-
1.
A prediction rule for severe adverse events in all inpatients with community-acquired pneumonia: a multicenter observational study.
Sakakibara, T, Shindo, Y, Kobayashi, D, Sano, M, Okumura, J, Murakami, Y, Takahashi, K, Matsui, S, Yagi, T, Saka, H, et al
BMC pulmonary medicine. 2022;(1):34
Abstract
BACKGROUND Prediction of inpatients with community-acquired pneumonia (CAP) at high risk for severe adverse events (SAEs) requiring higher-intensity treatment is critical. However, evidence regarding prediction rules applicable to all patients with CAP including those with healthcare-associated pneumonia (HCAP) is limited. The objective of this study is to develop and validate a new prediction system for SAEs in inpatients with CAP. METHODS Logistic regression analysis was performed in 1334 inpatients of a prospective multicenter study to develop a multivariate model predicting SAEs (death, requirement of mechanical ventilation, and vasopressor support within 30 days after diagnosis). The developed ALL-COP-SCORE rule based on the multivariate model was validated in 643 inpatients in another prospective multicenter study. RESULTS The ALL-COP SCORE rule included albumin (< 2 g/dL, 2 points; 2-3 g/dL, 1 point), white blood cell (< 4000 cells/μL, 3 points), chronic lung disease (1 point), confusion (2 points), PaO2/FIO2 ratio (< 200 mmHg, 3 points; 200-300 mmHg, 1 point), potassium (≥ 5.0 mEq/L, 2 points), arterial pH (< 7.35, 2 points), systolic blood pressure (< 90 mmHg, 2 points), PaCO2 (> 45 mmHg, 2 points), HCO3- (< 20 mmol/L, 1 point), respiratory rate (≥ 30 breaths/min, 1 point), pleural effusion (1 point), and extent of chest radiographical infiltration in unilateral lung (> 2/3, 2 points; 1/2-2/3, 1 point). Patients with 4-5, 6-7, and ≥ 8 points had 17%, 35%, and 52% increase in the probability of SAEs, respectively, whereas the probability of SAEs was 3% in patients with ≤ 3 points. The ALL-COP SCORE rule exhibited a higher area under the receiver operating characteristic curve (0.85) compared with the other predictive models, and an ALL-COP SCORE threshold of ≥ 4 points exhibited 92% sensitivity and 60% specificity. CONCLUSIONS ALL-COP SCORE rule can be useful to predict SAEs and aid in decision-making on treatment intensity for all inpatients with CAP including those with HCAP. Higher-intensity treatment should be considered in patients with CAP and an ALL-COP SCORE threshold of ≥ 4 points. TRIAL REGISTRATION This study was registered with the University Medical Information Network in Japan, registration numbers UMIN000003306 and UMIN000009837.
-
2.
Does Lowering Low-Density Lipoprotein Cholesterol With Statin Restore Low Risk in Middle-Aged Adults? Analysis of the Observational MESA Study.
Liu, K, Wilkins, JT, Colangelo, LA, Lloyd-Jones, DM
Journal of the American Heart Association. 2021;(11):e019695
Abstract
Background It is unclear if statin therapy in midlife can restore low cardiovascular risk in hypercholesterolemic individuals. Methods and Results At baseline, we grouped 5687 MESA (Multi-Ethnic Study of Atherosclerosis) participants aged ≥50 years without clinical cardiovascular disease (CVD) by Adult Treatment Panel III statin treatment recommendation and statin treatment status. We used Cox regression to compare the risks for coronary heart disease and CVD between the untreated group with low-density lipoprotein cholesterol (LDL-C) <100 mg/dL (reference) and other groups, adjusting for CVD risk factors. We also grouped participants by LDL-C level (< or ≥100 mg/dL), coronary artery calcium score (0 or >0 Agatston units), and statin status (untreated or treated) with the untreated LDL-C <100 mg/dL and coronary artery calcium=0 Agatston units as the reference. There were 567 coronary heart disease and 848 CVD events over 15 years of follow-up. The hazard ratios (HRs) for coronary heart disease and CVD in the group with statin-treated LDL-C <100 mg/dL were 1.16 (95% CI, 0.85-1.58) and 1.02 (95% CI, 0.78-1.32), respectively. However, participants with coronary artery calcium >0 Agatston units, treated to LDL-C <100 mg/dL had HRs of 2.6 (95% CI, 1.7-4.2) for coronary heart disease and 1.8 (95% CI, 1.2-2.6) for CVD. Conclusions Individuals treated with statins to LDL-C <100 mg/dL had similar levels of risk for atherosclerotic CVD as individuals with untreated LDL-C <100 mg/dL. However, individuals with coronary artery calcium >0 Agatston units have substantially higher risks despite lipid-lowering therapy, suggesting that statin treatment in midlife may not restore a low-risk state in primary prevention patients with established coronary atherosclerosis.
-
3.
Impact of gender: Rivaroxaban for patients with atrial fibrillation in the XANTUS real-world prospective study.
Camm, AJ, Amarenco, P, Haas, S, Bach, M, Kirchhof, P, Kuhls, S, Lambelet, M, Turpie, AGG, ,
Clinical cardiology. 2020;(12):1405-1413
Abstract
BACKGROUND The XANTUS study (NCT01606995) demonstrated low rates of stroke and major bleeding in patients with atrial fibrillation (AF) receiving rivaroxaban in clinical practice for the prevention of thromboembolic events (N = 6784). HYPOTHESIS Because previous real-world studies have not reported gender-dependent responses to rivaroxaban treatment, this sub-analysis of the XANTUS study investigated the effect of gender on outcomes. METHODS The centrally adjudicated outcomes were compared between genders. Primary outcomes were major bleeding and all-cause death. Secondary outcomes included symptomatic thromboembolic events. Multivariable Cox regression analysis was performed to assess the effect of risk factors on outcomes between genders. RESULTS A total of 2765 female and 4016 male patients were included in the analysis. Baseline characteristics were generally similar. No nominally significant interaction between gender and risk factors for the study outcomes was observed. Rates of major bleeding, all-cause death and symptomatic thromboembolic events in patients with non-valvular AF receiving rivaroxaban for stroke prevention were similar in men and women; no significant differences in risk factors for these outcomes were observed between genders. CONCLUSIONS Further research is needed to better characterize the relative importance of different risk factors on outcomes in men vs women and to determine whether gender differences exist in patients treated with non-vitamin K antagonist oral anticoagulants.
-
4.
Critical review of methods for risk ranking of food-related hazards, based on risks for human health.
Van der Fels-Klerx, HJ, Van Asselt, ED, Raley, M, Poulsen, M, Korsgaard, H, Bredsdorff, L, Nauta, M, D'agostino, M, Coles, D, Marvin, HJP, et al
Critical reviews in food science and nutrition. 2018;(2):178-193
Abstract
This study aimed to critically review methods for ranking risks related to food safety and dietary hazards on the basis of their anticipated human health impacts. A literature review was performed to identify and characterize methods for risk ranking from the fields of food, environmental science and socio-economic sciences. The review used a predefined search protocol, and covered the bibliographic databases Scopus, CAB Abstracts, Web of Sciences, and PubMed over the period 1993-2013. All references deemed relevant, on the basis of predefined evaluation criteria, were included in the review, and the risk ranking method characterized. The methods were then clustered-based on their characteristics-into eleven method categories. These categories included: risk assessment, comparative risk assessment, risk ratio method, scoring method, cost of illness, health adjusted life years (HALY), multi-criteria decision analysis, risk matrix, flow charts/decision trees, stated preference techniques and expert synthesis. Method categories were described by their characteristics, weaknesses and strengths, data resources, and fields of applications. It was concluded there is no single best method for risk ranking. The method to be used should be selected on the basis of risk manager/assessor requirements, data availability, and the characteristics of the method. Recommendations for future use and application are provided.
-
5.
Clinical relevance and validity of tools to predict infant, childhood and adulthood obesity: a systematic review.
Canfell, OJ, Littlewood, R, Wright, OR, Walker, JL
Public health nutrition. 2018;(17):3135-3147
-
-
Free full text
-
Abstract
OBJECTIVE To determine the global availability of a multicomponent tool predicting overweight/obesity in infancy, childhood, adolescence or adulthood; and to compare their predictive validity and clinical relevance.Design/SettingThe PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The databases PubMed, EMBASE, CINAHL, Web of Science and PsycINFO were searched. Additional articles were identified via reference lists of included articles. Risk of bias was assessed using the Academy of Nutrition and Dietetics' Quality Criteria Checklist. The National Health and Medical Research Council's Levels of Evidence hierarchy was used to assess quality of evidence. Predictive performance was evaluated using the ABCD framework. SUBJECTS Eligible studies: tool could be administered at any life stage; quantified the risk of overweight/obesity onset; used more than one predictor variable; and reported appropriate prediction statistical outcomes. RESULTS Of the initial 4490 articles identified, twelve articles (describing twelve tools) were included. Most tools aimed to predict overweight and/or obesity within childhood (age 2-12 years). Predictive accuracy of tools was consistently adequate; however, the predictive validity of most tools was questioned secondary to poor methodology and statistical reporting. Globally, five tools were developed for dissemination into clinical practice, but no tools were tested within a clinical setting. CONCLUSIONS To our knowledge, a clinically relevant and highly predictive overweight/obesity prediction tool is yet to be developed. Clinicians can, however, act now to identify the strongest predictors of future overweight/obesity. Further research is necessary to optimise the predictive strength and clinical applicability of such a tool.
-
6.
Comparison of QRS Duration and Associated Cardiovascular Events in American Indian Men Versus Women (The Strong Heart Study).
Deen, JF, Rhoades, DA, Noonan, C, Best, LG, Okin, PM, Devereux, RB, Umans, JG
The American journal of cardiology. 2017;(11):1757-1762
Abstract
Electrocardiographic QRS duration at rest is associated with sudden cardiac death and death from coronary heart disease in the general population. However, its relation to cardiovascular events in American Indians, a population with persistently high cardiovascular disease mortality, is unknown. The relation of QRS duration to incident cardiovascular disease during 17.2 years of follow-up was assessed in 1,851 male and female Strong Heart Study participants aged 45 to 74 years without known cardiovascular disease at baseline. Cox regression with robust standard error estimates was used to determine the association between quintiles of QRS duration and incident cardiovascular disease in gender-stratified analyses, adjusted for age, systolic blood pressure, hypertension, antihypertensive medication use, body mass index, current smoking, diabetes, total cholesterol, high-density lipoprotein cholesterol, and albuminuria. In women only, QRS duration in the highest quintile (≥105 ms) conferred significantly higher risk of cardiovascular disease than QRS duration in the lowest quintile (64 to 84 ms) (hazard ratio 1.6, 95% CI 1.1 to 2.4) likely because of higher risks of coronary heart disease (hazard ratio 1.8, 95% CI 1.1 to 3.1) and myocardial infarction (hazard ratio 2.1, 95% CI 1.0 to 4.7). Furthermore, when added to the Strong Heart Study Coronary Heart Disease Risk Calculator, QRS duration significantly improved prediction of future coronary heart disease events in women (Net Reclassification Index 0.17, 95% CI 0.06 to 0.47). In conclusion, QRS duration is an independent predictor of cardiovascular disease in women in the Strong Heart Study cohort and may have value in estimating risk in populations with similar risk profiles and a high lifetime incidence of cardiovascular disease.
-
7.
Prevalence and severity of coronary artery calcification based on the epidemiologic pattern: A propensity matched comparison of asymptomatic Korean and Chinese adults.
