Adult Disease Research Articles

The epidemiology of inflammatory skin disease in older adults

The epidemiology of inflammatory skin disease in older adults

Prevalence of common upper gastrointestinal diseases in Chinese adults aged 18–64 years

To investigate the prevalence of gastroesophageal reflux disease (GERD), reflux esophagitis (RE), digestive ulcer gastric ulcer (GU), duodenal ulcer (DU), and Helicobacter pylori infection in Chinese adults aged 18–64 years and their associated factors, a community-based cross-sectional study using a stratified multistage sampling method was conducted. A standardized questionnaire survey, the 13C-urea breath test, and gastroscopy were performed. Weighted methods were used to estimate the prevalence of diseases or infection mentioned above and their risk factors. Finally, 27,637 participants aged 18–64 years were enrolled from 2017 to 2018. The prevalence (95% confidence interval) of GERD, RE, GU, DU, and H. pylori infection was estimated to be 10.5% (7.8%–14.2%), 5.4% (3.9%–7.3%), 2.5% (1.7%–3.7%), 4.5% (3.6%–5.4%), and 41.5% (36.7%–46.4%), respectively. The fraction of H. pylori infection reached 58.6% and 61.1% among the GU and DU patients, respectively. Weighted multivariable logistic regression models showed that GERD, RE, and GU shared the common risk factors of age and obesity. Dose-response relationships were observed between smoking and all four diseases, as well as alcohol consumption and GERD and H. pylori infection. Northwest China had the highest prevalence of GERD (23.9%), RE (8.7%), GU (7.8%), DU (7.3%), and H. pylori infection (63.6%); however, the southwest region had the highest prevalence of GU but the lowest of DU, RE, and H. pylori infection. Non-steroidal anti-inflammatory drugs were positively associated with GERD risk. On the contrary, a reduced risk of GU was observed among H. pylori-infected patients taking this drug. In summary, the prevalence of GERD, RE, and H. pylori infection still appears high in China. H. pylori infection eradication remains the priority to reduce the burden of peptic ulcer disease. The aging population, high prevalence of overweight or obesity, smoking, and drinking in China could explain the high burden of these diseases, thus suggesting the targeted preventive measures for upper gastrointestinal diseases in the future.

Adverse events following immunization with DTaP-IPV (Tetraxim) in school-aged children in Taiwan, 2017–2020

Vaccination has been an effective method to prevent and control diphtheria, tetanus, pertussis and polio diseases in infancy and adults for years. To maintain the protective effect, a DTaP-IPV vaccine, Tetraxim, was introduced into Taiwan’s national immunization program for children at 5 years of age after primary series vaccination in infancy in October 2017 replacing a Tdap-IPV. To survey the safety of this vaccine, data between 01 October 2017 and 31 December 2020 from two surveillance systems, the Vaccine Adverse Events Reporting System (VAERS) and Vaccine Injury Compensation Program (VICP), were reviewed. We analysed patient’s demographics, symptoms, time of onset, and outcome. A total of 667,497 doses of DTaP-IPV vaccine were administered during the study period. We combined data from VAERS and VICP and deleted duplicate subjects and reports. There was a total of 59 subjects with AEs and the reporting rate of AEs was 8.8 subjects per 100,000 doses. The most common AEs were injection site erythema and swelling. AEs occurred with a median 1 day after vaccination (range 0–3 days). Among the 59 subjects, eight (13.6 %) with serious AEs were hospitalized. These serious AEs included injection site erythema, swelling or extensive limb swelling after vaccination and hospitalization might have been due to ELS that was misdiagnosed as cellulitis. The national passive surveillance data support the safety profile of Tetraxim as a school-entry booster in children at 5 years old in Taiwan.

Does High Self-Control Accelerate Epigenetic Aging in Low-Income Adolescents?

