Prevalence of Comorbidities and Risk Factors for Comorbidities in Patients with Spondyloarthritis in Latin America: A Comparative Study with the General Population and Data from the ASAS-COMOSPA Study

Abstract Abstract 478 Black-White Differences in Venous Thrombosis Risk: The Longitudinal Investigation of Thromboembolism Etiology (LITE). Neil A. Zakai, Pamela L. Lutsey, Aaron R. Folsom, Mary Cushman. Introduction: Venous thrombosis (VT) is more common in blacks than whites. The reasons for this difference and whether it is explained by racial differences in VT risk factors is not known. Methods: VT was ascertained by physician review of medical records in the Longitudinal Investigation of Thromboembolism Etiology (LITE), a prospective observational study of 21,680 men and women age 45–100 years participating in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS) cohorts. VT was classified as provoked if preceded within 90 days by major surgery, trauma, immobility, or associated with active cancer or chemotherapy. We used age- and sex-adjusted Cox models to evaluate whether certain VT risk factors explained the increased risk of VT in blacks vs whites. We also tested if the impact of VT risk factors differed by race using interaction terms. Most risk factors were assessed in both ARIC and CHS cohorts (body mass index (BMI), diabetes, hypertension, chronic kidney disease (CKD), factor VIII, and education) except the activated partial thromboplastin time (aPTT), von Willebrand factor (vWF), and protein C were measured in ARIC only and C-reactive protein was measured in CHS only. Results: With up to 15 years of follow up, among 20,964 participants (5,054 blacks) without VT at baseline, 648 developed new VT (200 blacks). The age- and sex-standardized incidence of VT per 1000 person-years was higher in blacks than whites for all VT (3.18 vs 1.96), whether the VT was provoked (2.11 vs. 1.24) or unprovoked (1.12 vs. 0.74), all p <0.01. Blacks and whites had a similar incidence of pulmonary embolism (PE) (0.83 vs. 0.76, p = 0.56). Blacks had more adverse levels of many VT risk factors except CKD and a lower aPTT: BMI (29.3 vs. 26.8 kg/m2), diabetes (21 vs 11%), hypertension (59 vs 38%), CKD (5 vs. 12%), high school graduation (58 vs 80%), factor VIII (146 vs 124%), vWF (134 vs 113%), CRP (2.4 vs 1.8 mg/L) protein C (3.13 vs. 3.18 mg/L), all p <0.01. In age- and sex-adjusted Cox models, the relative risk of total VT for blacks vs. whites was 1.67 (95% CI 1.41, 1.97). When risk factors were added to age-, sex- and race-adjusted Cox models, BMI explained 36% of the excess risk of VT in blacks, factor VIII 58%, and vWF 54%. The other risk factors had a minimal impact on the HR for race. When all risk factors measured in both cohorts were considered in the same model, the association of black race with VT was attenuated (HR 1.15; 95% CI 0.94, 1.42). Of the risk factors evaluated, there were significant interactions between race and hypertension, CKD, and aPTT below the median (29s). The table lists the HR for each of these risk factors stratified by race; hypertension and CKD were stronger risk factors for VT in blacks while an aPTT less than the median was a stronger risk factor for VT in whites. Conclusions: Blacks have a higher incidence of VT than whites, whether provoked or unprovoked. The increased risk in blacks was largely explained by a greater prevalence of VT risk factors among blacks, particularly obesity, higher factor VIII and higher vWF. Further, CKD and hypertension were stronger risk factors for VT in blacks, while a shorter aPTT was a weaker risk factor for VT in blacks. Larger studies of VT in blacks addressing environmental and genetic risk factors and health-care disparities are needed to fully understand reasons for these ethnic differences in VT incidence. Disclosure: No relevant conflicts of interest to declare.

