The Role of Blood Pressure in Carotid Plaque Incidence: Interactions With Body Mass Index, Age, and Sex-Based on a 7-Years Cohort Study

Background: Although high blood pressure (BP) is a risk factor for carotid plaque, its long-term prognostic value might be underestimated due to its confounding interactions with BMI, age, and gender. Therefore, we conducted a 7-year prospective cohort study to evaluate the prognostic value of BP for the incidence of carotid plaque.Methods: The subjects enrolled in 2011 were free of carotid plaque at baseline and were followed up in 2018. Multivariate Cox proportional-hazards models were used to evaluate the association between BP and carotid plaque incidence.Results: During the follow-up study, the incidence of carotid plaque was 36.5%. The significant positive linear trend showed that subjects with higher BP levels at baseline were more likely to develop carotid plaques at the end. Especially in the female subpopulation, after confounders being adjusted, the carotid plaque was associated with higher BP (adjusted HR 1.52, 95% CI 1.02–2.26), pulse pressure (PP) (adjusted HR 1.15, 95% CI 0.76–1.75), and mean arterial pressure (MAP) (adjusted HR 1.44, 95% CI 1.00–2.08). The adjusted HRs of hypertension, PP, and MAP (HR 27.71, 95% CI 2.27–338.64; HR 14.47, 95% CI 1.53–137.18; HR 9.97, 95% CI 1.29–77.28) were significantly higher after the potential antagonistic interactions between BP categorical indicators and age being adjusted, respectively.Conclusion: High BP indicators might be associated with higher HRs of carotid plaque after adjusting interactions between BP indicators and BMI, age, and gender, which suggests that the incidence of carotid plaque in female adults with high BP indicators might increase significantly with the increase of age.

Download Full-text

Prevalence and Prognostic Value of Heart Failure Stages: An Elderly Inpatient Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.639453 ◽

2021 ◽

Vol 8 ◽

Author(s):

Pei-Pei Zheng ◽

Si-Min Yao ◽

Di Guo ◽

Ling-ling Cui ◽

Guo-Bin Miao ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Prognostic Value ◽

Proportional Hazards ◽

Regression Tree ◽

Cox Proportional Hazards ◽

Hospitalized Patients ◽

Classification And Regression Tree ◽

Major Adverse Cardiovascular Events ◽

Cox Proportional Hazards Models

Background: The prevalence and prognostic value of heart failure (HF) stages among elderly hospitalized patients is unclear.Methods: We conducted a prospective, observational, multi-center, cohort study, including hospitalized patients with the sample size of 1,068; patients were age 65 years or more, able to cooperate with the assessment and to complete the echocardiogram. Two cardiologists classified all participants in various HF stages according to 2013 ACC/AHA HF staging guidelines. The outcome was rate of 1-year major adverse cardiovascular events (MACE). The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses. Survival classification and regression tree analysis were used to determine the optimal cutoff of N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict MACE.Results: Participants' mean age was 75.3 ± 6.88 years. Of them, 4.7% were healthy and without HF risk factors, 21.0% were stage A, 58.7% were stage B, and 15.6% were stage C/D. HF stages were associated with worsening 1-year survival without MACE (log-rank χ2 = 69.62, P < 0.001). Deterioration from stage B to C/D was related to significant increases in HR (3.636, 95% CI, 2.174–6.098, P < 0.001). Patients with NT-proBNP levels over 280.45 pg/mL in stage B (HR 2; 95% CI 1.112–3.597; P = 0.021) and 11,111.5 pg/ml in stage C/D (HR 2.603, 95% CI 1.014–6.682; P = 0.047) experienced a high incidence of MACE adjusted for age, sex, and glomerular filtration rate.Conclusions : HF stage B, rather than stage A, was most common in elderly inpatients. NT-proBNP may help predict MACE in stage B.Trial Registration: ChiCTR1800017204; 07/18/2018.

