The Influence of Early Menopause on Cardiovascular Risk in Women with Rheumatoid Arthritis

Objective.Early menopause is associated with an increased risk for developing rheumatoid arthritis (RA). The risk for cardiovascular disease (CVD) in women increases following menopause. Because RA is associated with an increased risk of CVD, this study was undertaken to determine whether early menopause affects the risk of developing CVD in women with RA.Methods.A population-based inception cohort of 600 women with RA who fulfilled 1987 American College of Rheumatology criteria for RA between 1955 and 2007 and were age ≥ 45 years at diagnosis was assembled and followed. Age at menopause and duration of hormone replacement therapy, along with occurrence of CVD, was ascertained by review of medical records. Cox proportional hazard models compared women who underwent early menopause (natural or artificial menopause at age ≤ 45 yrs) to those within the cohort who did not undergo early menopause.Results.Of 600 women, 79 experienced early menopause. Women who underwent early menopause were at significantly higher risk for developing CVD when compared to women who did not (HR 1.56; 95% CI 1.08–2.26).Conclusion.The risk of CVD in women with RA was higher in those who experienced early menopause, and like other known risk factors should increase clinician concern for development of CVD in these patients.

Download Full-text

The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study

Endocrine Related Cancer ◽

10.1530/erc-11-0392 ◽

2012 ◽

Vol 19 (3) ◽

pp. 381-387 ◽

Cited By ~ 12

Author(s):

Sunil Amin ◽

Richard R P Warner ◽

Steven H Itzkowitz ◽

Michelle Kang Kim

Keyword(s):

Small Bowel ◽

Population Based ◽

Proportional Hazard ◽

Population Based Study ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Before And After ◽

Cox Proportional Hazard Models ◽

Small Intestinal

Small-intestinal carcinoids (SIC) are the most common small-bowel malignancies. We sought to determine the risk of developing SIC before and after other primary malignancies (PM) and the prognosis of patients with SIC, with and without another PM. We used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with SICs between 1973 and 2007. Multiple primary-standardized incidence ratios were calculated as an approximation of relative risk (RR) to explore the association of SICs with metachronous malignancies. Survival analysis was performed using Kaplan–Meier methods and Cox proportional-hazard models. Among 8331 patients with SICs, 2424 (29%) had another PM at some time. The most common sites were prostate (26.2%), breast (14.3%), colon (9.1%), lung/bronchus (6.3%), and bladder (5.3%). Overall, 67% of patients had a PM diagnosed before SIC (pre-SIC), 33% after SIC (post-SIC), and 8% had a PM both before and after SIC. Among the pre-SIC group, the risk of future SIC was increased after cancers of the small bowel (RR 11.86 (95% CI: 6.13–20.72)), esophagus (4.05 (1.10–10.36)), colon (1.39 (1.05–1.81)), kidney (1.93 (1.12–3.09)), prostate (1.38 (1.17–1.62)), and leukemia (2.15 (1.18–3.61)). Among the post-SIC group, there was an increased risk of future PM of the small bowel (8.78 (4.54–15.34)), liver (2.49 (1.08–4.91)), prostate (1.25 (1.0–1.53)), and thyroid (2.73 (1.10–5.62)). Compared to patients with only SIC, those with a PM pre-SIC had worse mean survival (57.9 vs 40.9 months, HR 1.55 (1.42–1.69), P<0.001). In conclusion, almost one-third of patients with SICs have an associated metachronous primary tumor. When these primaries occur prior to (but not after) the SIC diagnosis, the prognosis is worse than with an initial SIC. The type of malignancies associated with SICs may guide future screening efforts.