PurposePersistent self-control in the context of upward mobility in low-income adolescents, especially those of color, may have physiological costs, such as greater risks of developing cardiometabolic diseases in young adulthood. One potential mechanism linking self-control to cardiometabolic health is epigenetic age acceleration (EAA). However, little is known regarding the association between high self-control and EAA, as well as what factors may play protective roles. Therefore, we evaluated (1) the association between self-control and EAA and if this association varies by race and ethnicity, and (2) whether neighborhood collective efficacy (NCE) and school connectedness moderate the association in low-income adolescents. MethodsThis study used data from the Future of Families and Child Wellbeing Study. Participants included 772 adolescents with a household income <300% of poverty level (mean age: 15.6 years). Self-control, NCE, and school connectedness were all self-reported. EAA was assessed in saliva and estimated using Horvath, Skin and Blood, and Pediatric-Buccal-Epigenetic clocks. Multiple linear regression and PROCESS analyses were employed. ResultsHigher self-control was positively associated with EAA estimated by the skin and blood clock in low-income adolescents of color. Further, the association of higher self-control with EAA was not significant among low-income adolescents of color with higher NCE. No significant association was found among low-income White adolescents. DiscussionThe results suggest that supportive resources like neighborhood collective efficacy could mitigate adverse associations of high self-control with health in low-income adolescents of color.

Heart Transplantation for Adult Congenital Heart Disease: Where We Are Now, and What Comes Next?

Heart Transplantation for Adult Congenital Heart Disease: Where We Are Now, and What Comes Next?

Association between nutritional status indices and non-alcoholic fatty liver disease in older adults: insights from the National Health and Nutrition Examination Survey 2017-2018.

While previous studies have identified a relationship between dietary intake and the risk of non-alcoholic fatty liver disease (NAFLD), the influence of overall nutritional status on NAFLD development has not been thoroughly investigated. This study sought to explore the association between different nutritional status indicators and NAFLD among the older adults. Nutritional status was evaluated using controlling nutritional status (CONUT), prognostic nutritional index (PNI) and nutritional risk index (GNRI), while NAFLD was identified based on a controlled attenuation parameter ≥ 285 dB/m, measured using transient elastography. The analysis included multivariate regression, receiver operating characteristic analysis, eXtreme Gradient Boosting and subgroup analysis to investigate the relationships between nutritional status indices and NAFLD. The study enrolled 1409 participants for the main analysis, with an NAFLD prevalence of 44·7 %. After accounting for potential confounders, a positive association between PNI and NAFLD was observed. Participants in the third and fourth quartiles of PNI showed increased odds of NAFLD compared with the lowest quartile (Q3: OR = 1·45, 95 % CI (1·03, 2·05); Q4: OR = 2·27, 95 % CI (1·59, 3·24)). Similarly, higher GNRI quartiles were significantly associated with greater odds of NAFLD (Q4 v. Q1: aOR = 1·84; 95 % CI (1·28, 2·65)). Conversely, higher CONUT values were linked to a reduced prevalence of NAFLD (OR = 0·65, 95 % CI (0·48, 0·87)). This study highlights that suboptimal nutritional status, indicating overnutrition as evaluated by PNI, GNRI and CONUT, is positively linked with the risk of NAFLD in individuals aged 50 years and above.

A Study to Assess the Effectiveness of Video Assisted Teaching Programme on Knowledge Regarding Prevention of Coronary Artery Disease among Students In A Selected Arts College of Durg, Chhattisgarh (State)

Coronary artery disease is an obstructed blood flow through the coronary arteries to the heart muscles. The primary cause of coronary artery disease is atherosclerosis. The term acute coronary syndrome is used to encompass the continuum of coronary artery disease. Coronary artery disease is most prevalent type of cardiovascular disease in adults, more death occurs in middle aged adults. In India, even younger age group are prone to get heart disease due to their health damaging life style. This study was conducted to assess the effectiveness of video assisted teaching programme on knowledge regarding prevention of coronary artery disease among students in a selected arts college of Durg, Chhattisgarh (State) The conceptual framework used in this study was based on J.W.Kenney’s open system model. A quantitative approach was used for the present study. Using purposive sampling technique,60 arts students were selected and video assisted teaching given after pre-test. Followed by that post test was conducted on day 7, the collected data was analyzed using descriptive and inferential statistics. The overall analysis of prevention of coronary artery disease the mean post-test knowledge score of the subjects 28.07 is higher than the mean pre-test knowledge score 18.17. Thecalculated‘t’ value 19.769nis greater than of table value (1.984) at 0.001 level of significance. This indicates that video assited teaching programme was effective in gaining knowledge regarding the prevention of coronary artery disease. The association between socio demographic variables with pre-test knowledge score significance (p&lt;0.001) was tested. Based on the findings indicate that there is a significant difference between pre-test and post-test knowledge score on prevention of coronary artery disease in a selected arts college students at Durg.