Download Full-text

Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION

Stroke ◽

10.1161/str.51.suppl_1.wp218 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adam H de Havenon ◽

Ka-Ho Wong ◽

Eva Mistry ◽

Mohammad Anadani ◽

Shadi Yaghi ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Proportional Hazards ◽

Secondary Analysis ◽

Cox Proportional Hazards ◽

Diabetic Patients ◽

Adjusted Risk ◽

Cox Proportional Hazards Models ◽

Increased Risk

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.

Download Full-text

Blood Pressure Change from Normal to 2017 ACC/AHA Defined Stage 1 Hypertension and Cardiovascular Risk

Journal of Clinical Medicine ◽

10.3390/jcm8060820 ◽

2019 ◽

Vol 8 (6) ◽

pp. 820 ◽

Cited By ~ 4

Author(s):

Joung Sik Son ◽

Seulggie Choi ◽

Gyeongsil Lee ◽

Su-Min Jeong ◽

Sung Min Kim ◽

...

Keyword(s):

Blood Pressure ◽

Proportional Hazards ◽

Heart Association ◽

Pressure Change ◽

Cox Proportional Hazards ◽

Cvd Risk ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Stage 1 ◽

Second Period

The purpose of this study was to investigate the clinical significance of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) defined stage 1 hypertension (systolic blood pressure (SBP) 130–139 mmHg or diastolic blood pressure (DBP) 80–89 mmHg), and increase in BP from previously normal BP in Korean adults. We conducted a retrospective analysis of 60,866 participants from a nationally representative claims database. Study subjects had normal BP (SBP < 120 mmHg and DBP < 80 mmHg), no history of anti-hypertensive medication, and cardiovascular disease (CVD) in the first period (2002–2003). The BP change was defined according to the BP difference between the first and second period (2004–2005). We used time-dependent Cox proportional hazards models in order to evaluate the effect of BP elevation on mortality and CVD with a mean follow-up of 7.8 years. Compared to those who maintained normal BP during the second period, participants with BP elevation from normal BP to stage 1 hypertension had a higher risk for CVD (adjusted hazard ratio (aHR) 1.23; 95% confidence interval (CI), 1.08–1.40), and ischemic stroke (aHR 1.32; 95% CI, 1.06–1.64). BP elevation to 2017 ACC/AHA defined elevated BP (SBP 120–129 mmHg and DBP < 80 mmHg) was associated with an increased risk of CVD (aHR 1.26; 95% CI, 1.06–1.50), but stage 1 isolated diastolic hypertension (SBP < 130 and DBP 80–89 mmHg) was not significantly related with CVD risk (aHR 1.12; 95% CI, 0.95–1.31).

Download Full-text

Risk of depressive disorders after tobacco smoking cessation: a retrospective cohort study in Fukuoka, Japan

BMJ Open ◽

10.1136/bmjopen-2018-025124 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025124 ◽

Cited By ~ 1

Author(s):

Takako Fujita ◽

Akira Babazono ◽

Yumi Harano ◽

Peng Jiang

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Survival Analysis ◽

Retrospective Cohort ◽

Depressive Disorders ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Significant Difference

ObjectiveWe sought to examine the effect of smoking cessation on subsequent development of depressive disorders.DesignThis was a retrospective cohort study.MethodsWe used administrative claim and health check data from fiscal years 2010 to 2014, obtained from the largest health insurance association in Fukuoka, Japan. Study participants were between 30 and 69 years old. The end-point outcome was incidence of depressive disorders. Survival analysis and Cox proportional hazards models were conducted. The evaluated potential confounders were sex, age, standard monthly income and psychiatric medical history.ResultsThe final number of participants was 87 255, with 7841 in the smoking cessation group and 79 414 in the smoking group. The result of survival analysis showed no significant difference in depressive disorders between the two groups. The results of Cox proportional hazards models showed no significant difference by multivariate analysis between participants, including users of smoking cessation medication (HR 1.04, 95% Cl 0.89 to 1.22) and excluding medication use (HR 0.97, 95% Cl 0.82 to 1.15).ConclusionsThe present study showed that there were no significant differences with respect to having depressive disorders between smoking cessation and smoking groups. We also showed that smoking cessation was not related to incidence of depressive disorders among participants, including and excluding users of smoking cessation medication, after adjusting for potential confounders. Although the results have some limitations because of the nature of the study design, our findings will provide helpful information to smokers, health professionals and policy makers for improving smoking cessation.