Download Full-text

Colorectal cancer survival among Ministry of National Guard-Health Affairs (MNG-HA) population 2009–2017: retrospective study

BMC Cancer ◽

10.1186/s12885-021-08705-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mesnad Alyabsi ◽

Fouad Sabatin ◽

Majed Ramadan ◽

Abdul Rahman Jazieh

Keyword(s):

Colorectal Cancer ◽

Distant Metastasis ◽

Cancer Survival ◽

National Guard ◽

Population Based ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Cox Proportional Hazard Models

Abstract Background Colorectal cancer (CRC) is the most diagnosed cancer among males and third among females in Saudi Arabia, with up to two-third diagnosed at advanced stage. The objective of our study was to estimate CRC survival and determine prognostic factors. Methods Ministry of National Guard- Health Affairs (MNG-HA) registry data was utilized to identify patients diagnosed with CRC between 2009 and 2017. Cases were followed until December 30th, 2017 to assess their one-, three-, and five-year CRC-specific survivals. Kaplan-Meier method and Cox proportional hazard models were used to assess survival from CRC. Results A total of 1012 CRC patients were diagnosed during 2009–2017. Nearly, one-fourth of the patients presented with rectal tumor, 42.89% with left colon and 33.41% of the cases were diagnosed at distant metastasis stage. The overall one-, three-, and five-year survival were 83, 65 and 52.0%, respectively. The five-year survival was 79.85% for localized stage, 63.25% for regional stage and 20.31% for distant metastasis. Multivariate analyses showed that age, diagnosis period, stage, nationality, basis of diagnosis, morphology and location of tumor were associated with survival. Conclusions Findings reveal poor survival compared to Surveillance, Epidemiology, and End Results (SEER) population. Diagnoses at late stage and no surgical and/or perioperative chemotherapy were associated with increased risk of death. Population-based screening in this population should be considered.

Download Full-text

Farming tasks and the development of rheumatoid arthritis in the agricultural health study

Occupational and Environmental Medicine ◽

10.1136/oemed-2018-105361 ◽

2019 ◽

pp. oemed-2018-105361 ◽

Cited By ~ 4

Author(s):

Christine G Parks ◽

Armando Meyer ◽

Laura E Beane Freeman ◽

Jonathan Hofmann ◽

Dale P Sandler

Keyword(s):

Rheumatoid Arthritis ◽

Self Report ◽

Health Study ◽

Proportional Hazard ◽

Agricultural Health ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Cox Proportional Hazard Models ◽

Agricultural Health Study

ObjectivesFarming has been associated with rheumatoid arthritis (RA). Some studies have evaluated the effects of pesticides, but other agricultural exposures may also affect immune response.MethodsWe investigated non-pesticide agricultural exposures in relation to RA in licensed pesticide applicators (n=27 175, mostly male farmers) and their spouses (n=22 231) in the Agricultural Health Study (AHS) cohort (1993–1997) who completed at least one follow-up survey through 2015. Incident RA cases (n=229 applicators and 249 spouses) were identified based on self-report confirmed by use of disease-modifying antirheumatic drugs or medical records. Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) were estimated by Cox proportional hazard models adjusting for applicator status, state, smoking, education and specific pesticide use, allowing estimates to vary by median age when hazards assumptions were not met.ResultsOverall, RA was associated with regularly applying chemical fertilisers (HR=1.50; 95% CI 1.11 to 2.02), using non-gasoline solvents (HR=1.40; 95% CI 1.09 to 1.80), and painting (HR=1.26; 95% CI 1.00 to 1.59). In older applicators (>62 years), RA was associated with driving combines (HR=2.46; 95% CI 1.05 to 5.78) and milking cows (HR=2.56; 95% CI 1.01 to 6.53). In younger participants (≤62 years), RA was inversely associated with raising animals as well as crops (HR=0.68; 95% CI 0.51 to 0.89 vs crops only). Associations with specific crops varied by age: some (eg, hay) were inversely associated with RA in younger participants, while others (eg, alfalfa) were associated with RA in older participants.ConclusionThese findings suggest several agricultural tasks and exposures may contribute to development of RA.