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Is foot deformity associated with developmental dysplasia of the hip?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b11.bjj-2020-0290.r3 ◽

2020 ◽

Vol 102-B (11) ◽

pp. 1582-1586

Author(s):

Øvind Håberg ◽

Olav A. Foss ◽

Østein Bjerkestrand Lian ◽

Ketil Jarl Holen

Keyword(s):

Risk Factors ◽

Risk Factor ◽

General Population ◽

Developmental Dysplasia ◽

Foot Deformity ◽

Breech Delivery ◽

Increased Risk ◽

History Of ◽

Congenital Foot Deformity ◽

Dysplasia Of The Hip

Aims To assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH). Methods Between 1996 and 2012, 60,844 children were born in Sør-Trøndelag county in Norway. In this cohort study, children with risk factors for DDH were examined using ultrasound. The risk factors evaluated were clinical hip instability, breech delivery, a family history of DDH, a foot deformity, and some syndromes. As the aim of the study was to examine the risk for DDH and foot deformity in the general population, children with syndromes were excluded. The information has been prospectively registered and retrospectively analyzed. Results Overall, 494 children (0.8%) had DDH, and 1,132 (1.9%) a foot deformity. Of the children with a foot deformity, 49 (4.3%) also demonstrated DDH. There was a statistically significant increased association between DDH and foot deformity (p < 0.001). The risk of DDH was highest for talipes calcaneovalgus (6.1%) and club foot (3.5%), whereas metatarsus adductus (1.5%) had a marginal increased risk of DDH. Conclusion Compared with the general population, children with a congenital foot deformity had a significantly increased risk for DDH and therefore we regard foot deformity as a true risk factor for DDH. Cite this article: Bone Joint J 2020;102-B(11):1582–1586.

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Patients with type 2 diabetes have an increased demand for pacemaker treatment - a comparison with age- and sex matched controls from the general population.

10.2337/figshare.12818687 ◽

2020 ◽

Author(s):

Elina Rautio ◽

Fredrik Gadler ◽

Soffia Gudbjörnsdottir ◽

Stefan Franzén ◽

Lars Rydén ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

General Population ◽

Diabetes Duration ◽

Lipid Lowering ◽

Increased Risk ◽

Age And Sex

Objective: Patients with type 2 diabetes mellitus have an increased risk for cardiovascular disease including arrhythmias. The prevalence of bradyarrhythmia and the subsequent need for treatment with pacemakers (PM) is less well explored in a contemporary patient population. The present study explores 1) whether patients with type 2 diabetes mellitus have an increased demand for PM implantation compared with an age- and sex-matched control population without diabetes mellitus; 2) Patient characteristics associated with increased demand of receiving a PM. Methods: In this population-matched registry study a total of 416 247 patients with type 2 diabetes mellitus from the Swedish National Diabetes Registry (NDR) and 2 081 235 age and sex-matched controls selected from the general population were included between 1 January 1998 and 31 December 2012 and followed until 31 December 2013. Mean follow-up time was 7 years. Cox’s proportional hazard regression analyses were performed to estimate the demand of PM-treatment and factors identifying patients with such demand. Results: Type 2 diabetes mellitus was associated with increased need of PM-treatment (Hazard ratio (HR) 1.65, 95% CI 1.60-1.69; p<0.0001) which remained (HR 1.56, 95% CI 1.51-1.60; p<0.0001) after adjustments for age, sex, educational level, marital status, country of birth and coronary heart disease. Risk factors for receiving a PM included increasing age, HbA1c, BMI, diabetes duration, blood pressure- and lipid lowering medication. Conclusion: The need for PM treatment is higher in patients with type 2 diabetes than in matched population-based controls. Age, diabetes duration and HbA1c seem to be risk factors for PM treatment.