Download Full-text

A cohort study of dietary fibre intake and menarche

Public Health Nutrition ◽

10.1079/phn2002261 ◽

2002 ◽

Vol 5 (2) ◽

pp. 353-360 ◽

Cited By ~ 40

Author(s):

Malcolm M Koo ◽

Thomas E Rohan ◽

Meera Jain ◽

John R McLaughlin ◽

Paul N Corey

Keyword(s):

Cohort Study ◽

Dietary Intake ◽

Dietary Fibre ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Age At Menarche ◽

Relative Hazard ◽

Component Level ◽

Cox Proportional Hazards Models

AbstractObjective:To evaluate the influence of dietary fibre on menarche in a cohort of pre-menarcheal girls.Design:Prospective cohort study.Setting:Ontario, Canada.Subjects:Free-living pre-menarcheal girls (n = 637), 6 to 14 years of age.Methodology:Information on dietary intake, physical activity and date of menarche was collected at baseline and was updated annually by self-administered questionnaires for three years. Cox proportional hazards models were used to evaluate the association between dietary fibre and menarche, adjusting for age at entry to the study and potential confounders.Results:A higher intake of energy-adjusted dietary fibre was associated with a lower risk of (i.e. a later age at) menarche (relative hazard 0.54, 95% confidence interval (CI) 0.31–0.94 for highest vs. lowest quartile, P for trend = 0.027). At the fibre component level, a higher intake of energy-adjusted cellulose was associated with a lower risk of menarche (relative hazard 0.45, 95% CI 0.26–0.76, P for trend = 0.009).Conclusions:The findings are consistent with the hypothesis that pre-menarcheal dietary intake can influence menarche.

Download Full-text

Association of Mid- to Late-Life Blood Pressure Patterns With Risk of Subsequent Coronary Heart Disease and Death

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.632514 ◽

2021 ◽

Vol 8 ◽

Author(s):

Menghui Liu ◽

Shaozhao Zhang ◽

Xiaohong Chen ◽

Xiangbin Zhong ◽

Zhenyu Xiong ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Proportional Hazards ◽

Late Life ◽

Cox Proportional Hazards ◽

Atherosclerosis Risk In Communities ◽

Cox Proportional Hazards Models ◽

Significant Difference ◽

All Cause Mortality

Background: The elevated blood pressure (BP) at midlife or late-life is associated with cardiovascular disease and death. However, there is limited research on the association between the BP patterns from middle to old age and incident coronary heart disease (CHD) and death.Methods: A cohort of the Atherosclerosis Risk in Communities (ARIC) Study enrolled 9,829 participants who attended five in-person visits from 1987 to 2013. We determined the association of mid- to late-life BP patterns with incident CHD and all-cause mortality using multivariable-adjusted Cox proportional hazards models.Results: During a median of 16.7 years of follow-up, 3,134 deaths and 1,060 CHD events occurred. Compared with participants with midlife normotension, the adjusted hazard ratio for all-cause mortality and CHD was 1.14 (95% CI, 1.04–1.25) and 1.28 (95% CI, 1.10–1.50) in those with midlife hypertension, respectively. In further analyses, compared with a pattern of sustained normotension from mid- to late-life, there was no significant difference for the risk of incident death (HR, 1.15; 95% CI, 0.96–1.37) and CHD (HR, 1.33; 95% CI, 0.99–1.80) in participants with a pattern of midlife normotension and late-life hypertension with effective BP control. A higher risks of death and CHD were found in those with pattern of mid- to late-life hypertension with effective BP control (all-cause mortality: HR, 1.24; 95% CI, 1.08–1.43; CHD: HR, 1.65; 95% CI 1.30–2.09), pattern of midlife normotension and late-life hypertension with poor BP control (all-cause mortality: HR, 1.27; 95% CI, 1.12–1.44; CHD: HR, 1.53; 95% CI, 1.23–1.92), and pattern of mid- to late-life hypertension with poor BP control (all-cause mortality: HR, 1.49; 95% CI, 1.30–1.71; CHD: HR, 1.87; 95% CI, 1.48–2.37).Conclusions: The current findings underscore that the management of elderly hypertensive patients should not merely focus on the current BP status, but the middle-aged BP status. To achieve optimal reductions in the risk of CHD and death, it may be necessary to prevent, diagnose, and manage of hypertension throughout middle age.

