Cardio-cerebrovascular Diseases Research Articles

Red Meat Consumption and Risk of Cardio-Cerebrovascular Disease in Chinese Older Adults.

Associations between red meat consumption and cardio-cerebrovascular diseases (CCVDs) are mostly studied in Western populations but not in Chinese or elderly. This prospective study investigated adults ≥65 years from the China Kadoorie Biobank (CKB). Associations between red meat consumption and CCVD, ischemic stroke/transient ischemic attack (TIA), CCVD mortality, and all-cause mortality were determined by Cox regression. A total of 59,980 participants were analyzed, 14,715 (24.53%) of whom ate red meat daily, 9,843 (16.41%) ate red meat 4-6 days/week, 23,472 (39.13%) ate red meat 1-3 days/week, and 11,950 (19.92%) ate red meat less than 1 day/week. Average amount of red meat usual consumption was 38 g/day. After adjustment, per 50 g/day higher red meat consumption at baseline was significantly associated with increased incident CCVD (aHR = 1.10) among high-income subjects (≥ 10,000 RMB) and urban residents (aHR = 1.12). Per 50 g/day higher baseline red meat consumption was significantly associated with increased ischemic stroke/TIA in urban residents (aHR = 1.08) but decreased risk in rural residents (aHR = 0.84). Higher baseline red meat consumption was associated with lower CCVD mortality in the poorest (aHR = 0.78) and rural residents (aHR = 0.72) and lower all-cause mortality in the poorest (aHR = 0.82) and rural residents (aHR = 0.80). In general, among older adults in China, higher red meat intake independently predicted increased CCVD among urban and high-income individuals but not poor ones. Higher red meat intake appears to be protective against mortality in rural and low-income subjects. Socioeconomic status is a crucial modifying factor on the association between red meat consumption and adverse cardiovascular outcomes in China.

Association of ultra-processed foods consumption with risk of cardio-cerebrovascular disease: A systematic review and meta-analysis of cohort studies

AimsThe epidemiological evidence regarding the impact of ultra-processed foods (UPFs) on the risk of cardio-cerebrovascular diseases (CCVDs) is controversial. The aim of this systematic review and meta-analysis is to examine the association between UPF consumption and the risk of CCVDs within cohort studies. Data synthesisA systematic literature search was conducted across multiple databases, including PubMed/Medline, Embase, Web of Science, Scopus, and the Cochrane Library databases, covering the inception of these databases up until January 1st, 2023. A total of 39 cohort studies involving 63,573,312 human participants were deemed eligible according to the inclusion criteria. Utilizing random-effects models, risk ratios (RRs) were estimated to determine the pooled results. Our findings indicate a significant association between a higher consumption of UPF and an increased likelihood of CCVDs (RR: 1.08, 95% CI: 1.01–1.16, I2 = 89%; p < 0.01) compared to individuals who either abstain from or consume lesser amounts of UPF. Nonlinear dose-response meta-analyses showed that a consistent high intake of UPFs was associated with an elevated risk of developing CCVDs (p non-linearity <0.001). Notably, the risk of CCVDs escalated by approximately 7% with an UPF intake of up to 1 serving per day. Subgroup analysis further revealed a significant augmentation in the risk of total CVD and hypertension with increased UPF consumption. ConclusionsA higher intake of UPF significantly increases the risk of developing CCVDs. Prospective studies controlling for confounding factors are needed to validate the relationship between UPF intake and the development of CCVDs.

Cardiocerebrovascular risk in sensorineural hearing loss: results from the National Health and Nutrition Examination Survey 2015 to 2018.

