Circulatory Causes Research Articles

Increased mortality associated with extreme-heat exposure in King County, Washington, 1980-2010.

Extreme heat has been associated with increased mortality, particularly in temperate climates. Few epidemiologic studies have considered the Pacific Northwest region in their analyses. This study quantified the historical (May to September, 1980-2010) heat-mortality relationship in the most populous Pacific Northwest County, King County, Washington. A relative risk (RR) analysis was used to explore the relationship between heat and all-cause mortality on 99th percentile heat days, while a time series analysis, using a piece-wise linear model fit, was used to estimate the effect of heat intensity on mortality, adjusted for temporal trends. For all ages, all causes, we found a 10% (1.10 (95% confidence interval (CI), 1.06, 1.14)) increase in the risk of death on a heat day versus non-heat day. When considering the intensity effect of heat on all-cause mortality, we found a 1.69% (95% CI, 0.69, 2.70) increase in the risk of death per unit of humidex above 36.0°C. Mortality stratified by cause and age produced statistically significant results using both types of analyses for: all-cause, non-traumatic, circulatory, cardiovascular, cerebrovascular, and diabetes causes of death. All-cause mortality was statistically significantly modified by the type of synoptic weather type. These results demonstrate that heat, expressed as humidex, is associated with increased mortality on heat days, and that risk increases with heat's intensity. While age was the only individual-level characteristic found to modify mortality risks, statistically significant increases in diabetes-related mortality for the 45-64 age group suggests that underlying health status may contribute to these risks.

Abstract 16: A Pro-Vegetarian Food Pattern and Cardiovascular Mortality in the Epic Study

Background: Plant-based dietary pattern consumption, especially the Mediterranean Diet, have consistently shown inverse risk associations with mortality due to cardiovascular disease (CVD). In agreement, adherence to a vegetarian diet has been associated with reduced CVD risk compared to non-vegetarian; however, the proportion of vegetarians in the population is low. The Pro-vegetarian food pattern (PVEG) has recently been proposed as an intermediate dietary pattern towards vegetarianism which consists in favouring only plant-based foods while concomitantly reducing animal-derived foods. Hypothesis: We aimed to investigate the associations between the a priori defined PVEG score and CVD mortality across 10 different European countries. Methods: Included in the analysis were 451,256 participants (130,370 men and 320,886 women) between 35 and 70 years from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. At recruitment, between 1992 and 2000, dietary, anthropometric and lifestyle data was collected. CVD mortality was defined as death from circulatory cause (I00–I99 according to the ICD 10th revision). An a priori PVEG dietary score was constructed comprising 12 components. The consumption of 7 plant-based food groups (vegetables, fruit, legumes, cereals, potatoes, nuts, olive oil) were categorized into quintiles, positively rated, and 5 animal-based food groups (meats/meat products, animal fats, eggs, fish and other seafood and dairy products) were inversely rated for a total score ranging from 12 to 60. Five categories of the total score were created: very low (<30), low (30-34), moderate (35-39), high (40-44), and very high (>45) adherence to a PVEG diet. Associations with the PVEG dietary score and CVD mortality were estimated using Cox regression analysis using age as the primary time metrics providing Hazard Ratios (HR) and 95% Confidence Intervals (95%CI). The fully adjusted models included total energy intake, body mass index, physical activity, educational level and stratified by centre, sex and age at baseline. Restricted cubic splines were used to assess the shape of the association in continuous. Results: Over follow-up (median: 12.8 years), 5083 CVD deaths occurred. Compared to very low adherence to a PVEG diet (reference category), the fully-adjusted HRs (95%CI) were: 0.92 (0.85-1.01) in the low, 0.88 (0.80-0.74) in the moderate, 0.81 (0.74-0.90) in the high and 0.80 (0.70-0.93) in the very high adherence categories. The suggested floor effect for a score >=40 was also seen by restricted cubic spline. Conclusion: Adherence to the plant-based PVEG food pattern was associated with overall decreased risks of CVD mortality up to 20% risk reduction, although no further risk reduction was obtained from a very strong compared to a strong adherence.