Download Full-text

U-Shaped Association of Serum Uric Acid With All-Cause and Cause-Specific Mortality in US Adults: A Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz068 ◽

2019 ◽

Vol 105 (3) ◽

pp. e597-e609 ◽

Cited By ~ 1

Author(s):

Lihua Hu ◽

Guiping Hu ◽

Benjamin Ping Xu ◽

Lingjuan Zhu ◽

Wei Zhou ◽

...

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Serum Uric Acid ◽

Inflection Point ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Specific Mortality ◽

The Relationship

Abstract Background In addition to the controversy regarding the association of hyperuricemia with mortality, uncertainty also remains regarding the association between low serum uric acid (SUA) and mortality. We aimed to assess the relationship between SUA and all-cause and cause-specific mortality. Methods This cohort study included 9118 US adults from the National Health and Nutrition Examination Survey (1999-2002). Multivariable Cox proportional hazards models were used to evaluate the relationship between SUA and mortality. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and 2-piecewise Cox proportional hazards models, to address the nonlinearity between SUA and mortality. Results During a median follow-up of 5.83 years, 448 all-cause deaths occurred, with 100 cardiovascular disease (CVD) deaths, 118 cancer deaths, and 37 respiratory disease deaths. Compared with the reference group, there was an increased risk of all-cause, CVD, cancer, and respiratory disease mortality for participants in the first and third tertiles of SUA. We further found a nonlinear and U-shaped association between SUA and mortality. The inflection point for the curve was found at a SUA level of 5.7 mg/dL. The hazard ratios (95% confidence intervals) for all-cause mortality were 0.80 (0.65-0.97) and 1.24 (1.10-1.40) to the left and right of the inflection point, respectively. This U-shaped association was observed in both sexes; the inflection point for SUA was 6 mg/dL in males and 4 mg/dL in females. Conclusion Both low and high SUA levels were associated with increased all-cause and cause-specific mortality, supporting a U-shaped association between SUA and mortality.

Download Full-text

Use of single polymorphism arrays (SNP-A) to modify prognostic scoring systems for myelodysplastic syndromes.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6521 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6521-6521

Author(s):

Manojkumar Bupathi ◽

Paul Elson ◽

Visconte Valeria ◽

Fabiola Traina ◽

Christine O' Keefe ◽

...

Keyword(s):

Prognostic Value ◽

Proportional Hazards ◽

Uniparental Disomy ◽

Scoring Systems ◽

Risk Groups ◽

Cox Proportional Hazards ◽

Clinical Factors ◽

Cox Proportional Hazards Models ◽

Revised Definitions ◽

Endpoint Data

6521 Background: MDS are hematologic neoplasms characterized by dysplasia and cytopenias. Two commonly used risk stratifications, IPSS (Greenberg et al Blood 1997) and IPSS-R are based on clinical factors (marrow blasts, number of cytopenias and genetic abnormalities determined by conventional karyotyping), with the IPSS based on 4 cytogenetic risk groups and the IPSS-R based on 5 cytogenetic risk groups defined by Schanz et al JCO 2012. A drawback to metaphase cytogenetics (MC) is its inability to detect small cryptic chromosomal defects and uniparental disomy (UPD). SNP-A can identify these small cytogenetic lesions/UPD and has been shown to be of prognostic value in MDS. The goal of this investigation was to determine if SNP-A detected defects could be used to refine the IPSS and IPSS-R. Methods: SNP-A karyotyping was performed as previously described (Tiu et al, Blood, 2011). We reviewed data from 327 patients idenfitying SNP-A results, MC, and the IPSS/IPSS-R-related clinical factors were identified. Overall survival (OS) measured from the date of sampling for SNP-A karyotyping was the primary endpoint. Data were analyzed using Cox proportional hazards models. Results: SNP-A lesions not detected by MC were grouped as 1) none or only gains/losses; 2) UPD only or gains+losses but no UPD; and 3) UPD+other defects. The frequencies/median os in months (mo) of the groups were: 66%/20.0, 23%/12.7 and 11%/5.8, respectively, p<.0001 for OS. Combining the SNP-A groups with MC resulted in revised definitions of cytogenetic risk that had better discrimination than the underlying models; and when combined with the relevant clinical factors resulted in refined IPSS (IPSSSNP-A) and IPSS-R (IPSS-RSNP-A) risk stratifications (Table). Conclusions: Detection of chromosomal gains, losses, and UPD by SNP-A has prognostic value in MDS and can be used to refine current risk stratifications. [Table: see text]

