Incident Atrial Fibrillation and the Risk of Stroke in Adults with Chronic Kidney Disease

Background and objectivesPatients with CKD have a high risk of atrial fibrillation. Both CKD and atrial fibrillation are associated with higher risk of stroke and death. However, the effect of incident atrial fibrillation on stroke risk among patients with CKD is unknown.Design, setting, participants, & measurementsOur study included adults with CKD (eGFR<60 ml/min per 1.73 m2) without previously documented atrial fibrillation who had been in contact with health care in Stockholm, Sweden during 2006–2011. Incident atrial fibrillation was identified by administrative diagnostic codes in outpatient or inpatient care and treated as a time-updated exposure in the analysis of stroke and death risk. Stroke events and deaths were ascertained from regional and national registers with complete coverage. Covariates included demographics, comorbidities, therapeutic procedures, and medications. Multivariable Cox regression analysis and competing risk analysis (accounting for death) were used to estimate the association between incident atrial fibrillation and stroke.ResultsAmong 116,184 adults with CKD, 13,412 (12%) developed clinically recognized atrial fibrillation during a mean follow-up of 3.9 years (interquartile range, 2.3–5.7 years). Incidence of atrial fibrillation increased across lower eGFR strata: from 29.4 to 46.3 atrial fibrillations per 1000 person-years in subjects with eGFR=45–60 and <30 ml/min per 1.73 m2, respectively; 1388 (53.8 per 1000 person-years) cases of stroke and 5592 (205.1 per 1000 person-years) deaths occurred after incident atrial fibrillation compared with 6850 (16.6 per 1000 person-years) cases of stroke and 28,613 (67.5 per 1000 person-years) deaths during periods without atrial fibrillation. After adjustment, incident atrial fibrillation was associated with higher risk of stroke (hazard ratio, 2.00; 95% confidence interval, 1.88 to 2.14) and death (hazard ratio, 1.76; 95% confidence interval, 1.71 to 1.82). This was attributed to both ischemic stroke (hazard ratio, 2.11; 95% confidence interval, 1.96 to 2.28) and intracranial bleeds (hazard ratio, 1.64; 95% confidence interval, 1.42 to 1.90). Stroke risk was similar across all eGFR strata. In competing risk analyses accounting for death, the association between incident atrial fibrillation and stroke was attenuated but remained higher (subhazard ratio, 1.49; 95% confidence interval, 1.39 to 1.60).ConclusionsPatients with CKD who develop atrial fibrillation are at higher risk of stroke and death.

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Prevalence of Kidney Injury and Associations with Critical Illness and Death in Patients with COVID-19

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.04780420 ◽

2020 ◽

Vol 15 (11) ◽

pp. 1549-1556 ◽

Cited By ~ 2

Author(s):

Xizi Zheng ◽

Hongyu Yang ◽

Xiaolong Li ◽

Haichao Li ◽

Lingyi Xu ◽

...

Keyword(s):

