The effect of training GPs in motivational interviewing on incident cardiovascular disease and mortality in people with screen-detected diabetes. Results from the ADDITION-Denmark randomised trial

BackgroundThere is no long-term evidence on the effectiveness of training for motivational interviewing in diabetes treatment.AimWithin a trial of intensive treatment of people with screen-detected diabetes, which included training in motivational interviewing for GPs, the study examined the effect of the intervention on incident cardiovascular disease (CVD) and all-cause mortality.Design & settingIn the ADDITION-Denmark trial, 181 general practices were cluster randomised in a 2:1:1 ratio to: (i) to screening plus routine care of individuals with screen-detected diabetes (control group); (ii) screening plus training and support in intensive multifactorial treatment of individuals with screen-detected diabetes (intensive treatment group); or (iii) screening plus training and support in intensive multifactorial treatment and motivational interviewing for individuals with screen-detected diabetes (intensive treatment plus motivational interviewing group). The study took place from 2001–2009.MethodAfter around 8 years follow-up, rates of first fatal and non-fatal CVD events and all-cause mortality were compared between screen-detected individuals in the three treatment groups.ResultsCompared with the routine care group, the risk of CVD was similar in the intensive treatment group (hazard ratio [HR] 1.11, 95% confidence interval [CI] = 0.82 to 1.50) and the intensive treatment plus motivational interviewing group (HR 1.26, 95% CI = 0.96 to 1.64). The incidence of death was similar in all three treatment groups.ConclusionTraining of GPs in intensive multifactorial treatment, with or without motivational interviewing, was not associated with a reduction in mortality or CVD among those with screen-detected diabetes.

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Effects of Intensive Blood Pressure Control in Patients with Evident Cardiovascular Disease: An Investigation Using the SPRINT Study Data

Current Vascular Pharmacology ◽

10.2174/1570161116666180305160116 ◽

2019 ◽

Vol 17 (3) ◽

pp. 298-306 ◽

Cited By ~ 1

Author(s):

Charalambos Vlachopoulos ◽

Dimitrios Terentes-Printzios ◽

Konstantinos Aznaouridis ◽

Nikolaos Ioakeimidis ◽

Panagiotis Xaplanteris ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Beneficial Effect ◽

Harmful Effect ◽

Adverse Outcomes ◽

Intensive Treatment ◽

Serious Adverse Events ◽

Stroke Incidence ◽

Increased Risk ◽

All Cause Mortality

Background: Recent data advocate adoption of a more intensive treatment strategy for management of blood pressure (BP). Objective: We investigated whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients. Methods: In a post hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP) target of <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mmHg) baseline SBP on outcome. Results: In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was increased risk for study-related SAE, acute renal failure and electrolyte abnormalities. In patients with low baseline SBP there was a beneficial effect on allcause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; p=0.042). Conclusion: We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on specific adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke may increase.

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Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality

JAMA Internal Medicine ◽

10.1001/jamainternmed.2019.6969 ◽

2020 ◽

Vol 180 (4) ◽

pp. 503 ◽

Cited By ~ 12

Author(s):

Victor W. Zhong ◽

Linda Van Horn ◽

Philip Greenland ◽

Mercedes R. Carnethon ◽

Hongyan Ning ◽

...

Keyword(s):

Cardiovascular Disease ◽

Red Meat ◽

Fish Intake ◽

Processed Meat ◽

All Cause Mortality ◽

Incident Cardiovascular Disease

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Association of chronic respiratory symptoms with incident cardiovascular disease and all-cause mortality: findings from the Coronary Artery Risk Development in Young Adults Study

CHEST Journal ◽

10.1016/j.chest.2021.10.029 ◽

2021 ◽

Author(s):

Weijing Feng ◽

Zhaoyuan Zhang ◽

Yu Liu ◽

Zhibin Li ◽

Wenjie Guo ◽

...

