Identification of a High-Risk Group of New-Onset Cardiovascular Disease in Occupational Drivers by Analyzing Heart Rate Variability

Purpose: This cohort study evaluated the effectiveness of noninvasive heart rate variability (HRV) analysis to assess the risk of cardiovascular disease over a period of 8 years. Methods: Personal and working characteristics were collected before biochemistry examinations and 5 min HRV tests from the Taiwan Bus Driver Cohort Study (TBDCS) in 2005. This study eventually identified 161 drivers with cardiovascular disease (CVD) and 627 without between 2005 and 2012. Estimation of the hazard ratio was analyzed by using the Cox proportional-hazards model. Results: Subjects with CVD had an overall lower standard deviation of NN intervals (SDNN) than their counterparts did. The SDNN index had a strong association with CVD, even after adjusting for risk factors. Using a median split for SDNN, the hazard ratio of CVD was 1.83 (95% CI = 1.10–3.04) in Model 1 and 1.87 (95% CI = 1.11–3.13) in Model 2. Furthermore, the low-frequency (LF) index was associated with a risk of CVD in the continuous approach. For hypertensive disease, the SDNN index was associated with increased risks in both the continuous and dichotomized approaches. When the root-mean-square of the successive differences (RMSSDs), high frequency (HF), and LF were continuous variables, significant associations with hypertensive disease were observed. Conclusions: This cohort study suggests that SDNN and LF levels are useful for predicting 8 year CVD risk, especially for hypertensive disease. Further research is required to determine preventive measures for modifying HRV dysfunction, as well as to investigate whether these interventions could decrease CVD risk among professional drivers.

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Heart rate variability predicts 8-year risk of cardiovascular disease: The Taiwan Bus Driver Cohort Study (TBDCS)

10.21203/rs.3.rs-35202/v1 ◽

2020 ◽

Author(s):

Ying-Chuan Wang ◽

Chung-Ching Wang ◽

Bae-Ling Chen ◽

Wei-Te Wu

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Cohort Study ◽

Preventive Measures ◽

Hazard Ratio ◽

Hypertensive Disease ◽

Cvd Risk ◽

Professional Drivers ◽

Bus Driver

Abstract Background: Characteristics of professional drivers like irregular work shifts, long hours of driving, sedentary restricted postures, long-term sleep deficiency, increase the probability of developing cardiovascular disease (CVD). Therefore, early monitoring CVD risk is important to device preventive measures in the workplace.Objective: This cohort study used to evaluate the effectiveness of noninvasive heart rate variability (HRV) analysis to assess the 8-year risk of CVD events.Methods: Personal and working characteristics were collected before biochemistry examinations and 5-min HRV tests from Taiwan Bus Driver Cohort Study (TBDCS) in 2005. Then, this cohort was linked to Taiwan’s National Health Insurance Research Database (NHIRD) to obtain subjects’ medical information. This study eventually identified 161 drivers with CVD and 627 without from 2005 to 2012. Cox proportional hazards model were performed to estimate the hazard ratio for CVD.Results: Subjects with overall CVD had lower the standard deviation of NN intervals (SDNN) than their counterparts. Even after adjusting for risk factors, SDNN index have a strong association with overall CVD. Using median split for SDNN, hazard ratio of overall CVD was 1.83 (95% CI 1.10–3.04) in model 1 and 1.87 (95% CI 1.11–3.13) in model 2. Furthermore, Low frequency (LF) index associated with risk of overall CVD in the continuous approach. For hypertensive disease, the SDNN index was associated with increased risks in both the continuous and dichotomized approaches. When Root Mean Square of the Successive Differences (RMSSD), high frequency (HF), and LF as a continuous variable, the significant association with hypertensive disease were observed.Conclusions: This cohort study suggests that SDNN and LF levels are useful for predicting 8-year CVD risk, especially for hypertensive disease. Further research is required to determine preventive measures for modifying HRV dysfunction as well as to investigate whether these interventions could reduce CVD risk in professional drivers.

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Effects of Urate-Lowering Therapy on Risk of Hyperlipidemia in Gout by a Population-Based Cohort Study and on In Vitro Hepatic Lipogenesis-Related Gene Expression

Mediators of Inflammation ◽

10.1155/2020/8890300 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Yi-Jen Fang ◽

Tien-Yuan Wu ◽

Cheng-Li Lin ◽

Chih-Yang Su ◽

Jia-Rong Li ◽

...