Download Full-text

Increased Incidence and Impact of Upper and Lower Gastrointestinal Events in Patients with Rheumatoid Arthritis in Olmsted County, Minnesota: A Longitudinal Population-based Study

The Journal of Rheumatology ◽

10.3899/jrheum.111311 ◽

2012 ◽

Vol 39 (7) ◽

pp. 1355-1362 ◽

Cited By ~ 18

Author(s):

ELENA MYASOEDOVA ◽

ERIC L. MATTESON ◽

NICHOLAS J. TALLEY ◽

CYNTHIA S. CROWSON

Keyword(s):

Rheumatoid Arthritis ◽

Rate Ratio ◽

Population Based ◽

Incidence Rates ◽

Olmsted County ◽

Calendar Time ◽

Upper Gi ◽

American College Of Rheumatology ◽

Increased Risk ◽

Incidence And Mortality

Objective.To assess the incidence and mortality impact of upper and lower gastrointestinal (GI) events in rheumatoid arthritis (RA) compared to non-RA subjects.Methods.We identified incident upper and lower GI events and estimated their incidence rates using person-year methods in a population-based incident RA cohort of residents of Olmsted County, Minnesota, USA (1987 American College of Rheumatology criteria first fulfilled between January 1, 1980, and January 1, 2008) and non-RA subjects from the same population.Results.The study included 813 patients with RA and 813 non-RA subjects (mean followup 10.3 and 10.8 yrs, respectively); 68% women; mean age 55.9 yrs in both cohorts. The rate of upper GI events/100 person-years was 2.9 in RA versus 1.7 in the non-RA cohort (rate ratio 1.7, 95% CI 1.4, 2.2); for lower GI events, the rates were 2.1 in RA versus 1.4 in the non-RA cohort (rate ratio 1.5, 95% CI 1.1, 1.9). The incidence of upper GI bleed, perforation, ulcer, obstruction, and any upper GI event in RA declined over calendar time; the incidence of lower GI events remained unchanged. Exposure to glucocorticoids, prior upper GI disease, abdominal surgery, and smoking were associated with lower GI events in RA. Both upper and lower GI events were associated with increased mortality risk in RA.Conclusion.There is increased risk of serious upper and lower GI events in RA compared to non-RA subjects, and increased GI-related mortality in RA. Prominent declines in incidence of upper, but not lower GI events in RA highlight the need for studies investigating lower GI disease in patients with RA.

Download Full-text

Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Gut ◽

10.1136/gutjnl-2019-318932 ◽

2019 ◽

Vol 69 (5) ◽

pp. 852-858 ◽

Cited By ~ 2

Author(s):

Julien Kirchgesner ◽

Nynne Nyboe Andersen ◽

Fabrice Carrat ◽

Tine Jess ◽

Laurent Beaugerie

Keyword(s):

Incidence Rates ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Bowel Diseases ◽

Cox Proportional Hazard Models ◽

Inflammatory Bowel ◽

Artery Disease ◽

The Impact ◽

Necrosis Factor

ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

Download Full-text

Impact of Pre-diabetes alone or in combination with Hypertension, Dyslipidemia, or both on Major Adverse Cardiovascular Events

10.21203/rs.2.10473/v1 ◽

2019 ◽

Author(s):

Nahid Hashemi Madani ◽

Faramarz Ismail-Beigi ◽

Hossein Poustchi ◽

Mahdi Nalini ◽

Sadaf G. Sepanlou ◽

...

Keyword(s):