Keyword(s):

Cardiovascular Disease ◽

Young Adults ◽

Coronary Artery ◽

Respiratory Symptoms ◽

All Cause Mortality ◽

Incident Cardiovascular Disease

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Abstract 149: Impact of Baseline 10-year Cardiovascular Risk on Benefit and Harm of Intensive Treatment in SPRINT

Hypertension ◽

10.1161/hyp.70.suppl_1.149 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Robert A Phillips ◽

Jiaqiong Xu ◽

Leif E Peterson ◽

Joseph A Diamond ◽

Adam E Schussheim

Keyword(s):

Intensive Treatment ◽

Risk Scores ◽

Number Needed To Treat ◽

Cvd Risk ◽

Serious Adverse Events ◽

Treatment Groups ◽

Risk Algorithm ◽

All Cause Mortality ◽

The Impact ◽

Incremental Increase

We investigated the impact of baseline CV risk on outcomes in SPRINT. Using the ACC/AHA CVD risk algorithm, we stratified the SPRINT population into quartiles of baseline 10-year CV risk. Within each quartile, Cox proportional hazards models were used to examine the effect of intensive treatment vs. standard of care on the SPRINT CV outcomes, all-cause mortality and serious adverse events (SAEs). Number needed to treat (NNT) and number needed to harm (NNH) were calculated for each quartile. There were 9,323 participants with available baseline ACC/AHA 10-year risk scores. In each quartile of risk, the hazard ratio (HR) favored intensive treatment. For CV outcomes, NNT decreased from 91 in the 1 st quartile to 38 in the 4 th quartile. For all-cause mortality, NNT decreased from 333 in the 1 st quartile to 45 in the 4 th quartile. Although incidence of all SAEs increased with each quartile in both treatment groups (p for trend <0.0001), there was no difference in incidence of SAEs between the treatment groups in each quartile. However, SAEs classified as hypotension were more frequent in the 4 th quartile for the intensive treatment group (incremental increase 1.8%, NNH = 55) and SAEs classified as acute kidney injury or acute renal failure were significantly more frequent in the 2 nd , 3 rd and 4 th quartiles for the intensively treated group (incremental increase 1.7%, 2.4% and 2.1%; NNH 59, 42 and 48, respectively). Therefore, those with greatest baseline CVD risk got the most benefit from intensive BP treatment but were at greater risk for hypotension and renal injury. This analysis may help providers and patients make decisions regarding the intensity of BP treatment to prevent death and CV events.

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Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study

BMJ Open ◽

10.1136/bmjopen-2016-012386 ◽

2016 ◽

Vol 6 (8) ◽

pp. e012386 ◽

Cited By ~ 30

Author(s):

Grace Joshy ◽

Manish Arora ◽

Rosemary J Korda ◽

John Chalmers ◽

Emily Banks

Keyword(s):

Cardiovascular Disease ◽

Oral Health ◽

Risk Marker ◽

All Cause Mortality ◽

Incident Cardiovascular Disease

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Abstract P349: Association Of Fibroblast Growth Factor 23 With Incident Cardiovascular Disease And All-Cause Mortality In The Framingham Heart Study

Circulation ◽

10.1161/circ.129.suppl_1.p349 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Robin Haring ◽

Ramachandran S Vasan ◽

Henri Wallaschofski ◽

Lisa Sullivan ◽

Danielle Enserro

Keyword(s):

