Prediction of Cardiovascular Events in Patients with Ankylosing Spondylitis and Psoriatic Arthritis: Role of Lipoproteins in a High-risk Population

Objective.To evaluate lipids and apolipoproteins as predictors of cardiovascular mortality and morbidity (CVD) in patients with spondyloarthritis (SpA).Methods.In the pooled cohort of participants in the IDEAL, TNT, and CARDS trials, 50 had ankylosing spondylitis (AS), 36 had psoriatic arthritis (PsA), and 21,641 did not have AS or PsA (non-SpA). We compared lipid levels at baseline between AS or PsA and non-SpA, and hazard ratios (HR) for CVD were calculated in a Cox proportional hazard model.Results.Atherogenic lipids were lower in samples from AS, but not in PsA, compared to non-SpA. The HR for 1 SD increase in baseline lipids for future CVD was for total cholesterol 1.39 (95% CI 0.82, 2.36) in AS, 1.01 (95% CI 0.44, 2.31) in PsA, and 1.10 (95% CI 1.07, 1.14) in non-SpA. Both high-density lipoprotein (HDL) and apolipoprotein (ApoA-1) were significantly associated with CVD in AS (HR 3.67, 95% CI 1.47, 9.06, and HR 1.89, 95% CI 1.02, 3.54, respectively), in contrast to PsA (HDL: HR 1.03, 95% CI 0.49, 2.15; ApoA-1: HR 0.79, 95% CI 0.34, 1.89) and non-SpA (HDL: HR 0.86, 95% CI 0.84, 0.89; ApoA-1: HR 0.88, 95% CI 0.85, 0.91).Conclusion.HDL and ApoA-1 were surprisingly associated with increased risk of future CVD in patients with AS, whereas these lipids were protective in non-SpA.

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Interface of Multiple Sclerosis, Depression, Vascular Disease, and Mortality

Neurology ◽

10.1212/wnl.0000000000012610 ◽

2021 ◽

Vol 97 (13) ◽

pp. e1322-e1333 ◽

Cited By ~ 1

Author(s):

Raffaele Palladino ◽

Jeremy Chataway ◽

Azeem Majeed ◽

Ruth Ann Marrie

Keyword(s):

Multiple Sclerosis ◽

Vascular Disease ◽

Population Based ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Depression Status ◽

Increased Risk ◽

All Cause Mortality ◽

Cox Proportional Hazard Regression

Background and ObjectivesTo assess whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis (MS) compared with age-, sex-, and general practice–matched controls.MethodsWe conducted a population-based retrospective matched cohort study between January 1, 1987, and September 30, 2018, that included people with MS and matched controls without MS from England, stratified by depression status. We used time-varying Cox proportional hazard regression models to test the association among MS, depression, and time to incident vascular disease and mortality. Analyses were also stratified by sex.ResultsWe identified 12,251 people with MS and 72,572 matched controls. At baseline, 21% of people with MS and 9% of controls had depression. Compared with matched controls without depression, people with MS had an increased risk of incident vascular disease regardless of whether they had comorbid depression. The 10-year hazard of all-cause mortality was 1.75-fold greater in controls with depression (95% confidence interval [CI] 1.59–1.91), 3.88-fold greater in people with MS without depression (95% CI 3.66–4.10), and 5.43-fold greater in people with MS and depression (95% CI 4.88–5.96). Overall, the interaction between MS status and depression was synergistic, with 14% of the observed effect attributable to the interaction. Sex-stratified analyses confirmed differences in hazard ratios.DiscussionDepression is associated with increased risks of incident vascular disease and mortality in people with MS, and the effects of depression and MS on all-cause mortality are synergistic. Further studies should evaluate whether effectively treating depression is associated with a reduced risk of vascular disease and mortality.

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Analysis of Mortality and Morbidity in COVID-19 Patients with Obesity Using Clinical Epidemiological Data from the Korean Center for Disease Control & Prevention

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249336 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9336

Author(s):

So Young Kim ◽

Dae-Myoung Yoo ◽

Chanyang Min ◽

Jee Hye Wee ◽

Joo-Hee Kim ◽

...