Association of periodontal disease with stress levels and drinking frequency in adults: analysis using data from the 7th National Health and Nutrition Examination Survey

Objectives: This study aimed to investigate the association of stress level and alcohol consumption with periodontal disease in adults. Methods: Data from the 7th Korean National Health and Nutrition Examination Survey were used for this study, which included 13,199 Korean adults aged &gt;19 years. The variables analyzed included demographic characteristics (sex and age) and socioeconomic factors (income, education, and marital status). Multiple logistic regression analysis was performed to evaluate the association between periodontal disease, stress level, and drinking frequency after considering confounding factors such as income quartile and marital status. Results: After correcting for all confounding factors, the analysis showed that the group that drank more than four times a week had a 1.541 times higher risk of developing periodontal disease than the group that drank less than once a month (odds ratio [OR]=1.541, 95% confidence interval [CI]=1.245-1.906, p&lt;0.001). The prevalence of periodontal disease was higher in men, in those over 60 years of age, and in those with lower levels of education and income. Interestingly, those with lower perceived stress had a significantly higher disease prevalence (31.5%) than those with higher stress levels (28.0%; p&lt;0.001). Conclusions: The results of this study suggested that the higher the frequency of drinking, the higher the prevalence of periodontal disease.

The Impact of Anemia on Adolescent Girls in the Future

This community service activity aims to increase teenagers' knowledge about anemia when teenagers are at risk of becoming pregnant and giving birth to stunted children in Banjarbaru City. This activity needs to be done because development during adolescence, greatly determines a person's ability to become an adult. Nutritional problems that occur during adolescence will increase vulnerability to disease in adulthood and risk giving birth to a generation with nutritional problems. For this reason, the community service team is expected to be able to carry out outreach activities to teenagers about anemia when teenagers are at risk of becoming pregnant and giving birth to stunted children. This activity uses the method of counseling and asking and answering teenagers' knowledge about anemia when teenagers are at risk of becoming pregnant and giving birth to stunted children. After carrying out this community service activity, the conclusion that can be drawn is that there is an increase in teenagers' knowledge about anemia when teenagers are at risk of becoming pregnant and giving birth to stunted children. The hope is that after gaining knowledge about anemia, teenagers can avoid it.

The Impact of Comorbidity and Age on the Risk of Hospitalization and Mortality in Patients with Previous COVID-19 Infection-Based on Nationwide Data.

Objectives: The influence of comorbidity on long-term hospitalization and mortality after COVID-19 in adults (40-59 years) and older adults (≥60 years) is yet to be explored. Methods: This is a Danish population-based cohort study of patients with a first-time positive PCR test for COVID-19 from 1 March 2020, to 28 February 2022 (N = 1,034,103). Exposed cohorts were patients with 1) a Charlson Comorbidity Index (CCI) score of 1-2 and 2) a CCI score ≥3, who were compared to patients without comorbidity (CCI of zero) within the groups of adults (67.9%) and older adults (32.1%) for the risk of hospitalization and mortality. Next, within the age groups, each disease category of the CCI was considered as an exposed cohort and compared to patients who did not have the specific disease of interest. Adjusted hazard ratios (HR) for hospitalization and mortality were estimated by Cox regression models adjusted for confounders. Results: The highest HRs were in adult patients with a CCI score of ≥3. The adjusted HR was 4.54 (95%CI: 4.38-4.70) for hospitalization, and among older adults it was 3.05 (95%CI: 2.99-3.11). The adjusted HR for mortality among adults with a CCI score ≥3 was 21.04 (95%CI: 18.86-23.47), and the adjusted HR for mortality among older adults was 4.61 (95%CI: 4.44-4.78). The underlying disease influenced the risk estimates among adults and older adults, and "dementia" had the highest impact on mortality. Conclusion: A CCI score of 1 or above increases the risk of hospitalization and mortality up to 2 years after a positive PCR test of COVID-19 for adults and older adults. Further, the type of underlying disease in older adults highly influences the risk of hospitalization and mortality.

