HR For Cardiovascular Mortality Research Articles

Association of an inter-arm systolic blood pressure difference with all-cause and cardiovascular mortality: A meta-analysis of cohort studies.

This meta-analysis evaluated the potential association of a simultaneously measured inter-arm systolic blood pressure difference (IASBPD) and all-cause mortality and cardiovascular mortality. The Medline, Cochrane Library, Embase, and PubMed databases were searched through to April 14, 2023 for relevant literature. The outcomes were the associations of IASBPD with all-cause and cardiovascular mortality. Finally, 10 cohort studies that included 15320 individuals were included. An IASBPD of ≥15mm Hg was associated with increased all-cause mortality (pooled hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.02-1.61) but an IASBPD of ≥10mm Hg was not (pooled HR 1.28, 95% CI 0.89-1.85). The pooled HR for cardiovascular mortality was 1.88 (95% CI 1.31-2.71) for an IASBPD of ≥10mm Hg and 1.93 (95% CI 1.24-2.99) for an IASBPD of ≥15mm Hg. Subgroup analysis showed that younger patients (HR 9.03, 95% CI 2.00-40.82, p=.004) with an IASBPD ≥15mm Hg were at higher risk of cardiovascular mortality than older patients (HR 1.67, 95% CI 1.06-2.64, p=.03); the difference between groups was statistically significant (p=.04). In conclusions, our findings show that a simultaneously measured IASBPD ≥15mm Hg predicts increased all-cause mortality and an IASBPD of ≥15mm Hg or ≥10mm Hg predicts increased cardiovascular mortality. An IASBPD ≥15mm Hg appears to be more correlated with cardiovascular mortality in younger patients than in older patients.

Comparison of medical care and long-term mortality in two cohorts of patients 10 years apart with chronic coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Bundesministerium für Bildung und Forschung. Background and introduction Cardiovascular diseases (CVD) remain the most common cause of death, although mortality due to CVD in Germany has decreased continuously over the past 20 years. The reasons for this decline are manifold. Besides the identification of risk factors, the application of algorithms for risk stratification, and the promotion of preventive means, the improvement in treatment strategies was of crucial importance [1, 2]. The ABC-CHD risk model combines novel biomarkers such as N-terminal pro-B-natriuretic peptide (NT-proBNP) and cardiac troponin T (hs-cTnT) with conventional factors in a unifying risk score which has been shown to reliably assess risk for CV mortality in patients with chronic coronary syndrome (CCS) [3]. However, data from the tertiary prevention setting, comparing its performance during different time periods, are scarce. Aims This study aimed to describe the characteristics and mortality of two cohorts of patients with CCS with identical study designs recruited in the same rehabilitation clinics approximately 10 years apart. Methods The KAROLA cohorts included patients with CCS participating in an inpatient cardiac rehabilitation programme in Germany (KAROLA-I: 1999/2000, KAROLA-II: 2009-2011) [details in 4]. Blood samples and information on sociodemographic factors, lifestyle, and medical treatment were collected at baseline, at the end of rehabilitation, and after 1-year follow-up. A biomarker-based risk model (ABC-CHD model) [3] and Cox regression analysis were used to predict cardiovascular (CV) and non-CV mortality risk during 10 years of follow-up. Results We included 1130 patients from KAROLA-I (mean age 58.7 years, 84.4% men) and 860 from KAROLA-II (mean age 60.4 years, 83.4% men). Patients in the KAROLA-I cohort had significantly higher concentrations of CV biomarkers and fewer patients were taking CV medications, except for statins. The ABC-CHD model which also included age, current smoking, history of diabetes, peripheral arterial disease, as well as hs-cTNT, NT-proBNP, and LDL-cholesterol provided a higher estimate of CV death risk for patients in the KAROLA-I cohort (mean 3-year risk, 3.8%) than for patients in the KAROLA-II cohort (mean 3-year risk, 2.7%, p for difference <0.001). After 10 years of follow-up, 91 (8.1%) patients in KAROLA-I and 45 (5.2%) in KAROLA-II had died from a CV event. Non-CV mortality was quite similar among the two cohorts. Notably, when statin medication upon discharge was included as an exposure variable in the Cox model that included age, sex, biomarkers, and clinical variables for the combined analysis with both cohorts, the HR for CV mortality was 0.54 (95% CI 0.31-0.93) in patients taking high-potency statins compared with patients not on statin medication. Conclusions Advances in disease management including pharmacological treatment over the past 20 years may have led to modest improvement of long-term prognosis of patients with CCS.

Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data

ObjectiveThe FOURIER trial showed a benefit of the PCSK9 inhibitor evolocumab over placebo with respect to cardiovascular outcomes in patients with cardiovascular disease. However, we observed some inconsistencies between the...

The renin-angiotensin-aldosterone system, neurohumoral axis and cardiovascular mortality in LURIC.

Although neurohormones and Renin-Angiotensin-Aldosterone-System (RAAS) components are important predictors of cardiovascular mortality (CVM), their importance for predicting outcomes in patients with/without RAAS-blockers and different degrees of arterial stiffness is less understood. We therefore analyzed long-term data from the Ludwigshafen Risk and Cardiovascular Health (LURIC) study in 3316 patients subdivided according to pulse pressure (PP) and RAAS-blocker use. Patients on RAAS-inhibition had higher renin and noradrenaline, lower aldosterone and aldosterone/renin quotient (ARQ). Renin and noradrenaline significantly predicted CVM in patients without RAAS-blocker (HR=1.17, 1.15) and in patients receiving angiotensin-converting-enzyme (ACE) inhibitors (HR=1.17, 1.29), whereas aldosterone predicted CVM only in patients receiving ACE-inhibitors (HR=1.13). CVM was predicted independently from PP by renin, noradrenaline and angiotensin II. Independently from RAAS inhibition renin decreased and ARQs increased with rising PP. Furthermore, noradrenaline increased with PP, but only without ACE-inhibition. The HR for CVM in the ACE-inhibitor group were 1.29, 1.28, 1.29 for renin in the first, second and third PP quartiles and 1.22, and 1.19 for aldosterone in the second and fourth quartile. Furthermore, we showed that noradrenaline predicts CVM in all PP quartiles in patients with ACE-inhibition. In the RAAS-blocker-free group, the HR for renin for CVM were 1.36 and 1.18 in the third and fourth PP quartiles, but neither aldosterone nor noradrenaline were predictive for CVM within the PP quartiles. Renin and noradrenaline are strong predictors of CVM regardless of RAAS blockade, whereas aldosterone is predictive only in the ACE-inhibitor group. Catecholamines but not renin are associated with rising PP.

Abstract 14405: Impact of Educational Attainment on All-Cause and Cardiovascular Mortality: Findings From a National Study of US Adults

Introduction: Education is an important determinant of cardiovascular disease (CVD). However, the extent to which educational attainment impacts the risk of all-cause and cardiovascular (CV) mortality on a population level is relatively understudied. Methods: We used data from 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated age-adjusted mortality rates (AAMR) by levels of education (< High School (HS), HS/General Education Development (GED), Some College, and > College) in adults with and without CVD. Cox proportional hazards models were used to examine the association between educational attainment and all-cause and CV mortality. Results: Final sample comprised of 256,991 participants (mean age=46.3), representing ~230 million adults annually, of which 8% had ASCVD. Overall, 14.8% of participants had <HS education and 27.3%, 19.9% and 38.0% had HS/GED, Some College, and > College education, respectively. During a median follow-up of 4.5 (IQR: 2.5-6.8) years (1179 million person-years), all-cause and CV AAMRs were approximately 1.5 and 2 fold higher, respectively, for <HS vs. >College education in the CVD population and 2 fold higher in the non-CVD population ( Figure 1 ). In fully adjusted models, < HS (reference= >College) was associated with 20% increased risk of all-cause (HR 1.20, 95% CI: 1.07-1.35) and 40% increased risk of CV mortality (HR 1.41, 95% CI: 1.10-1.81) in the CVD population, compared to 40-45% increased risk of mortality in the non-CVD population (all-cause mortality HR 1.39, 95% CI: 1.29-1.49; CV mortality HR 1.45, 95% CI: 1.20-1.75). Similar trends were seen by race/ethnicity (data not shown). Conclusions: Lower education is an independent predictor of all-cause and CV mortality in both CVD and non-CVD populations. Efforts for integration of educational attainment into existing CV risk prediction algorithms are needed to mitigate observed socioeconomic disparities in mortality.