Download Full-text

Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study

RMD Open ◽

10.1136/rmdopen-2018-000670 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000670 ◽

Cited By ~ 12

Author(s):

Isabelle A Vallerand ◽

Ryan T Lewinson ◽

Alexandra D Frolkis ◽

Mark W Lowerison ◽

Gilaad G Kaplan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Future Research ◽

Health Improvement ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Antidepressant Use

ObjectivesMajor depressive disorder (MDD) is associated with increased levels of systemic proinflammatory cytokines, including tumour necrosis factor alpha. As these cytokines are pathogenic in autoimmune diseases such as rheumatoid arthritis (RA), our aim was to explore on a population-level whether MDD increases the risk of developing RA.MethodsA retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index and antidepressant use.ResultsA cohort of 403 932 patients with MDD and a referent cohort of 5 339 399 patients without MDD were identified in THIN. Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31, 95% CI 1.25 to 1.36, p<0.0001). When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38, 95% CI 1.31 to 1.46, p<0.0001). Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA.ConclusionMDD increased the risk of developing RA by 38%, and antidepressants may decrease this risk in these patients. Future research is necessary to confirm the underlying mechanism of MDD on the pathogenesis of RA.

Download Full-text

Higher postoperative plasma EV PD-L1 predicts poor survival in patients with gastric cancer

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002218 ◽

2021 ◽

Vol 9 (3) ◽

pp. e002218

Author(s):

Gaopeng Li ◽

Guoliang Wang ◽

Fenqing Chi ◽

Yuqi Jia ◽

Xi Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Value ◽

Proportional Hazards ◽

Prognostic Indicator ◽

High Plasma ◽

Cox Proportional Hazards ◽

Serum Biomarkers ◽

Poor Survival ◽

Term Survival ◽

Cox Proportional Hazards Models

BackgroundThe satisfactory prognostic indicator of gastric cancer (GC) patients after surgery is still lacking. Perioperative plasma extracellular vesicular programmed cell death ligand-1 (ePD-L1) has been demonstrated as a potential prognosis biomarker in many types of cancers. The prognostic value of postoperative plasma ePD-L1 has not been characterized.MethodsWe evaluated the prognostic value of preoperative, postoperative and change in plasma ePD-L1, as well as plasma soluble PD-L1, in short-term survival of GC patients after surgery. The Kaplan-Meier survival model and Cox proportional hazards models for both univariate and multivariate analyzes were used. And the comparison between postoperative ePD-L1 and conventional serum biomarkers (carcinoembryonic antigen (CEA), cancer antigen 19–9 (CA19-9) and CA72-4) in prognostic of GC patients was made.ResultsThe prognostic value of postoperative ePD-L1 is superior to that of preoperative ePD-L1 on GC patients after resection, and also superior to that of conventional serum biomarkers (CEA, CA19-9 and CA72-4). The levels of postoperative ePD-L1 and ePD-L1 change are independent prognostic factors for overall survival and recurrence free survival of GC patients. High plasma level of postoperative ePD-L1 correlates significantly with poor survival, while high change in ePD-L1 level brings the significant survival benefit.ConclusionsThe level of plasma postoperative ePD-L1 could be considered as a candidate prognostic biomarker of GC patients after resection.

Download Full-text