Triceps skinfold thickness trajectories and the risk of all-cause mortality:A prospective cohort study

BACKGROUND The measurement of triceps skinfold(TSF)thickness serves as a noninvasive metric for evaluating subcutaneous fat distribution.Despite its clinical utility,the TSF thickness trajectories and their correlation with overall mortality have not been thoroughly investigated.AIM To explore TSF thickness trajectories of Chinese adults and to examine their associations with all-cause mortality.METHODS This study encompassed a cohort of 14747 adults sourced from the China Health and Nutrition Survey.Latent class trajectory modeling was employed to identify distinct trajectories of TSF thickness.Subjects were classified into subgroups reflective of their respective TSF thickness trajectory.We utilized multivariate Cox regression analyses and mediation examinations to explore the link between TSF thickness trajectory and overall mortality,including contributory factors.RESULTS Upon adjustment for multiple confounding factors,we discerned that males in the‘Class 2:Thin-stable’and‘Class 3:Thin-moderate’TSF thickness trajectories exhibited a markedly reduced risk of mortality from all causes in comparison to the‘Class 1:Extremely thin’subgroup.In the mediation analyses,the Geriatric Nutritional Risk Index was found to be a partial intermediary in the relationship between TSF thickness trajectories and mortality.For females,a lower TSF thickness pattern was significantly predictive of elevated all-cause mortality risk exclusively within the non-elderly cohort.CONCLUSION In males and non-elderly females,lower TSF thickness trajectories are significantly predictive of heightened mortality risk,independent of single-point TSF thickness,body mass index,and waist circumference.

Heterogeneous body compositions and all-cause mortality in acute coronary syndrome patients:a ten-year retrospective cohort study

BACKGROUND The association of different body components,including lean mass and body fat,with the risk of death in acute coronary syndrome(ACS)patients are unclear.METHODS We enrolled adults diagnosed with ACS at our center between January 2011 and December 2012 and obtained fol-low-up outcomes via telephone questionnaires.We used restricted cubic splines(RCS)with the Cox proportional hazards model to analyze the associations between body mass index(BMI),predicted lean mass index(LMI),predicted body fat percentage(BF),and the value of LMI/BF with 10-year mortality.We also examined the secondary outcome of death during hospitalization.RESULTS During the maximum 10-year follow-up of 1398 patients,331 deaths(23.6%)occurred,and a U-shaped relationship was found between BMI and death risk(P_(nonlinearity)=0.03).After adjusting for age and history of diabetes,the overweight group(24≤BMI<28 kg/m^(2))had the lowest mortality(HR=0.53,95%CI:0.29-0.99).Predicted LMI and LMI/BF had an inverse linear relationship with a 10-year death risk(P_(nonlinearity)=0.24 and P_(nonlinearity)=0.38,respectively),while an increase in BF was associ-ated with increased mortality(P_(nonlinearity)=0.64).During hospitalization,31 deaths(2.2%)were recorded,and the associations of the indicators with in-hospital mortality were consistent with the long-term outcome analyses.CONCLUSION Our study provides new insight into the“obesity paradox”in ACS patients,highlighting the importance of considering body composition heterogeneity.Predicted LMI and BF may serve as useful tools for assessing nutritional status and predicting the prognosis of ACS,based on their linear associations with all-cause mortality.

Associations between aerobic and muscle-strengthening physical activity,sleep duration,and risk of all-cause mortality:A prospective cohort study of 282,473 U.S.adults

Purpose:To examine the joint associations between meeting guidelines for physical activity(PA)and sleep duration and all-cause mortality risk among adults.Methods:Participants were adults(n=282,473)aged 18-84 years who participated in the 2004-2014 U.S.National Health Interview Survey.Mortality status was ascertained using the National Death Index through December 2015.Self-reported PA(Active:meeting both aerobic(AER)and muscle-strengthening(MSA)guidelines,AER only(AER),MSA only(MSA),or not meeting either AER or MSA(Inactive))and sleep duration(Short,recommended(Rec),or Long)were classified according to guidelines,and 12 PA-sleep categories were derived.Adjusted hazard ratios and 95%confidence intervals(95%CIs)for all-cause mortality risk were estimated using Cox proportional hazards regression models.Results:A total of 282,473 participants(55%females)were included;18,793 deaths(6.7%)occurred over an average follow-up of 5.4 years.Relative to the Active-Rec group,all other PA-sleep groups were associated with increased mortality risk except for the Active-Short group(hazard ratio=1.08;95%CI:0.92-1.26).The combination of long sleep with either MSA or Inactive appeared to be synergistic.For a given sleep duration,mortality risk progressively increased among participants classified as AER,MSA,and Inactive.Within each activity level,the mortality risk was greatest among adults with long sleep.Conclusion:Relative to adults meeting guidelines for both PA and sleep duration,adults who failed to meet guidelines for both AER and muscle strengthening PA and who also failed to meet sleep duration guidelines had elevated all-cause mortality risks.These results support interventions targeting both PA and sleep duration to reduce mortality risk.

Association between the Khorana risk score and all-cause mortality in Japanese patients with gastric and colorectal cancer: A retrospective cohort study

BACKGROUND The Khorana risk score(KRS)has poor predictive value for cancer-associated thrombosis in a single tumor type but is associated with early all-cause mortality from cancer.Evidence for the association between KRS and all-cause mortality in Japanese patients with gastric and colorectal cancer is limited.AIM To investigate whether KRS was independently related to all-cause mortality in Japanese patients with gastric and colorectal cancer after adjusting for other covariates and to shed light on its temporal validity.METHODS Data from Dryad database were used in this study.Patients in the Gastroen-terology Department of Sapporo General Hospital,Sapporo,Japan,were enrolled.The starting and ending dates of the enrollment were January 1,2008 and January 5,2015,respectively.The cutoff date for follow-up was May 31,2016.The inde-pendent and dependent(target)variables were the baseline measured using the KRS and final all-cause mortality,respectively.The KRS was categorized into three groups:Low-risk group(=0 score),intermediate-risk group(1-2 score),and high-risk group(≥3 score).RESULTS Men and patients with Eastern Cooperative Oncology Group Performance Status(ECOG PS)≥2 displayed a higher 2-year risk of death than women and those with ECOG PS 0-1 in the intermediate/high risk group for KRS.The higher the score,the higher the risk of early death;however,the relevance of this independent prediction decreased with longer survival.The overall survival of each patient was recorded via real-world follow-up and retrospective observations,and this study yielded the overall relationship between KRS and all-cause mortality.CONCLUSION The prechemotherapy baseline of KRS was independently associated with all-cause mortality within 2 years;however,this independent predictive relationship weakened as survival time increased.

Hypoperfusion context as a predictor of 28-d all-cause mortality in septic shock patients:A comparative observational study

BACKGROUND As per the latest Surviving Sepsis Campaign guidelines,fluid resuscitation should be guided by repeated measurements of blood lactate levels until normalization.Nevertheless,raised lactate levels should be interpreted in the clinical context,as there may be other causes of elevated lactate levels.Thus,it may not be the best tool for real-time assessment of the effect of hemodynamic resuscitation,and exploring alternative resuscitation targets should be an essential research priority in sepsis.AIM To compare the 28-d mortality in two clinical patterns of septic shock:hyperlactatemic patients with hypoperfusion context and hyperlactatemic patients without hypoperfusion context.METHODS This prospective comparative observational study carried out on 135 adult patients with septic shock that met Sepsis-3 definitions compared patients with hyperlactatemia in a hypoperfusion context(Group 1,n=95)and patients with hyperlactatemia in a non-hypoperfusion context(Group 2,n=40).Hypoperfusion context was defined by a central venous saturation less than 70%,central venousarterial PCO_(2)gradient[P(cv-a)CO_(2)]≥6 mmHg,and capillary refilling time(CRT)≥4 s.The patients were observed for various macro and micro hemodynamic parameters at regular intervals of 0 h,3 h,and 6 h.All-cause 28-d mortality and all other secondary objective parameters were observed at specified intervals.Nominal categorical data were compared using theχ^(2)or Fisher’s exact test.Nonnormally distributed continuous variables were compared using the Mann-Whitney U test.Receiver operating characteristic curve analysis with the Youden index determined the cutoff values of lactate,CRT,and metabolic perfusion parameters to predict the 28-d all-cause mortality.A P value of<0.05 was considered significant.RESULTS Patient demographics,comorbidities,baseline laboratory,vital parameters,source of infection,baseline lactate levels,and lactate clearance at 3 h and 6 h,Sequential Organ Failure scores,need for invasive mechanical ventilation,days on mechanical ventilation,and renal replacement therapy-free days within 28 d,duration of intensive care unit stay,and hospital stay were comparable between the two groups.The stratification of patients into hypoperfusion and nonhypoperfusion context did not result in a significantly different 28-d mortality(24%vs 15%,respectively;P=0.234).However,the patients within the hypoperfusion context with high P(cva)CO_(2)and CRT(P=0.022)at baseline had significantly higher mortality than Group 2.The norepinephrine dose was higher in Group 1 but did not achieve statistical significance with a P>0.05 at all measured intervals.Group 1 had a higher proportion of patients requiring vasopressin and the mean vasopressor-free days out of the total 28 d were lower in patients with hypoperfusion(18.88±9.04 vs 21.08±8.76;P=0.011).The mean lactate levels and lactate clearance at 3 h and 6 h,CRT,P(cv-a)CO_(2)at 0 h,3 h,and 6 h were found to be associated with 28-d mortality in patients with septic shock,with lactate levels at 6 h having the best predictive value(area under the curve lactate at 6 h:0.845).CONCLUSION Septic shock patients fulfilling the hypoperfusion and non-hypoperfusion context exhibited similar 28-d all-cause hospital mortality,although patients with hypoperfusion displayed a more severe circulatory dysfunction.Lactate levels at 6 h had a better predictive value in predicting 28-d mortality than other parameters.Persistently high P(cv-a)CO_(2)(>6 mmHg)or increased CRT(>4 s)at 3 h and 6 h during early resuscitation can be a valuable additional aid for prognostication of septic shock patients.

Effect of Body Mass Index on All-cause Mortality and Incidence of Cardiovascular Diseases─Report for Meta-Analysis of Prospective Studies on Optimal Cut-off Points of Body Mass Index in Chinese Adults

Objective To verify the optimal cut-off points for overweight and obesity in Chinese adults based on the relationship of baseline body mass index (BMI) to all-cause mortality, and incidence of cardiovascular diseases from pooled data of Chinese cohorts. Methods The prospective study data of existing cohort studies in China were collected, and the age-adjusted all-cause mortality stratified by BMI were estimated. The similar analysis was repeated after excluding deaths within the first three years of follow-up and after excluding smokers. The incidence of age-adjusted coronary heart disease (CHD) and stroke stratified by BMI were also analyzed. Multiple Cox regression coefficients of BMI for the incidence of CHD and stroke after controlling other risk factors were pooled utilizing the methods of weighting by inverse of variance to reveal whether BMI had independent effect and its strength on the incidence of CHD and stroke. Results The data of 4 cohorts including 76 227 persons, with 745 346 person-years of follow-up were collected and analyzed. The age-adjusted all-cause mortality stratified by BMI showed a U-shaped curve, even after excluding deaths within the first three years of follow-up and excluding smokers. Age-adjusted all-cause mortality increased when BMI was lower than 18.5 and higher than 28. The incidence of CHD and stroke, especially ishemic stroke increased with increasing BMI, this was consistent with parallel increasing of risk factors. Cox regression analysis showed that BMI was an independent risk factor for both CHD and stroke. Each amount of 2 kg/m2 increase in baseline BMI might cause 15.4%, 6.1% and 18.8 % increase in relative risk of CHD, total stroke and ischemic stroke. Reduction of BMI to under 24 might prevent the incidence of CHD by 11% and that of stroke by 15 % for men, and 22 % of both diseases for women. Conclusion BMI ≤18.5, 24-27.9 and ≥28 (kg/m2) is the appropriate cut-off points for underweight, overweight and obesity in Chinese adults.

Adverse associations of sedentary behavior with cancer incidence and all-cause mortality:A prospective cohort study

Background:Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality,and evidence from the Chinese population is scarce.This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity(MVPA)on these relationships.Methods:We included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire.Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)for cancer and mortality were estimated using Cox proportional hazards regression models.Results:During 559,002 person-years of follow-up,2388 cancer events,1571 cancer deaths,and 4562 all-cause deaths were recorded.Sedentary behavior was associated with increased risk of developing cancer and deaths in a doseresponse manner.The multivariable-adjusted HRs(95%CIs)were the following:HR=1.16,95%CI:1.01-1.33;HR=1.24,95%CI:1.04-1.48;and HR=1.15,95%CI:1.04-1.28 for cancer incidence,cancer mortality,and all-cause mortality,respectively,for those having≥10 h/day of sedentary time compared with those having<6 h/day of sedentary time.Sedentary populations(≥10 h/day)developed cancer or died 4.09 years and 2.79 years earlier,respectively,at the index age of 50 years.Failure to achieve the recommended level of MVPA may further aggravate the adverse associations,with the highest cancer and mortality risks being observed among participants with both≥10 h/day of sedentary time and<150 min/week of MVPA.Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers.Conclusion:Sedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults,especially for those with≥10 h/day of sedentary time.It is necessary to reduce sedentary time,in addition to increasing MVPA levels,for the prevention of cancer and premature death.

BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing： a 20-year Cohort Study

Objective To explore the association between body mass index （BMI） and all-cause mortality among the elderly in Beijing. Methods This analysis was based on the Beijing multidimensional longitudinal study of aging （BLSA）, which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012. BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality. Cox proportional hazard models were used to obtain the hazard ratios （HRs） for BMI and BMI changes in the overall population and in specific stratified populations. Results During follow-up, 2,264 deaths were recorded; BMI-mortality curve was U-shaped, with the lowest mortality at a BMI of approximately 25 kg/m2. After adjusting for gender, age, smoking, drinking and some pre-existing diseases, HRs for underweight, overweight and obesity compared with normal weight were 2.372 （95% C/： 2.254-2.632）, 0.767 （95% CI： 0.666-0.884） and 0.872 （95% CI： 0.830-1.246）, respectively. HR for BMI drop was 3.245 （95% CI： 0.824-22.772） in the underweight group and 1.892 （95% C/： 0.830-1.246） in the normal weight group, HR for BMI rise was 1.795 （95% CI： 1.243-2.591） in normal weight group and 2.962 （95% CI： 2.202-3.203） in the overweight group. Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality

Abdominal Obesity and Its Attribution to All-cause Mortality in the General Population with 14 Years Follow-up:Findings from Shanxi Cohort in China

Objective This study aimed to assess the association of waist circumference(WC)with all-cause mortality among Chinese adults.Methods The baseline data were from Shanxi Province of 2002 China Nutrition and Health Survey.The death investigation and follow-up visit were conducted from December 2015 to March 2016.The visits covered up to 5,360 of 7,007 participants,representing a response rate of 76.5%.The Cox regression model and floating absolute risk were used to estimate hazard ratio and 95%floating CI of death by gender and age groups(≥60 and<60 years old).Sensitivity analysis was performed by excluding current smokers;participants with stroke,hypertension,and diabetes;participants who accidentally died;and participants who died during the first 2 years of follow-up.Results This study followed 67,129 person-years for 12.5 years on average,including 615 deaths.The mortality density was 916 per 100,000 person-years.Low WC was associated with all-cause mortality among men.Multifactor-adjusted hazard ratios(HR)were 1.60(1.35–1.90)for WC<75.0 cm and 1.40(1.11–1.76)for WC ranging from 75.0 cm to 79.9 cm.Low WC(<70.0 cm and 70.0–74.9 cm)and high WC(≥95.0 cm)groups had a high risk of mortality among women.The adjusted HRs of death were 1.43(1.11–1.83),1.39(1.05–1.84),and 1.91(1.13–3.22).Conclusion WC was an important predictor of death independent of body mass index(BMI).WC should be used as a simple rapid screening and predictive indicator of the risk of death.

Physical activity,fitness and all-cause mortality:An 18-year follow-up among old people

Background：Little is known about change in physical activity（PA） and its relationship to all-cause mortality among old people.There is even less information about the association between PA,fitness and all-cause mortality among people aged 80 years and above.The objective is to investigate persistence and change in PA over 5 years as a predictor of all-cause mortality,and fitnes as a mediator of this association,among people aged 80 and 85 years at the beginning of an 18-year mortality follow-up period.Methods：Using Evergreen Project data（started in 1989）,4 study groups were formed according to self-reported changes in PA level,over a 5-year period（starting in 1989–1990 and ending in 1994–1995）：remained active（RA,control group）,changed to inactive（CI）,remained inactive（RI）,and changed to active（CA）.Mortality was followed up over the 18-year period（1994–2012）.Cox models with different covariates such as age,sex,use of alcohol,smoking,chronic diseases,and a 10 m walking test were used to analyze the association between change in PA level and mortality.Results：Compared to RA,those who decreased their PA level（CI） between baseline and follow-up had higher all-cause mortality（hazard ratio（HR=2.09;95%CI：1.63–2.69） when adjusted for age,gender,and chronic diseases.RI showed the highest all-cause mortality（HR = 2.16;95%CI：1.59–2.93）.In CA,when compared against RA,the risk of all-cause mortality was not statistically significan（HR=1.51;95%CI：0.95–2.38）.In comparison with RA,when walking speed over 10 m was added as a covariate,all-cause mortality risk was almost statistically significan only in CI（HR=1.37;95%CI：1.00–1.87）.Conclusion：Persistence and change in PA level was associated with mortality.This association was largely explained by fitnes status.Randomized controlled studies are needed to test whether maintaining or increasing PA level could lengthen the life of old people.

Vitamin d deficiency and metabolic syndrome:The joint effect on cardiovascular and all-cause mortality in the United States adults

BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrations<20 ng/mL(defined as vitamin D deficiency),39%had serum 25(OH)D concentrations between 20 to 29 ng/mL(insufficiency),and 31%had serum 25(OH)D concentrations≥30 ng/mL(sufficiency).Prevalence of MetS was 28.4%.During a mean of 18 years follow-up,vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality.Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and allcause mortality.There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality.Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.

Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography

BACKGROUND Obesity is a major health problem due to its high prevalence. The relationship between obesity and cardiovascular disease is unclear. Some studies agree that certain conditions associated with obesity, such as physical inactivity or cardiovascular risk factors, are responsible for cardiovascular risk excess among obese people. Carotid intima-media thickness and carotid plaques(CP) have been associated with cardiovascular adverse events in healthy populations, and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients. However, there are no studies correlating subclinical atherosclerosis and adverse events(AE) in obese subjects.AIM To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography(EE).METHODS From January 1, 2006 to December 31, 2010, 2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography. Exclusion criteria included previous vascular disease, left ventricular ejection fraction < 50%, positive EE, significant valvular heart disease and inferior to submaximal EE. An AE was defined as all-cause mortality,myocardial infarction and cerebrovascular accident. Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.RESULTS Of the 652 patients who fulfilled the inclusion criteria, 226(34.7%) had body mass indexes ≥ 30 kg/m2, and 76 of them(33.6%) had CP. During a mean follow-up time of 8.2(2.1) years, 27 AE were found(11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1%(0.6), 95.1%(1.4) and 86.5%(2.7), respectively. In univariate analysis, CP predicted AE [hazard ratio(HR) 2.52, 95% confidence interval(CI) 1.17-5.46; P = 0.019]. In multivariable analysis, the presence of CP remained a predictor of AE(HR 2.26, 95%CI 1.04-4.95, P = 0.041). Other predictors identified were glomerular filtration rate(HR 0.98, 95%CI 0.96-0.99; P= 0.023), peak metabolic equivalents(HR 0.83, 95%CI 0.70–0.99, P = 0.034) and moderate mitral regurgitation(HR 5.02, 95%CI 1.42–17.75, P = 0.012).CONCLUSION Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE. These patients could benefit from aggressive prevention measures.

The serum anion gap is associated with disease severity and all-cause mortality in coronary artery disease

Objective To evaluate the associations between the serum anion gap （AG） with the severity and prognosis of coronary artery disease （CAD）. Methods We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation： AG = Na^＋ [（mmol/L） ＋ K^＋ （mmol/L）] - [Cl^- （mmol/L） ＋ HCO3^- （mmol/L）]. Results A total of 4510 （24.9%） participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD （P 〈 0.001） and worse cardiac function （P = 0.004）. Patients in the 4th quartile of serum AG （≥ 15.92 mmol/L） had a 5.171-fold increased risk of 30 days all-cause death （P 〈 0.001）. This association was robust, even after adjustment for age, sex, evaluated glomerular filtration rate [hazard ratio （HR）： 4.861, 95% confidence interval （CI）： 2.150–10.993, P 〈 0.001], clinical diagnosis, severity of coronary artery stenosis, cardiac function grades, and other confounders （HR： 3.318, 95% CI： 1.76–2.27, P = 0.009）. Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.

Heart rate is an independent predictor of all-cause mortality in individuals with type 2 diabetes: The diabetes heart study

AIM To assess the association of resting heart rate with allcause and cardiovascular disease(CVD) mortality in the Diabetes Heart Study(DHS).METHODS Out of a total of 1443 participants recruited into the DHS, 1315 participants with type 2 diabetes who were free of atrial fibrillation and supraventricular tachycardia during the baseline exam were included in this analysis. Heart rate was collected from baseline resting electrocardiogram and mortality(all-cause and CVD) was obtained from state and national death registry. Kaplan-Meier(K-M) and Cox proportional hazard analyses were used to assess the association.RESULTS The mean age, body mass index(BMI) and systolic blood pressure(SBP) of the cohort were 61.4 ± 9.2 years, 32.0 ± 6.6 kg/m2, and 139.4 ± 19.4 mmHg respectively. Fiftysix percent were females, 85% were whites, 15% were blacks, 18% were smokers. The mean ± SD heart rate was 69.8(11.9) beats per minute(bpm). After a median follow-up time of 8.5 years(maximum follow-up time is 14.0 years), 258 participants were deceased. In K-M analysis, participants with heart rate above the median had a significantly higher event rate compared with those below the median(log-rank P = 0.0223). A one standard deviation increase in heart rate was associated with allcause mortality in unadjusted(hazard ratio 1.16, 95%CI: 1.03-1.31) and adjusted(hazard ratio 1.20, 95%CI: 1.05-1.37) models. Similar results were obtained with CVD mortality as the outcome of interest.CONCLUSION Heart rate is an independent predictor of all-cause mortality in this population with type 2 diabetes. In this study, a 1-SD increase in heart rate was associated with a 20% increase in risk suggesting that additional prognostic information may be gleaned from this ubiquitously collected vital sign.

The association between orthostatic hypertension and all-cause mortality in hospitalized elderly persons

Background Little is known about the prevalence oforthostatic hypertension （OHT） and its effect on long-term mortality in the eld- erly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients. Methods Out of 1852 patients admit- ted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients （48% males） with a mean age of 81.5 ±6.8 years were en- rolled in this study. Blood pressure （BP） was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18th June 2014 were retrieved from the computerized system of the Ministry of the Interior. Results Four hundred and seven patients （86%） were diagnosed with OHT. Those without OHT had a lowerbody mass index and were more likely males, smokers, had a higher rate of Parkinson＇s disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT （P = 0.024）. Hazard ratios （HRs） for mortality in those with OHT adjusted to age and multiple risk factors were： 0.67 [95% confidence interval （CI）： 0.51-0.87] and 0.73 （95% CI： 0.55-0.97）, respectively; a similar tendency was noticed in a sensitivity analysis by gender. Conclusion Hospitalized elderly patients with OHT had a better survival rate than those without OHT.

Association of frailty with all-cause mortality and bleeding among elderly patients with acute myocardial infarction: a systematic review and meta-analysis

Background Frailty is a multidimensional syndrome that reflects the physiological reserve of elderly.It is related to unfavorable outcomes in various cardiovascular conditions.We conducted a systematic review and meta-analysis of the association of frailty with all-cause mortality and bleeding after acute myocardial infarction(AMI)in the elderly.Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2019.The studies that reported mortality and bleeding in AMI patients who were evaluated and classified by frailty status were included.Data from each study were combined using the random-effects,generic inverse variance method of Der Simonian and Laird to calculate hazard ratio(HR),and 95%confidence interval(CI).Results Twenty-one studies from 2011 to 2019 were included in this meta-analysis involving 143,301 subjects(mean age 75.33-year-old,60.0%male).Frailty status was evaluated using different methods such as Fried Frailty Index.Frailty was statistically associated with increased early mortality in nine studies(pooled HR=2.07,95%CI:1.67-2.56,P<0.001,I^2=41.2%)and late mortality in 11 studies(pooled HR=2.30,95%CI:1.70-3.11,P<0.001,I^2=65.8%).Moreover,frailty was also statistically associated with higher bleeding in 7 studies(pooled HR=1.34,95%CI:1.12-1.59,P<0.001,I^2=4.7%).Conclusion Frailty is strongly and independently associated with bleeding,early and late mortality in elderly with AMI.Frailty assessment should be considered as an additional risk factor and used to guide toward personalized treatment strategies.

The association of grip strength with cardiovascular diseases and all-cause mortality in people with hypertension:Findings from the Prospective Urban Rural Epidemiology China Study

Background:Both hypertension and grip strength(GS)are predictors of mortality and cardiovascular disease(CVD),but whether these risk factors interact to affect CVD and all-cause mortality is unknown.This study sought to investigate the associations of GS with the risk of major CVD incidence,CVD mortality,and all-cause mortality in patients with hypertension.Methods:GS was measured using a Jamar dynamometer(Sammons Preston,Bolingbrook,IL,USA)in participants aged 3570 years from 12 provinces included in the Prospective Urban Rural Epidemiology China Study.Cox frailty proportional hazards models were used to examine the associations of GS and hypertension and the outcomes of all-cause mortality and CVD incidence/mortality.Results:Among 39,862 participants included in this study,15,964 reported having hypertension,and 9095 had high GS at baseline.After a median follow-up of 8.9 years(interquartile range,6.79.9 years),1822 participants developed major CVD,and 1250 deaths occurred(388 as a result of CVD).Compared with normotensive participants with high GS,hypertensive patients with high GS had a higher risk of major CVD incidence(hazard ratio(HR)=2.39;95%confidence interval(95%CI):1.863.06;p<0.001)or CVD mortality(HR=3.11;95%CI:1.596.06;p<0.001)but did not have a significantly increased risk of all-cause mortality(HR=1.24;95%CI:0.921.68;p=0.159).These risks were further increased if hypertensive participants whose GS level was low(major CVD incidence,HR=3.31,95%CI:2.604.22,p<0.001;CVD mortality,HR=4.99,95%CI:2.649.43,p<0.001;and all-cause mortality,HR=1.93,95%CI:1.472.53,p<0.001).Conclusion:The present study demonstrates that low GS is associated with the highest risk of major CVD incidence,CVD mortality,and all-cause mortality among hypertensive patients.High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.

Fatty liver disease:Disparate predictive ability for cardiometabolic risk and all-cause mortality

AIM: To assess the association of a surrogate of fatty liver disease(FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality.METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index(FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease(CHD), and all-cause mortality.RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormonebinding globulin. In adjusted Cox models, FLD was(with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio(HR) = 1.72, 95% confidence interval(CI): 1.17-2.53] and men(HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women.CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. Allcause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies.

Elevated serum uric acid level as a predictor for cardiovascu-lar and all-cause mortality in Chinese patients with high cardiovascular risk

Objective To assess the predictive value of serum uric acid levels for cardiovascular and all-cause mortality in a large prospective population based study.Methods The study was based on 3648 participants in Shanghai and Beijing,who were inpatients with high cardiovascular(CV) risk at baseLine (2004.7 to 2005.1),and blood was taken.Follow-up for death from cardiovascular disease and any cause was complete until January 1,2006.Results The mean follow-up was 1 years.There were 303 deaths during follow-up,of which 121 were cardiovascular.Crude mortality rates were 8.3 % for all patients,6.8% for female patients (116/1715),and 9.7% (187/1933) for male patients.Among men,patients in the lower and higher uric acid groups had increased cardiac and overall mortality risks compared with patients in the normal uric acid groups.Similar relation was found in women but not statistically significant.After adjusting for other conventional risk factors (age,diabetes,hypertension,diuretic use and smoking),baseline uric acid level was still associated with increased risk for death from cardiovascular disease (P=0.005),or death from all causes (P=0.014) Conclusion Our data suggest that abnormal serum uric acid levels are independently and significantly associated with risk of cardiovascular and all-cause mortality.(J Geriatr Cardiol 2008;5:15-20)

Age of onset of diabetes and all-cause mortality

Diabetes mellitus continues to present a large social,financial and health system burden across the world.The relationship between age of onset of the different types of diabetes and all-cause mortality is uncertain.In this review paper,the relationship between age of onset of the different types of diabetes and all-cause mortality will be reviewed and an update of the current evidence will be presented.There is strong evidence of the relationship between age of onset of type 2 diabetes mellitus(T2 DM) and all-cause mortality,good evidence of the relationship between age of onset of T1 DM and all-cause mortality and no evidence of the relationship between age of onset of gestational diabetes or prediabetes and all-cause mortality.Further research is needed to look at whether aggressive management of earlier onset of T2 DM can help to reduce premature mortality.