Nighttime ambulatory pulse pressure predicts cardiovascular and all-cause mortality among middle-aged participants in the 21-year follow-up.

Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long‐term risk factor in a random cohort of middle‐aged participants. The Opera study took place in years 1991–1993, with a 24‐h ambulatory blood pressure measurement (ABPM) performed to 900 participants. The end‐points were non‐fatal and fatal CV events, and deaths of all‐causes. Follow‐up period, until the first event or until the end of the year 2014, was 21.1 years (mean). Of 900 participants, 22.6% died (29.6% of men/15.6% of women, p<.001). A CV event was experienced by 208 participants (23.1%), 68.3% of them were male (p<.001). High nighttime ambulatory PP predicted independently CV mortality (hazard ratio [HR] 2.60; 95% confidence interval [CI 95%] 1.08–6.31, p=.034) and all‐cause mortality in the whole population (HR 1.72; Cl 95% 1.06–2.78, p=.028). In males, both 24‐h PP and nighttime PP associated with CV mortality and all‐cause mortality (24‐h PP HR for CV mortality 2.98; CI 95% 1.11–8.04, p=.031 and all‐cause mortality HR 2.40; CI 95% 1.32–4.37, p=.004). Accordingly, nighttime PP; HR for CV mortality 3.13; CI 95% 1.14–8.56, p=.026, and for all‐cause mortality HR 2.26; CI 95% 1.29–3.96, p=.004. Cox regression analyses were adjusted by sex, CV risk factors, and appropriate ambulatory mean systolic BP. In our study, high ambulatory nighttime PP was detected as a long‐term risk factor for CV and all‐cause mortality in middle‐aged individuals.

Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women

BackgroundThis study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women.MethodsBaseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n = 524). Mortality data were analyzed until 2012 through Swedish national registers.ResultsPerceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78–2.96; all-cause HR 1.32, 95% CI 0.77–2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14–4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04–5.65).ConclusionsLoneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

Serum uromodulin and risk for cardiovascular morbidity and mortality in the community-based KORA F4 study

Background and aimsSerum uromodulin, a novel biomarker of kidney function and tubular integrity, has been linked to cardiovascular events and total mortality in patients at high cardiovascular risk. Here, we analyze the association of serum uromodulin with cardiovascular morbidity and cardiovascular as well as total mortality in the population-based KORA F4 study stratified by sex. MethodsBaseline serum uromodulin was measured in 1079 participants of the KORA F4 study (age 62–81 years). Using multivariable adjusted Cox proportional hazards models, the associations of serum uromodulin with total mortality and cardiovascular mortality were analyzed after a median follow-up period of 8.6 years, and with non-fatal and fatal stroke and myocardial infarction/coronary death after a median follow-up time of 8.4 years. ResultsSerum uromodulin was significantly inversely associated with total mortality (HR 0.65; 95% CI 0.53–0.79 per standard deviation of logarithmized serum uromodulin; p < 0.001) and cardiovascular mortality (HR 0.70; 95% CI 0.52–0.93) in men, but not in women (HR for all-cause mortality in women 0.98; 95% CI 0.77–1.25, HR for cardiovascular mortality 0.78; 95% CI 0.56–1.11) after adjustment for age, BMI, diabetes and eGFR. In addition, serum uromodulin was significantly inversely associated with incident stroke in men (HR 0.68; 95% CI 0.50–0.92), but not in women (HR 0.96; 95% CI 0.68–1.38) after multivariable adjustment. The association of serum uromodulin with incident myocardial infarction was attenuated and lost significance after multivariable adjustment in both sexes. ConclusionsSerum uromodulin is an independent biomarker for total and cardiovascular mortality in men from the general community aged 62 years or older.