Critical Illness ◽

Confidence Interval ◽

Cox Regression ◽

Kidney Injury ◽

Hazard Ratio ◽

Secondary Outcome ◽

Cox Regression Analysis ◽

Shenzhen City ◽

Critical Patients

Background and objectivesCoronavirus disease 2019 is spreading rapidly across the world. This study aimed to assess the characteristics of kidney injury and its association with disease progression and death of patients with coronavirus disease 2019.Design, setting, participants, & measurementsThis is a retrospective study. Two representative cohorts were included. Cohort 1 involved severe and critical patients with coronavirus disease 2019 from Wuhan, China. Cohort 2 was all patients with coronavirus disease 2019 in Shenzhen city (Guangdong province, China). Any kidney injury was defined as the presence of any of the following: hematuria, proteinuria, in-hospital AKI, or prehospital AKI. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. The primary outcome was death at the end of follow-up. The secondary outcome was progression to critical illness during the study period.ResultsA total of 555 patients were enrolled; 42% of the cases (229 of 549) were detected with any kidney injury, 33% of the cases (174 of 520) were detected with proteinuria, 22% of the cases (112 of 520) were detected with hematuria, and 6% of the cases (29 of 520) were detected with AKI. Of the 29 patients with AKI, 21 cases were recognized as in-hospital AKI, and eight were recognized as prehospital AKI. Altogether, 27 (5%) patients died at the end of follow-up. The death rate was 11% (20 of 174) in patients with proteinuria, 16% (18 of 112) in patients with hematuria, and 41% (12 of 29) in the AKI settings. Multivariable Cox regression analysis showed that proteinuria (hazard ratio, 4.42; 95% confidence interval, 1.22 to 15.94), hematuria (hazard ratio, 4.71; 95% confidence interval, 1.61 to 13.81), and in-hospital AKI (hazard ratio, 6.84; 95% confidence interval, 2.42 to 19.31) were associated with death. Among the 520 patients with noncritical illness at admission, proteinuria (hazard ratio, 2.61; 95% confidence interval, 1.22 to 5.56) and hematuria (hazard ratio, 2.50; 95% confidence interval, 1.23 to 5.08) were found to be associated with progression to critical illness during the study period.ConclusionsKidney injury is common in coronavirus disease 2019, and it is associated with poor clinical outcomes.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_09_18_CJN04780420.mp3

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Clinical application of the novel 4S-AF scheme for the characterisation of patients with atrial fibrillation: a report from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) registry

European Heart Journal ◽

10.1093/eurheartj/ehab724.0440 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

W.Y Ding ◽

M Proietti ◽

G Boriani ◽

F Marin ◽

C Blomstrom-Lundqvist ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Left Atrial ◽

Thromboembolic Event ◽

Stroke Risk ◽

Cox Regression ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Atrial Enlargement

Abstract Background Current classification systems recommended by major international guidelines are based on a single domain of atrial fibrillation (AF): temporal pattern, symptom severity or underlying comorbidity. Lack of integration between these various elements limits our approach to patients with AF and acts as a barrier against the delivery of better holistic care. The 4S-AF classification scheme was recently introduced as a means for the characterisation of patients with AF. It comprises of 4 domains: stroke risk (St), symptoms (Sy), severity of AF burden (Sb) and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and effects of individual domains on outcomes in AF. Methods Patients with AF from 250 centres across 27 participating European countries were included. All patients were over 18 years old and had electrocardiographic confirmation of AF within 12 months prior to enrolment. Data on demographics and comorbidities were collected at baseline. Individual domains of the 4S-AF scheme were assessed using the CHA2DS2-VASc score (St), European Heart Rhythm Association classification (Sy), temporal classification of AF (Sb), and cardiovascular risk factors and the degree of left atrial enlargement (Su). Each of these domains were used during multivariable cox regression analysis. Results A total of 6321 patients were included in the present analysis, corresponding to 57.0% of the original cohort of 11096 patients. The median age of patients was 70 (interquartile range [IQR] 62–77) years with 2615 (41.4%) females. Among these patients, 528 (8.4%) had low stroke risk (St=0), 3002 (47.5%) no or mild symptoms (Sy=0), 2558 (40.5%) newly diagnosed or paroxysmal AF (Sb=0), and 322 (5.1%) no cardiovascular risk factors or left atrial enlargement (Su=0). Median follow-up was 24 months. Using multivariable cox regression analysis, independent predictors of all-cause mortality were (St) (adjusted hazard ratio [aHR] 8.21 [95% CI, 2.60–25.9]), (Sb) (aHR 1.21 [95% CI, 1.08–1.35]) and (Su) (aHR 1.27 [95% CI, 1.14–1.41]). For cardiovascular mortality and any thromboembolic event, only (Su) (aHR 1.73 [95% CI, 1.45–2.06]) and (Sy) (aHR 1.29 [95% CI, 1.00–1.66]) were statistically important, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Conclusion Overall, we demonstrated that the 4S-AF scheme may be used to provide clinical characterisation of patients with AF using routinely collected data, and each of the domains within the 4S-AF scheme were independently associated with adverse long-term outcomes of all-cause mortality, cardiovascular mortality and/or any thromboembolic event. FUNDunding Acknowledgement Type of funding sources: None.

