: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population

2004 ◽  
Vol 8 (5) ◽  
pp. 303-309 ◽  
Author(s):  
Anatoli Freiman ◽  
John Yu ◽  
Antoine Loutfi ◽  
Beatrice Wang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Groups ◽  
High Risk Population ◽  
Awareness Campaigns ◽  
Number Of Patients ◽  
Increased Risk ◽  
Patients At Risk ◽  
And Behavior ◽  
Attitudes And Behavior

Background: Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. Objectives: The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Methods: Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. Results: The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. Conclusions: The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.

Risk of Surgery and Anesthesia for Ischemic Stroke

2000 ◽  
Vol 92 (2) ◽  
pp. 425-425 ◽  
Author(s):  
Gilbert Y. Wong ◽  
David O. Warner ◽  
Darrell R. Schroeder ◽  
Kenneth P. Offord ◽  
Mark A. Warner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
High Risk ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Independent Risk Factor ◽  
Index Date ◽  
Stroke Index ◽  
Increased Risk

Background The goal of this study was to determine if the combination of surgery and anesthesia is an independent risk factor for the development of incident (first-time) ischemic stroke. Methods All residents of Rochester, MN, with incident ischemic stroke from 1960 through 1984 (1,455 cases and 1,455 age- and gender-matched controls) were used to identify risk factors associated with ischemic stroke. Cases and controls undergoing surgery involving general anesthesia or central neuroaxis blockade before their stroke/index date of diagnosis were identified. A conditional logistic regression model was used to estimate the odds ratio of surgery and anesthesia for ischemic stroke while adjusting for other known risk factors. Results There were 59 cases and 17 controls having surgery within 30 days before their stroke/index date. After adjusting for previously identified risk factors, surgery within 30 days before the stroke/index date (perioperative period) was found to be an independent risk factor for stroke (P&lt;0.001; odds ratio, 3.9; 95% confidence interval, 2.1-7.4). In an analysis that excluded matched pairs where the case and/or control underwent surgery considered "high risk" for stroke (cardiac, neurologic, or vascular procedures), "non-high-risk surgery" was also found to be an independent risk factor for perioperative stroke (P = 0.002; odds ratio, 2.9; 95% confidence interval, 1.5-5.7). Conclusion Our results suggest that there is an increased risk of ischemic stroke in the 30 days after surgery and anesthesia. This risk remains elevated even after excluding surgeries (cardiac, neurologic, and vascular surgeries) considered to be high risk for ischemic stroke.

scholarly journals Contribution of Individual Risk Factor Changes to Reductions in Population Absolute Cardiovascular Risk

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Thomas Cochrane ◽  
Rachel Davey ◽  
Christopher Gidlow ◽  
Zafar Iqbal ◽  
Jagdish Kumar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
High Blood Pressure ◽  
Individual Risk ◽  
High Cholesterol ◽  
Cvd Risk ◽  
Individual Risk Factor ◽  
One Year ◽  
Individual Risk Factors

Background. Few studies have investigated individual risk factor contributions to absolute cardiovascular disease (CVD) risk. Even fewer have examined changes in individual risk factors as components of overall modifiable risk change following a CVD prevention intervention.Design. Longitudinal study of population CVD risk factor changes following a health screening and enhanced support programme.Methods. The contribution of individual risk factors to the estimated absolute CVD risk in a population of high risk patients identified from general practice records was evaluated. Further, the proportion of the modifiable risk attributable to each factor that was removed following one year of enhanced support was estimated.Results. Mean age of patients (533 males, 68 females) was 63.7 (6.4) years. High cholesterol (57%) was most prevalent, followed by smoking (53%) and high blood pressure (26%). Smoking (57%) made the greatest contribution to the modifiable population CVD risk, followed by raised blood pressure (26%) and raised cholesterol (17%). After one year of enhanced support, the modifiable population risk attributed to smoking (56%), high blood pressure (68%), and high cholesterol (53%) was removed.Conclusion. Approximately 59% of the modifiable risk attributable to the combination of high blood pressure, high cholesterol, and current smoking was removed after intervention.

P468Pre-diabetes a new risk factor for stroke in non-valvular atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Kezerle ◽  
M A Tsadok ◽  
A Akriv ◽  
B Feldman ◽  
M Leventer-Roberts ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Study Groups ◽  
Individual Risk ◽  
Historical Cohort ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Individual Risk Factors

Abstract Funding Acknowledgements Pfizer Israel Background Diabetes mellitus is a well-established independent risk factor for embolic complications in patients with non-valvular atrial fibrillation (NVAF). The association between prediabetes and risk of ischemic stroke, however, has not been studied separately in patients with NVAF. Purpose To evaluate whether pre-diabetes is associated with increased risk of stroke and death in patients with NVAF Methods We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1 2010 to December 31 2016 and a minimal follow-up period of 1 year. We compared three groups of patients:  prediabetes, those with established DM, and normoglycemic individuals Results A total of 44,451 cases were identified. The median age was 75 years and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.14 in non-diabetics, 1.40 in pre-diabetics and 2.15 in diabetics. In both univariate and multivariate analyses, pre-diabetes was associated with an increased risk of stroke compared with non-diabetics (Adjusted Hazard Ratio (HR) = 1.19 {95% CI 1.01-1.4}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants while diabetes conferred an even higher risk (vs non-diabetics { HR = 1.56, 95% CI ;1.37 - 1.79}). The risk for mortality was higher for diabetics (HR =1.47,  95% CI ;1.41, 1.54}) but not for pre-diabetics (HR = 0.98 ,CI 95%; 0.92 - 1.03). Conclusion: In this observational cohort of patients with incident newly diagnosed patients with NVAF, pre-diabetes was associated with an increased risk of stroke even after accounting for other recognized risk factors. Abstract Figure. Kaplan-Meier for stroke-free survival

Sign in / Sign up

Export Citation Format

Share Document