Han, D, Gao, Y, Ó Hartaigh, B, Gransar, H, Lee, JH, Rizvi, A, Choi, SY, Chun, EJ, Sung, J, Han, HW, et al
International journal of cardiology. 2017;:353-358
Abstract
BACKGROUND Lifestyle, environmental, and genetic factors substantially influence cardiovascular disease (CVD) risk. We aimed to explore epidemiologic trends in coronary artery calcium scores (CACS), as a marker of CVD, along with possible differences by geographic area and study period in separate East Asian populations. METHODS We generated 3 matched groups (n=702) using a propensity scoring approach derived from a Korean (N=48,901) and Chinese cohort (N=927) as follows: (1) A recent Chinese group and (2) recent Korean group, both of whom underwent CACS scanning from 2012-2014; and (3) a past Korean group who underwent CACS scanning 8-10years before the index group (2002-2006). We used logistic regression to generate odds ratios (OR) with 95% confidence intervals (95% CI) to estimate the likelihood of having CACS between the groups, based on CACS stratified by severity: >0 (any), >100 (moderate), and >400 (severe). RESULTS The prevalence of any, moderate, or severe CACS did not differ significantly between the recent Chinese and Korean groups. Notably, the odds of the presence of moderate CACS in the recent Chinese group (OR: 3.05, 95% CI: 1.49-6.71, P-value<0.001) and the presence of any CACS in the recent Korean group (OR: 1.58, 95% CI: 1.17-2.15, P-value<0.001) were significantly higher than in the past Korean group. CONCLUSIONS In this study involving separate East Asian populations, there were no geographic differences in the prevalence of CACS. However, changes in other unmeasured factors over time are likely the culprits for the elevated prevalence of CACS in asymptomatic East Asians.
-
8.
Prevalence and control of cardiovascular risk factors in stable coronary artery outpatients in India compared with the rest of the world: An analysis from international CLARIFY registry.
KauL, U, Natrajan, S, Dalal, J, Saran, RK
Indian heart journal. 2017;(4):447-452
Abstract
OBJECTIVES We describe the clinical characteristics, prevalence and control of coronary artery disease (CAD) risk factors of the Indian cohort enrolled in the CLARIFY registry and compare them with data from rest of the world (ROW). METHODS CLARIFY is an international, prospective, observational, longitudinal cohort study in stable CAD outpatients. The baseline data of Indian cohort (n=709) were compared to ROW (n=31994). RESULTS The CLARIFY India patients were significantly younger than the ROW (59.6±10.9 vs 64.3±10.4). Indian patients were more likely than those in ROW to have diabetes (42.9% vs 28.8%) and angina (27.8% vs 21.9%). Mean heart rate was significantly greater in Indians measured by either palpatory method (76.1±10.4 vs 68.0±10.5) or ECG (74.9±12.9 vs 67.0±11.3). The use of aspirin (85.6% vs 87.8%), β-blockers (69.4% vs 75.4%), and lipid-lowering agents (90% vs 92.4%) was lower in India. A significantly greater proportion of patients in India exhibited low HDL cholesterol (41.6% vs 31.2%), and heart rate ≥70bpm (82.2% vs 48.5%). The risk factors control was poor in India with heart rate goal of ≤60bpm achieved in 2.5%; HbA1c <7% in 9.9%; and HbA1c <6.5% in 4.6% patients. CONCLUSION The CLARIFY registry demonstrates a high prevalence and poor control of cardiovascular risk factors in Indian patients. Systematic efforts to improve risk factor control are required.
-
9.
Value of CACS compared with ETT and myocardial perfusion imaging for predicting long-term cardiac outcome in asymptomatic and symptomatic patients at low risk for coronary disease: clinical implications in a multimodality imaging world.