Nationwide reduction in COVID-19 mortality among patients with asthma and other chronic diseases in Mexican adults according to epidemic wave.

Nationwide reduction in COVID-19 mortality among patients with asthma and other chronic diseases in Mexican adults according to epidemic wave.

A prospective study on etiology and clinical profile of chronic Cor pulmonale

Background: Cor pulmonale accounts for approximately 6% to 7% of all adult heart disease cases in the United States and is involved in 10% to 30% of hospital admissions for congestive heart failure nationwide. Materials and Methods: This prospective study was conducted at Al-Ameen Medical College and Hospital in Vijayapura, adhering to specific inclusion and exclusion criteria. The sample included 73 cases, with detailed medical histories and symptom analyses collected from each participant. A thorough clinical examination was also performed. Results: Among the 73 patients, 25 (34.3%) were aged 40 to 50 years, while another 25 (34.3%) were over 60 years. The majority were male (80.8%), and 50 patients (68.5%) had a history of smoking. All participants presented with symptoms of breathlessness, cough, and swelling of the feet. Physical examinations showed tachypnea, crepitations, and rhonchi in all individuals. Chronic bronchitis and emphysema were identified as the leading causes of chronic cor pulmonale in 44 patients (60.2%). Conclusion: This study found that chronic bronchitis and emphysema were common causes of chronic cor pulmonale, primarily affecting middle-aged and older individuals, with males affected more than females and smoking identified as a major contributing factor. Common symptoms included breathlessness, cough, and lower extremity swelling. Physical examinations frequently revealed tachypnea, crepitations, rhonchi, and notable signs such as epigastric pulsations, loud P2, pansystolic murmur of tricuspid regurgitation, and parasternal heave. Chronic cor pulmonale has a substantial impact on both pulmonary and cardiac function; 53.7% of patients are at risk of readmission within one year of discharge. The condition is generally associated with a poor prognosis. This highlights the importance of early detection of signs and symptoms to enhance management outcomes.

From Real-World Data to Causally Interpretable Models: A Bayesian Network to Predict Cardiovascular Diseases in Adolescents and Young Adults with Breast Cancer.

Background: In the last decades, the increasing number of adolescent and young adult (AYA) survivors of breast cancer (BC) has highlighted the cardiotoxic role of cancer therapies, making cardiovascular diseases (CVDs) among the most frequent, although rare, long-term sequalae. Leveraging innovative artificial intelligence (AI) tools and real-world data (RWD), we aimed to develop a causally interpretable model to identify young BC survivors at risk of developing CVDs. Methods: We designed and trained a Bayesian network (BN), an AI model, making use of expert knowledge and data from population-based (1036 patients) and clinical (339 patient) cohorts of female AYA (i.e., aged 18 to 39 years) 1-year survivors of BC, diagnosed in 2009-2019. The performance achieved by the BN model was validated against standard classification metrics, and two clinical applications were proposed. Results: The model showed a very good classification performance and a clear causal semantic. According to the predictions made by the model, focusing on the 25% of AYA BC survivors at higher risk of developing CVDs, we could identify 81% of the patients who would actually develop it. Moreover, a desktop-based app was implemented to calculate the individual patient's risk. Conclusions: In this study, we developed the first causal model for predicting the CVD risk in AYA survivors of BC, also proposing an innovative AI approach that could be useful for all researchers dealing with RWD. The model could be pivotal for clinicians who aim to plan personalized follow-up strategies for AYA BC survivors.

Cost-Effectiveness of Bivalent Respiratory Syncytial Virus Prefusion F Vaccine for Prevention of Respiratory Syncytial Virus Among Older Adults in Greece.