Cardiovascular Events ◽

Fasting Glucose ◽

Population Based ◽

Major Adverse Cardiovascular Events ◽

Proportional Hazard ◽

Population Based Study ◽

Cox Proportional Hazard ◽

Normal Fasting Glucose ◽

Cox Proportional Hazard Models

Abstract Background Whether pre-diabetes in the absence of hypertension (HTN) or dyslipidemia (DLP) is a risk factor for occurrence of major adverse cardiovascular events (MACE) is not fully established. We investigated the effect of impaired fasting glucose (IFG) alone and in combination with HTN, DLP or both on subsequent occurrence of MACE as well as individual MACE components. Methods This longitudinal population-based study included 9,831 inhabitants of Northeastern Iran. The participants were free of any cardiovascular disease at baseline and were followed yearly from 2010 to 2017. Cox proportional hazard models were fitted to measure the hazard of IFG alone or in combination with HTN and DLP on occurrence of MACE as the primary endpoint. Results 297 MACE were recorded during 6.2±0.1 years follow up. IFG alone compared to normal fasting glucose (NFG) was not associated with increased in occurrence of MACE (HR, 1.05; 95% CI, 0.59-1.86; p, 0.8). However, combination of IFG and HTN (HR, 2.75; 95% CI, 1.93-3.90; p, 0.001) or HTN + DLP (HR, 2.85; 95% CI, 1.79-4.54; p, 0.001) significantly increased the hazard of MACE. In contrast, IFG with DLP at baseline did not increase the hazard of MACE compared to normoglycemic- normolipemic individuals (p,0.2). The results also indicated IFG with HTN, DLP, or HTN+DLP were associated with significant higher HRs for some individual components of MACE. Conclusion IFG, per se, does not appear to increase hazard of MACE. However, IFG with HTN or HTN + DLP conferred a significant hazard for MACE in an incremental manner.

Download Full-text

Positive Association of Dietary Inflammatory Index with Incidence of Cardiovascular Disease: Findings from a Korean Population-Based Prospective Study

Nutrients ◽

10.3390/nu12020588 ◽

2020 ◽

Vol 12 (2) ◽

pp. 588

Author(s):

Imran Khan ◽

Minji Kwon ◽

Nitin Shivappa ◽

James R. Hébert ◽

Mi Kyung Kim

Keyword(s):

Cardiovascular Disease ◽

Positive Association ◽

Population Based ◽

Proportional Hazard ◽

Dietary Inflammatory Index ◽

Cvd Risk ◽

Inflammatory Index ◽

Cox Proportional Hazard ◽

Increased Risk

Recently, diets with higher inflammatory potentials based on the dietary inflammatory index (DII®) have been shown to be associated with increased cardiovascular disease (CVD) risk in the general population. We aimed to prospectively investigate the association between the DII and CVD risk in the large Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort comprised of 162,773 participants (men 55,070; women 107,703). A validated semi-quantitative food frequency questionnaire (SQ-FFQ) was used to calculate the DII score. Statistical analyses were performed by using a multivariable Cox proportional hazard model. During the mean follow-up of 7.4 years, 1111 cases of CVD were diagnosed. Higher DII score was associated with increased risk of CVD in men (hazard ratio [HR]Quintile 5 vs. 1 1.43; 95% CI 1.04–1.96) and in women (HRQuintile 5 vs. 1 1.19; 95% CI 0.85–1.67), although not significant for women. The risk of CVD was significantly higher in physically inactive men (HRQuintile 5 vs. 1 1.80; 95% CI 1.03–3.12), obese men (HRQuintile 5 vs. 1 1.77; 95% CI 1.13–2.76) and men who smoked (HRQuintile 5 vs. 1 1.60; 95% CI 1.10–2.33), respectively. The risk of developing stroke was significantly higher for men (HRQuintile 5 vs. 1 2.06; 95% CI 1.07–3.98; p = 0.003), but not for women. A pro-inflammatory diet, as indicated by higher DII scores, was associated with increased risk of CVD and stroke among men.

Download Full-text

Expanding Research on the School-to-Prison Pipeline: Examining the Relationships between Suspension, Expulsion, and Recidivism among Justice-Involved Youth

Crime & Delinquency ◽

10.1177/0011128721999334 ◽

2021 ◽

pp. 001112872199933

Author(s):

Abigail Novak ◽

Abigail Fagan

Keyword(s):

Juvenile Justice ◽

Hazard Models ◽

Educational Systems ◽

Proportional Hazard ◽

Proportional Hazard Models ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Using Data ◽

Pathways To Desistance

Limited research has examined the associations between different forms of school exclusion and offending, and variation in these associations according to age of first exclusionary event, among justice-involved youth. Using data from the Pathways to Desistance Study, the current study examined the associations between suspension, expulsion, and recidivism and the association between age at first suspension/expulsion and recidivism. According to Cox proportional hazard models, both expulsion and frequency of suspension increased risk of recidivism; age at first suspension was not associated with recidivism, and youth who were first expelled in childhood were significantly less likely to recidivate than youth first expelled in adolescence. Results suggest juvenile justice and educational systems should provide collaborative services to better support justice-involved youth.