This study aims to determine whether the risks of cardiocerebrovascular disease are relevant to sensorineural hearing loss (SNHL) based on a national database. A total of 1,321 participants aged from 18 to 69 with complete data including medical history and audiometry from the NHANES database (2015-2018) were analyzed. All included participants had available hearing data and the average thresholds of the hearing data were measured and calculated as low-frequency pure-tone average (LFPTA; 500, 1,000, and 2,000 Hz) and high-frequency pure-tone average (HFPTA; 3,000, 4,000, 6,000, and 8,000 kHz). SNHL was defined as an average pure tone of more than or equal to 20 dB in at least one better ear. Multivariable models to assess the association between cardiocerebrovascular risks and SNHL were used in this study. The prevalence of stroke was 1.6% in individuals with SNHL and 0.4% in individuals without SNHL (p = 0.023). A higher cardiovascular risk score was observed in SNHL patients compared to participants without SNHL (1.58 vs. 0.90, p < 0.001). Stroke was associated with a 3.67-fold increase in the risk of SNHL (95% CI: 1.12-12.00, p = 0.032) in univariable logistic regression, and the association (OR = 4.22, 95%CI = 1.28-13.93, p = 0.020) remained significant after adjusting for several covariates. Multivariable logistic regression models indicated a positive correlation between cardiovascular risk and SNHL (OR = 1.66, 95% CI = 1.40-1.96, p < 0.001), but no significant relationship was shown with all covariates adjusted. However, significant associations were found between SNHL and both age and sex in both univariable and multivariable logistic regression models. Our findings suggested that a higher cardiocerebrovascular risk burden was associated with an increased risk of SNHL, and the relationship may be influenced by age and sex. Future longitudinal studies are needed to investigate the mechanistic and pathologic vascular hypothesis of SNHL.

Association Between Migraine and Ischemic Cardio-Cerebrovascular Disease (CCVD) and Effects of Triptans and Ergotamine on the Risk of Ischemic CCVD in Patients with Migraine in the Korean NHIS-HEALS Cohort.

Triptans and ergotamine are commonly used to treat migraine, a risk factor for ischemic stroke. This study aimed to investigate the association between migraine and ischemic cardio-cerebrovascular disease (CCVD). Further analyses were performed to examine whether symptom-relieving treatment of migraine with triptans and ergotamine reduces ischemic CCVD in migraineurs. Participants from the Korean NHIS-HEALS cohort database were divided into patients reporting headache without migraine (HA), migraineurs who received at least one prescription for triptans or ergotamine (TE), and migraineurs who were prescribed neither triptans nor ergotamine (NTNE). Ischemic CCVDs comprised ischemic cerebrovascular diseases and cardiovascular diseases. Using cox proportional hazards regression models, primary and secondary analysis for risk of ischemic CCVDs was compared. Among 62,272 patients diagnosed with migraine or HA, men with migraine or HA numbered 14,747 and 8935, respectively, while the numbers of women were 27,836 and 10,754, respectively. The median follow-up was 6.65 years. The overall incidence rate of CCVDs was 4728/38,590 (12.25%) in females and 3158/23,682 (13.33%) in males. Compared with the HA group, the hazard ratios (HRs) (95% CIs) of the TE and NTNE groups for ischemic CCVDs were 1.18 (1.01-1.39) and 1.39 (1.28-1.50), respectively, in males, and 1.22 (1.09-1.37) and 1.53 (1.42-1.65), respectively, in females, after full adjustment for confounding variables. Compared with the NTNE group, the HRs (95% CIs) of the TE group for ischemic CCVDs were 0.86 (0.73-0.999) in males and 0.80 (0.72-0.88) in females. Migraine increased the risk of ischemic CCVDs in both sexes, and migraineurs treated with triptans and ergotamine were at lower risk of ischemic CCVDs than migraineurs who did not take those medications, especially in women.

1341-P: The Improvement in Age at Mortality in Individuals with Peritoneal Dialysis Was Less Prominent in Persons with Diabetes in Korea

Backgrounds: The most prevalent underlying cause of end-stage kidney disease (ESKD) is diabetes mellitus (DM). If kidney transplantation is not possible, people with ESKD must undergo hemodialysis (HD) or peritoneal dialysis (PD). This study investigated whether the prognosis of individuals with diabetes who received PD improved recently. In addition, we analyzed the age of death and the cause of mortality to determine if there was a difference based on DM or gender from 2006 to 2018. Methods: We Used data from the National National Health Insurance database maintained by the Korean National Health Insurance Service (NHIS) and mortality records from the National Statistical Information Service (NSIS). The NHIS claims data was merged with NSIS death records from 2006 to 2018 and then analyzed. We excluded those who underwent HD or transplanting from the 93,487 cases of ESKD-related death to include only those who underwent PD. Results: A total of 11,174 deaths were documented (4,818 individuals with DM and 6,356 individuals without DM). Age at death increased by 0.11 and 0.44 years/year in persons with and without DM, respectively. Changes in mortality age were the biggest in females without DM (0.47 years/year) and lowest among men with DM (0.10 years/year). DM itself, cardio-cerebrovascular diseases, and cancer were the leading causes of death among people with DM receiving PD. Conclusions: In conclusion, this study, which utilized the entire Korean population, revealed that the death age of individuals with DM receiving PD increased marginally over 12 years, but the change was much smaller than in persons without DM. Based on these results, efforts should be made to improve the prognosis of the person with DM who underwent PD. In addition, identifying the precise cause of death and the optimal management strategy in this population would be important. Disclosure H.Kim: None. K.Son: None. S.Song: None.