Keyword(s):

Disease Control ◽

Epidemiological Data ◽

The Body ◽

Proportional Hazard ◽

Mortality And Morbidity ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Control And Prevention ◽

Relationship Of ◽

The Relationship

Previous studies have reported the association of obesity with increased morbidity or mortality due to the coronavirus disease 2019 (COVID-19). This study aims to investigate the relationship of obesity, as defined by the body mass index (BMI), with morbidity and mortality due to COVID-19. Data from 5628 confirmed COVID-19 patients were collected by the Centers for Disease Control and Prevention of Korea. The hazard ratios (HRs) for mortality in the BMI groups were analyzed using the Cox proportional hazard model adjusted for covariates. The odds ratios (ORs) of morbidity and diabetes in the BMI groups were analyzed using logistic regression adjusted for the same covariates. Both underweight and obesity were associated with a higher HR for mortality (adjusted HR = 2.28, 95% confidence intervals [95% CI] = 1.23–4.25, p = 0.009 for underweight and adjusted HR = 1.71, 95% CI = 1.10–2.66, p = 0.017 for obese). Obesity was related to higher odds of morbidity (adjusted OR = 1.71, 95% CI = 1.32–2.21, p < 0.001). Underweight and obesity were associated with high mortality and/or morbidity due to COVID-19 in Korea.

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Risk of Tuberculosis Reactivation in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis Receiving Non-Anti-TNF-Targeted Biologics

Mediators of Inflammation ◽

10.1155/2017/8909834 ◽

2017 ◽

Vol 2017 ◽

pp. 1-15 ◽

Cited By ~ 44

Author(s):

Fabrizio Cantini ◽

Carlotta Nannini ◽

Laura Niccoli ◽

Linda Petrone ◽

Giuseppe Ippolito ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Underdeveloped Countries ◽

Increased Risk ◽

Tuberculosis Reactivation ◽

Necrosis Factor

Tuberculosis (TB) still represents an important issue for public health in underdeveloped countries, but the use of antitumor necrosis factor agents (anti-TNF) for the treatment of inflammatory rheumatic disorders has reopened the problem also in countries with low TB incidence, due to the increased risk of TB reactivation in subjects with latent tuberculosis infection (LTBI). Over the last 5 years, several non-anti-TNF-targeted biologics have been licensed for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We reviewed the epidemiology of TB, the role of different cytokines and of the immune system cells involved in the immune response against TB infection, the methods to detect LTBI, and the risk of TB reactivation in patients exposed to non-anti-TNF-targeted biologics. Given the limited role exerted by the cytokines different from TNF, as expected, data from controlled trials, national registries of biologics, and postmarketing surveillance show that the risk of TB reactivation in patients receiving non-anti-TNF-targeted biologics is negligible, hence raising the question whether the screening procedures for LTBI would be necessary.

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Association Between Metabolic Syndrome and an Increased Risk of Hospitalization for Heart Failure in Population of HFpEF

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.698117 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ying Zhou ◽

Liyao Fu ◽

Jiaxing Sun ◽

Zhaowei Zhu ◽

Zhenhua Xing ◽

...

Keyword(s):

Heart Failure ◽

Metabolic Syndrome ◽

Heart Function ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Increased Risk ◽

Multivariable Adjustment

Background: The association between metabolic syndrome and the development of heart failure (HF) with preserved ejection fraction (HFpEF) has not been completely clarified.Aim: To evaluate the association between metabolic syndrome and the risk of HF hospitalization for patients with HFpEF.Methods: Patient data were obtained from the American cohort of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial database. Data for the primary outcome (hospitalization for HF) and secondary outcomes (all-cause mortality, cardiovascular mortality, and all-cause hospitalization) were collected, and hazard ratios (HRs) for the patients with and without metabolic syndrome were analyzed by applying a multivariable Cox proportional hazard model.Results: Among the 1,548 total participants, 1,197 had metabolic syndrome. The patients with metabolic syndrome exhibited worse heart function and a lower quality of life than those without metabolic syndrome. During the 3.3 years of follow-up, 351 patients were hospitalized for HF. After a multivariable adjustment, the risk of hospitalization for HF and all-cause hospitalization (adjusted HR = 1.42, 95% CI: 1.01–2.00; p = 0.042 and adjusted HR = 1.27; 95% CI: 1.04–1.54; p = 0.017, respectively) were independently associated with HFpEF for the patients with metabolic syndrome. In addition, the risks of HF hospitalization and all-cause hospitalization among 267 propensity score-matched patients were higher for patients with metabolic syndrome (HR = 1.53, 95% CI = 1.05–2.23, and p = 0.025 and HR = 1.34, 95% CI = 1.08–1.67, and p = 0.009, respectively).Conclusion: The risks of HF hospitalization and all-cause hospitalization were higher for patients with HFpEF having metabolic syndrome than for those without metabolic syndrome.