Cardiovascular Disease ◽

Growth Factor ◽

Fibroblast Growth Factor ◽

Regression Models ◽

Cox Regression ◽

Fibroblast Growth Factor 23 ◽

Positive Association ◽

Fibroblast Growth ◽

All Cause Mortality ◽

Incident Cardiovascular Disease

Objective: To investigate the association of fibroblast growth factor 23 (FGF23) with incident cardiovascular disease (CVD) and mortality risk in the general population. Methods: We evaluated 3,236 Framingham Offspring and Omni Study participants to examine the associations of serum FGF23 (measured by immunoassay) with 10-year incident CVD (N = 2,823) and all-cause mortality (N = 3,223) using multivariable Cox regression models. Results: During a median follow-up time of 10.8 years (Q1, 10.0; Q3, 11.4), 347 participants developed new-onset CVD and 412 died. Age- and sex-adjusted Cox regression models revealed a positive association of FGF23 with incident CVD (hazard ratio (HR) per unit increase in logFGF23: 1.43, 95% confidence interval (CI) 1.11-1.84) and all-cause mortality (HR 2.26, 95% CI, 1.86-2.75). After multivariable adjustment, the association of FGF23 with incident CVD was rendered non-significant (HR 1.12, 95% CI 0.86-1.46), whereas the positive association of FGF23 with all-cause mortality was maintained (HR: 1.87, 95% CI: 1.52 - 2.29). Analyses modeling FGF23 quartiles yielded similar findings (multivariable-adjusted HR Q4 vs. Q1 for incident CVD: 1.17, 95% CI: 0.87 - 1.59; for death: 1.87, 95% CI: 1.38 - 2.53). Conclusion: In our large community-based sample, serum FGF23 shows an independent positive association with all-cause mortality, but not with incident CVD risk.

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Dietary cholesterol and egg intake in relation to incident cardiovascular disease and all-cause and cause-specific mortality in postmenopausal women

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa353 ◽

2020 ◽

Author(s):

Guo-Chong Chen ◽

Li-Hua Chen ◽

Yasmin Mossavar-Rahmani ◽

Victor Kamensky ◽

Aladdin H Shadyab ◽

...

Keyword(s):

Cardiovascular Disease ◽

Postmenopausal Women ◽

Dietary Cholesterol ◽

Saturated Fat ◽

Inverse Association ◽

Egg Consumption ◽

All Cause Mortality ◽

Specific Mortality ◽

Cholesterol Intake ◽

Incident Cardiovascular Disease

ABSTRACT Background The potential cardiovascular impact of dietary cholesterol intake has been actively debated for decades. Objectives We aimed to evaluate associations of dietary cholesterol and egg intakes with incident cardiovascular disease (CVD) and all-cause and cause-specific mortality. Methods We included 96,831 US postmenopausal women aged 50–79 y without known CVD or cancer during baseline enrollment (1993–1998) of the Women's Health Initiative. Dietary information was collected using a validated FFQ. Incident CVD [i.e., ischemic heart disease (IHD) and stroke] and all-cause and cause-specific mortality were ascertained and adjudicated through February 2018. Results A total of 9808 incident CVD cases and 19,508 all-cause deaths occurred during a median follow-up of 17.8 y and 18.9 y, respectively. After multivariable adjustment for traditional risk factors and key dietary nutrients including dietary saturated fat, there were modest associations of dietary cholesterol intake with incident CVD (HRQ5versusQ1: 1.12; 95% CI: 1.03, 1.21; P-trend < 0.001) and all-cause mortality (HRQ5versusQ1: 1.09; 95% CI: 1.02, 1.15; P-trend < 0.001). Significant positive associations were also observed between dietary cholesterol and incident IHD (P-trend = 0.007), incident ischemic stroke (P-trend = 0.002), and CVD mortality (P-trend = 0.002), whereas there was an inverse association for incident hemorrhagic stroke (P-trend = 0.037) and no association for mortality from cancer, Alzheimer disease/dementia, respiratory diseases, or other causes (P-trend > 0.05). Higher egg consumption was also associated with modestly higher risk of incident CVD (P-trend = 0.004) and all-cause mortality (P-trend < 0.001), with HRs of 1.14 (95% CI: 1.04, 1.25) and 1.14 (95% CI: 1.07, 1.22), respectively, when comparing ≥1 egg/d with <1 egg/wk. Conclusions Both higher dietary cholesterol intake and higher egg consumption appeared to be associated with modestly elevated risk of incident CVD and all-cause mortality in US postmenopausal women.

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