Kidney Failure-Related Mortality in Patients with Cancer: Insights from the Cancer Public Library Database in South Korea.

Background and Aims The population with cancer is associated with an increased risk of death. However, the impact of cancer on mortality among individuals with kidney failure remains unclear. We investigated cancer-related mortality in patients with kidney failure, stratified by various types of cancer. Method A total of 1,307,680 participants who were newly diagnosed with cancer identified from the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) database between 2013 and 2019. We analyzed data from 7,719 patients with preexisting kidney failure before cancer diagnosis and compared their mortality risk with patients without kidney failure using multivariable Cox proportional hazard models. Results The mortality rate was significantly higher in the kidney failure group (196.6 vs 91.1 per 1,000 person-years). Adjusted hazard models indicated that preexisting kidney failure was associated with an increased risk of mortality all cancer types after adjusting for comorbidities and treatment modalities (adjusted hazard ratio [AHR] 1.75, 95% CI 1.70–1.81). Among specific cancer types, breast, uterine, ovarian, pharyngeal, and thyroid cancers showed the highest mortality risks, with thyroid cancer presenting the greatest risk (AHR 4.96, 95% CI 3.73–6.60). Furthermore, interaction analyses revealed higher AHRs for mortality in localized cancers compared to regional and distant stages. Conclusion Preexisting kidney failure significantly increases the mortality risk among cancer patients, particularly in those with localized disease stages and specific types of cancer. This underscores the importance of developing tailored management strategies for this vulnerable population.

Objective: To investigate the effect of physical activity on mortality risk in patients with chronic obstructive pulmonary disease (COPD) in Sichuan Province. Methods: Based on baseline data from 2004 to 2008 from the China Kadoorie Biobank project site in Pengzhou City, Sichuan Province, a total of 8 501 COPD patients aged 30-79 years were enrolled and followed up for a long period to determine mortality outcomes. Quartiles were used to group physical activity levels. The Cox proportional hazards regression model was used to analyze the effect of physical activity level on mortality outcomes. Results: As of December 31, 2017, the cumulative follow-up of the participants totaled 85 600.58 person-years (mean follow-up duration: 10.07 years). During this period, a total of 2 000 deaths were recorded, yielding a cumulative mortality rate of 23.53%. Among these deaths, 665 were attributed to COPD, corresponding to a cumulative mortality rate of 7.82%; and 1 116 were attributed to cardiovascular and cerebrovascular disease (CVD), corresponding to a cumulative mortality rate of 13.13%. The Cox proportional hazards regression model analysis revealed that, after adjusting for confounding factors, total physical activity was associated with a reduced risk of mortality from COPD, CVD, and all causes in patients with COPD. Compared with the low-level group of total physical activity, the medium-high-level group had the lowest risk of COPD mortality, with an HR of 0.39 (95%CI: 0.30-0.49). The high-level group had the lowest risk of CVD death and all-cause death, with HRs of 0.46 (95%CI: 0.37-0.56) and 0.55 (95%CI: 0.48-0.64), respectively. The lowest risk of COPD death and CVD death was found in the medium-high level of work-based physical activity group, with HRs of 0.36 (95%CI: 0.28-0.46) and 0.43 (95%CI: 0.36-0.51), respectively; the risk of all-cause mortality was lowest in the medium-high and high-level groups, with HRs values of 0.53 (95%CI: 0.46-0.61) and 0.53 (95%CI: 0.45-0.61). The risk of COPD death was lowest in the high-level transportation physical activity group, with an HR of 0.66 (95%CI: 0.53-0.83), and the risk of CVD and all-cause death was lowest in the medium-high level group, with HRs of 0.63 (95%CI: 0.53-0.76) and 0.73 (95%CI: 0.64-0.84), respectively. The risk of COPD death and CVD death was the lowest in the high-level domestic physical activity group, with HRs of 0.66 (95%CI: 0.49-0.89) and 0.76 (95%CI: 0.61-0.95), respectively, and the risk of all-cause death was the lowest in the medium-high level group, with an HR of 0.82 (95%CI: 0.72-0.94). There is no statistical association between leisure physical activity and the risk of death from three types of diseases. Conclusions: Total physical activity, including work-based, transportation-based, and domestic physical activity, reduced the risk of COPD, CVD, and all-cause mortality in patients with COPD in Sichuan Province. The magnitude of mortality risk was influenced by the type and level of physical activity.