To evaluate the health benefits, costs, and cost-effectiveness of vaccination with bivalent respiratory syncytial virus stabilized prefusion F vaccine (RSVpreF) for the prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) in Greek adults 60 years of age and older. A Markov model was adapted to simulate lifetime risk of health and economic outcomes from the public payer's perspective over a lifetime horizon. Epidemiology, vaccine effectiveness, utilities, and direct medical costs (EUR, 2024) were obtained from published studies, official sources, and local experts. Model outcomes included the number of medically attended RSV cases, stratified by care setting (i.e., hospital, emergency department [ED], outpatient visits [OV]), and attributable RSV-related deaths, costs, life years (LY), quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICERs) of RSVpreF vaccination compared with no vaccination. The model projected 258,170 hospitalizations, 112,248 ED encounters, 1,201,604 OV, and 25,463 deaths related to RSV in Greek older adults resulting in direct medical costs of EUR 1.6 billion over the lifetime horizon. Assuming RSV vaccination would reach the same coverage rates as pneumococcal and influenza programmes, 18,118 hospitalizations, 7874 ED encounters, 48,079 OV, and 1706 deaths could be prevented over the modelled time horizon. The health benefits associated with RSVpreF contributed to an incremental gain of 10,976 LYs and 7230 QALYs compared with no vaccination. The incremental analysis reported that vaccination with RSVpreF was estimated to be a cost-effective strategy resulting in ICERs of EUR 12,991 per LY gained, EUR 19,723 per QALY gained, and EUR 7870 per hospitalized RSV case avoided compared with no vaccination. Vaccination with RSVpreF was a cost-effective strategy for the prevention of RSV disease in Greek adults over 60 years of age. The introduction of RSV vaccination can improve public health by averting RSV cases and deaths and has the potential to fulfil an unmet medical need.

Clinical characteristics of pediatric and adult myelin oligodendrocyte antibody-associated disease (MOGAD): A single-center study in the Northeast

BackgroundMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an immune-mediated, inflammatory, demyelinating disorder with a range of clinical presentations including acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), myelitis, and cerebral cortical encephalitis. Phenotypic expression of MOGAD varies with age. MOG antibody (MOG-Ab) titers at disease onset, as well as longitudinally, may predict clinical disease course. The objectives of this study were to (1) describe a cohort of pediatric and adult patients with MOGAD at a single center and (2) investigate if clinical outcomes correlate with ethnicity and MOG-Ab. MethodsThe clinical data of 36 pediatric and adult patients with MOGAD who were evaluated at onset and longitudinally were collected between January 2018 and June 2023 at our center. Inclusion criteria were positive MOG-Ab titers, a presentation consistent with proposed consensus criteria for MOGAD, and at least one initial or follow-up visit at our center. Patients were divided into monophasic and relapsing courses. Demographic data and clinical phenotypes were assessed as possible predictors of relapsing disease. ResultsWe describe demographic and clinical characteristics of 36 patients with MOGAD. Hispanic adults and children had increased rates of disease relapse compared to other ethnicities. Male sex and pediatric onset disease were also associated with increased risk of relapse. MOG-Ab titers at disease onset were not associated with a particular disease course. In adults, an initial phenotype of unilateral optic neuritis was associated with monophasic disease. ConclusionOur findings within a diverse population suggest that specific characteristics, both of patients and of disease presentation, may be associated with a monophasic or relapsing course. Additional studies with larger cohorts are needed.

Adult celiac disease presented with celiac crisis: Report of two cases

Two patients (case 1: 29 years old and case 2: 66 years old. female) with no known medical history of chronic diseases, including celiac disease, presented to the hospital with prolonged diarrhea, weight loss, and severe hypocalcemia at different times. They were admitted to the hospital for hemodynamic instability in the setting of severe dehydration and electrolyte disturbances. Physical examination revealed a positive trousseau sign in Case 1. The typical laboratory features of both cases were low magnesium, low potassium, low vitamin D, low ferritin, and prolonged coagulation tests. In addition to those labs, case 2 also has metabolic acidosis. In both cases, the titers of the tissue transglutaminase IgA and IgG and the anti-endomysium antibody were high, and the histopathology of the duodenal biopsy was consistent with villous atrophy, crypt hyperplasia, and an increase in intraepithelial lymphocytes, suggesting celiac disease. Both cases responded quickly to treatment with a gluten-free diet, fluid, electrolyte, vitamin D, and K replacements, and were discharged. Celiac crisis is a rare presentation of celiac disease characterized by acute, severe metabolic imbalances resulting in high mortality and morbidity, with severe diarrhea, hypoproteinemia, and metabolic and electrolyte disturbances. It is typically seen in children under 2 years of age but can also be encountered in adulthood. Most cases respond to gluten cessation, nutritional support, and rarely steroid treatment.