Abstract 132: Predictive Value of Inflammation Markers With Stroke Recurrence and Cardiovascular Mortality

Background: Inflammation markers are associated with the risk of cardiovascular events, however, the relationships of inflammation markers with risk of post-stroke remain controversial. Objects: To investigated association of two clinical recorded inflammation markers, white blood cell count (WBC) and platelet count (PLTC) with first-onset stroke and long-term prognosis of stroke. Methods: A Chinese case-control study was conducted, comprising 2002 stroke cased (885 atherothrombosis, 565 lacunar stroke, 552 hemorrhagic stroke) and 1996 controls. Stroke patients were prospectively followed-up for a median of 4.5 years (range, 0.1-6.0). Results: The WBC and PLTS were higher in stroke patients than controls, however, the ratio of PLTS to WBC was lower in stroke patients than controls. During the follow-up, 369 recurrent strokes and 343 cardiovascular mortality were documented. Adjusted for cardiovascular disease, the increased ration of PLTC to WBC was negatively correlated with stroke recurrence (HR, 0.60, 95%CI 0.44 to 0.81, P =0.001), with no associations for PLTC and WBC. Compared with stroke patients with WBC in the first quartile (2.1-5.6х10 9 /L) , subjects in the fourth quartile (7.8-19.8х10 9 /L) had 2.10-fold risk for cardiovascular mortality (hazard ration [HR],2.10, 95% confidence interval [CI], 1.20 to 2.48, P =0.004), with no associations for PLTC. However, the increased ratio of PLTC to WBC decreased risk of cardiovascular mortality HR was 0.61 in the second quartile (2.09-17.60х10 9 /L), HR was 0.58 in the third quartile (17.61-24.04х10 9 /L) and HR was 0.48 in the fourth quartile (24.05-34.54х10 9 /L) (all P &lt;0.01). Conclusion: Higher WBC and PLTC are associated with poorer prognosis of stroke, and the ration of WBC to PLTC improved the predictive value for cardiovascular mortality and stroke recurrence.

MON-111 Effect of the dialysate calcium concentration and of the mineral bone disease therapies on mortality in the REIN registry

The different chemical elements of the dialysate could influence survival and calcium especially modifies the mineral and bone metabolism and the vascular calcification rate. Having garnered both the dialysate calcium concentration and the mineral bone disease (MBD) therapies, we studied the influence of these prescriptions on survival. Data from the national Renal Epidemiology Information Network registry were extracted for all the subjects having started hemodialysis from 2010 to 2013. Their exposure to the different dialysate calcium concentrations was established by center and classified by tertiles of the percentage of use of calcium <1.5mmol/l and >1.5mmol/L., updated yearly. Drug therapies involved in the MBD metabolism were extracted at the patient level from the SNIIRAM (Service National d'Information Inter régime de l'Assurance Maladie) and converted in a daily dose updated monthly. Cox survival analysis was performed on 25,629 incident patients being alive after 3 months of dialysis, adjusted for 14 baseline co-morbidities, biological data, 4 technical data and the acid of the dialysate and accounting for patient clustering within facilities. Dialysate exposure and MBD therapies were analyzed as time-dependent variables. Analysis was censored at Dec 31, 2014, or at kidney transplantation, loss to follow-up, dialysis weaning and transfer to peritoneal dialysis or home hemodialysis. The 1.5 mmol/L dialysate calcium concentration was the main dialysate in 81% of the dialysis centers in 2010 to 83% in 2014 followed by the >1.5mmol/L used as the main dialysate in 19% of the centers in 2010 to 14% in 2014. Most centers were using several formulas in up to 78% for 3 formulas in 2010 to 86% in 2014. The dialysate calcium <1.5mmol/L was scarcely used at a median level of 2.5% by center in 2010 to 4.4% in 2014. In full adjusted Cox survival analyses, all-cause mortality HRs of dialysate calcium >1.5 mmol/L and <1.5mmol/l by tertile of use by center were not associated with survival. The number of formula used by center was also not significantly associated with survival. Sole the cardiovascular mortality HR of the use of dialysate calcium >1.5mmol/L in all tertiles was significantly lowered to about 0.75 [0.57;0.91] compared to no use. The MBD therapies were broadly associated with survival improvement for calcium, native vitamine D, active vitamine D, sevelamer, lanthanum and cinacalcet and depending of the daily dose used. No influence of the dialysate calcium concentration was evidenced on survival whereas all MBD therapies were associated with a survival improvement depending on the daily dose used. More information towards HD subjects is needed.