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Is foot deformity associated with developmental dysplasia of the hip?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b9.bjj-2020-0290.r3 ◽

2020 ◽

pp. 1-5

Author(s):

Øyvind Håberg ◽

Olav A. Foss ◽

Øystein Bjerkestrand Lian ◽

Ketil Jarl Holen

Keyword(s):

Risk Factors ◽

Risk Factor ◽

General Population ◽

Developmental Dysplasia ◽

Foot Deformity ◽

Breech Delivery ◽

Increased Risk ◽

History Of ◽

Congenital Foot Deformity ◽

Dysplasia Of The Hip

Aims To assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH). Methods Between 1996 and 2012, 60,844 children were born in Sør-Trøndelag county in Norway. In this cohort study, children with risk factors for DDH were examined using ultrasound. The risk factors evaluated were clinical hip instability, breech delivery, a family history of DDH, a foot deformity, and some syndromes. As the aim of the study was to examine the risk for DDH and foot deformity in the general population, children with syndromes were excluded. The information has been prospectively registered and retrospectively analyzed. Results Overall, 494 children (0.8%) had DDH, and 1,132 (1.9%) a foot deformity. Of the children with a foot deformity, 49 (4.3%) also demonstrated DDH. There was a statistically significant increased association between DDH and foot deformity (p < 0.001). The risk of DDH was highest for talipes calcaneovalgus (6.1%) and club foot (3.5%), whereas metatarsus adductus (1.5%) had a marginal increased risk of DDH. Conclusion Compared with the general population, children with a congenital foot deformity had a significantly increased risk for DDH and therefore we regard foot deformity as a true risk factor for DDH.

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Inflammation in Peritoneal Dialysis: A Latin-American Perspective

Peritoneal Dialysis International ◽

10.1177/089686080702700326 ◽

2007 ◽

Vol 27 (3) ◽

pp. 347-352 ◽

Cited By ~ 9

Author(s):

Alfonso M. Cueto-Manzano ◽

Liliana González-Espinoza ◽

Fabiola Martin del Campo ◽

Paulo C. Fortes ◽

Roberto Pecoits-Filho

Keyword(s):

Risk Factors ◽

Latin America ◽

Peritoneal Dialysis ◽

Latin American ◽

High Mortality ◽

Mortality Risk ◽

Adult Population ◽

High Energy ◽

Increased Risk ◽

Sanitary Conditions

Peritoneal dialysis (PD) patients present an extremely high mortality rate, but the mechanisms mediating the increased risk of mortality observed in this group of patients are still largely unknown, which limits the perspective of effective therapeutic strategies. The leading hypothesis that tries to explain this high mortality risk is that PD patients are exposed to a number of traditional risk factors for cardiovascular disease (CVD) already at the onset of their chronic kidney disease (CKD), since many of these risk factors are common to both CVD and CKD. Of particular importance, chronic inflammation recently emerged as an important novel risk factor related to multiple complications of CKD. There are many stimuli of the inflammatory response in CKD patients, such as fluid overload, decreased cytokine clearance, presence of uremia-modified proteins, presence of chronic infections, metabolic disturbances (including hyperglycemia), obesity. Many of these factors are related to PD. Latin America has made some progress in economic issues; however, a large portion of the population is still living in poverty, in poor sanitary conditions, and with many health-related issues, such as an increasing elderly population, low birth weights, and increasingly high energy intake in the adult population, which, in combination with changes in lifestyle, has provoked an increase in the prevalence of obesity, diabetes, and CVD. Therefore, in Latin America, there seems to be a peculiar situation combining high prevalence of low education level, poor sanitary conditions, and poverty with increases in obesity, diabetes, and sedentary lifestyle. Since inflammation and mortality risk are intimately related to both sides of those health issues, in this review we aim to analyze the peculiarities of inflammation and mortality risk in the Latin-American PD population.

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Patients with type 2 diabetes have an increased demand for pacemaker treatment - a comparison with age- and sex matched controls from the general population.