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is rapidly increasing. AF is associated with increased risks of stroke and all-cause death. Understanding the causes of death (COD), the relative risks of each cause in AF patients compared to non-AF population, and finding out modalities to stratify the risk of death among AF patients is essential to plan optimal care of AF patients. Purpose We aimed to analyze the COD of AF patients and the relative risk of death from specific causes in AF patients compared to non-AF population using a nationwide population based cohort. Also, we identified the role of CHA2DS2-VASc score to stratify the risk for all-cause death and death from cardiovascular causes in AF patients. Methods Using the Korean nationwide claims database, subjects who received nationwide health screening examination at 2009 and aged 40 or older were included (n=7,240,800). Patients with missing values in health examinations were excluded. Finally, 6,87,929 patients were included: 40,585 patients with AF and 6,837,344 subjects without AF. COD were classified by diagnostic codes. Results A total of 490,807 deaths were reported during follow-up (incidence rate of all-cause death: non-AF group, 19.1 and AF group, 34.2 per 1000 person-years). In AF group, cardiovascular diseases were the most common COD occupying 39.8% of all-death, whereas only 19% of non-AF subjects died due to cardiovascular diseases (Figure A). The proportion of death from cerebrovascular diseases in the AF group was two times higher than that of the non-AF group (15.1% vs. 7.5%, respectively). Compared to non-AF group, AF group was associated with a significantly higher risk of all-cause death (hazard ratio [HR] 1.739, 95% confidence interval [CI] 1.708-1.771, p <0.001) (Figure B). AF group was associated with higher risks of death from cardiovascular diseases and death from cerebrovascular diseases by almost 3-fold than non-AF group (HR [95% CI], 2.899 [2.814-2.985] for death from cardiovascular diseases; 2.899 [2.814-2.985] for death from cerebrovascular diseases, all p <0.001) (Figure B). Among AF patients, the risks of all-cause, cardiovascular, and cerebrovascular death were well-stratified by CHA2DS2-VASc scores (Figure C). The increases of HRs by increases of CHA2DS2-VASc score were more prominent in the risk of death from cerebrovascular diseases, followed by death from cardiovascular causes, and all-cause death. Conclusions Compared to non-AF subjects, AF patients showed higher risks of death from cardiovascular and cerebrovascular diseases. The risks of death from cardiovascular and cerebrovascular diseases were clearly stratified according to CHA2DS2-VASc score. Integrated management for AF patients should be focused on to prevent death from cardiovascular and cerebrovascular causes. CHA2DS2-VASc score could help to stratify the risk of all-cause death and death from specific causes in AF patients.

Association Between Bilirubin and Mode of Death in Severe Systolic Heart Failure

The long-term use of aspirin for preventing cardiovascular disease has been recommended for decades. However, there is currently uncertainty regarding the long-term effects of aspirin use on the risk of all-cause, cardiovascular, and cancer mortality in cancer patients. The aim of this work was to analyze the connection between the prophylactic use of low-dose aspirin and the risk of all-cause death, cardiovascular death, and carcinoma death in carcinoma patients in the United States. A cohort study was conducted using National Health and Nutrition Examination Survey (NHANES) data (2011–2012, 2013–2014, 2015–2016, and 2017–2018) and associated mortality data. The 95% confidence intervals (CIs) and hazard ratios (HRs) between non-aspirin use and prophylactic low-dose aspirin use and the risk of death were measured via Cox proportional hazard regression models. A total of 1819 participants were included in the present research, of whom 945 were nonaspirin users and 874 were prophylactic aspirin users. Compared with non-aspirin users, prophylactic low-dose aspirin users had a decreased risk of all-cause death (HR = 0.647, 95% CI = 0.489–0.857). There was no statistically significant difference in the risk of cardiovascular death (HR = 0.623, 95% CI = 0.362–1.074) or cancer death (HR = 0.709, 95% CI = 0.410–1.226). Prophylactic use of low-dose aspirin may lower all-cause mortality in individuals with cancer but does not have a substantial effect on cardiovascular risk or cancer-specific mortality in this patient population.