Cardiocerebrovascular Disease or Fatty Liver Incidence Associated with Pattern of Metabolic Risk Factors and Nutritional Status of Korean Adults: A Prospective Cohort Study

Objectives: To determine the nutrient intake according to patterns of metabolic risk factors, and examine the relationship between patterns of metabolic risk factors and incidence of cardiocerebrovascular disease or fatty liver in Korean adults.Methods: Data from the Korean Genome and Epidemiology Study were used to analyze 7,019 adults aged 50-64 years old. Depending on patterns of metabolic risk factors, participants were classified into four categories: ‘normal, NOR’, ‘obesity risk factors, ORF’ , ‘vascular risk factors, VRF’, ‘cluster risk factors, CRF’. Cox regression analysis was used to evaluate the incidence of cardiocerebrovascular disease or fatty liver.Results: The mean adequacy ratio (MAR) of VRF pattern women was significantly lower than that of the normal women. In Model 3, the incidence of cardiovascular disease or fatty liver decreased by 64.4% (hazard ratio (HR), 0.36; 95% confidence interval (CI), 0.15-0.84) in MAR Q3 women compared to MAR Q1 women. In Model 2 adjusted for age and energy intake, the incidence of cardiovascular disease or fatty liver increased by 87.6% (HR, 1.88; 95% CI, 1.01-3.48) in CRF pattern women compared to NOR women, but there was no significant difference in Model 3.Conclusions: The study showed that among women, VRF patterns were associated with poor nutrient intake. There was an association between nutrient intake levels and metabolic risk factor patterns in women. Therefore, these findings can be used a basis to emphasize the need to establish nutrition management strategies tailored to individual’s metabolic risk status, for the prevention and management of metabolic syndrome complications.

Association between urinary IPM3 and the presence of cardio-cerebrovascular diseases: a cross-sectional study.

Our study aims to investigate the association of urinary IPM3 and cardio-cerebrovascular diseases (CVD) in general adults. A total of 1775 participants were enrolled from the National Health and Nutrition Examination Surveys. Urinary levels of IPM3 were measured by LC/MS as exposure to isoprene. The associations between isoprene exposure and the risk of CVD were evaluated by restricted cubic splines based on multivariable logistic regression models. The prevalence of CVD was significantly higher across IPM3 quartiles. Comparing with the lowest quartile, the highest quartile was associated with 2.47-fold risk of CVD (odds ratio: 2.47, 95% confidence interval: 1.40-4.39, P = 0.002). Restricted cubic spline confirmed that the levels of urinary IPM3 were linearly associated with cardio-cerebrovascular diseases, angina and heart attack, while nonlinearly related to CHF and CAD. In conclusion, the urinary IPM3, as a long-term isoprene exposure, was associated with the presence of cardio-cerebrovascular diseases, including CHF, CAD, angina, and heart attack.

The activation of histone deacetylases 4 prevented endothelial dysfunction: A crucial mechanism of HuangqiGuizhiWuwu Decoction in improving microcirculation dysfunction in diabetes.