10.2337/figshare.12818687.v1 ◽

2020 ◽

Author(s):

Elina Rautio ◽

Fredrik Gadler ◽

Soffia Gudbjörnsdottir ◽

Stefan Franzén ◽

Lars Rydén ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

General Population ◽

Diabetes Duration ◽

Lipid Lowering ◽

Increased Risk ◽

Age And Sex

Objective: Patients with type 2 diabetes mellitus have an increased risk for cardiovascular disease including arrhythmias. The prevalence of bradyarrhythmia and the subsequent need for treatment with pacemakers (PM) is less well explored in a contemporary patient population. The present study explores 1) whether patients with type 2 diabetes mellitus have an increased demand for PM implantation compared with an age- and sex-matched control population without diabetes mellitus; 2) Patient characteristics associated with increased demand of receiving a PM. Methods: In this population-matched registry study a total of 416 247 patients with type 2 diabetes mellitus from the Swedish National Diabetes Registry (NDR) and 2 081 235 age and sex-matched controls selected from the general population were included between 1 January 1998 and 31 December 2012 and followed until 31 December 2013. Mean follow-up time was 7 years. Cox’s proportional hazard regression analyses were performed to estimate the demand of PM-treatment and factors identifying patients with such demand. Results: Type 2 diabetes mellitus was associated with increased need of PM-treatment (Hazard ratio (HR) 1.65, 95% CI 1.60-1.69; p<0.0001) which remained (HR 1.56, 95% CI 1.51-1.60; p<0.0001) after adjustments for age, sex, educational level, marital status, country of birth and coronary heart disease. Risk factors for receiving a PM included increasing age, HbA1c, BMI, diabetes duration, blood pressure- and lipid lowering medication. Conclusion: The need for PM treatment is higher in patients with type 2 diabetes than in matched population-based controls. Age, diabetes duration and HbA1c seem to be risk factors for PM treatment.

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Epidemiology of Hypertension and Diabetes Mellitus in Latin America

Current Hypertension Reviews ◽

10.2174/1573402116999200917152952 ◽

2020 ◽

Vol 16 ◽

Author(s):

Patricio Lopez-Jaramillo ◽

Jose Lopez-Lopez ◽

Daniel Cohen ◽

Natalia Alarcon-Ariza ◽

Margarita Mogollon-Zehr

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Latin America ◽

Cardiovascular Diseases ◽

Latin American ◽

Premature Mortality ◽

Increased Risk ◽

And Control

: Hypertension and type 2 diabetes mellitus are two important risk factors that contribute to cardiovascular diseases worldwide. In Latin America hypertension prevalence varies from 30 to 50%. Moreover, the proportion of awareness, treatment and control of hypertension is very low. The prevalence of type 2 diabetes mellitus varies from 8 to 13% and near to 40% are unaware of their condition. In addition, the prevalence of prediabetes varies from 6 to 14% and this condition has been also associated with increased risk of cardiovascular diseases. The principal factors linked to a higher risk of hypertension in Latin America are increased adiposity, low muscle strength, unhealthy diet, low physical activity and low education. Besides being chronic conditions, leading causes of cardiovascular mortality, both hypertension and type 2 diabetes mellitus represent a substantial cost for the weak health systems of Latin American countries. Therefore, is necessary to implement and reinforce public health programs to improve awareness, treatment and control of hypertension and type 2 diabetes mellitus, in order to reach the mandate of the Unit Nations of decrease the premature mortality for CVD.

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Cardiovascular disease risk factors of ultra-Orthodox Jewish women in Israel: a comparison study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.735 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Leiter ◽