Keyword(s):

Cohort Study ◽

Proportional Hazards Model ◽

Treatment Guidelines ◽

Strong Association ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Case Group ◽

Control Cohort ◽

Hepatic Expression ◽

Lowering Therapy

Patients with gout are at a higher risk of cardiovascular disease, which is associated with hyperlipidemia. Management of gout in Taiwan is poor, and the association between urate-lowering therapy (ULT) among gout patients and hyperlipidemia is unclear. We conducted a retrospective cohort study using data from the Longitudinal Health Insurance Database (LHID) of Taiwan on new-onset gout patients and a comparison cohort without gout. A Cox proportional hazards model was used to analyze differences in the risk of hyperlipidemia between patients with and without gout after considering related comorbidities. We also examined the ULT medications on the hepatic expression of lipogenesis-related genes. After adjusting for potential confounders, the case group (44,413 patients) was found to have a higher risk of hyperlipidemia than the control cohort (177,652 patients) [adjusted hazards ratio aHR = 2.55 ]. Gout patients without antigout treatment had significantly higher risk of hyperlipidemia than the control cohort ( aHR = 3.10 ). Among gout patients receiving ULT, except those receiving probenecid ( aHR = 0.80 ), all had significantly lower risk of hyperlipidemia than gout patients without ULT (all aHR < 0.90 ). Using real-time polymerase chain reaction, we found that most of the antigout drugs decreased the expression of hepatic genes related to lipogenesis in differentiated HepaRG cells. These data indicate that these antigout drugs reduce hyperlipidemia in gout patients, partly via the reduction in expression of lipogenesis-related genes, leading to improved blood lipid profiles. We provide evidence of the strong association between gout and hyperlipidemia and highlight the need for appropriate treatment guidelines.

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0237 The relationship between heart rate variability and 5 year risk of cardiovascular disease: evidence from the taiwan bus driver cohort study

10.1136/oemed-2017-104636.189 ◽

2017 ◽

Author(s):

Chung-Ching Wang ◽

Ying-Chuan Wang ◽

Wei-Te Wu ◽

Sheng-Ta Chiang ◽

Saou-Hsing Liou

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Cohort Study ◽

Bus Driver ◽

The Relationship

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Effect of resting heart rate on the risk of all-cause death in Chinese patients with hypertension: analysis of the Kailuan follow-up study

BMJ Open ◽

10.1136/bmjopen-2019-032699 ◽

2020 ◽

Vol 10 (3) ◽

pp. e032699 ◽

Cited By ~ 1

Author(s):

Mao Xiang Zhao ◽

Quanhui Zhao ◽

Mengyi Zheng ◽

Tong Liu ◽

Yao Li ◽

...

Keyword(s):

Heart Rate ◽

Cohort Study ◽

Proportional Hazards Model ◽

Cox Regression ◽

Cox Proportional Hazards Model ◽

Chinese Patients ◽

Health Examination ◽

Resting Heart Rate ◽

All Cause Mortality

ObjectivePrevious studies have shown that an elevated heart rate is associated with a higher risk of cardiovascular events. This study aimed to prospectively examine the relationship between resting heart rate (RHR) and all-cause mortality in Chinese patients with hypertension.DesignAn observational, prospective and population-based cohort study.SettingThe Kailuan cohort study was conducted in Tangshan City in northern China.ParticipantsWe enrolled 46 561 patients who did not receive beta-blocker treatment and were diagnosed with hypertension for the first time during an employee health examination in Kailuan Group in 2006 and 2008.OutcomeThe primary outcome of this study was all-cause mortality.MethodsThe patients in this study were followed for 9.25±1.63 years. All patients were followed up face to face every 2 years. According to the distribution of RHR in the study population, RHR was categorised into five groups on the basis of quintiles: Q1: RHR ≤68 beats per minute (bpm); Q2: RHR >68 and ≤72 bpm; Q3: RHR >72 and ≤76 bpm; Q4: RHR >76 and ≤82 bpm; Q5: RHR >82 bpm. Cox proportional hazards model, which was adjusted for traditional risk factors, was used.ResultsDuring follow-up, 4751 deaths occurred. After adjustment for potential confounders, restricted cubic spline regression showed that the risk of all-cause mortality increased with heart rate. In multivariate Cox regression analyses adjusted for age, sex and major covariates, the HR for all-cause mortality was 1.31 (95% CI 1.27 to 1.33) in the highest quintile group (Q5) compared with the lowest quintile group (Q1).ConclusionAn increase in RHR is a long-term risk factor of all-cause mortality in Chinese patients with hypertension.Trial registration numberChiCTR-TNC-11001489.