The regulation of epigenetic factors is considered a crucial target for solving complex chronic diseases such as cardio-cerebrovascular diseases. HuangqiGuizhiWuwu Decoction (HGWWD), a classic Chinese prescription, is mainly used to treat various vascular diseases. Although our previous studies reported that HGWWD could effectively prevent vascular dysfunction in diabetic rodent models, the precise mechanism is still elusive. In this study, we investigated the epigenetic mechanisms of modulating the damage of vascular endothelial cells in diabetes by HGWWD. We first analyzed common active components of HGWWD by using HPLC-Q-TOF-MS/MS analysis, and predicted the isoforms of histone deacetylase (HDAC) that can potentially combine the above active components by systems pharmacology. Next, we screened the involvement of specific HDAC isoforms in the protective effect of HGWWD on vascular injury by using pharmacological blockade combined with the evaluation of vascular function in vivo and in vitro. Firstly, HDAC1, HDAC2, HDAC3, HDAC4, HDAC6, HDAC7, SIRT2, and SIRT3 have been implicated with the possibility of binding to the thirty-one common active components in HGWWD. Furthermore, the protective effect of HGWWD is reversed by both TSA (HDAC inhibitor) and MC1568 (class II HDAC inhibitor) on vascular impairment accompanied by reduced aortic HDAC activity in STZ mice. Finally, inhibition of HDAC4 blocked the protective effect of HGWWD on microvascular and endothelial dysfunction in diabetic mice. These results prove the key role of HDAC4 in diabetes-induced microvascular dysfunction and underlying epigenetic mechanisms for the protective effect of HGWWD in diabetes.

Effects of a Person Centred, Nurse Led Follow Up Programme On Adherence To Prescribed Medication Among Patients Surgically Treated For Intermittent Claudication: A Randomised Clinical Trial

Objective: Management of intermittent claudication (IC) should include secondary prevention to reduce the increased risk of cardiocerebrovascular diseases. Patients’ non-adherence to secondary prevention is a challenge and person centred care has been suggested to ameliorate this. This randomised controlled trial aimed to investigate the effects of a person centred, nurse led follow up programme among patients surgically treated for IC compared with standard care. The hypothesis was that the intervention programme would improve patients’ adherence to prescribed medication.

Correlation analysis of cancer incidence after pravastatin treatment

Background: Few studies have investigated the cancer-preventive effects of statins, which are known to protect against cardio-cerebrovascular diseases. In this study, we analyzed the degree to which pravastatin, a low-potency statin, could prevent cancer.Methods: This retrospective cohort study used data from the Korean National Health Insurance Service database. Patients diagnosed with diabetes after the age of 50 years were divided into a pravastatin group and a control group that did not receive any statin prescriptions.Results: This study included 557 patients in the pravastatin group and 2,221 patients in the control (no statin) group. During the 5-year follow-up, the incidence of cancer was 16.7% (93 of 557 patients) in the pravastatin group and 19.9% (442 of 2,221 patients) in the control group. The incidence of cancer was 22% higher in the control group than in the pravastatin group (hazard ratio, 1.22; 95% confidence interval, 0.97–1.52; P=0.09). Death from various causes occurred at a 45% higher frequency in the control group than in the pravastatin group (hazard ratio, 1.45; 95% confidence interval, 0.99–2.12; P=0.06). However, neither of those relationships reached statistical significance.Conclusions: Although pravastatin use did not show a significant causal relationship with cancer incidence, fewer cases of cancer occurred in pravastatin users than in controls. However, further large-scale studies are required to confirm these findings.

Causes of death among early-onset colorectal cancer population in the United States: a large population-based study.

Early-onset colorectal cancer (EOCRC) has an alarmingly increasing trend and arouses increasing attention. Causes of death in EOCRC population remain unclear. Data of EOCRC patients (1975-2018) were extracted from the Surveillance, Epidemiology, and End Results database. Distribution of death was calculated, and death risk of each cause was compared with the general population by calculating standard mortality ratios (SMRs) at different follow-up time. Univariate and multivariate Cox regression models were utilized to identify independent prognostic factors for overall survival (OS). The study included 36,013 patients, among whom 9,998 (27.7%) patients died of colorectal cancer (CRC) and 6,305 (17.5%) patients died of non-CRC causes. CRC death accounted for a high proportion of 74.8%-90.7% death cases within 10 years, while non-CRC death (especially cardiocerebrovascular disease death) was the major cause of death after 10 years. Non-cancer death had the highest SMR in EOCRC population within the first year after cancer diagnosis. Kidney disease [SMR = 2.10; 95% confidence interval (CI), 1.65-2.64] and infection (SMR = 1.92; 95% CI, 1.48-2.46) were two high-risk causes of death. Age at diagnosis, race, sex, year of diagnosis, grade, SEER stage, and surgery were independent prognostic factors for OS. Most of EOCRC patients died of CRC within 10-year follow-up, while most of patients died of non-CRC causes after 10 years. Within the first year after cancer diagnosis, patients had high non-CRC death risk compared to the general population. Our findings help to guide risk monitoring and management for US EOCRC patients.

Estimated pulse wave velocity is associated with all-cause and cardio-cerebrovascular disease mortality in stroke population: Results from NHANES (2003-2014).

Arterial stiffness is a significant determinant and evaluation of cardio-cerebrovascular disease and all-cause mortality risk in the stroke population. Estimated pulse wave velocity (ePWV) is a well-established indirect measure of arterial stiffness. We examined the association of ePWV with all-cause and cardio-cerebrovascular disease (CCD) mortality in the stroke population in a large sample of US adults. The study design was a prospective cohort study with data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014, between the ages of 18-85 years, with follow-up through December 31, 2019. 1,316 individuals with stroke among 58,759 participants were identified and ultimately, 879 stroke patients were included in the analysis. ePWV was calculated from a regression equation using age and mean blood pressure according to the following formula: ePWV = 9.587 - (0.402 × age) + [4.560 × 0.001 × (age2)] - [2.621 × 0.00001 × (age2) × MBP] + (3.176 × 0.001 × age × MBP) - (1.832 × 0.01 × MBP). Survey-weighted Cox regression models were used to assess the association between ePWV and all-cause and CCD mortality risk. The high ePWV level group had a higher increased risk of all-cause mortality and CCD mortality compared to the low ePWV level group after fully adjusting for covariates. With an increase in ePWV of 1 m/s, the risk of all-cause and CCD mortality increased by 44%-57% and 47%-72% respectively. ePWV levels were linearly correlated with the risk of all-cause mortality (P for nonlinear = 0.187). With each 1 m/s increase in ePWV, the risk of all-cause mortality increased by 44% (HR 1.44, 95% CI: 1.22-1.69; P < 0.001). When ePWV was <12.1 m/s, an increase in ePWV per 1 m/s was associated with a 119% (HR 2.19, 95% CI: 1.43-3.36; P < 0.001) increase in CCD mortality risk; when ePWV was ≥12.1 m/s, an increase in ePWV per 1 m/s was not associated with in CCD mortality risk. ePWV is an independent risk factor for all-cause and CCD mortality in stroke patients. Higher levels of ePWV are associated with higher all-cause mortality and CCD mortality in stroke patients.

Exogenous leucine alleviates heat stress and improves saponin synthesis in Panax notoginseng by improving antioxidant capacity and maintaining metabolic homeostasis.

Panax notoginseng saponins (PNSs) are used as industrial raw materials to produce many drugs to treat cardio-cerebrovascular diseases. However, it is a heat-sensitive plant, and its large-scale artificial cultivation is impeded by high temperature stress, leading to decreases in productivity and PNSs yield. Here, we examined exogenous foliar leucine to alleviate heat stress and explored the underlying mechanism using metabolomics. The results indicated that 3 and 5 mM exogenous foliar leucine significantly alleviated heat stress in one-year- and two-year-old P. notoginseng in pots and field trials. Exogenous foliar leucine enhanced the antioxidant capacity by increasing the activities of antioxidant enzymes (POD, SOD) and the contents of antioxidant metabolites (amino acids). Moreover, exogenous foliar leucine enhanced carbohydrate metabolism, including sugars (sucrose, maltose) and TCA cycle metabolites (citric acid, aconitic acid, succinic acid and fumaric acid), in P. notoginseng leaves, stems, and fibrous roots to improve the energy supply of plants and further alleviate heat stress. Field experiments further verified that exogenous foliar leucine increased the productivity and PNSs accumulation in P. notoginseng. These results suggest that leucine application is beneficial for improving the growth and quality of P. notoginseng under heat stress. It is therefore possible to develop plant growth regulators based on leucine to improve the heat resistance of P. notoginseng and other crops.

A long-term follow-up study of noninvasive positive pressure ventilation on all-cause mortality in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome

Objective: To investigate the effect of noninvasive positive pressure ventilation(NIPPV) on all-cause mortality in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome(OVS) through long-term follow-up. Methods: A total of 187 OVS patients were divided into the NIPPV group(n=92) and the non-NIPPV group(n=95). Of these, 85 males and 7 females were in the NIPPV group with an average age of (66.5±8.5) years(range 47-80 years); 89 males and 6 females were in the non-NIPPV group with an average age of (67.4±7.8) years(range 44-79 years). Follow-up was performed from enrolment with an average duration of 39(20, 51) months. The all-cause mortality was compared between the two groups. Result: There were no significant differences in their baseline clinical characteristics(all P>0.05), indicating that the data from the two groups were comparable. The Kaplan-Meier curve showed no difference in all-cause mortality between the two groups(log rank P=0.229). However, deaths from cardio-cerebrovascular diseases were higher in the non-NIPPV than in the NIPPV group(15.8% vs. 6.5%,P=0.045). Age, BMI, neck circumference, PaCO2, FEV1, FEV1%, moderate to severe OSA(AHI>15 events/h), mMRC, CAT, number of acute exacerbations of COPD and number of hospitalizations were associated with all-cause death in OVS patients; among which, age(HR 1.067, 95%CI 1.017-1.119, P=0.008), FEV1(HR 0.378, 95%CI 0.176-0.811, P=0.013), and number of COPD exacerbations(HR 1.298, 95%CI 1.102-1.530, P=0.002) were independent risk factors for all-cause mortality in OVS patients. Conclusions: The combination of NIPPV and conventional treatment may reduce cardio-cerebrovascular disease-related mortality in OVS patients. The deceased OVS patients had severe airflow limitation and mild to moderate OSA. Old age, low FEV1 and COPD exacerbations were independent risk factors for all-cause mortality in OVS patients.

Is discontinuation of dental treatment related to exacerbation of systemic medical diseases in Japan?

Aims Since it is known that oral problems affect various medical diseases, the effects of restrictions on visits for dental treatment on exacerbations of various systemic medical diseases were examined.Method and materials The data were used from the Japan COVID-19 and Society Internet Survey, a large-scale internet survey conducted in 2021 (n = 28,175). The questionnaires were distributed to 33,081 candidates who were selected to represent the Japanese population regarding age, sex and residential prefecture using a simple random sampling procedure. Patients currently undergoing treatment for diabetes mellitus, hypertension, asthma, cardiocerebrovascular disease, hyperlipidemia, atopic dermatitis, and mental illness, such as depression, were extracted from the total participants. Then, whether discontinuation of dental treatment affected the exacerbation of their systemic disease was examined.Results Overall, 50-60% of patients with each systemic disease had continued to receive dental treatment, and 4-8% of them had discontinued dental treatment. On univariate and multivariate analyses, discontinuation of dental treatment is a risk factor in the exacerbation of diabetes mellitus, hypertensive conditions, asthma, cardiocerebrovascular disease and hyperlipidemia.Conclusion The present epidemiological study showed the relationship between oral health and systemic health, which can provide meaningful insights regarding future medical-dental collaboration in Japan.

The Pathogenesis of Diabetes.

Diabetes is the most common metabolic disorder, with an extremely serious effect on health systems worldwide. It has become a severe, chronic, non-communicable disease after cardio-cerebrovascular diseases. Currently, 90% of diabetic patients suffer from type 2 diabetes. Hyperglycemia is the main hallmark of diabetes. The function of pancreatic cells gradually declines before the onset of clinical hyperglycemia. Understanding the molecular processes involved in the development of diabetes can provide clinical care with much-needed updates. This review provides the current global state of diabetes, the mechanisms involved in glucose homeostasis and diabetic insulin resistance, and the long-chain non-coding RNA (lncRNA) associated with diabetes.

PD21-12 SECOND PRIMARY MALIGNANCY RELATED MORTALITY IN MEN TREATED WITH RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER: AN INSIGHT INTO PROSTATE CANCER SURVIVORSHIP AT 15-YEARS OF FOLLOW-UP

You have accessJournal of UrologyCME1 Apr 2023PD21-12 SECOND PRIMARY MALIGNANCY RELATED MORTALITY IN MEN TREATED WITH RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER: AN INSIGHT INTO PROSTATE CANCER SURVIVORSHIP AT 15-YEARS OF FOLLOW-UP Akshay Sood, Ralph Grauer, Mireya Diaz-Insua, Firas Abdollah, and Mani Menon Akshay SoodAkshay Sood More articles by this author , Ralph GrauerRalph Grauer More articles by this author , Mireya Diaz-InsuaMireya Diaz-Insua More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , and Mani MenonMani Menon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003287.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A high life-expectancy in men following treatment of prostate cancer (PCa) has brought into focus post-therapy survivorship. In this report, we examined the ultimate cause of death in men with localized PCa treated with upfront radical prostatectomy (RP), with a focus on second primary malignancy (SPM)-related mortality. METHODS: Overall, 6,067 men that underwent robotic RP between September 2001 and December 2013 and were eligible for >5 years of follow-up were included in the study. Patients were stratified by burden of comorbidity (age-adjusted Charlson comorbidity index [aa-CCI]) and postoperative tumor-specific risk (Diaz classification [risk-groups 1-5]), and mortality from PCa, SPM, cardio-cerebrovascular disease, and other/unknown causes was estimated using competing-risk cumulative incidence analysis. RESULTS: The median follow-up was 8.2 years. At 15-years, 2.0% of all patients had died from a SPM. All-cause mortality at 15-years was 7.6%. SPMs were the leading cause of death in healthy men (aa-CCI ≤3) with low-to-intermediate risk disease (Diaz risk-groups ≥3), with 1.1 to 4.4% of these patients dying of SPMs during the study-period. In contrast, only 0.1 to 0.2% of these patients died of PCa and 1.1 to 3.7% of cardio-cerebrovascular disease (Figure). The top three most lethal SPMs were lung, pancreatic, and liver cancers. Standardized mortality ratio (SMR) analysis demonstrated that SPM-related mortality in PCa survivors was higher than that in the general public (2- to 12-fold higher, depending on SPM). Family history of prostate or other cancers and/or use of post-RP radiation/hormone therapy were not associated with increased risk of SPM mortality. CONCLUSIONS: Prostate cancer survivors, especially those in good health, may be at increased risk for death from second primary malignancies and may benefit from tailored cancer screening programs. These data require further validation -- if verified, may have important implications with regards to long-term surveillance of PCa survivors. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e595 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Sood More articles by this author Ralph Grauer More articles by this author Mireya Diaz-Insua More articles by this author Firas Abdollah More articles by this author Mani Menon More articles by this author Expand All Advertisement PDF downloadLoading ...

The role of three-dimensional models in preoperative communication and postoperative management of partial nephrectomy

ObjectiveThis study aims to examine the significance of utilizing three-dimensional (3D) image reconstruction technique in preoperative communication prior to partial nephrectomy (PN) and its impact on postoperative follow-up. MethodsA retrospective study was performed with 158 renal cancer patients treated with PN at our center from May 1, 2017 to April 30, 2019. 81 patients (group A) had preoperative communication using the 3D reconstruction technique, while 77 patients (group B) did not. The surgeon explained the anatomical structure, tumor characteristics, and surgical approach in detail to the two groups of patients. Each patient completed a questionnaire. The loss to follow-up rate over a 3-year period was counted for both groups, and non-cancer-related serious complications such as renal failure and cardio-cerebrovascular disease were observed. This research did not include patients who returned for follow-up care owing to associated complications such as postoperative chronic kidney disease. Comparisons between two groups were performed using the Mann–Whitney U test and chi-square test. ResultsAll patients showed no statistically significant differences in basic clinical parameters, such as age, gender, body mass index, tumor size, and R.E.N.A.L. score (P ​> ​0.05). In group A, patients were significantly more likely to experience understanding of renal anatomy (P ​= ​0.001), characteristics of renal cell carcinoma (P ​= ​0.003), surgical approach (P ​= ​0.007), and relief of preoperative anxiety (P ​= ​0.013). The follow-up adherence at 3 years postoperatively in group A and group B was 21 cases and 10 cases, respectively (P ​= ​0.041). In addition, glomerular filtration rate < 60 ​mL/min/1.73 ​m2 or serum creatinine > 186 ​μmol/L at 3 years after surgery occurred in 5 patients in group A and 13 in group B (P ​= ​0.034), and a systolic blood pressure rise greater than 20 ​mmHg occurred in 9 patients in group A and 18 in group B (P ​= ​0.041). ConclusionsThe findings of this study suggest that the integration of 3D reconstruction techniques in preoperative communication effectively enhances patients’ understanding and perception of kidney tumors and PN. Moreover, the utilization of these techniques can contribute to the prevention of significant non-cancer-related complications during the postoperative phase.