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Επίπεδα αδιπονεκτίνης στον ορό και τη βρογχοκυψελιδική έκπλυση (BAL) ασθενών με μη μικροκυτταρικό καρκίνο πνεύμονα (NSCLC)

10.12681/eadd/42314 ◽

2017 ◽

Author(s):

Παρασκευή Μπούρα

Keyword(s):

Body Mass Index ◽

Regression Analysis ◽

Confidence Interval ◽

Bronchoalveolar Lavage ◽

Body Mass ◽

Cox Regression ◽

Performance Status ◽

Hazard Ratio ◽

Cox Regression Analysis

Η αδιπονεκτίνη είναι μια από τις κυριότερες αδιποκίνες που παράγονται από τον λιπώδη ιστό. Προηγούμενες μελέτες έδειξαν τη δυνητική χρησιμότητα της αδιπονεκτίνης ορού ως διαγνωστικού ή/και προγνωστικού βιοδείκτη σε διάφορους συμπαγείς όγκους, αλλά τα σχετικά δεδομένα για τον καρκίνο του πνεύμονα, ειδικότερα, είναι ελλιπή. Επιπρόσθετα, η διαγνωστική ή και προγνωστική αξία των επιπέδων αδιπονεκτίνης σε άλλα βιολογικά υγρά -εκτός του περιφερικού αίματος- ασθενών με καρκίνο πνεύμονα ή και με οποιαδήποτε άλλη μορφή καρκίνου, δεν έχει, απ’ όσο γνωρίζουμε, μελετηθεί. Ο πρωταρχικός σκοπός της παρούσας μελέτης ήταν η περαιτέρω διερεύνηση της δυνητικής προγνωστικής αξίας των προθεραπευτικών επιπέδων αδιπονεκτίνης στον ορό και σε δείγματα βρογχοκυψελιδικής έκπλυσης (bronchoalveolar lavage, BAL) ασθενών με μη μικροκυτταρικό καρκίνο πνεύμονα (ΜΜΚΠ) προχωρημένου σταδίου. Στον παρόν ερευνητικό έργο μελετήθηκαν προοπτικά 29 νεοδιαγνωσθέντες ασθενείς με ΜΜΚΠ σταδίου IV. Τα προθεραπευτικά επίπεδα αδιπονεκτίνης ορού και BAL μετρήθηκαν με τη χρήση ανοσοενζυμικής μεθόδου (ELISA), και, ακολούθως, συσχετίσθηκαν με δημογραφικές, κλινικές και παθολογοανατομικές παραμέτρους. Αναλυτικότερα, οι παράμετροι που αξιολογήθηκαν συμπεριελάμβαναν το φύλο, την ηλικία, το Performance Status (PS), το δείκτη μάζας σώματος (Body Mass Index, BMI), την απώλεια βάρους > 10%, καθώς και τον ιστολογικό τύπο, βαθμό διαφοροποίησης (grade) και μέγεθος του πρωτοπαθούς όγκου. Η συσχέτιση των επιπέδων αδιπονεκτίνης και των λοιπών μεταβλητών με τη συνολική επιβίωση των ασθενών αξιολογήθηκε με μονοπαραγοντική και πολυπαραγοντική ανάλυση παλινδρόμησης του Cox (univariate and multivariate Cox regression analysis).Σύμφωνα με τα αποτελέσματα της μελέτης μας, η μέση ηλικία των ασθενών ήταν 65.6 έτη (SD= 10.1 έτη), ενώ η πλειοψηφία ήταν άνδρες (24/29 περιπτώσεις, 82.8%). Ο κυρίαρχος ιστολογικός τύπος ήταν το αδενοκαρκίνωμα (18/29 περιπτώσεις, 62.1%). Η λειτουργική κατάσταση (performance status, PS) των ασθενών ήταν 0 και 1-2 σε 17/29 περιπτώσεις (58.6%) και 12/29 περιπτώσεις (41.4%), αντιστοίχως. Απώλεια βάρους μεγαλύτερη του 10% παρατηρήθηκε σε 10/29 ασθενείς (34.5%). Οι διάμεσες τιμές επιπέδων αδιπονεκτίνης σε ορό και BAL ήταν 17710 ng/ml και 911.5 ng/ml, αντιστοίχως. Δεν παρατηρήθηκαν στατιστικώς σημαντικές συσχετίσεις μεταξύ των επιπέδων αδιπονεκτίνης (τόσο στον ορό όσο και στο BAL) και των κλινικών και παθολογοανατομικών παραμέτρων που αξιολογήθηκαν. Η μονοπαραγοντική ανάλυση παλινδρόμησης του Cox έδειξε ότι τα επίπεδα αδιπονεκτίνης δεν συσχετίζονταν σε στατιστικά σημαντικό βαθμό με την επιβίωση. Ο μόνος προγνωστικός παράγοντας που αναγνωρίστηκε, τόσο στη μονοπαραγοντική όσο και στην πολυπαραγοντική ανάλυση επιβίωσης, ήταν το PS [Hazard ratio (95% Confidence Interval): 2.75 (1.17-6.46), (p=0.02)]Συμπερασματικά, τα αποτελέσματα της προοπτικής μας μελέτης απέτυχαν να αναδείξουν στατιστικά σημαντικά συσχετίσεις των επιπέδων αδιπονεκτίνης (ορού και BAL) με τη συνολική επιβίωση καθώς και με τις δημογραφικές και κλινικοπαθολογοανατομικές παραμέτρους που αξιολογήθηκαν (συμπεριλαμβανομένου του BMI και της απώλειας βάρους), σε ασθενείς με ΜΜΚΠ σταδίου IV, σε συμφωνία με τις περισσότερες προηγούμενες κλινικές παρατηρήσεις.