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Heart Rate and Heart Rate Variability Changes Are Not Related to Future Cardiovascular Disease and Death in People With and Without Dysglycemia: A Downfall of Risk Markers? The Whitehall II Cohort Study

Diabetes Care ◽

10.2337/dc20-2490 ◽

2021 ◽

pp. dc202490

Author(s):

Christian S. Hansen ◽

Marit E. Jørgensen ◽

Marek Malik ◽

Daniel R. Witte ◽

Eric J. Brunner ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Cohort Study ◽

Risk Markers

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The Effects of Calculated Remnant-Like Particle Cholesterol on Incident Cardiovascular Disease: Insights from a General Chinese Population

Journal of Clinical Medicine ◽

10.3390/jcm10153388 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3388

Author(s):

Yanli Chen ◽

Guangxiao Li ◽

Xiaofan Guo ◽

Nanxiang Ouyang ◽

Zhao Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Renal Dysfunction ◽

Large Scale ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Atherosclerotic Cardiovascular Disease ◽

Cvd Risk ◽

High Level ◽

Nonlinear Association

Background: Growing evidence suggests that remnant cholesterol (RC) contributes to residual atherosclerotic cardiovascular disease (ASCVD) risk. However, the cutoff points to treat RC for reducing ASCVD are still unknown. This study aimed to investigate the relationships between RC and combined cardiovascular diseases (CVDs) in a general China cohort, with 11,956 subjects aged ≥ 35 years. Methods: Baseline RC was estimated with the Friedewald formula for 8782 subjects. The outcome was the incidence of combined CVD, including fatal and nonfatal stroke and coronary heart disease (CHD). The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals. The restricted cubic spline (RCS) model was used to evaluate the dose–response relationship between continuous RC and the natural log of HRs. Results: After a median follow-up of 4.66 years, 431 CVD events occurred. In the Cox proportional models, participants with a high level of categorial RC had a significantly higher risk for combined CVD (HR: 1.37; 95% CI: 1.07–1.74) and CHD (HR: 1.63; 95% CI: 1.06–2.53), compared to those with a medium level of RC. In the stratification analyses, a high level of RC significantly increased combined CVD risk for subgroups females, age < 65 years, noncurrent smokers, noncurrent drinkers, normal weight, renal dysfunction, and no hyperuricemia. The same trends were found for CHD among subgroups males, age < 65 years, overweight, renal dysfunction, and no hyperuricemia; stroke among subgroup females. In RCS models, a significant linear association between RC and combined CVD and a nonlinear association between RC and CHD resulted. The risk of outcomes was relatively flat until 0.84 mmol/L of RC and increased rapidly afterwards, with an HR of 1.308 (1.102 to 1.553) for combined CVD and 1.411 (1.061 to 1.876) for CHD. Stratified analyses showed a significant nonlinear association between RC and CVD outcomes in the subgroup aged < 65 years or the diabetes subgroup. Conclusions: In this large-scale and long-term follow-up cohort study, participants with higher RC levels had a significantly worse prognosis, especially for the subgroup aged 35–65 years or the diabetes mellitus subgroup.

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Heart Rate and Heart Rate Variability Changes Are Not Related to Future Cardiovascular Disease and Death in People With and Without Dysglycemia: A Downfall of Risk Markers? The Whitehall II Cohort Study

10.2337/figshare.13526351.v1 ◽

2021 ◽

Author(s):

Christian S Hansen ◽

Marit E Jørgensen ◽

Marek Malik ◽

Daniel R Witte ◽

Eric J Brunner ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Cohort Study ◽

Population Based ◽

Increased Risk ◽

All Cause Mortality ◽

Future Events ◽

Design And Methods

Objective Higher resting heart rate (rHR) and lower heart rate variability (HRV) are associated with increased risk of cardiovascular disease (CVD) and all-cause mortality in people with and without diabetes It is unknown whether temporal changes in rHR and HRV may contribute to this risk. We investigated associations between 5-year changes in rHR and HRV and risk of future CVD and death, taking into account participants’ baseline glycemic state. Research design and Methods In this prospective population-based cohort study we investigated 4,611 CVD-free civil servants (mean age 60, SD=5.9 years, 70% men). rHR and/or 6 indices of HRV were measured. Associations of 5-year change in 5-minute rHR and HRV with fatal- and non-fatal CVD and all-cause mortality or the composite of the two were assessed with adjustments for relevant confounders. Effect modification by glycemic state was tested. Results At baseline, 63% of participants were normoglycemic, 29% had prediabetes and 8% had diabetes. During a median (IQR) follow-up of 11.9 (11.4;12.3) years, 298 participants (6.5%) experienced a CVD event and 279 (6.1%) died from non-CVD related causes. We found no association between 5-year changes in rHR and HRV and future events. Only baseline rHR was associated with all-cause mortality. A 10 beats per minute higher baseline level showed a 11.4% higher rate of all-cause mortality (95%CI:1.0;22.9%, P=0.032). Glycemic state did not modify associations. Conclusion Changes in rHR and HRV and possibly also baseline values of these measures are not associated with future CVD or mortality in people with or without dysglycemia.

