scholarly journals Growth Differentiation Factor-15 is a Biomarker for All-cause Mortality but Less Evident for Cardiovascular Outcomes: A Prospective Study

2020 ◽  
Author(s):  
Xue Bao ◽  
Yan Borné ◽  
BIAO XU ◽  
Marju Orho-Melander ◽  
Jan Nilsson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cardiovascular Mortality ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Competing Risk ◽  
Growth Differentiation Factor 15 ◽  
Markers Of Inflammation ◽  
Differentiation Factor ◽  
All Cause Mortality ◽  
Coronary Events

Abstract Background Previous studies have proposed growth differentiation factor-15 (GDF-15) as a predictor of adverse cardiovascular outcomes and mortality. The present study aimed to determine if such associations remain after accounting for markers of inflammation and cardiac dysfunction as well as death as a competing risk. Methods Plasma GDF-15 levels and cardiovascular risk factors were measured in individuals without cardiovascular diseases (n = 4,518, aged 57.4 ± 5.96 years, 39.2% men), who participated in Malmö Diet and Cancer-Cardiovascular Cohort during 1991–1994 and were followed up for more than 20 years. Incidence of coronary events, ischemic stroke, cardiovascular mortality and all-cause mortality was studied in relation to GDF-15 using Cox proportional hazards regression, with adjustment for potential confounders including high sensitive C-reactive protein (hsCRP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Confounding from death as competing risk was carefully checked using the Fine and Gray subdistribution hazard model. Results During follow-up, 473 coronary events, 366 ischemic stroke, 405 cardiovascular deaths, and 1,445 all-cause deaths occurred. The associations of GDF-15 with coronary events, ischemic stroke, or cardiovascular mortality were attenuated and non-significant after adjusting for NT-proBNP or controlling for death from other causes as a competing risk. All-cause mortality remained significantly related to GDF-15. After multivariate adjustment, the hazard ratio (95% confidence interval) for all-cause mortality was 1.60 (1.34, 1.91), in the top compared with the bottom quartile of GDF-15. Conclusions GDF-15 concentration is a robust biomarker for all-cause mortality but less reliable for coronary event, ischemic stroke or cardiovascular mortality.

scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

scholarly journals High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody–associated Vasculitis

2018 ◽  
Vol 46 (3) ◽  
pp. 285-293 ◽  
Author(s):  
Amy Kang ◽  
Marilina Antonelou ◽  
Nikki L. Wong ◽  
Anisha Tanna ◽  
Nishkantha Arulkumaran ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Independent Predictor ◽  
Antineutrophil Cytoplasmic Antibody ◽  
First Year ◽  
High Incidence ◽  
All Cause Mortality ◽  
Coronary Events ◽  
The Uk ◽  
Event Rates

Objective.To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV).Methods.This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014.Results.There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1–10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE.Conclusion.Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.

scholarly journals Body Weight Variability and the Risk of Cardiovascular Outcomes and Mortality in Patients with Type 2 Diabetes: a Nationwide Cohort Study

2020 ◽  
Author(s):  
Ga Eun Nam ◽  
Wonsock Kim ◽  
Kyungdo Han ◽  
Chung-woo Lee ◽  
Yeongkeun Kwon ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Large Scale ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
National Health Insurance System ◽  
All Cause Mortality ◽  
Quartile Group ◽  
Diabetes Patients

<b>Objective: </b>Obesity and type 2 diabetes are risk factors for cardiovascular diseases and mortality, and that commonly result in weight variabilities. We aimed to investigate the association between body weight variability and risk of major cardiovascular outcomes and mortality in individuals with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. <div><p><b>Research Design and Methods: </b>We enrolled 624,237 individuals with type 2 diabetes who underwent health examinations provided by the Korean National Health Insurance System between 2009 and 2010, with ≥3 body weight measurements within 5 years since enrollment and followed up until the end of 2017. We assessed body weight variability using four indices, including variability independent of the mean (VIM). Multivariable-adjusted Cox proportional hazards regression analysis was performed.</p> <p><b>Results: </b>During the follow-up, 15,832, 25,038, and 44,716 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively, were recorded. Body weight variability was associated with increased risks of major cardiovascular outcomes after adjusting for confounding variables. Compared with the hazard ratios (HRs) of the lowest quartile group, the HRs (95% CIs) of the highest quartile group of VIM for body weight were 1.15 (1.10–1.20), 1.22 (1.18–1.26), and 1.58 (1.53–1.62) for MI, stroke, and all-cause mortality, respectively.</p> <p><b>Conclusions: </b>Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in type 2 diabetes patients and may be a predictor of cardiovascular outcomes in such patients. Appropriate interventions to maintain stable weight could positively influence health outcomes in type 2 diabetes patients.</p> </div> <br>

Abstract P009: Growth Differentiation Factor 15 And The Subsequent Risk Of Atrial Fibrillation: The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Mengkun Chen ◽  
Ning Ding ◽  
Lena Mathews ◽  
Ron C Hoogeveen ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Proportional Hazards ◽  
Troponin T ◽  
Cox Proportional Hazards ◽  
Atherosclerosis Risk In Communities ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Icd 10

Introduction: Growth differentiation factor 15 (GDF-15) is a marker of oxidative stress and inflammation and has been associated with several cardiovascular disease (CVD) phenotypes. However, conflicting results have been reported regarding the association of GDF-15 with incident atrial fibrillation (AF) in the general population. Hypotheses: Higher GDF-15 level is associated with increased risk of incident AF independent of potential confounders. Methods: In 10,101 White and Black ARIC participants (mean age 60 years and 20.9% Blacks) free of AF at baseline (1993-95), we quantified the association of GDF-15 and incident AF using three Cox proportional hazards models. GDF-15 was measured by SOMA scan assay. AF was defined by hospitalizations with AF diagnosis or death certificates (ICD-9 codes: 427.31-427.32; ICD-10 codes: I48.x) or AF diagnosis by ECG at subsequent ARIC visits. Results: There were 2165 cases of incident AF over a median follow-up of 20.7 years (incidence rate 12.1 cases/1,000 person-years). After adjusting for demographic characteristics and cardiovascular risk factors, log GDF-15 was significantly associated with incident AF (hazard ratio 1.42 (1.25-1.63) for top vs. bottom quartile) (Model 1 in Table ). The result was robust even further adjusting for history of other CVD phenotypes and cardiac markers (Models 2 and 3 in Table ). In Model 3, quartiles of high-sensitive cardiac troponin T (hs-cTnT) did not demonstrate significant associations with incident AF. Conclusions: In community-based population, elevated GDF-15 level was independently and robustly associated with incident AF (even more strongly than troponin). These results suggest the involvement of GDF-15 in the development of AF and the potential of GDF-15 as a risk marker to identify individuals at high risk of AF.

Sign in / Sign up

Export Citation Format

Share Document