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Increased risk of non-multiple sclerosis demyelinating syndromes in patients with preexisting septicaemia: a nationwide retrospective cohort study

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136667 ◽

2019 ◽

Vol 95 (1124) ◽

pp. 307-313

Author(s):

Chung-Hsing Chou ◽

Jiunn-Tay Lee ◽

Chia-Kuang Tsai ◽

Li-Ming Lien ◽

Jiu-Haw Yin ◽

...

Keyword(s):

Multiple Sclerosis ◽

Epidemiological Data ◽

Population Based ◽

Research Database ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Regression ◽

The Relationship

BackgroundGrowing evidence shows links between septicaemia and non-multiple sclerosis demyelinating syndromes (NMSDS); nevertheless, epidemiological data are still very limited. This study aimed to explore the relationship between septicaemia and NMSDS in a general population.MethodsThe study included 482 781 individuals diagnosed with septicaemia and 1 892 825 age/sex-matched non-septicaemia patients for the comparison. Data were drawn from a population-based nationwide National Health Insurance Research Database Taiwan, from 1 January 2002 to 31 December 2011. The two cohorts of patients with and without septicaemia were followed up for the occurrence of NMSDS. The Cox-proportional hazard regression model was performed to estimate adjusted HR after multivariate adjustment.ResultsIndividuals with septicaemia had a 4.17-fold (95% CI 3.21 to 5.4, p < 0.001) higher risk to develop NMSDS compared with those without septicaemia. Patients aged <65 years had a greater NMSDS risk (<45 years: HR = 6.41, 95% CI 3.65 to 11.3, p < 0.001; 45–64 years: HR = 6.66, 95% CI 3.98 to 11.2, p < 0.001). Furthermore, females with septicaemia and individuals with higher severity of septicaemia were associated with increased risks of developing NMSDS.ConclusionsOur results indicated that patients with septicaemia were likely to develop NMSDS. A possible contributing role of septicaemia in increasing the hazard of NMSDS is proposed, based on the outcome that individuals with higher severity of septicaemia carried elevated threat of encountering NMSDS.

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Abstract 17144: Architecture of Atrial Fibrosis is Associated With Increased Risk of Recurrence Post Af Treatment

Circulation ◽

10.1161/circ.132.suppl_3.17144 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Pim Gal ◽

Christina F Pacchia ◽

Robert White ◽

Alan Morris ◽

Joshua Cates ◽

...

Keyword(s):

Treatment Failure ◽

Patch Size ◽

Proportional Hazard ◽

Fibrosis Score ◽

Atrial Tissue ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Increased Risk ◽

The Mean ◽

Z Transformation

Background: Previous studies reported the association between left atrial (LA) fibrosis as assessed by delayed enhancement (DE)-MRI and arrhythmia recurrence post AF ablation. In this study we report the significance of atrial fibrotic infiltrations architecture in predicting treatment failure. Methods: 271 patients (mean age was 59 years, 64% had paroxysmal AF) from the multicenter prospective DECAAF study were included in this sub-analysis. We assessed the location and size of patchy fibrotic atrial tissue infiltrations (figure 1) in all patients who underwent ablation of AF. Due to the strong correlation between LA fibrosis and the largest patch(r=0.875, P<0.001), a Z-transformation of LA fibrosis and the sum of LA fibrosis and largest patch was performed. This allowed direct comparison of hazard ratios (HR) in a Cox proportional hazard model. Results: Mean LA fibrosis score was 18%, the mean largest patch was 21.5 cm2. AF recurrences were associated with the largest patch size per quartile: Q1: 15%, Q2: 28%, Q3: 34%, Q4: 45%, P<0.001. The HR for the standardized LA fibrosis was 1.317, P=0.009.compared to 1.437 for the standardized sum of LA fibrosis and largest patch size, demonstrating that the addition of largest patch to the LA fibrosis score improved the predictive properties of the model. In a multivariate model with age, AF type and LA volume, the standardized sum of LA fibrosis and largest patch size was significantly associated with AF recurrences post-ablation (HR 1.404, P=0.001). Conclusion: From our preliminary data not only the quantity but also the architectural presentation of atrial tissue fibrotic infiltrations was significantly associated with AF treatment failure. This finding would help better understand the severity of AF in addition to improving patient selection undergoing various treatments of AF.