Chang, SM, Nabi, F, Xu, J, Pratt, CM, Mahmarian, AC, Frias, ME, Mahmarian, JJ
JACC. Cardiovascular imaging. 2015;(2):134-44
Abstract
OBJECTIVES This prospective, observational study in 988 asymptomatic or symptomatic low-risk patients without prior coronary artery disease was conducted to define the relative value of coronary artery calcium score (CACS), exercise treadmill testing (ETT), and stress myocardial perfusion single-photon emission computed tomography (SPECT) variables in predicting long-term risk stratification. BACKGROUND CACS, ETT, and stress myocardial perfusion SPECT results predict patients' outcome. There are currently no data comparing their relative value in long-term risk stratification. METHODS Patients were stratified by Framingham risk score (FRS), with a median follow-up of 6.9 years. Cardiac events were defined as a composite of cardiac death, nonfatal myocardial infarction, and the need for coronary revascularization. Most patients (87%) were considered appropriate candidates for functional testing as defined by current appropriate use criteria. RESULTS The long-term cardiac event rate was 11.2% (1.6% per year). Multivariate risk predictors in all patients and in the appropriate use cohort were abnormal SPECT (hazard ratio [HR]: 1.83 and 1.99), ETT ischemia (HR: 1.70 and 1.76), decreasing exercise capacity (HR: 1.11 and 1.17), decreasing Duke treadmill score (HR: 1.07 for both), and CACS severity (HR: 1.29 for both), respectively. Throughout the 10-year follow-up, CACS improved risk prediction, with event rates ranging from 0.6% per year (CACS ≤10) to 3.7% per year (CACS >400) (p < 0.0001). CACS also improved risk prediction in all patients, in the appropriate use cohort and among those with low-risk ETT and SPECT results (all, p < 0.001). Area under the receiver-operating characteristic curve was increased when CACS variables (from 0.63 to 0.70; p = 0.01) but not ETT variables (from 0.63 to 0.65) were added to FRS. Moreover, net reclassification improvement was significantly increased when CACS was added to FRS + functional variables in all patients and in the appropriate use cohort (both, p < 0.0001). CONCLUSIONS CACS significantly improved long-term risk stratification beyond FRS, ETT, and SPECT results across the spectrum of clinical risk and importantly even among those who are currently considered appropriate candidates for functional testing or have low-risk functional test results. Our findings support CACS as a first-line test over ETT or SPECT for accurately assessing long-term risk in such patients.
-
10.
Cardiovascular status after Kawasaki disease in the UK.
Shah, V, Christov, G, Mukasa, T, Brogan, KS, Wade, A, Eleftheriou, D, Levin, M, Tulloh, RM, Almeida, B, Dillon, MJ, et al
Heart (British Cardiac Society). 2015;(20):1646-55
-
-
Free full text
-
Abstract
OBJECTIVE Kawasaki disease (KD) is an acute vasculitis that causes coronary artery aneurysms (CAA) in young children. Previous studies have emphasised poor long-term outcomes for those with severe CAA. Little is known about the fate of those without CAA or patients with regressed CAA. We aimed to study long-term cardiovascular status after KD by examining the relationship between coronary artery (CA) status, endothelial injury, systemic inflammatory markers, cardiovascular risk factors (CRF), pulse-wave velocity (PWV) and carotid intima media thickness (cIMT) after KD. METHODS Circulating endothelial cells (CECs), endothelial microparticles (EMPs), soluble cell-adhesion molecules cytokines, CRF, PWV and cIMT were compared between patients with KD and healthy controls (HC). CA status of the patients with KD was classified as CAA present (CAA+) or absent (CAA-) according to their worst-ever CA status. Data are median (range). RESULTS Ninety-two KD subjects were studied, aged 11.9 years (4.3-32.2), 8.3 years (1.0-30.7) from KD diagnosis. 54 (59%) were CAA-, and 38 (41%) were CAA+. There were 51 demographically similar HC. Patients with KD had higher CECs than HC (p=0.00003), most evident in the CAA+ group (p=0.00009), but also higher in the CAA- group than HC (p=0.0010). Patients with persistent CAA had the highest CECs, but even those with regressed CAA had higher CECs than HC (p=0.011). CD105 EMPs were also higher in the KD group versus HC (p=0.04), particularly in the CAA+ group (p=0.02), with similar findings for soluble vascular cell adhesion molecule 1 and soluble intercellular adhesion molecule 1. There was no difference in PWV, cIMT, CRF or in markers of systemic inflammation in the patients with KD (CAA+ or CAA-) compared with HC. CONCLUSIONS Markers of endothelial injury persist for years after KD, including in a subset of patients without CAA.