A systematic review and meta-analysis of premature mortality in bipolar affective disorder.

ObjectiveTo review and complete meta‐analysis of studies estimating standardised mortality ratios (SMRs) in bipolar affective disorder (BPAD) for all‐cause and cause‐specific mortalities.MethodCause‐specific mortality was grouped into natural and unnatural causes. These subgroups were further divided into circulatory, respiratory, neoplastic and infectious causes, and suicide and other violent deaths. Summary SMRs were calculated using random‐effects meta‐analysis. Heterogeneity was examined via subgroup analysis and meta‐regression.ResultsSystematic searching found 31 studies meeting inclusion criteria. Summary SMR for all‐cause mortality = 2.05 (95% CI 1.89–2.23), but heterogeneity was high (I 2 = 96.2%). This heterogeneity could not be accounted for by date of publication, cohort size, mid‐decade of data collection, population type or geographical region. Unnatural death summary SMR = 7.42 (95% CI 6.43–8.55) and natural death = 1.64 (95% CI 1.47–1.83). Specifically, suicide SMR = 14.44 (95% CI 12.43–16.78), other violent death SMR = 3.68 (95% CI 2.77–4.90), deaths from circulatory disease = 1.73 (95% CI 1.54–1.94), respiratory disease = 2.92 (95% CI 2.00–4.23), infection = 2.25 (95% CI 1.70–3.00) and neoplasm = 1.14 (95% CI 1.10–1.21).ConclusionDespite considerable heterogeneity, all summary SMR estimates and a large majority of individual studies showed elevated mortality in BPAD compared to the general population. This was true for all causes of mortality studied.

Cardiac pre-load alteration with MRI-compatible lower body suction device

Background Our group studies circulatory causes of exercise limitation in congenital heart patients with dilated right ventricle, but normal resting left ventricular ejection fraction. Cardiac MRI is the gold standard non-invasive tool for measuring heart chamber volume and blood vessel flow. We designed an MRI-compatible lower body negative pressure (LBNP) device (Image) in order to study the effect of pre-load reduction on the heart with MRI. This is a pilot study to establish our methodology.

Changes in cause-specific mortality during heat waves in central Spain, 1975-2008.

The relationship between heat waves and mortality has been widely described, but there are few studies using long daily data on specific-cause mortality. This study is undertaken in central Spain and analysing natural causes, circulatory and respiratory causes of mortality from 1975 to 2008. Time-series analysis was performed using ARIMA models, including data on specific-cause mortality and maximum and mean daily temperature and mean daily air pressure. The length of heat waves and their chronological number were analysed. Data were stratified in three decadal stages: 1975-1985, 1986-1996 and 1997-2008. Heat-related mortality was triggered by a threshold temperature of 37 °C. For each degree that the daily maximum temperature exceeded 37 °C, the percentage increase in mortality due to circulatory causes was 19.3 % (17.3-21.3) in 1975-1985, 30.3 % (28.3-32.3) in 1986-1996 and 7.3 % (6.2-8.4) in 1997-2008. The increase in respiratory cause ranged from 12.4 % (7.8-17.0) in the first period, to 16.3 % (14.1-18.4) in the second and 13.7 % (11.5-15.9) in the last. Each day of heat-wave duration explained 5.3 % (2.6-8.0) increase in respiratory mortality in the first period and 2.3 % (1.6-3.0) in the last. Decadal scale differences exist for specific-causes mortality induced by extreme heat. The impact on heat-related mortality by natural and circulatory causes increases between the first and the second period and falls significantly in the last. For respiratory causes, the increase is no reduced in the last period. These results are of particular importance for the estimation of future impacts of climate change on health.