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Wrist circumference as a novel predictor of transition from metabolically healthy to unhealthy phenotype in overweight/obese adults: a gender-stratified 15.5-year follow-up

BMC Public Health ◽

10.1186/s12889-021-12371-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pouria Mousapour ◽

Maryam Barzin ◽

Majid Valizadeh ◽

Maryam Mahdavi ◽

Farzad Hadaegh ◽

...

Keyword(s):

Predictive Performance ◽

Proportional Hazard ◽

Obese Adults ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Wrist Circumference ◽

Cox Proportional Hazard Models ◽

Metabolically Healthy

Abstract Background Individuals with transition from metabolically healthy overweight/obese (MHO) to metabolically unhealthy overweight/obese (MUO) phenotype are significantly predisposed to greater risks of cardiovascular events compared to those with a persistent MHO phenotype. The aim of this study was to evaluate the predictive performance of wrist circumference for this transition in adults over a 15.5-year follow-up. Methods We included 309 males and 821 females with the age of ≥18 years old, body mass index ≥25 kg/m2, and metabolically healthy status according to the criteria of the Joint Interim Statement. The incidence of MUO phenotype was evaluated for each gender, across tertiles wrist circumference, using Cox-proportional hazard models. Results The overall rate of transition from MHO to MUO phenotype was 87.1% in males and 77.5% in females. The hazard ratios (HRs) with 95% CI across second and third tertiles of wrist circumference were 0.89 (0.64-1.24) and 1.31 (0.99-1.73) in men (P for trend =0.027); and 1.34 (1.09-1.66) and 1.61 (1.30-2.00) in women (P for trend <0.001), respectively. After multivariable adjustment, HRs across second and third tertiles of wrist circumference were 0.92 (0.64-1.32) and 1.18 (0.83-1.67) in males (p for trend =0.352), and 1.32 (1.05-1.65) and 1.34 (1.06-1.96) in females (p for trend =0.025), respectively. Conclusions Wrist circumference significantly predicts the transition from MHO to MUO phenotype in adults of both genders. However, it is an independent predictor of the transition only in females. Future studies are warranted to clarify the role of wrist circumference mechanisms on metabolic risk deterioration.

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Androgen-deprivation Therapy and the Risk of newly Developed Fractures in Patients with Prostate Cancer: A Nationwide Cohort Study in Korea

10.21203/rs.3.rs-140143/v1 ◽

2021 ◽

Author(s):

Do Kyung Kim ◽

Jong Won Kim ◽

Hye Sun Lee ◽

Ju-Young Park ◽

Hyun Kyu Ahn ◽

...

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Cox Regression ◽

Androgen Deprivation ◽

Proportional Hazard ◽

Cox Regression Analysis ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Increased Risk ◽

Cox Proportional Hazard Regression

Abstract Purpose: We evaluated the risk of osteoporosis and fractures associated with androgen deprivation therapy (ADT) use and duration in men with prostate cancer.Methods: From the nationwide claims database in South Korea, a total of 218,203 men with prostate cancer were identified between 2008 and 2017. To adjust for comorbidities between cohorts, 1:1 propensity score matching was used. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events associated with ADT. Results: In the matched cohort, there were differences in the incidence of newly developed osteoporosis (8.79% in the ADT group vs. 7.08% in the non-ADT group, p < 0.0001) and fractures (8.12% in the ADT group vs. 5.04% in the non-ADT group, p < 0.0001). Age-adjusted Cox regression analysis revealed that the ADT group had a significantly higher risk of osteoporosis (HR, 1.381; 95% CI, 1.305–1.461; p < 0.0001) and fractures (HR, 1.815; 95% CI; 1.703–1.935; p < 0.0001) compared to the non-ADT group. Furthermore, the risk of osteoporosis and fractures increased as the duration of ADT increased.Conclusions: The ADT was associated with an increased risk of osteoporosis and fractures in prostate cancer patients.