Adult Immunization Board: A platform to provide guidelines for implementation of adult immunization

Abstract Background Several organizations, including governments, (inter)national public health organizations and vaccine manufactures are currently considering how adult immunization can be further improved to increase health impact and promote a lifelong approach to vaccination. Despite many organizations thinking about ways to improve adult immunization, there is currently no multidisciplinary discussion platform focusing on this topic at the European level. Therefore, a group of experts in the field of adult immunization established the Adult Immunization Board (AIB). Methods AIB is established with the aim of contributing to the reduction of the impact of vaccine-preventable infections and diseases in European adults. AIB works by organizing 2 meetings per year: 1) a technical meeting to discuss specific technical aspects on adult immunization with subject-matter experts, and 2) a country meeting to discuss country specific aspects of adult immunization together with local experts. Results In April 2023 and 2024 the AIB organized its first technical meetings on “Assessing the health burden of vaccine-preventable infections in European Adults (2023)” and “Strategies for introducing and implementing vaccines for adults into National Immunization Programs in Europe (2024)”. In December 2023, the AIB organized its first country meeting in Italy with local experts to learn out best practices in adult immunization and address aspects to improve. Conclusions AIB is a platform that brings together the different key European stakeholders in adult immunization to effectively contribute towards the implementation and optimization of adult immunization programs in Europe. Key messages • Continued efforts to promote research, implementation, awareness, accessibility, and vaccine uptake are crucial to mitigate the burden of (future) infectious diseases in the adult population. • The AIB represents a significant step towards bolstering adult immunization efforts in the EU.

Increasing trends in hypertension-related mortality in European Union 27 countries from 2011 to 2019

Abstract Background Arterial Hypertension (HT) is one of the most common chronic cardiovascular disease in adults and a leading cause of disability and mortality worldwide. However, update data regarding the HT-related mortality trends in Europe are lacking. Therefore, we assess the age- and sex- specific trends in HT-related mortality in the 27 European Union Member States (EU-27) between years 2011 and 2029. Methods Data were retrieved from the free publicly available EUROSTAT death certificate database to examine age-adjusted HT-related mortality rates (AAMR) (per 100.000 people) and relative average annual percentage change (AAPC) across all European Union 27 countries (EU27) from 2011 to 2019 using the International Classification of diseases, Tenth Revision (ICD-10) codes I10-I13 and I15. To calculate annual trends in HT-related mortality, we assessed the average annual percent change (AAPC) and relative 95% confidence intervals (CIs) using Joinpoint regression analysis. Results Over the study period, 254.540 HT-related deaths (157,081 males) were listed in EU27. Age-adjusted HT-related death increased from 9.12 to 10.7 per 100,000 people [AAPC: +1.5% (95% CI: 0.8-2.0), p&amp;lt;0.001]. Specifically, the HT-related mortality increased in males [AAPC: +1.8 (95% CI: 0.9-2.6) while decreased in women [AAPC: -1.1 (95% CI: -2.0 to 0.2), p=0.001]. Additionally, the HT-related mortality rates increased in northern [+1.5 (95% CI: 0.7 to 2.3), p&amp;lt;0.001] and eastern [AAPC: +3.9 (95% CI: 2.3 to 5.4), p&amp;lt;0.001] EU-27 states. Conversely, the AAMR plateaued in southern [AAPC: -0.1 (95% ci: 0.6 to 0.7), p=0.96)] and western EU-27 countries [AAPC: 1.0 (95% CI: -0.1 to 2.1, p=0.07] over the same period. Conclusions In EU27, HT-related mortality increased from 2011 to 2019, especially in men. However, significant disparities in HT-related mortality rates still exist between different European regions.