Download Full-text

Post-Diagnostic Beta Blocker Use and Breast Cancer-Specific Mortality: A Population-Based Cohort Study

10.21203/rs.3.rs-1106678/v1 ◽

2021 ◽

Author(s):

Oliver William Scott ◽

Sandar TinTin ◽

J Mark Elwood ◽

Alana Cavadino ◽

Laurel A Habel ◽

...

Keyword(s):

Breast Cancer ◽

Beta Blockers ◽

Cancer Registries ◽

Population Based ◽

Hospital Discharges ◽

Cox Proportional Hazard ◽

Breast Cancer Outcomes ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Cancer Specific Mortality

Abstract Purpose Beta blockers (BB) have been associated with improved, worsened, or unchanged breast cancer outcomes in previous studies. This study examines the association between the post-diagnostic use of BBs and death from breast cancer in a large, representative sample of New Zealand (NZ) women with breast cancer. Methods Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to national pharmaceutical data, hospital discharges, and death records. The median follow up time was 4.51 years. Cox proportional hazard models were used to estimate the hazard of breast cancer-specific death (BCD) associated with post-diagnostic BB use. Results Of the 14,976 women included in analyses, 21% used a BB after diagnosis. BB use (vs non-use) was associated with a small and non-statistically significant increased risk of BCD ( adjusted hazard ratio: 1.11; 95% CI: 0.95-1.29). A statistically significant increased risk confined to short-term use (0-3 months) was seen (HR=1.40; 1.14-1.73), and this risk steadily decreased with increasing duration of use and became a statistically significant protective effect at 3+ years of use (HR=0.54; 0.34-0.87). Conclusion Our findings suggest that any increased risk associated with BB use may be driven by risk in the initial few months of use. Long-term BB use may be associated with a reduction in BCD.

Download Full-text

No Increased Risk of Alopecia in Ankylosing Spondylitis Patients: A Population-based Cohort Study in Taiwan

10.21203/rs.3.rs-19782/v1 ◽

2020 ◽

Author(s):

Jason Peijer Hsieh ◽

Hsi-Kai Tsou ◽

Yung-Heng Lee ◽

Yu-Hsun Wang ◽

James Cheng-Chung Wei

Keyword(s):

Statistical Significance ◽

Hazard Model ◽

Population Based ◽

Hazard Ratio ◽

Cox Proportional Hazard Model ◽

Proportional Hazard ◽

Proportional Hazard Model ◽

Negative Results ◽

Cox Proportional Hazard ◽

Increased Risk

Abstract Background: Investigate the association between AS and alopecia.Methods: Using over 1,000,000 patients’ data from Taiwan Longitudinal Health Insurance Database, we selected the sample with ICD code, diagnosing date, index date, and propensity score matching. We had 3,640 patients with AS and 14,560 non-AS controls. Cox proportional hazard model and Kaplan-Meier analysis were used to present the results.Results: The crude and adjusted hazard ratio of AS for developing alopecia showed no statistical significance in the Cox proportional hazard model [crude hazard ratio (HR) 1.16, 95% CI 0.67-1.99; adjusted HR 1.16, 95% CI 0.67-1.98]. Negative results were found as well in subgroup analysis (Age 20-40: HR 1.03, 95% CI 0.53-2.01; Age≧40: HR 1.49, 95% CI 0.58-3.80; Female: HR 1.17, 95% CI 0.43-3.17; Male: HR 1.15, 95% CI 0.61-2.19). A significant positive correlation was found between atopic dermatitis and alopecia (adjusted HR 8.05, 95% CI 1.11-58.14).Conclusions: No increased risk of alopecia was observed in AS patients

Download Full-text