Comparison of cardiocerebrovascular disease incidence between angiotensin converting enzyme inhibitor and angiotensin receptor blocker users in a real-world cohort.

Both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are known to be effective in managing cardiovascular diseases, but more evidence supports the use of an ACEI. This study investigated the difference in cardiovascular disease incidence between relatively low-compliance ACEIs and high-compliance ARBs in the clinical setting. Patients who were first prescribed ACEIs or ARBs at two tertiary university hospitals in Korea were observed in this retrospective cohort study for the incidence of heart failure, angina, acute myocardial infarction, cerebrovascular disease, ischemic heart disease, and major adverse cardiovascular events for 5 years after the first prescription. Additionally, 5-year Kaplan-Meier survival curves were used based on the presence or absence of statins. Overall, 2,945 and 9,189 patients were prescribed ACEIs and ARBs, respectively. When compared to ACEIs, the incidence of heart failure decreased by 52% in those taking ARBs (HR [95% CI] = 0.48 [0.39-0.60], P < 0.001), and the incidence of cerebrovascular disease increased by 62% (HR [95% CI] = 1.62 [1.26-2.07], P < 0.001). The incidence of ischemic heart disease (P = 0.223) and major adverse cardiovascular events (P = 0.374) did not differ significantly between the two groups. ARBs were not inferior to ACEIs in relation to reducing the incidence of cardiocerebrovascular disease in the clinical setting; however, there were slight differences for each disease. The greatest strength of real-world evidence is that it allows the follow-up of specific drug use, including drug compliance. Large-scale studies on the effects of relatively low-compliance ACEIs and high-compliance ARBs on cardiocerebrovascular disease are warranted in the future.

Long-term exposure to PM2.5 and O3 with cardiometabolic multimorbidity: Evidence among Chinese elderly population from 462 cities

Cardiometabolic multimorbidity (CMM) refers to the presence of multiple cardiovascular and metabolic diseases (CMDs), such as hypertension, diabetes, and cardio-cerebrovascular diseases (CCVD), in the same individual, and has emerge as a significant global health concern due to population aging. Although previous research has demonstrated the association between cardiovascular and metabolic diseases and air pollutants, evidence on the link between CMM and air pollution exposure among Chinese older adults is limited. To address this research gap, we conducted a national representative survey of 222,179 adults aged 60 and older to investigate the epidemiology of CMM and its association with long-term exposure to PM2.5 and O3 in China's elderly population. We found that the prevalence of CMM among Chinese older adults was 16.9%, and hypertension and CCVD were the most common CMM cluster (10.8%). After adjusting for confounding variables, we observed a significant positive association between PM2.5 exposure and the prevalence of hypertension, diabetes, and CCVD, with a respective excess risk increase of 3.2%, 3.6%, and 5.5% for every 10-unit increase. Moreover, every 10-unit increase in PM2.5 was linked to a higher risk of hypertension and diabetes (2.2%), hypertension and CCVD (5.4%), diabetes and CCVD (5.6%), and hypertension, diabetes, and CCVD combined (7.6%). We also found a U-shaped curve relationship between O3 exposure and the occurrence of hypertension, diabetes, and CCVD, as well as different subtypes of CMM, with the lowest risk of O3 exposure was observed near 75–80 μg/m3. Furthermore, we identified that female and rural residents are more vulnerable to the health risks of air pollution than male and urban residents. Given the increasing aging of the population and rising prevalence of multimorbidity, policymakers should focus more attention on the female and rural elderly population to prevent and control CMM. This study provides compelling evidence that reducing air pollution levels can be an effective strategy to prevent and manage CMM among older adults.