K L Greenberg ◽

M Donchin ◽

O Keidar ◽

S Siemiatycki ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

General Population ◽

Secondhand Smoke ◽

Smoke Exposure ◽

Orthodox Jewish ◽

Minority Population ◽

Secondhand Smoke Exposure ◽

Community Based ◽

Increased Risk

Abstract Background Women from low socio-economic, culturally insular populations are at increased risk for cardiovascular disease (CVD). The ultra-Orthodox Jewish (UOJ) community in Israel is a difficult to access, rapidly growing low socio-economic, insular minority with numerous obstacles to health. The current study investigates CVD-related risk factors (RF) in a sample of OUJ women, comparing sample characteristics with the general population. Addressing the questions, 'Are UOJ women at increased risk for CVD?', 'Which RFs should be addressed beyond the general population's?', this study can inform public health initiatives (PHI) for this and similar populations. Methods Self-administered questionnaires completed by a cluster randomized sample of 239 women from a UOJ community included demographics, fruit, vegetables, and sweetened drink consumption, secondhand smoke exposure, physical activity (PA) engagement, and BMI. Population statistics utilized for comparison of demographic and cardiovascular risk factors were obtained from government-sponsored national surveys. Results Compared with the general population, UOJ women were less likely to consume 5 fruits and vegetables a day (12.7% vs. 24.3%, p<.001) and more likely to consume > 5 cups of sweetened beverages a day (18.6% vs. 12.6%, p=.019). UOJ women also reported less secondhand smoke exposure (7.2% vs. 51.4%, p<.001) and higher rates of PA recommendation adherence (60.1% vs. 25.6%, p<.0001) than the general population. Obesity was higher in UOJ women (24.3% vs. 16.1%, p<.0001). Conclusions This study suggests that PHIs in this population target healthy weight maintenance, nutrition, and PA. As a consequence of this study, the first CVD prevention intervention has been implemented in this population, targeting the identified RFs. Utilizing a mixed methods and community-based participatory approach, this innovative 3-year intervention reached over 2,000 individuals. Key messages This study identified nutrition risk behaviors and high levels of obesity in a difficult to access, minority population. This study informed the planning and implementation of a community-based PHI.

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Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211033755 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110337

Author(s):

Iván Ferraz-Amaro ◽

Javier Rueda-Gotor ◽

Fernanda Genre ◽

Alfonso Corrales ◽

Ricardo Blanco ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Multivariable Analysis ◽

Activity Score ◽

Increased Risk ◽

Activity Measurements ◽

Beta Coefficient

Background: Axial spondyloarthritis (axSpA) patients are known to have a higher prevalence of several comorbidities, including, among others, an increased risk of atherosclerosis, hypertension, dyslipidemia, and diabetes. The purpose of the present study was to determine whether the sum of traditional cardiovascular (CV) risk factors is related to disease characteristics, such as disease activity, in patients with axSpA. Methods: A cross-sectional study that encompassed 804 patients with axSpA was conducted. Patients were assessed for the presence of five traditional CV risk factors (diabetes mellitus, dyslipidemia, hypertension, obesity, and smoking status), and disease activity measurements. A multivariable regression analysis was performed to evaluate whether the number of classic CV risk factors was independently associated with specific features of the disease, to include disease activity. Results: A multivariable analysis showed that Ankylosing Spondylitis Disease Activity Score–C reactive protein (ASDAS-CRP) activity score was significantly higher in patients with 1 [beta coefficient 0.3 (95% confidence interval (CI) 0.1–0.5), p = 0.001] and ⩾2 [beta coefficient 0.5 (95% CI 0.3–0.7), p = 0.000] CV risk factors compared with those without CV risk factors. Similarly, patients with 1 [OR 2.00 (95%CI 0.99–4.02), p = 0.053] and ⩾2 [OR 3.39 (95%CI 1.82–6.31), p = 0.000] CV risk factors had a higher odds ratio for the presence of high disease activity compared with the zero CV category. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) activity score was significantly associated with the number of CV risk factors, being higher in patients with more CV risk factors. These relationships showed a CV risk factor-dependent effect being beta coefficients and ORs higher for the effect of ⩾2 over 1 CV risk factor. Conclusion: Among patients with axSpA, as the number of traditional CV risk factors increased, disease activity similarly increases in an independent manner.

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Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.200 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

C Verdicchio ◽

A Elliott ◽

R Mahajan ◽

D Linz ◽

D Lau ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Risk Factor ◽

Cardiorespiratory Fitness ◽

Meta Analysis ◽

Exercise Stress ◽

Inverse Association ◽

Exercise Interventions ◽

Increased Risk ◽

Statistical Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF. Purpose The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF. Methods The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF. Results Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p < 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p < 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03). Conclusion There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence. Abstract Figure. AF risk between high and low-CRF

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