Temperature and Risk for Post-Neonatal Mortality in California

Temperature and Risk for Post-Neonatal Mortality in CaliforniaAbstract Number:2050 Dharshani Pearson*, Rupa Basu, Brian Malig, and Rachel Broadwin Dharshani Pearson* California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author , Rupa Basu California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author , Brian Malig California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author , and Rachel Broadwin California Environmental Protection Agency/ Office of Environmental Health Hazard Assessment, United States, E-mail Address: [email protected] Search for more papers by this author AbstractBackground: Infants have limited ability to adapt to temperature extremes because they lack well-developed thermoregulatory response mechanisms. However, very few studies of temperature and adverse health outcomes have focused on infants. Aim: To examine the relationship between apparent temperature, a combination of heat and humidity, and mortality among infants between 28 and 365 days old (post-neonatal period).Methods: Using California death certificates from 1999 to 2011, we used a case-crossover analysis to investigate the effects of mean daily apparent temperature on post-neonatal mortality. First, we identified post-neonates who died in California from May through October. We then combined these data with mean daily apparent temperature gathered from meteorological monitors located within 20 kilometers of each mother’s residential zip code to comprise our final study population of 3,398 cases. We examined deaths from circulatory causes (International Classification of Disease [ICD]-10 No. I00-I99), respiratory causes (ICD J00-J98) and sudden infant death syndrome (SIDS [ICD R95]), in addition to all-cause mortality (ICD A00-Y899). Overall, mean daily apparent temperature was associated with post-neonatal deaths related to circulatory causes (excess risk: 36.9% per 5.6°C (10°F)); 95% confidence interval: -0.7, 88.8). We found this effect to be larger in non-coastal areas (43.5%; 2.0, 101.8). When stratifying by race/ethnicity, we noted that Hispanics (46.4%; -6.8, 129.8) and Whites (73.6%,-5.5, 218.9) both showed elevated mortality associated with circulatory causes.Conclusions: Our findings suggest that parents of children under one year of age, especially those with known preexisting circulatory conditions, should receive advance warning of potential harmful health outcomes associated with high outdoor temperature.

Cognitive impairment assessed at annual geriatric health examinations predicts mortality among the elderly

ObjectiveTo determine whether cognitive impairment assessed at annual geriatric health examinations is associated with increased mortality in the elderly. MethodThis cohort study was based on data obtained from the government-sponsored Annual Geriatric Health Examination Program for the elderly in Taipei City between 2006 and 2010. The study sample consisted of 77,541 community-dwelling Taipei citizens aged 65years or older. The Short Portable Mental Status Questionnaire (SPMSQ) was selected to measure cognitive impairment. Mortality was ascertained by matching cohort IDs with national death files. ResultsThere was a dose–response relationship between cognitive impairment and mortality (increased one score of SPMSQ, Hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.10–1.14). Relative to no cognitive impairment, the HRs were 1.67 (95% CI: 1.43–1.94), 2.26 (95% CI: 1.90–2.70), and 2.68 (95% CI: 2.25–3.19) for mild, moderate, and severe cognitive impairments, respectively. The causes of death associated with cognitive impairment were circulatory, respiratory, and other causes, but not death from cancer. ConclusionCognitive impairment as measured by the SPMSQ is associated with an increased risk for mortality. Even mild cognitive impairment was associated with greater risk of mortality at a relatively short follow-up time.

Letters

Letters

Gastos relacionados a hospitalizações de idosos no Brasil: perspectivas de uma década

ABSTRACTObjective:To describe the profile of morbidities and expenses related to hospitalization of the elderly compared to the adult population (20 to 59 years).Methods:A descriptive, cross-sectional investigation of hospitalizations of the elderly (60 years or older) in Brazil during the period from 2002 to 2011, with data from DATASUS and based on ICD-10.Results:Although the highest number of hospitalizations were in the adult age range, the expenses were greater with the elderly, and in this case especially with mental and behavioral disorders, musculoskeletal and connective tissue diseases, followed by circulatory diseases and external causes.Conclusion:The results suggest the adoption of more comprehensive policies and increased investment in health promotion, disease prevention, and appropriate and suitable treatment for the most prevalent diseases in the elderly, particularly in primary care.

Age- and Sex-related Risk Factors for Influenza-associated Mortality in the United States Between 1997–2007

Limited information on age- and sex-specific estimates of influenza-associated death with different underlying causes is currently available. We regressed weekly age- and sex-specific US mortality outcomes underlying several causes between 1997 and 2007 to incidence proxies for influenza A/H3N2, A/H1N1, and B that combine data on influenza-like illness consultations and respiratory specimen testing, adjusting for seasonal baselines and time trends. Adults older than 75 years of age had the highest average annual rate of influenza-associated mortality, with 141.15 deaths per 100,000 people (95% confidence interval (CI): 118.3, 163.9), whereas children under 18 had the lowest average mortality rate, with 0.41 deaths per 100,000 people (95% CI: 0.23, 0.60). In addition to respiratory and circulatory causes, mortality with underlying cancer, diabetes, renal disease, and Alzheimer disease had a contribution from influenza in adult age groups, whereas mortality with underlying septicemia had a contribution from influenza in children. For adults, within several age groups and for several underlying causes, the rate of influenza-associated mortality was somewhat higher in men than in women. Of note, in men 50-64 years of age, our estimate for the average annual rate of influenza-associated cancer mortality per 100,000 persons (1.90, 95% CI: 1.20, 2.62) is similar to the corresponding rate of influenza-associated respiratory deaths (1.81, 95% CI: 1.42, 2.21). Age, sex, and underlying health conditions should be considered when planning influenza vaccination and treatment strategies.

Divergent Paths for Adult Mortality in Russia and Central Asia: Evidence from Kyrgyzstan

Adult mortality has been lower in Kyrgyzstan vs. Russia among males since at least 1981 and among females since 1999. Also, Kyrgyzstan’s mortality fluctuations have had smaller amplitude. This has occurred in spite of worse macro-economic outcomes in Kyrgyzstan. To understand these surprising patterns, we analyzed cause-specific mortality in Kyrgyzstan vs. Russia for the period 1981-2010, using unpublished official data. We find that, as in Russia, fluctuations in Kyrgyzstan have been primarily due to changes in external causes and circulatory causes, and alcohol appears to play an important role. However, in contrast with Russia, mortality from these causes in Kyrgyzstan has been lower and has increased by a smaller amount. As a result, the mortality gap between the two countries is overwhelmingly attributable to external and cardio-vascular causes, and more generally, to causes that have been shown to be strongly related to alcohol consumption. These cause-specific results, together with the existence of large ethnic differentials in mortality in Kyrgyzstan, highlight the importance of cultural and religious differences, and their impact on patterns of alcohol consumption, in explaining the mortality gap between the two countries. These findings show that explanatory frameworks relying solely on macro-economic factors are not sufficient for understanding differences in mortality levels and trends among former Soviet republics.

Smoking in young women in Scotland and future burden of hospital admission and death: a nested cohort study

Many women smoke, yet few longitudinal studies have examined the non-fatal burden of smoking in women. To investigate smoking in young women, and hospital admission and death in Scotland; and to compare mortality risk with elsewhere in the UK. Nested cohort study: Royal College of General Practitioners' Oral Contraception Study, UK. A total of 4121 women categorised by smoking habits and living in Scotland at recruitment (1968-1969) were followed until March 2009. Cox regression was used to investigate smoking and survival time; mortality from cancer, circulatory, or respiratory disease, and all other causes; and hospitalisation for any reason, and for specific reasons. The number and type of hospital admissions and bed-days were examined by smoking status. Life tables and Cox regression were used to compare the mortality risk of women living in Scotland with that of women living elsewhere. All-cause mortality was increased in women who smoked <15 cigarettes daily (adjusted hazard ratio = 1.99, 95% confidence interval [CI] = 1.74 to 2.27) and those who smoked ≥15 cigarettes daily (adjusted HR = 2.81, 95% CI = 2.47 to 3.20). Smoking any amount increased death from cancer, circulatory, respiratory, and other causes. Increased risk estimates were seen in one or both smoking groups for hospitalisation for any cause, and for several specific causes. More smokers than non-smokers were admitted to hospital, for four or more reasons, and had a longer total stay. The median survival age among smokers was lower in Scotland than elsewhere. Higher adjusted hazard ratios for mortality were found among smokers in Scotland. This study provides a powerful reminder of the burden of smoking in young women. In the UK, harmful effects appear to be worse in smokers in Scotland.

Differences in cardiovascular risk factors and socioeconomic status do not explain the increased risk of death after a first stroke in diabetic patients: results from the Swedish Stroke Register

This study compared survival rates and causes of death after stroke in diabetic and non-diabetic patients in Sweden. We hypothesised that differences in cardiovascular risk factors, acute stroke management or socioeconomic status (SES) could explain the higher risk of death after stroke in diabetic patients. The study included 155,806 first-ever stroke patients from the Swedish Stroke Register between 2001 and 2009. Individual patient information on SES was retrieved from Statistics Sweden. Survival was followed until 2010 (532,140 person-years) with a median follow-up time of 35 months. Multiple Cox regression was used to analyse survival adjusting for differences in background characteristics, in-hospital treatment, SES and year of stroke. Causes of death were analysed using cause-specific proportional hazard models. The risk of death after stroke increased in diabetic patients (HR 1.28, 95% CI 1.25, 1.31), and this risk was greater in younger patients and in women. Differences in background characteristics, cardiovascular risk factors, in-hospital treatment and SES did not explain the increased risk of death after stroke (HR 1.35, 95% CI 1.32, 1.37) after adjustments. Diabetic patients had an increased probability of dying from cerebrovascular disease and even higher probabilities of dying from other circulatory causes and all other causes except cancer. Differences in cardiovascular risk factors, acute stroke management and SES do not explain the lower survival after stroke in diabetic compared with non-diabetic patients. Diabetic patients are at higher risk of dying from cardiovascular causes and all other causes of death, other than cancer.

Were Equatorial Regions Less Affected by the 2009 Influenza Pandemic? The Brazilian Experience

Although it is in the Tropics where nearly half of the world population lives and infectious disease burden is highest, little is known about the impact of influenza pandemics in this area. We investigated the mortality impact of the 2009 influenza pandemic relative to mortality rates from various outcomes in pre-pandemic years throughout a wide range of latitudes encompassing the entire tropical, and part of the subtropical, zone of the Southern Hemisphere (+5°N to −35°S) by focusing on a country with relatively uniform health care, disease surveillance, immunization and mitigation policies: Brazil. To this end, we analyzed laboratory-confirmed deaths and vital statistics mortality beyond pre-pandemic levels for each Brazilian state. Pneumonia, influenza and respiratory mortality were significantly higher during the pandemic, affecting predominantly adults aged 25 to 65 years. Overall, there were 2,273 and 2,787 additional P&I- and respiratory deaths during the pandemic, corresponding to a 5.2% and 2.7% increase, respectively, over average pre-pandemic annual mortality. However, there was a marked spatial structure in mortality that was independent of socio-demographic indicators and inversely related with income: mortality was progressively lower towards equatorial regions, where low or no difference from pre-pandemic mortality levels was identified. Additionally, the onset of pandemic-associated mortality was progressively delayed in equatorial states. Unexpectedly, there was no additional mortality from circulatory causes. Comparing disease burden reliably across regions is critical in those areas marked by competing health priorities and limited resources. Our results suggest, however, that tropical regions of the Southern Hemisphere may have been disproportionally less affected by the pandemic, and that climate may have played a key role in this regard. These findings have a direct bearing on global estimates of pandemic burden and the assessment of the role of immunological, socioeconomic and environmental drivers of the transmissibility and severity of this pandemic.

Saharan dust and association between particulate matter and case-specific mortality: a case-crossover analysis in Madrid (Spain)

BackgroundSaharan dust intrusions are a common phenomenon in the Madrid atmosphere, leading induce exceedances of the 50 μg/m3- EU 24 h standard for PM10.MethodsWe investigated the effects of exposure to PM10 between January 2003 and December 2005 in Madrid (Spain) on daily case-specific mortality; changes of effects between Saharan and non-Saharan dust days were assessed using a time-stratified case-crossover design.ResultsSaharan dust affected 20% of days in the city of Madrid. Mean concentration of PM10 was higher during dust days (47.7 μg/m3) than non-dust days (31.4 μg/m3). The rise of mortality per 10 μg/m3 PM10 concentration were always largely for Saharan dust-days. When stratifying by season risks of PM10, at lag 1, during Saharan dust days were stronger for respiratory causes during cold season (IR% = 3.34% (95% CI: 0.36, 6.41) versus 2.87% (95% CI: 1.30, 4.47)) while for circulatory causes effects were stronger during warm season (IR% = 4.19% (95% CI: 1.34, 7.13) versus 2.65% (95% CI: 0.12, 5.23)). No effects were found for cerebrovascular causes.ConclusionsWe found evidence of strongest effects of particulate matter during Saharan dust days, providing a suggestion of effect modification, even though interaction terms were not statistically significant. Further investigation is needed to understand the mechanism by which Saharan dust increases mortality.

Alcohol Consumption and Mortality Risks in the USA

To estimate all-cause and cause-specific mortality risks by alcohol consumption level for the US population. The survival analysis of data from National Health Interview Survey participants from 1997 to 2004 who were followed for mortality through 2006. Hazard ratios (HRs) adjusted for available demographic and health characteristics were calculated by alcohol consumption level for all-cause mortality and for mortality from circulatory and external causes. Alcohol consumption levels were generally defined as 'never drinker' (<12 drinks in life), 'former drinker' (0 drinks during last year), 'infrequent drinker' (<12 drinks in any year), 'light drinker' (1 drink per drinking day), 'moderate drinker'(2 drinks) and 'heavy drinker' (3+ drinks). Adjusted mortality hazards for lifetime infrequent drinkers were much lower than the hazards for never drinkers among women, so lifetime infrequent drinkers were used as the reference category in survival analysis to estimate the mortality effects of alcohol consumption. Estimated all-cause mortality HRs for moderate drinkers were generally somewhat lower when compared with infrequent drinkers [HR for male moderate drinkers = 0.87, 95% confidence interval (CI) = 0.75-1.01 and HR for female occasional moderate drinkers = 0.80, 95% CI = 0.69-0.93]. Former drinkers and regular heavy drinkers had higher mortality hazards among both men and women. US light to moderate drinkers may have reduced mortality risks, but some portion of their previously observed lower mortality may be due to factors other than alcohol consumption such as medical care and social integration, particularly among women. Alcohol consumption among former and heavy drinkers appears to have increased their mortality risks.

Morbidity burden of end‐stage kidney disease in Australia: Hospital separation rates among people receiving kidney replacement therapy

Mortality associated with dialysis and transplantation is well characterized. Less well described are hospital separation rates for "non-renal" diagnoses among people receiving kidney replacement therapy (KRT = haemodialysis, peritoneal dialysis and kidney transplantation). We examined these rates among Australians receiving KRT. Observational study based on Australian National Hospital Morbidity Database, incorporating Australian public and private hospitals. Separations from this dataset were examined for 2002-7, excluding day-only haemodialysis. ICD (International Classification of Disease) codes were used to identify separations for people receiving chronic KRT. Separations categorized into "renal" and "non-renal" by principal diagnosis. Separation rate, admission length and in-hospital mortality were compared with the general population. Overall hospital separation rate (adjusted for age and gender) was increased relative to the general population for all groups: for HD patients, relative rate (RR) was 4.49 [95% confidence interval 4.460-4.53]; for PD patients 5.52 [5.460-5.59]; for transplant recipients 4.83 [4.20-4.28] (all p < 0.001). When restricted to separations with a "non-renal" principal diagnosis, the excess remained among KRT groups: HD adjusted RR 2.20 [2.170-2.22], PD 2.00 [1.950-2.04] and transplants 2.63 [2.600-2.66], all p < 0.001). The length and in-hospital mortality for separations in each KRT group was also increased. By ICD-10 chapter, rates of separations with infectious and metabolic causes were increased in all KRT groups; separations with circulatory and respiratory causes were also increased. Among people receiving KRT in Australia, there is a substantial burden of morbidity in addition to that directly related to KRT. This is most marked for infective, endocrine and circulatory and respiratory hospitalisations.

An implantable Fabry-Pérot pressure sensor fabricated on left ventricular assist device for heart failure

Continuous flow left ventricular assist devices (LVADs) are commonly used as bridge-to-transplantation or destination therapy for heart failure patients. However, non-optimal pumping speeds can reduce the efficacy of circulatory support or cause dangerous ventricular arrhythmias. Optimal flow control for continuous flow LVADs has not been defined and calls for an implantable pressure sensor integrated with the LVAD for real-time feedback control of pump speed based on ventricular pressure. A MEMS pressure sensor prototype is designed, fabricated and seamlessly integrated with LVAD to enable real-time control, optimize its performance and reduce its risks. The pressure sensing mechanism is based on Fabry-Pérot interferometer principle. A biocompatible parylene diaphragm with a silicon mirror at the center is fabricated directly on the inlet shell of the LVAD to sense pressure changes. The sensitivity, range and response time of the pressure sensor are measured and validated to meet the requirements of LVAD pressure sensing.

Statin usage and all‐cause and disease‐specific mortality in a nationwide study

The consumption of statins (HMG-CoA reductase inhibitors) in most Western countries has increased to the extent that it may affect all-cause and disease-specific mortality. To analyze the association of statin use with all-cause and disease-specific mortality utilizing nationwide databases in a record linkage study in Finland. The study population included all statin users in Finland who had purchased at least one prescription between 1997 and 2005. A control population matched for age, sex, and place of residence and without statin usage was selected. The study population consisted of 336, 618 pairs of individuals, and the mean length of follow-up was 4.4 years. All-cause mortality and mortality caused by coronary heart disease (CHD), stroke, other circulatory causes, cancer, unnatural causes, and suicide were analyzed. Persistence to treatment was calculated by varying adherence criteria between 20 and 80%. We observed association between all-cause, non-CHD and CHD and treatment with statins in statin user group. For CHD mortality, we observed a relationship between the persistence to statin treatment and a decreasing CHD mortality. For each 10% increase in adherence criteria, a 5% (2-8%) decrease in CHD mortality was observed within the range of 20% (RR 0.81, 95%CI 0.32-2.02) to 80% (RR 0.54, 95%CI 0.46-0.64). In this nationwide study, long-term use of statins is associated with the reduction in CHD mortality.

Apparent Temperature and Air Pollution vs. Elderly Population Mortality in Metro Vancouver

BackgroundMeteorological conditions and air pollution in urban environments have been associated with general population and elderly mortality, showing seasonal variation.ObjectivesThis study is designed to evaluate the relationship between apparent temperature (AT) and air pollution (PM2.5) vs. mortality in elderly population of Metro Vancouver.MethodsStatistical analyses are performed on moving sum daily mortality rates vs. moving average AT and PM2.5 in 1-, 2-, 3-, 5-, and 7-day models for all seasons, warm temperatures above 15°C, and cold temperatures below 10°C.ResultsApproximately 37% of the variation in all-season mortality from circulatory and respiratory causes can be explained by the variation in 7-day moving average apparent temperature (r2 = 0.37, p<0.001). Although the analytical results from air pollution models show increasingly better prediction ability of longer time-intervals (r2 = 0.012, p<0.001 in a 7-day model), a very weak negative association between elderly mortality and air pollution is observed.ConclusionsApparent temperature is associated with mortality from respiratory and circulatory causes in elderly population of Metro Vancouver. In a changing climate, one may anticipate to observe potential health impacts from the projected high- and particularly from the low-temperature extremes.