Multiple risk factor control, mortality and cardiovascular events in type 2 diabetes and chronic kidney disease: a population-based cohort study

ObjectivesThis study aimed to evaluate the effectiveness of multiple risk factor control (MRFC) at reducing mortality and cardiovascular events in diabetes and chronic kidney disease (CKD) in clinical practice.DesignPopulation-based cohort...

Impact of Late Gadolinium Enhancement on mortality, sudden death and major adverse cardiovascular events in ischemic and nonischemic cardiomyopathy: A systematic review and meta-analysis

BackgroundThe central role of left ventricular ejection fraction (LVEF) as the definitive risk marker of adverse outcomes in ischemic and nonischemic cardiomyopathy is increasingly uncertain. The current study aimed to conduct a systematic review and meta-analysis with the objective of evaluating the prognostic importance of Late Gadolinium Enhancement (LGE) in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) on the key endpoints of all-cause mortality, cardiovascular mortality and sudden death. MethodsThe study was prospectively registered in PROPSERO (CRD 42016039034). Electronic databases and reference lists were searched for studies evaluating the impact of LGE-CMR on all-cause mortality, cardiovascular mortality, ventricular arrhythmia or sudden death, or major adverse cardiovascular events. Data were extracted from 36 studies including n=7882 patients. ResultsLGE was strongly associated with all-cause mortality HR 2.96 (95%CI: 2.37, 3.70, P<0.001), cardiovascular mortality HR 3.27 (95% CI: 2.05, 5.22, P<0.001), ventricular arrhythmia and sudden cardiac death HR 3.76 (95% CI: 3.14, 4.52, P<0.001), and major adverse cardiovascular events HR 3.24 (95% CI: 2.32, 4.52, P<0.001). In subgroup analyses, LGE was associated with all-cause mortality and cardiovascular mortality in both LVEF≤35% and LVEF>35% patients (P<0.001 all endpoints), as well as in nonischemic and ischemic cardiomyopathy. ConclusionLate Gadolinium Enhancement (LGE) in CMR predicts all-cause mortality, cardiovascular mortality, ventricular arrhythmia and sudden death, and major adverse cardiovascular events, independent of LVEF. Future trials of investigational therapies in NICM and ICM should consider the utilization of LGE to identify patients at risk of adverse outcomes.