Exploring the association between hypertension and atherosclerotic cardiovascular disease in adults with familial hypercholesterolemia: insights from the HELLAS-FH registry

Abstract Aim While the link between hypertension and atherosclerotic cardiovascular disease (ASCVD) is well-established, its impact on patients with familial hypercholesterolemia (FH) remains less explored. This study aims to assess the association between hypertension and ASCVD in adult FH patients. Material-Methods: Participants from the HELLAS-FH registry were divided into two groups based on the presence or absence of hypertension. We compared demographic information, lipid profile and history of ASCVD between the two groups. Results The study included 2367 FH patients, of whom 602 (25.4%) had a diagnosis of hypertension. Hypertensive patients were generally older and exhibited higher rates of ASCVD risk factors such as increased body mass index (28.6 vs 26.3 kg/m2), waist circumference (98 cm in men and 97 cm in women compared with 95 cm and 88 cm in non-hypertensive counterparts), and more prevalent history of smoking (44.2% vs 35.8%) (p&amp;lt;0.01 for all comparisons). Patients with hypertension had higher triglyceride levels (148 vs 123 mg/dL; p&amp;lt;0.05), lower high-density lipoprotein cholesterol (HDL-C) levels (48 vs 53 mg/dL; p&amp;lt;0.05) while total cholesterol and non-HDL-C levels were not significantly different. When adjusted for age, sex, and major ASCVD risk factors, hypertension was significantly associated with prevalent coronary artery disease (CAD) (adjusted odds ratio [OR] 3.10; 95% CI 2.29-4.19; p&amp;lt;0.001), ischemic stroke (OR 1.89; 95% CI 1.02-3.49; p=0.04), and peripheral arterial disease (PAD) (OR 3.15; 95% CI 1.62-6.13; p&amp;lt;0.001). Conclusions Hypertension is frequent and is independently associated with an increased risk of CAD, stroke, and PAD in patients with FH.

Prognostic impact of cardiac events in asymptomatic mitral regurgitation

Abstract Background Mitral regurgitation (MR) is the most common valvular heart disease in adults and is associated with increased morbidity and mortality. Treatment recommendations of degenerative MR have been liberalized, however, the role of asymptomatic patients is still insufficiently defined. Purpose The purpose of this study were to evaluate the prevalence of cardiac events in a large asymptomatic MR cohort, based on health insurance data analysis, in comparison with healthy propensity score-matched general population and to define the prognostic impact of such cardiac events on ten-year survival. Methods We retrospectively analyzed health insurance claims data from Germany’s second largest health insurance fund, which maintains longitudinal data on outpatient and inpatient medical services for 8.7 million German residents. We included all patients with an outpatient diagnosis of MR (I34.0) in a minimum of two quarters during a calendar year and first recorded diagnosis between 2008 and 2011. To identify an asymptomatic MR cohort (study group), all patients with at least one complication attributable to MR / mitral valve intervention during the incidence quarter of MR were excluded. Ten-year outcomes were compared between study group vs. age- and sex-matched healthy control group. Cardiac events of interest were new congestive heart failure, new-onset atrial fibrillation, pulmonary hypertension, or cardiac decompensation. Results A total of 56.577 (62.7%) asymptomatic MR patients were identified from the whole cohort of 90.245 individuals with a newly diagnosed MR in the BARMER database. During a ten-year follow-up, 26.282 (46.5%) patients in the study group experienced at least one cardiac event vs. 11.763 (20.8%) individuals in the control group (OR: 3.31, 95%CI: 0.251-0.262, P&amp;lt;0.0001). The occurrence of at least one cardiac event (i.e., congestive heart failure, new-onset atrial fibrillation, pulmonary hypertension or cardiac decompensation) in the study group was associated with a significantly worse ten-year survival as compared to the control group. The risk of cardiac events was age- and sex-dependent, while female patients with an asymptomatic MR had a lower risk as compared to males in all age groups (OR: 0.38, 95%CI: -1.193- -0.754, P&amp;lt;0.0001). Only 1.530 (2.7%) patients underwent mitral valve (MV) intervention in the study group during ten-year follow-up. Conclusions Our study reveals high incidence of asymptomatic MR in a representative cohort of health insurance claims data in Germany. Every second patient with an asymptomatic MR experiences at least one cardiac event during a ten-year follow-up period that is associated with a significantly worse survival. The definition of asymptomatic MR cohort at risk of developing cardiac events may potentially improve early treatment strategies and lead to better outcome in the future.Abstract picture