Abdominal obesity modifies the risk of hypertriglyceridemia for all-cause and cardiovascular mortality in hemodialysis patients

Objective: To investigate the association of the interaction and combined effect of renal function and body mass index (BMI) with the risk for all-cause death in patients with type 2 diabetes mellitus (T2DM) in communities of Jiangsu Province. Methods: The study subjects were from the Comprehensive Research Project of Diabetes Prevention and Control conducted in Jiangsu from December 2013 to January 2014, and follow up was conducted for them until September 30, 2023. A total of 20 025 subjects were included in the study. Cox proportional hazards regression model was used to analyze the association of renal function with risk for death in T2DM patients, and the association of interaction between renal function and BMI and their combined effect with all-cause death risk in T2DM patients. Results: In the follow up for 198 370 person-years, a total of 4 459 deaths were recorded. Cox proportional hazards regression model analysis showed that renal dysfunction was associated with 71% risk of all-cause mortality in all T2DM patients [hazard ratio (HR) =1.71, 95%CI: 1.59-1.84], as well as in all BMI subgroups. Likelihood ratio test indicated an interaction between renal function and BMI (interaction for P=0.030). Compared with patients with normal renal function and normal BMI, those with normal renal function and over weight or obesity had a lower risk of all-cause mortality, and those with renal dysfunction and low weight had the highest risk for death (HR=2.78, 95%CI: 1.87-4.14). Conclusions: There is association of interaction between renal function and BMI with all-cause mortality in T2DM patients. T2DM patients with renal dysfunction and low body weight had significant higher risk for death.

World Kidney Day 2011: Protect Your Kidneys, Save Your Heart

Chronic Kidney Disease and Kidney Cancer Surgery: New Perspectives.

Both baseline cardiorespiratory fitness and adiposity predict the risk of cancer mortality. However, the effects of changes in these two factors over time have not been evaluated thoroughly. The aim of this study was to examine the independent and joint associations of changes in cardiorespiratory fitness and body composition on cancer mortality. The cohort consisted of 13,930 men (initially cancer-free) with two or more medical examinations from 1974 to 2002. Cardiorespiratory fitness was assessed by a maximal treadmill exercise test, and body composition was expressed by body mass index (BMI) and percent body fat. Changes in cardiorespiratory fitness and body composition between the baseline and the last examination were classified into loss, stable, and gain groups. There were 386 deaths from cancer during an average of 12.5 yr of follow-up. After adjusting for possible confounders and BMI, change hazard ratios (95% confidence intervals) of cancer mortality were 0.74 (0.57-0.96) for stable fitness and 0.74 (0.56-0.98) for fitness gain. Inverse dose-response relationships were observed between changes in maximal METs and cancer mortality (P for linear trend = 0.05). Neither BMI change nor percent body fat change was associated with cancer mortality after adjusting for possible confounders and maximal METs change. In the joint analyses, men who became less fit had a higher risk of cancer mortality (P for linear trend = 0.03) compared with those who became more fit, regardless of BMI change levels. Being unfit or losing cardiorespiratory fitness over time was found to predict cancer mortality in men. Improving or maintaining adequate levels of cardiorespiratory fitness appears to be important for decreasing cancer mortality in men.

Background Studies assessing whether heart failure (HF) is associated with an excess risk of cancer and cancer-related mortality yielded conflicting results. Here, we assessed the incidence and mortality of cancer according to the presence of HF in a community-based cohort. Methods By reviewing the health care records of the Puglia region in Italy, we first selected individuals ≥50-year-old, with no history of cancer within 3 years before the baseline evaluation and ≥5 years of follow-up, during the period from January 1st, 2005 to December 31st, 2013. Next, we matched 1:1 104,020 subjects with HF at baseline and 104,020 controls based on age, sex, Charlson Comorbidity Index, Drug-Derived Complexity Index, and follow-up duration. Cancer incidence and mortality were analyzed by Kaplan-Meier method and Cox regression models. Fine and Grey's regression model was also used to compare cancer-specific mortality while taking into account the competing risk of non-cancer death. Results Overall, the mean age of the study population was 76±10 years and the mean follow-up was 5.7 years. The incidence rate of cancer in HF patients and controls was 21.36 (95% CI, 20.98–21.74) and 12.42 (95% CI, 12.14–12.72) per 1000 person/years, respectively, corresponding to a 76% higher risk of incident cancer in HF patients (HR, 1.76; 95% CI, 1.71–1.81). HF patients also died from cancer more frequently than controls (HR 4.11; 95% CI, 3.86–4.38; Figure 1). This excess mortality was highest when age was <70 years (HR 7.54, 95% CI 6.33–8.98), and declined in subjects aged 70–79 years (HR 3.80, 95% CI 3.44–4.19) and ≥80 years (HR 3.10, 95% CI 2.81–3.43). The association of HF with cancer mortality was confirmed in the competing risk analysis (HR 3.48, 95% CI 3.27–3.72), as well as the interaction with age: <70 years of age: HR 6.65, 95% CI 5.60–7.94; 70–80 years: HR 3.14, 95% CI 2.84–3.48; and ≥80 years: HR 2.81, 95% CI 2.55–3.10. The HF-related risk applied to the majority of cancer types, with the exception of neoplasm of the male reproductive system. Interestingly, among HF patients a high consumption of loop diuretic (>37.5 mg/d of furosemide) was associated with a higher mortality for cancer (HR 1.34, 95% CI 1.26–1.42 vs. ≤37.5 mg/d). Conclusions The analysis of this large community-based sample suggests that HF does portend an increased risk of cancer and cancer-related mortality, which is blunted, yet remains substantial, with increasing age and competing risk of dying from other causes. The risk of cancer may be heightened when HF is poorly compensated. Funding Acknowledgement Type of funding sources: None. Figure 1. Cancer mortality in HF patient