Hepatitis C and Its Metabolic Complications in Kidney Disease

IntroductionEvidence has been accumulated during the last decade showing that HCV infection plays an important activity at hepatic and extra-hepatic level. Chronic HCV is associated with a large spectrum of extra-hepatic manifestations including lympho-pro-liferative diseases and metabolic abnormalities (such as insulin resistance and fatty liver disease). Material and methodsWe have performed an extensive review of the medical literature regarding the increased risk of cardiovascular and kidney disease that has been observed in various groups of HCV-infected patients. The potential link between such increased risk and the metabolic consequences of chronic HCV infection has been explored. ResultsAccording to a systematic review with a meta-analysis of longitudinal studies (n = 9 clinical observational studies; n = 1,947,034 unique patients), we found a strong relationship between positive anti-HCV serologic status and increased incidence of chronic kidney disease in the adult general population, the summary estimate for adjusted hazard ratio was 1.43 (95% confidence intervals, 1.23; 1.63, P = 0.0001) (random-effects model) in anti-HCV positive patients. In another meta-analysis of clinical observational studies (n = 145,608 unique patients on long term dialysis; n = 14 observational studies), anti-HCV sero-positive status was an independent and significant risk factor for death in patients on maintenance dialysis. The summary estimate for adjusted relative risk (all-cause mortality) was 1.35 with a 95% confidence interval (CI) of 1.25; 1.47 (P < 0.01) in anti-HCV positive patients on maintenance dialysis. An updated and stratified analysis (n = 4 studies, n = 91,916 patients on maintenance dialysis) resulted in an adjusted HR for cardiovascular mortality among anti-HCV positive patients of 1.21 (95% CI, 1.06; 1.39) (P < 0.01); the homogeneity assumption was not rejected. The mechanisms underlying such relationships remain unclear; it has been suggested that HCV promotes atherogenesis through direct and indirect mechanisms. ConclusionsClinical trials are under way to assess whether the clearance of HCV RNA from serum by direct-acting antiviral drugs reduces all-cause or disease-specific (cardiovascular) mortality among patients on maintenance dialysis.

Hemodiafiltration Reduces All-Cause and Cardiovascular Mortality in Incident Hemodialysis Patients: A Propensity-Matched Cohort Study

Background: The majority of studies suggesting that online hemodiafiltration reduces the risk of mortality compared to hemodialysis (HD) have been performed in dialysis-prevalent populations. In this report, we conducted an epidemiologic study of mortality in incident dialysis patients, comparing post-dilution online hemodiafiltration and high-flux HD, with propensity score matching (PSM) used to correct indication bias. Methods: Our study cohort comprised 3,075 incident dialysis patients treated in 64 Spanish Fresenius Medical Care clinics between January 2009 and December 2012. The primary outcome of this study was to investigate the impact of the type of renal replacement on all-cause mortality. An analysis of cardiovascular mortality was defined as the secondary outcome. To achieve these objectives, patients were followed until December 2016. Patients were categorized as high-flux HD patients if they underwent this treatment exclusively. If >90% of their treatment was with online hemodiafiltration, then the patient was grouped to that modality. Results: After PSM, a total of 1,012 patients were matched. Compared with patients on high-flux HD, those on online hemodiafiltration received a median replacement volume of 23.45 (interquartile range 21.27–25.51) L/session and manifested 24 and 33% reductions in all-cause and cardiovascular mortality (all-cause mortality hazards ratio [HR] 0.76, 95% CI 0.62–0.94 [p = 0.01]; and cardiovascular mortality HR 0.67, 95% CI 0.50–0.90 [p = 0.008]). Conclusions: This study shows that post-dilution online hemodiafiltration reduces all-cause and cardiovascular mortality compared to high-flux HD in an incident HD population.

Left ventricular longitudinal systolic function analysed by 2D speckle-tracking echocardiography in heart failure with preserved ejection fraction: a meta-analysis

BackgroundThe purpose of this meta-analysis was to confirm if the global longitudinal systolic function of the left ventricle (LV) is altered in patients with heart failure with preserved ejection fraction...

Rheumatoid factor positivity increases all-cause and cancer mortality: a cohort study.