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Abstract 3114: Antiplatelet Therapy Use and the Risk of Venous Thromboembolic Events in the Double-Blind Raloxifene Use in The Heart (RUTH) Trial

Circulation ◽

10.1161/circ.116.suppl_16.ii_698-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Claire S Duvernoy ◽

Adeline A Yeo ◽

Mayme Wong ◽

David A Cox ◽

Hyungin M Kim

Keyword(s):

Clinical Symptoms ◽

Proportional Hazard ◽

Thromboembolic Events ◽

Double Blind ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Cox Proportional Hazard Models

Background: Raloxifene (RLX) use in postmenopausal women (PMW) with osteoporosis increases risk of venous thromboembolic events (VTE) 2-fold, compared to placebo (PL). Platelet activation is involved in the pathophysiology of arterial thromboses more than venous thromboses, but some data suggest that aspirin may reduce VTE risk associated with estrogen use. This analysis examines the effects of concomitant antiplatelet (AP) therapy on VTE risk in RLX-treated women. Methods: In RUTH, 10,101 PMW with coronary heart disease (CHD) or increased risk of CHD were randomized to either PL or RLX 60 mg/d and followed for a median 5.6 yr. Reports of clinical symptoms of VTE were supported by relevant diagnostic data and adjudicated. Concomitant use of AP agents (aspirin, clopidogrel, ticlopidine, dipyridamole) was allowed. Cox proportional hazard models, with use of warfarin, presence of fracture, and/or hospitalization as covariates, were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results: Overall, RLX 60 mg/d use was associated with an increased VTE risk [HR 1.44 (95% CI 1.06 –1.95)] from PL. Most women (71%) reported using aspirin, and 14.2% reported using non-aspirin AP agents. VTE risk was similar (HR = 1.04, Table ) for women who used RLX alone versus those who used RLX with AP agents. The increase in VTE risk with RLX compared to PL was similar between women who used any AP prior to VTE and those who did not (interaction P=0.29). Women who used aspirin prior to VTE had a similar increased VTE risk with RLX from PL [HR 1.57(95% CI 1.00 –2.47)], compared to women who did not use aspirin [HR 1.34 (95% CI 0.89 –2.01)] (interaction P=0.62). Conclusion: In RUTH, PMW with CHD or at high risk of CHD treated with RLX had an increased risk of VTE compared to PL. Concomitant use of aspirin or non-aspirin AP agents with RLX therapy did not lower VTE risk from RLX alone.

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Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-209334 ◽

2016 ◽

Vol 76 (3) ◽

pp. 521-525 ◽

Cited By ~ 39

Author(s):

Stefán Már Thorarensen ◽

Na Lu ◽

Alexis Ogdie ◽

Joel M Gelfand ◽

Hyon K Choi ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Health Improvement ◽

Proportional Hazard ◽

Physical Trauma ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

The Health Improvement Network ◽

Using Data ◽

Joint Trauma

ObjectivesTo evaluate the risk of psoriatic arthritis (PsA) among patients with psoriasis exposed to physical trauma.MethodsA matched cohort study was performed using data from The Health Improvement Network (THIN). Patients with psoriasis exposed to trauma were randomly matched to up to five unexposed psoriasis controls based on gender, age, duration of psoriasis and the date of entry into THIN. Trauma exposure was stratified into subgroups of joint, bone, nerve and skin trauma. Cox proportional hazard models were used to estimate the HRs for developing PsA. For comparison, an identical analysis was performed in the entire THIN population evaluating rheumatoid arthritis (RA) risk following physical trauma.ResultsPatients with psoriasis exposed to trauma (N=15 416) and matched unexposed patients (N=55 230) were followed for a total of 425 120 person-years during which 1010 incident PsA cases were recorded. Adjusting for potential confounders, patients with psoriasis exposed to trauma had an increased risk of PsA compared with controls, with a multivariate HR of 1.32 (95% CI 1.13 to 1.54). In our subset analysis, bone and joint trauma were associated with multivariate HRs of 1.46 (95% CI 1.04 to 2.04) and 1.50 (95% CI 1.19 to 1.90), respectively; while nerve and skin trauma were not associated with a statistically significant increase in risk compared with controls. Patients exposed to trauma in the entire THIN population did not have an increased risk of developing RA: HR 1.04 (95% CI 0.99 to 1.10).ConclusionsPatients with psoriasis exposed to physical trauma are at an increased risk of developing PsA.

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