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Heart Rate and Heart Rate Variability Changes Are Not Related to Future Cardiovascular Disease and Death in People With and Without Dysglycemia: A Downfall of Risk Markers? The Whitehall II Cohort Study

10.2337/figshare.13526351 ◽

2021 ◽

Author(s):

Christian S Hansen ◽

Marit E Jørgensen ◽

Marek Malik ◽

Daniel R Witte ◽

Eric J Brunner ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Cohort Study ◽

Population Based ◽

Increased Risk ◽

All Cause Mortality ◽

Future Events ◽

Design And Methods

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Risk of Hospital Encounters With Kidney Stones in Autosomal Dominant Polycystic Kidney Disease: A Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211000227 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110002

Author(s):

Vinusha Kalatharan ◽

Blayne Welk ◽

Danielle M. Nash ◽

Stephanie N. Dixon ◽

Justin Slater ◽

...

Keyword(s):

Cohort Study ◽

Kidney Disease ◽

Polycystic Kidney Disease ◽

Kidney Stones ◽

Autosomal Dominant ◽

Significant Risk ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Polycystic Kidney ◽

Autosomal Dominant Polycystic Kidney

Background: There is a perception that patients with autosomal dominant polycystic kidney disease (ADPKD) are more likely to develop kidney stones than the general population. Objective: To compare the rate of hospital encounter with kidney stones and the rate of stone interventions between patients with and without ADPKD. Design: Retrospective cohort study. Setting: Ontario, Canada. Patients: Patients with and without ADPKD who had a prior hospital encounter between 2002 and 2016. Measurements: Rate of hospital encounter with kidney stones and rate of stone intervention. Methods: We used inverse probability exposure weighting based on propensity scores to balance baseline indicators of health between patients with and without ADPKD. We followed each patient until death, emigration, outcomes, or March 31, 2017. We used a Cox proportional hazards model to compare event rates between the two groups. Results: Patients with ADPKD were at higher risk of hospital encounter with stones compared with patients without ADPKD (81 patients of 2094 with ADPKD [3.8%] vs 60 patients of 1902 without ADPKD [3.2%]; 8.9 vs 5.1 events per 1000 person-years; hazard ratio 1.6 [95% CI, 1.3-2.1]). ADPKD was not associated with a higher risk of stone intervention (49 of 2094 [2.3%] vs 47 of 1902 [2.4%]; 5.3 vs 3.9 events per 1000 person-years; hazard ratio 1.2 [95% CI = 0.9-1.3]). Limitations: We did not have information on kidney stone events outside of the hospital. There is a possibility of residual confounding. Conclusion: ADPKD was a significant risk factor for hospital encounters with kidney stones.

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Regular Use of VKA Prior to COVID-19 Associated with Lower 7-Day Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Cohort Study

Nutrients ◽

10.3390/nu13010039 ◽

2020 ◽

Vol 13 (1) ◽

pp. 39

Author(s):

Pierre Ménager ◽

Olivier Brière ◽

Jennifer Gautier ◽

Jérémie Riou ◽

Guillaume Sacco ◽

...

Keyword(s):

Cohort Study ◽

Vitamin K ◽

Frail Elderly ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Clinical Severity ◽

Survival Times ◽

Short Term Mortality

Background. Vitamin K concentrations are inversely associated with the clinical severity of COVID-19. The objective of this cohort study was to determine whether the regular use of vitamin K antagonist (VKA) prior to COVID-19 was associated with short-term mortality in frail older adults hospitalized for COVID-19. Methods. Eighty-two patients consecutively hospitalized for COVID-19 in a geriatric acute care unit were included. The association of the regular use of VKA prior to COVID-19 with survival after 7 days of COVID-19 was examined using a propensity-score-weighted Cox proportional-hazards model accounting for age, sex, severe undernutrition, diabetes mellitus, hypertension, prior myocardial infarction, congestive heart failure, prior stroke and/or transient ischemic attack, CHA2DS2-VASc score, HAS-BLED score, and eGFR. Results. Among 82 patients (mean ± SD age 88.8 ± 4.5 years; 48% women), 73 survived COVID-19 at day 7 while 9 died. There was no between-group difference at baseline, despite a trend for more frequent use of VKA in those who did not survive on day 7 (33.3% versus 8.2%, p = 0.056). While considering “using no VKA” as the reference (hazard ratio (HR) = 1), the HR for 7-day mortality in those regularly using VKA was 5.68 [95% CI: 1.17; 27.53]. Consistently, COVID-19 patients using VKA on a regular basis had shorter survival times than the others (p = 0.031). Conclusions. Regular use of VKA was associated with increased mortality at day 7 in hospitalized frail elderly patients with COVID-19.

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