The aim of this study was to determine whether rheumatoid factor (RF) is associated with mortality from all-cause, cardiovascular disease (CVD), and cancer in the healthy adults. We recruited South Korean health check-up examinees without rheumatoid arthritis (RA). A cohort study was performed in 295,837 participants presumably free of osteoarthritis or RA, and who had undergone health screening between 2002 and 2012 and been followed up to determine the risk of all-cause, CVD, and cancer-specific mortality with respect to the presence or titer of RF. To determine whether the participants were deceased, we used National Death Index death certificates. The prevalence of RF positivity (≥20IU/mL) was 4.4%. During 1,447,403 person-years of follow-up, 1402 participants died. Comparing subjects negative for RF with those positive for RF, the multivariable adjusted hazard ratio (HR; 95% CI) for all-cause and cancer mortality in subjects with RF-positivity was 1.50 (1.19-1.90) and 1.56 (1.12-2.16), respectively. Also, all-cause and cancer mortality risk was significantly greater in subjects with an RF titer greater than 100IU/mL than in those with RF-negativity (HR=2.68, 95% CI=1.72-4.19; HR=2.89, 95% CI=1.58-5.28, respectively) after adjusting for multiple confounders. However, the HR for cardiovascular mortality was not higher in subjects with RF positivity than in those with RF negativity (HR=0.98, 95% CI=0.45-2.11). In Korean healthy adults, presumably without RA, RF was associated with a greater risk of all-cause and cancer mortality.

Defining thresholds for home blood pressure monitoring in octogenarians.

To generate outcome-driven thresholds for home blood pressure (BP) in the elderly, we analyzed 375 octogenarians (60.3% women; 83.0 years [mean]) enrolled in the International Database on home BP in relation to cardiovascular outcome. Over 5.5 years (median), 155 participants died, 76 from cardiovascular causes, whereas 104, 55, 36, and 51 experienced a cardiovascular, cardiac, coronary, or cerebrovascular event, respectively. In 202 untreated participants, home diastolic in the lowest fifth of the distribution (≤65.1 mm Hg) compared with the multivariable-adjusted average risk was associated with increased risk of cardiovascular mortality and morbidity (hazard ratios [HRs], ≥1.96; P≤0.022), whereas the HR for cardiovascular mortality in the top fifth (≥82.0 mm Hg) was 0.37 (P=0.034). Among 173 participants treated for hypertension, the HR for total mortality in the lowest fifth of systolic home BP (<126.9 mm Hg) was 2.09 (P=0.020). In further analyses of home BP as continuous variable (per 1-SD increment), higher diastolic BP predicted lower cardiovascular mortality and morbidity and cardiac and coronary risk (HR≤0.65; P≤0.039) in untreated participants. In those treated, cardiovascular morbidity was curvilinearly associated with systolic home BP with nadir at 148.6 mm Hg and with a 1.45 HR (P=0.046) for a 1-SD decrease below this threshold. In conclusion, in untreated octogenarians, systolic home BP ≥152.4 and diastolic BP ≤65.1 mm Hg entails increased cardiovascular risk, whereas diastolic home BP ≥82 mm Hg minimizes risk. In those treated, systolic home BP <126.9 mm Hg was associated with increased total mortality with lowest risk at 148.6 mm Hg.

Prognostic impact of ß-blocker use in patients with stable coronary artery disease

ObjectiveTo assess the association of ß-blocker use with cardiovascular mortality in patients with stable coronary artery disease (CAD).MethodsWe analysed the data of 4184 outpatients included in a prospective cohort study...

P228 Impact of long-acting bronchodilator therapy on mortality in copd: a real-life retrospective cohort study

Introduction and ObjectivesLong-acting muscarinic antagonists (LAMA) and long-acting beta-agonists (LABA) are first-line treatments for COPD. The addition of inhaled corticosteroids (ICS) is recommended for patients with frequent exacerbations who are...

S27 Cardiovascular events following Clarithromycin use in lower respiratory tract infections: analysis of two prospective cohort studies

BackgroundPrevious studies have suggested that use of macrolide antibiotics may increase cardiovascular risk.ObjectiveTo study the effects of clarithromycin on cardiovascular events in the setting of acute exacerbations of chronic obstructive...