PurposeAnticoagulants may reduce mortality of cancer patients, though the evidence remains controversial. We studied the association between different anticoagulants and cancer death.MethodsAll anticoagulant use during 1995–2015 was analyzed among 75,336 men in the Finnish Randomized Study of Screening for Prostate Cancer. Men with prevalent cancer were excluded. Multivariable Cox regression was performed to compare risk of death from any cancer and disease-specific death from 9 specific cancer types between (1) anticoagulant users overall and (2) warfarin users compared to anticoagulant non-users and (3) warfarin or (4) low-molecular-weight heparins (LMWH) compared to users of other anticoagulants. Medication use was analyzed as time-dependent variable to minimize immortal time bias. 1-, 2- and 3-year lag-time analyses were performed.ResultsDuring a median follow-up of 17.2 years, a total of 27,233 men died of whom 8033 with cancer as the primary cause of death. In total, 32,628 men (43%) used anticoagulants. Any anticoagulant use was associated with an increased risk of cancer death (HR = 2.50, 95% CI 2.37–2.64) compared to non-users. Risk was similar independent of the amount, duration, or intensity of use. The risk increase was observed both among warfarin and LMWH users, although not as strong in warfarin users. Additionally, cancer-specific risks of death were similar to overall cancer mortality in all anticoagulant categories.ConclusionOur study does not support reduced cancer mortality among anticoagulant users. Future studies on drug use and cancer mortality should be adjusted for anticoagulants as they are associated with significantly higher risk of cancer death.

Cardiovascular diseases (CVD) occupy a leading position in the structure of all-cause mortality. Prospective and interventional studies have identified the major risk factors for CVD and shown their associations with the risk of cardiovascular outcomes and all-cause death. The impact on the individual risk of death may vary by age, sex, study design, and may be population-specific. We aimed to study the contribution of major CVD risk factors to the 15-year risk of all-cause death in the Russian (Siberian) population cohort aged 45–69 years.Material and methods. A random population sample (men and women 45–69 years old, n = 9360) was examined at baseline in 2003–2005 (Novosibirsk, Russian branch of the HAPIEE project) and re-examined twice in 2006–2008 and 2015–2018. Current analysis included individuals without baseline CVD (n = 8087), the average follow-up period – 15.6 (SD 0.69) years. The fatal events were registered based on death certificates from the Population Registration Bureau (ZAGS), and using the data received at serial examinations and postal interview. We analyzed the association between CVD risk factors and all-cause death using multivariate Cox regression.Results. In a cohort aged 45–69, in the adjusted model, 15-year risk of all-cause death was positively associated with age (HR = 1.08; 95 % CI 1.07–1.09), male sex (HR = 1.46; 95 % CI 1.24–1.71), hypertension (HT) (HR = 1.39; 95 % CI 1.25–1.55), smoking (HR = 2.37; 95 % CI 2.08–2.70), high WHR (HR = 1.19; 95 % CI 1.06–1.33), and type 2 diabetes (T2DM) (HR = 1.52; 95 % CI 1.34–1.73), and it was negatively associated with elevated total cholesterol (TC) or LDL-C in blood. In age- and sex-adjusted model, the risk was additionally associated with high triglycerides (HTG), obesity and elevated fasting plasma glucose (FPG). In men, the risk of death was independently associated with age, HT, smoking, low HDL-C, high WHR, and T2DM. In women, the risk of death was independently associated with age, HT, T2DM smoking, and, in age-standardized models, obesity, high WHR, and hyperglycemia.Conclusions. In a population cohort of 45 years and older, among CVD risk factors male sex, HT, smoking, central obesity, and T2DM independently contributed to the risk of all-cause death. Among lipid parameters, low HDL-C and high TG levels increased the risk of death in men. Associations between cardiovascular risk factors and the risk of all-cause death in older people have the patterns specific for older age; these features are important to take into account in a strategy to reduce mortality in the population.