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CCBE1 is a Prognostic Biomarker and Contributes to Prostate Cancer Cell Progression.

10.21203/rs.3.rs-585903/v1 ◽

2021 ◽

Author(s):

Peizhang Li ◽

Huan Xu ◽

Ming Zhan ◽

Yanbo Chen ◽

Dachao Zheng ◽

...

Keyword(s):

Prostate Cancer ◽

Regression Analysis ◽

Confidence Interval ◽

Cancer Cell ◽

Prostate Cancer Cell ◽

Cox Regression ◽

Hazard Ratio ◽

Cancer Tissue ◽

Cox Regression Analysis ◽

Kaplan Meier

Abstract Subject: Collagen And Calcium Binding EGF Domains 1 (CCBE1) is a coding protein which plays a significant role in extracellular matrix remodeling and migration and is involved in the development of Hennekam syndrome and lymphangiogenesis. Here, we investigate its prognostic value in prostate cancer based on TCGA database and its antioncogenic role in prostate cancer.Methods: Wilcoxon rank sum test, Pearson χ2 test, and logistic regression analysis were utilized to evaluate the correlation between CCBE1 and clinicopathological variables. Kaplan-Meier and Cox regression analysis were used to reveal the relation between CCBE1 and survival rates. The role of CCBE1 in prostate cancer was investigated using CCK-8 assay, EdU assay, and transwell experiments, respectively.Results: Here, we found that CCBE1 expression is down-regulated in prostate cancer tissue dramatically in TCGA database. Furthermore, high CCBE1 expression predicted a good prognosis in patients with prostate cancer. High expression level of CCBE1 in PRAD cohort was prominently correlated with T classification (OR =0.49 for T3&T4 vs T2, P<0.001), Gleason score (OR = 0.42 for8&9&10 vs. 6&7, P<0.001). Kaplan-Meier and Cox regression analysis showed that prostate cancer patients with high CCBE1 expression had a better progression-free interval (hazard ratio [HR]:0.50; 95% confidence interval [CI]: 0.33-0.77; P = 0.002) and overall survival (hazard ratio [HR]:0.38; 95% confidence interval [CI]: 0.15-0.92; P = 0.032). In vitro experiments indicated that overexpressed CCBE1 inhibited prostate cancer cell proliferation, migration, and invasion.Conclusion: CCBE1 plays a pivotal role in the progression of prostate cancer and up-regulated CCBE1 expression inhibits prostate cancer tumorgenicity.

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Low testosterone levels are predictive for incident atrial fibrillation and ischaemic stroke in men, but protective in women – results from the FINRISK study

European Journal of Preventive Cardiology ◽

10.1177/2047487318778346 ◽

2018 ◽

Vol 25 (11) ◽

pp. 1133-1139 ◽

Cited By ~ 16

Author(s):

Tanja Zeller ◽

Renate B Schnabel ◽

Sebastian Appelbaum ◽

Francisco Ojeda ◽

Filip Berisha ◽

...

Keyword(s):

Atrial Fibrillation ◽

Confidence Interval ◽

Ischaemic Stroke ◽

Cox Regression ◽

Experimental Studies ◽

Hazard Ratio ◽

Total Testosterone ◽

Testosterone Levels ◽

Increased Risk ◽

Low Testosterone

Background Atrial fibrillation is the most common serious abnormal heart rhythm, and a frequent cause of ischaemic stroke. Recent experimental studies, mainly in orchiectomised rats, report a relationship between sex hormones and atrial electrophysiology and electroanatomy. We aimed to evaluate whether low testosterone levels are predictive for atrial fibrillation and/or ischaemic stroke in men and women. Design and methods The serum total testosterone levels were measured at baseline in a population cohort of 7892 subjects (3876 male, 4016 female), aged 25–74 years, using a commercially available immunoassay. The main outcome measure was atrial fibrillation or ischaemic stroke, whichever came first. Results During a median follow-up of 13.8 years, a total of 629 subjects (8.0%) suffered from incident atrial fibrillation ( n = 426) and/or ischemic stroke ( n = 276). Cox regression analyses, adjusted for age (used as time-scale), geographical region, total cholesterol (log), high-density lipoprotein-cholesterol (log), hypertension medication, known diabetes, smoking status, waist-hip-ratio, and time of blood drawn, documented differential predictive value of low sex-specific testosterone levels for atrial fibrillation and/or ischaemic stroke, in men and in women: Increasing levels were associated with lower risk in men (hazard ratio per one nmol/l increase 0.98 (95% confidence interval 0.93–1.00); p = 0.049). On the other hand, increasing testosterone levels were associated with higher risk in women (hazard ratio per one nmol/l increase 1.17 (95% confidence interval 1.02–1.36); p = 0.031). Conclusion Our study indicates that low testosterone levels are associated with increased risk of future atrial fibrillation and/or ischaemic stroke in men, while they are protective in women.

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Gender differences in stroke risk of atrial fibrillation patients on oral anticoagulant treatment

Thrombosis and Haemostasis ◽

10.1160/th08-10-0635 ◽

2009 ◽

Vol 101 (05) ◽

pp. 938-942 ◽

Cited By ~ 61

Author(s):

Emilia Antonucci ◽

Elisa Grifoni ◽

Rosanna Abbate ◽

Gian Franco Gensini ◽

Domenico Prisco ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulant ◽

Stroke Risk ◽

Cox Regression ◽

Female Gender ◽

Bleeding Risk ◽

Anticoagulant Treatment ◽

Oral Anticoagulant Treatment ◽

Cox Regression Analysis

SummaryThe efficacy of adjusted-dose oral anticoagulant treatment (OAT) in the prevention of stroke in atrial fibrillation (AF) is well documented. Available data show that AF patients are widely heterogeneous in terms of ischaemic stroke risk. The role of female gender as a predictor of stroke risk is inconsistent, in particular it is unclear if warfarin treatment is able to prevent stroke equally in both sexes. We performed a prospective study on 780 AF patients on OAT, followed by an Anticoagulation Clinic, to evaluate if female gender is a risk factor for stroke among patients on OAT and if the quality of anticoagulation is different between genders. No difference was found in relation to the quality of anticoagulation between genders (p=0.5). During follow-up 33 patients had major bleedings (rate 1.37x100 pt/yrs) but no difference was found between genders in bleeding risk. Forty patients had ischaemic events [rate 1.66x100 pt/yrs; males rate 1.2 x100 pt/yrs; females rate 2.43x100 pt/yrs; p=0.042; relative risk (RR) of females vs. males 2.0 (95% confidence interval [CI] 1.3–3.1); p= 0.004]. The higher rate of ischaemic events in females with respect to males was confirmed at Cox regression analysis after correction for age (p=0.009). In addition, strokes occurring in females were more disabling, and RR for severe and fatal stroke, defined according to Modified Rankin scale, of females vs. males was 3.1 (95% CI 1.3–6.5; p=0.001). In conclusion, our data show a higher risk of stroke in anticoagulated AF females with respect to males, despite a similar quality of anticoagulation.

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Assessing the external validity of the VALIDATE-SWEDEHEART trial

Clinical Trials ◽

10.1177/17407745211012438 ◽

2021 ◽

pp. 174077452110124

Author(s):

Rebecca T Rylance ◽

Philippe Wagner ◽

Elmir Omerovic ◽

Claes Held ◽

Stefan James ◽

...

Keyword(s):

Propensity Score ◽

Confidence Interval ◽

Cox Regression ◽

Hazard Ratio ◽

Inclusion Criteria ◽

Cox Regression Analysis ◽

Inverse Probability ◽

Weighted Analysis ◽

Score Difference ◽

Inverse Probability Weighted

Aims: The VALIDATE-SWEDEHEART trial was a registry-based randomized trial comparing bivalirudin and heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention. It showed no differences in mortality at 30 or 180 days. This study examines how well the trial population results may generalize to the population of all screened patients with fulfilled inclusion criteria in regard to mortality at 30 and 180 days. Methods: The standardized difference in the mean propensity score for trial inclusion between trial population and the screened not-enrolled with fulfilled inclusion criteria was calculated as a metric of similarity. Propensity scores were then used in an inverse-probability weighted Cox regression analysis using the trial population only to estimate the difference in mortality as it would have been had the trial included all screened patients with fulfilled inclusion criteria. Patients who were very likely to be included were weighted down and those who had a very low probability of being in the trial were weighted up. Results: The propensity score difference was 0.61. There were no significant differences in mortality between bivalirudin and heparin in the inverse-probability weighted analysis (hazard ratio 1.11, 95% confidence interval (0.73, 1.68)) at 30 days or 180 days (hazard ratio 0.98, 95% confidence interval (0.70, 1.36)). Conclusion: The propensity score difference demonstrated that the screened not-enrolled with fulfilled inclusion criteria and trial population were not similar. The inverse-probability weighted analysis showed no significant differences in mortality. From this, we conclude that the VALIDATE results may be generalized to the screened not-enrolled with fulfilled inclusion criteria.

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Migraine with visual aura is a risk factor for incident atrial fibrillation

Neurology ◽

10.1212/wnl.0000000000006650 ◽

2018 ◽

Vol 91 (24) ◽

pp. e2202-e2210 ◽

Cited By ~ 24

Author(s):

Souvik Sen ◽

X. Michelle Androulakis ◽

Viktoriya Duda ◽

Alvaro Alonso ◽

Lin Yee Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Confidence Interval ◽

Stroke Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Visual Aura ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Atherosclerosis Risk

ObjectiveMigraine with visual aura is associated with cardioembolic stroke risk. The aim of this study was to test association between migraine with visual aura and atrial fibrillation (AF), in the Atherosclerosis Risk in Communities study.MethodsIn the Atherosclerosis Risk in Communities study, a longitudinal, community-based cohort study, participants were interviewed for migraine history in 1993–1995 and were followed for incident AF through 2013. AF was adjudicated using ECGs, discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Mediation analysis was conducted to test whether AF was a mediator of migraine with visual aura-associated stroke risk.ResultsOf 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraines with visual aura, 1,090 migraine without visual aura, 1,018 nonmigraine headache, and 9,405 no headache. Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1,516 with migraine and 1,623 (17%) of 9,405 without headache. After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache (hazard ratio 1.30, 95% confidence interval 1.03–1.62) as well as when compared to migraine without visual aura (hazard ratio 1.39, 95% confidence interval 1.05–1.83). The data suggest that AF may be a potential mediator of migraine with visual aura–stroke risk.ConclusionsMigraine with aura was associated with increased risk of incident AF. This may potentially lead to ischemic strokes.

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Disability progression in relapse-free multiple sclerosis patients on fingolimod versus interferon-beta/glatiramer acetate

Multiple Sclerosis Journal ◽

10.1177/1352458520918489 ◽

2020 ◽

pp. 135245852091848

Author(s):

Viktor von Wyl ◽

Pascal Benkert ◽

André Moser ◽

Johannes Lorscheider ◽

Bernhard Décard ◽

...

Keyword(s):

Multiple Sclerosis ◽

Regression Analysis ◽

Confidence Interval ◽

Glatiramer Acetate ◽

Interferon Beta ◽

Cox Regression ◽

Hazard Ratio ◽

Disability Progression ◽

Cox Regression Analysis ◽

Multiple Sclerosis Patients

Background: Disability progression independent of relapses (PIRA) has been described as a frequent phenomenon in relapsing-remitting multiple sclerosis (RRMS). Objective: To compare the occurrence of disability progression in relapse-free RRMS patients on interferon-beta/glatiramer acetate (IFN/GA) versus fingolimod. Methods: This study is based on data from the Swiss association for joint tasks of health insurers. Time to relapse and 12-month confirmed disability progression were compared between treatment groups using multivariable Cox regression analysis with confounder adjustment. Inverse-probability weighting was applied to correct for the bias that patients on fingolimod have a higher chance to remain relapse-free than patients on IFN/GA. Results: We included 1640 patients (64% IFN/GA, 36% fingolimod, median total follow-up time = 4–5 years). Disease-modifying treatment (DMT) groups were well balanced with regard to potential confounders. Disability progression was observed in 155 patients (8.8%) on IFN/GA and 51 (7.6%) on fingolimod, of which 44 and 23 were relapse-free during the initial DMT, respectively. Adjusted standard regression analysis on all patients indicated that those on fingolimod experience less frequently disability progression compared with IFN/GA (hazard ratio = 0.53 (95% confidence interval = 0.37–0.76)). After bias correction, this was also true for patients without relapses (hazard ratio=0.56 (95% confidence interval = 0.32–0.98). Conclusion: Our analysis indicates that fingolimod is superior to IFN/GA in preventing disability progression in both relapsing and relapse-free, young, newly diagnosed RRMS patients.

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Carbamylated Lipoproteins and Progression of Diabetic Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.11710919 ◽

2020 ◽

Vol 15 (3) ◽

pp. 359-366 ◽

Cited By ~ 1

Author(s):

Kathryn C.B. Tan ◽

Ching-Lung Cheung ◽

Alan C.H. Lee ◽

Joanne K.Y. Lam ◽

Ying Wong ◽

...

Keyword(s):

Type 2 Diabetes ◽

Confidence Interval ◽

Cox Regression ◽

Hdl Cholesterol ◽

Hazard Ratio ◽

Healthy Controls ◽

Cox Regression Analysis ◽

Control Study

Background and objectivesProtein carbamylation is a consequence of uremia and carbamylated lipoproteins contribute to atherogenesis in CKD. Proteins can also be carbamylated by a urea-independent mechanism, and whether carbamylated lipoproteins contribute to the progression of CKD has not been investigated.Design, setting, participants, & measurementsA case-control study was performed to determine whether there were changes in plasma levels of carbamylated lipoproteins in individuals with type 2 diabetes with eGFR >60 ml/min per 1.73 m2 compared with a group of age- and sex-matched healthy controls. A cohort of 1320 patients with type 2 diabetes with baseline eGFR ≥30 ml/min per 1.73 m2 was longitudinally followed up to evaluate the association between carbamylated lipoproteins and progression of CKD. The primary kidney outcome was defined as doubling of serum creatinine and/or initiation of KRT during follow-up. Plasma carbamylated LDLs and HDLs was measured by ELISA.ResultsIn individuals with diabetes with eGFR >60 ml/min per 1.73 m2, both plasma carbamylated LDL and HDL levels were higher compared with healthy controls (P<0.001). After a mean follow-up of 9 years of the diabetic cohort, individuals in the top quartile of carbamylated LDL (hazard ratio, 2.21; 95% confidence interval, 1.42 to 3.46; P<0.001) and carbamylated HDL (hazard ratio, 4.53; 95% confidence interval, 2.87 to 7.13; P<0.001) had higher risk of deterioration of kidney function compared with those in the lowest quartile. On multivariable Cox regression analysis, plasma carbamylated LDL was no longer associated with kidney outcome after adjusting for baseline eGFR and potential confounding factors. However, the association between plasma carbamylated HDL and kidney outcome remained significant and was independent of HDL cholesterol.ConclusionsPlasma carbamylated HDL but not carbamylated LDL was independently associated with progression of CKD in patients with type 2 diabetes.

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