Heart failure (HF) is a growing public health problem in the United States. Nearly 5 million Americans suffer from HF, and an estimated 550 000 new cases of HF are diagnosed each year.1 HF is the No. 1 discharge diagnosis in patients ≥65 years of age and results in a substantial burden on healthcare expenditures. It is estimated that in 2001, more than $24 billion was spent as direct cost for the care of patients with HF.1 Furthermore, HF is associated with a significant increase in morbidity and mortality. See p 1764 Although considerable progress has been made in our approach to the pharmacological management of patients with HF, most patients remain at increased risk of cardiac death. To further improve outcomes in patients with HF, newer therapeutic modalities, including devices such as biventricular pacemaker, automatic internal cardioverter-defibrillators (AICDs), and left ventricular assist devices, have been increasingly utilized. Several recent randomized controlled trials have shown that such devices can indeed further improve the outcome in patients with HF.2–4 However, these devices are expensive, and their widespread or injudicious application in unselected patients with HF is likely to have a substantial impact on healthcare expenditures. On the other hand, appropriate use of device therapy in properly selected patients (who are at high risk of mortality) is essential to improve clinical outcome. Thus, there is a need to develop a strategy to accurately identify those patients with HF who are at increased risk of mortality. The paper by Vrtovec and associates5 in the present issue of Circulation provides such a strategy by showing that routinely available diagnostic tests, such as measurement of QT interval on 12-lead ECG and measurement of B-type natriuretic peptide (BNP), can indeed identify the HF patients who are at increased risk of overall mortality, …

Introduction Angiopoietin-like 4 protein (ANGPTL4) has multiple physiological functions including modulation of angiogenesis, vascular permeability and lipid-metabolism. Acting as an inhibitor of lipoprotein lipase, ANGPTL4 has previously been found to be associated with lipid levels and risk of coronary artery disease. Purpose To assess the prognostic value of ANGPTL4 for long-term outcome, in addition to conventional clinical risk factors, in chest-pain patients admitted with clinically suspected acute coronary syndrome (ACS). Methods 1853 patients from Norway and Northern-Argentina were consecutively included in this prospective 2-center cohort study. ANGPTL4 concentrations were measured in 1829 admission-samples by enzyme immunoassay. Data were pooled for analysis. Multivariable Cox proportional-hazards models were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24-months, comparing event rates across ANGPTL4-quartiles (Q1–4). Of patients with suspected ACS, 845 had a troponin T (TnT) value above the detection-limit. Subgroup analysis was performed for all-cause mortality in patients stratified according to TnT release >/≤0.01 ng/mL. Results During 24-months follow-up, 254 patients (13.9%) died, of which 150 (8.2%) suffered cardiac death and 76 (4.2%) SCD. Patients who died had significantly higher admission-levels of ANGPTL4 compared to long-term survivors [4.99 (3.54–8.37) ng/mL versus 3.18 (2.14–4.78) ng/mL (median, 25 and 75% percentiles), p<0.001]. A stepwise increase in risk of all-cause death was seen with increasing quartiles of ANGPTL4, Figure 1. For cardiac death, ANGPTL4-levels in Q4 [Hazard Ratio (HR) 2.86 (95% confidence interval (CI); 1.10–7.45), p=0.031] as compared to Q1 were found to be an independent predictor of outcome. Similar results were seen for SCD in adjusted analysis for ANGPTL4-Q4 [HR 7.37 (95% CI: 1.75–31.1), p=0.007] as compared to Q1. In subgroup analysis, ANGPTL4 concentrations in the highest quartile were significantly associated with increased risk of all-cause mortality in patients with TnT-release [HR 2.07 (95% CI: 1.06–4.02), p=0.032], but not in patients without TnT-release. Conclusion High admission-levels of ANGPTL4 were found to be an independent long-term predictor of all-cause mortality, cardiac death and SCD in patients with suspected ACS. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority