HRs For All-cause Mortality Research Articles

Systolic Blood Pressure, Cardiovascular Mortality, and All-Cause Mortality in Normoglycemia, Prediabetes, and Diabetes.

BackgroundThe optimal blood pressure (BP) level for diabetic patients remains controversial, while studies provided limited evidence on BP management for individuals with normoglycemia or prediabetes. We aimed to investigate the associations between systolic blood pressure (SBP) and all-cause and cardiovascular (CVD) mortality among US adults with different glycemic profiles.MethodsWe used data from the 1999–2014 National Health and Nutrition Examination Survey (NHANES, n=40,046) with comprehensive baseline examination and follow-up assessment. Restricted cubic spline analysis was performed to examine dose–response relationship between SBP and mortality risk. Cox regression models were used to estimate hazard ratios of all-cause mortality and CVD mortality for SBP categories.ResultsU-shaped associations between SBP and all-cause mortality were observed regardless of glucose status. The relationship between SBP and CVD mortality was found to be U-shaped only in normoglycemic participants. The lowest mortality risk of optimal SBP (mmHg) by group was 115–120 (normoglycemia), 120–130 (prediabetes), and 125–135 (diabetes). When compared with the reference group, SBP < 100 mmHg was significantly associated with 49% (HR=1.49, 95% CI: 1.13–1.96), 57% (1.57, 1.07–2.3), and 59% (1.59, 1.12–2.25) higher all-cause mortality risk in people with normoglycemia, prediabetes, and diabetes, respectively. The multivariable-adjusted HRs of all-cause mortality for SBP ≥150 mmHg were 1.51 (1.25–1.82), 1.56 (1.27–1.93), and 1.33 (1.08–1.64), respectively. As for CVD mortality, the multivariable-adjusted HRs were 2.85 (1.29–6.33) for SBP <100 mmHg and 2.71 (1.56–4.69) for SBP ≥150 mmHg in normoglycemia; HR was 1.66 (1.05–2.63) for SBP ≥150 mmHg in diabetic patients.ConclusionU-shaped relationships between SBP and all-cause mortality were observed regardless of diabetes status. The optimal SBP range was gradually higher with worsening glucose status.

Chocolate Consumption in Relation to All-Cause and Cause-Specific Mortality in Women: The Women’s Health Initiative

Abstract Objectives To examine the association of chocolate consumption with all-cause and cause-specific mortality. Methods We included 84,709 postmenopausal women free of cardiovascular disease (CVD) and cancer at baseline in the prospective Women's Health Initiative cohort who were enrolled during 1993–1998. Chocolate consumption was assessed using a validated food frequency questionnaire. These women were followed through March 2018. Results During 1608,856 person-years of follow up (19.0 years on average [SD = 4.2]), 25,388 deaths occurred, including 7069 deaths from CVD, 7030 deaths from cancer, and 3279 deaths from dementia. After adjustment for a variety of covariates, compared to no chocolate consumption, the HRs (95% CIs) for all-cause mortality were 0.95 (0.92, 0.98), 0.93 (0.89, 0.96), 0.97 (0.90, 1.04) and 0.90 (0.84, 0.97) for &amp;lt;1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.02). For CVD mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.96 (0.91, 1.01), 0.88 (0.82, 0.95), 0.96 (0.93, 1.12) and 0.92 (0.80, 1.05) for &amp;lt;1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.45). For dementia mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.91 (0.84, 0.99), 0.89 (0.80, 0.99), 0.97 (0.79, 1.18) and 0.97 (0.80, 1.08) for &amp;lt;1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.95). Chocolate consumption was not associated with cancer mortality. Conclusions Our results suggested modest inverse association of chocolate consumption with mortality from all-causes, CVD or dementia, specifically for a moderate chocolate consumption of ≤3 servings/week. Funding Sources None.

Association of mean arterial pressure with all-cause and cardiovascular mortality in young adults

BackgroundMean arterial pressure (MAP) is a predictor of all-cause and cardiovascular disease (CVD) mortality in middle-aged population and elderly, but less evidence has been shown in young adults.ObjectivesWe examined the...

Associations of egg consumption with incident cardiovascular disease and all-cause mortality.

Eggs are nutrient-dense while also loaded with abundant cholesterol, thus making the public hesitant about their consumption. We conducted the study to investigate if egg consumption is associated with incident cardiovascular disease (CVD) and all-cause mortality. Using the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China, we included 102,136 adults free of CVD and assessed their egg consumption with food-frequency questionnaires. CVD endpoints and all-cause mortality were confirmed during follow-ups by interviewing participants or their proxies and checking hospital records/death certificates. The HRs (95% CIs) were calculated using the cohort-stratified Cox regression models. During 777,163 person-years of follow-up, we identified 4,848 incident CVD and 5,511 deaths. U-shaped associations of egg consumption with incident CVD and all-cause mortality were observed. Compared with consumption of 3-<6/week, the multivariable-adjusted HRs (95% CIs) of <1/week and ≥10/week for incident CVD were 1.22 (1.11 to 1.35) and 1.39 (1.28 to 1.52), respectively. The corresponding HRs (95% CIs) for all-cause mortality were 1.29 (1.18 to 1.41) and 1.13 (1.04 to 1.24). Our findings identified that both low and high consumption were associated with increased risk of incident CVD and all-cause mortality, highlighting that moderate egg consumption of 3-<6/week should be recommended for CVD prevention in China.

Other- and all-cause Mortality among women with breast cancer

BackgroundAdvances in early detection and treatment of breast cancer (BrCA) have led to better survival. Consequently, more women with BrCA now die from non-BrCA causes. We investigated all-cause and other-cause (non-BrCA) survival among women with BrCA. MethodsFrom the Prostate, Lung, Colorectal and Ovarian (PCLO) cohort, we selected women diagnosed with BrCA from 1994-2014. To compare survival of cases to non-cases, we used exposure density sampling. We computed standard mortality ratios (SMRs) and performed Cox proportional hazards models with matched case-control sets, controlling for demographics (Model I) and additional covariates (Model II). We also examined survival by stage within BrCA cases. ResultsAmong 78,215 women enrolled in PLCO, there were 1211 in-situ and 4790 invasive BrCA cases. 15-year survival rates were 97.1 % (BrCA-specific) and 77.2 % (other-cause) among in-situ and 86.4 % (BrCA-specific) and 73.4 % (other-cause) among invasive cases. For other-cause mortality, in-situ cases had lower risk in models I (HR = 0.74; 95 % CI:0.62-0.89) and II (HR = 0.75; 95 % CI:0.62-0.92) versus controls. All-cause mortality HRs for in-situ cases were 0.83 (95 % CI:0.70-0.99) and 0.85 (95 % CI:0.70–1.02) in Models I and II, respectively. Other-cause mortality was similar among invasive cases and controls. Within BrCA cases, higher stage was associated with increased other-cause mortality; HRs were 1.2 (95 % CI:1.1–1.5) and 1.7 (95 % CI:1.2–2.3) for stage II and III/IV versus stage I (Model II). DiscussionMortality from other causes exceeded that of BrCA in both in-situ and invasive cases, highlighting the importance of managing patients’ chronic conditions during and following cancer treatment.

Exploring the Possible Impact of Unbalanced Open-Label Drop-In of Glucose-Lowering Medications on EXSCEL Outcomes.

EXSCEL (Exenatide Study of Cardiovascular Event Lowering) assessed the impact of once-weekly exenatide 2 mg versus placebo in patients with type 2 diabetes mellitus, while aiming for glycemic equipoise. Consequently, greater drop-in of open-label glucose-lowering medications occurred in the placebo group. Accordingly, we explored the potential effects of their unbalanced use on major adverse cardiovascular events (MACE), defined as cardiovascular death, nonfatal myocardial infarction or nonfatal stroke, and all-cause mortality (ACM), given that some of these agents are cardioprotective. Cox hazard models were performed by randomized treatment for drug classes where >5% open-label drop-in glucose-lowering medication occurred, and for glucagon-like peptide-1 receptor agonists (GLP-1 RAs; 3.0%) using three methodologies: drop-in visit right censoring, inverse probability for treatment weighting (IPTW), and applying drug class risk reductions. Baseline glucose-lowering medications for the 14 752 EXSCEL participants (73.1% with previous cardiovascular disease) did not differ between treatment groups. During median 3.2 years follow-up, open-label drop-in occurred in 33.4% of participants, more frequently with placebo than exenatide (38.1% versus 28.8%), with metformin (6.1% versus 4.9%), sulfonylurea (8.7% versus 6.9%), dipeptidyl peptidase-4 inhibitors (10.6% versus 7.5%), SGLT-2i (10.3% versus 8.1%), GLP-1 RA (3.4% versus 2.4%), and insulin (13.8% versus 9.4%). The MACE effect size was not altered meaningfully by right censoring, but the favorable HR for exenatide became nominally significant in the sulfonylurea and any glucose-lowering medication groups, while the ACM HR and p-values were essentially unchanged. IPTW decreased the MACE HR from 0.91 (P=0.061) to 0.85 (P=0.008) and the ACM HR from 0.86 (P=0.016) to 0.81 (P=0.012). Application of literature-derived risk reductions showed no meaningful changes in MACE or ACM HRs or P values, although simulations of substantially greater use of drop-in cardioprotective glucose-lowering agents demonstrated blunting of signal detection. EXSCEL-observed HRs for MACE and ACM remained robust after right censoring or application of literature-derived risk reductions, but the exenatide versus placebo MACE effect size and statistical significance were increased by IPTW. Effects of open-label drop-in cardioprotective medications need to be considered carefully when designing, conducting, and analyzing cardiovascular outcome trials of glucose-lowering agents under the premise of glycemic equipoise. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01144338.

Abstract WMP115: Hemorrhagic and Ischemic Stroke in Patients on Oral Anticoagulants for Nonvalvular Atrial Fibrillation With and Without Antiplatelet Therapy

Introduction: Antiplatelet (APT) therapy is challenging in patients on oral anticoagulants (OACs) for nonvalvular atrial fibrillation (NVAF) who have coronary artery diseases (CAD). Analyzing large scale registry of consecutive patients with NVAF should provide further guide for the safety and efficacy of combination therapy. Methods: We conducted historical multicenter registry at 71 centers in Japan between March 2017 and March 2018. The eligibility criteria were patients on OACs for NVAF on February 2013. There were no exclusion criteria and consecutive patients who met the eligibility criteria were registered. All patients were followed until March 2017. Co-primary endpoints were ischemic strokes including transient ischemic attack and hemorrhagic stroke including subarachnoid hemorrhage. The secondary endpoints were all-cause mortality, ischemic events (acute coronary syndrome, ischemic strokes, or systemic embolism), and major bleedings defined by ISTH and TIMI criteria. We estimated HRs of OACs and APT combination relative to OACs alone by Cox proportional hazard model adjusting for clinically relevant confounders. Results: Median age was 74 (range 20-101) years of 7826 registered patients. Sustained NVAF accounted for 49% and 73% of patients had history of CAD. Cumulative incidences of ischemic stroke and hemorrhagic stroke at 4 years were 3.8% and 0.91% in No-APT group while 5.3% and 1.2% in APT group, respectively (Figure). Adjusted HRs (95%CI) of APT group for ischemic stroke and hemorrhagic stroke were 1.03 (0.76-1.40) and 1.27 (0.67-2.4), respectively. Adjusted HRs (95%CI) for all-cause mortality, ischemic events, and major bleedings were 0.98 (0.79-1.23), 0.98 (0.74-1.32), and 1.25 (1.00-1.57), respectively. Conclusions: Adding APT in patients on AOC for NVAF did not decrease ischemic strokes and not increase hemorrhagic strokes. Because combination therapy might increase the risk of major bleedings, OAC alone should be prioritized.

Is Cohort Study Representativeness &lt;i&gt;Passé&lt;/i&gt;?&amp;nbsp; Matching the UK Biobank Sample to Target Population Characteristics and Recalculating the Associations between Lifestyle Risk Factors and Mortality

Background: The UK Biobank (UKB) has been used widely to examine the associations between lifestyle risk factors (LRF) and mortality outcomes. It is unknown if the extremely low UKB response rate (5·5%) and lack of representativeness materially affects the magnitude and direction of observed associations. Methods: We used post-stratification to match the UKB sample to the target population in terms of age, sex, education, and prevalence of LRFs (physical inactivity, alcohol intake, smoking, fruit and vegetable intake, and obesity). We compared unweighted and post-stratified associations between each LRF and tertiles of a lifestyle index score with all-cause, CVD, and cancer mortality. We also calculated the unweighted/post-stratified ratio of hazard ratios and 95%CI (RHR) as a marker of statistically significant effect sizes difference. Findings: Out of 371,974 UKB participants with no missing data, 302,009 had no history of CVD or cancer, corresponding to 2,345142 person years of follow-up. The protective associations between alcohol use and CVD mortality observed in the unweighted UKB were attenuated to the null after post-stratification, e.g. from an HR of 0·63 (0·45 to 0·87) unweighted to 0·99 (0·65 to 1·50) post-stratified for drinking ≥5 times/week compared to never drinker. The post-stratified all-cause mortality HRs were consistently lower than the unweighted estimates across obesity groups. The magnitude of the post-stratified all-cause mortality HR comparing the least healthy with the healthiest tertiles of the lifestyle risk factor index was 9% higher (95%CI: 2% to 18%) than the unweighted estimates. Interpretation: Lack of representativeness may lead to spurious cardio-protective associations of alcohol; may under-estimate health hazards among those with the least healthy lifestyles; and may exaggerate the risks of BMI-defined obesity. Funding Statement: This study did not receive specific funding. Declaration of Interests: None of the authors reported a conflict of interest related to this study. Ethics Approval Statement: All participants consented to the use of their de-identified data, including access to their health-related records, for research.

Predictive Validity of Each Item of the 8-Item Short-Form Health Survey for All-Cause Mortality in Japanese patients with type 2 diabetes: A prospective Cohort Study (Diabetes Distress and Care Registry at Tenri [DDCRT 19]).

While health-related quality of life (HRQOL) is reported to be associated with mortality, this assessment was made using surveys with a large number of questions, not specifically focused on populations with diabetes, or in western countries alone. We thus evaluated the predictive validity of summary scores, and each item score of the 8-Item Short-Form Health Survey in Japanese individuals with type-2 diabetes. Longitudinal data from 3269 individuals with diabetes were obtained from a large Japanese diabetes registry. To assess the independent correlation between the 10-point scores of the SF-8 physical component summary (PCS) and mental component summary (MCS), each item score, and all-cause mortality, the Cox proportional hazards model was used with adjustment for potential confounders. Mean cohort parameters included age (64.9 years [SD 11.2]), body mass index (24.6 kg/m2 [SD, 3.9]), and HbA1c level (7.5% [SD, 1.2]; or 58.6 mmol/mol [SD, 12.7]). We recorded 248 deaths during the median follow-up of 7.2 years (incidence ratio, 12.2 per 1000 person-years). Multivariable-adjusted HRs for all-cause mortality were 0.780 (95%CI, 0.674-0.902; p=0.001) and 0.776 (95%CI, 0.656-0.917; p=0.003), respectively, for 10-point increment of PCS and MCS scores. Higher score of any single item of SF-8 was associated with lower risk of all-cause mortality even after adjusting for possible confounders. As assessed by the SF-8, higher PCS, MCS, and any single 1-item scores were associated with lower risk of all-cause mortality in Japanese individuals with type 2 diabetes.

Higher Dietary Non-enzymatic Antioxidant Capacity Is Associated with Decreased Risk of All-Cause and Cardiovascular Disease Mortality in Japanese Adults

Few studies have assessed associations of non-enzymatic antioxidant capacity (NEAC) in the overall diet with all-cause or specific mortality, and their results have been inconsistent. The present study investigated the association between dietary NEAC and all-cause or cause-specific mortality. The study was a large-scale population-based prospective cohort study in Japan consisting of 42,520 men and 50,207 women aged 44-76 y, who had no history of cancer, stroke, ischemic heart disease, or chronic liver disease. We evaluated FFQ-based dietary NEAC with use of published databases in which the NEACs of individual foods were analyzed by ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) assays. Dietary NEAC was calculated by multiplying the estimated NEAC with the consumed amount and summing up those values for all foods, and was categorized in quartiles. We identified death and cause of death with use of residential registry and death certificates. HRs and 95% Cls for death from the second survey, which was conducted from April 1995 to December 2014 were estimated with Cox proportional hazards regression analysis. After 1,498,308 person-years of follow-up, 12,978 total deaths occurred. The multivariable-adjusted HRs (95% Cls) for all-cause mortality for the highest compared with the lowest quartile of FRAP and ORAC were 0.85 (0.80, 0.89) and 0.84 (0.79, 0.89), respectively. Dietary NEACs were inversely associated with mortality from cardiovascular disease (CVD), but not from cancer. The multivariable-adjusted HRs (95% Cls) for CVD for the highest compared with the lowest quartile of FRAP and ORAC were 0.83 (0.75, 0.92) and 0.79 (0.70, 0.89), respectively. Higher dietary NEACs from FRAP and ORAC were associated with lower risk of all-cause mortality and mortality from CVD in Japanese adults.

Lifestyle Risk Factors and All-Cause and Cardiovascular Disease Mortality: Data from the Korean Longitudinal Study of Aging.

This study examined the association between lifestyle risk factors and all-cause and cardiovascular disease (CVD) mortality in 9945 Korea adults (56% women) aged 45 years and older. Smoking, heavy alcohol intake, underweight or obesity, physical inactivity, and unintentional weight loss (UWL) were included as risk factors. During 9.6 ± 2.0 years of follow-up, there were a total of 1530 cases of death from all causes, of which 365 cases were from CVD. Compared to a zero risk factor (hazard ratio, HR = 1), the crude HR of all-cause mortality was 1.864 (95% CI, 1.509–2.303) for one risk factor, 2.487 (95% confidence interval, CI, 2.013–3.072) for two risk factors, and 3.524 (95% CI, 2.803–4.432) for three or more risk factors. Compared to a zero risk factor (HR = 1), the crude HR of CVD mortality was 2.566 (95% CI, 1.550–4.250) for one risk factor, 3.655 (95% CI, 2.211–6.043) for two risk factor, and 5.416 (95% CI, 3.185–9.208) for three or more risk factors. The HRs for all-cause and CVD mortality remained significant even after adjustments for measured covariates. The current findings showed that five lifestyle risk factors, including smoking, at-risk alcohol consumption, underweight/obesity, physical inactivity, and UWL, were significantly associated with an increased risk of all-cause and CVD mortality in Korean adults.

Body mass index and clinical outcomes in patients after ischaemic stroke in South Korea: a retrospective cohort study

ObjectivesAlthough obesity is a risk factor for stroke, its impact on mortality in patients with stroke remains unclear. In this study, we aimed to evaluate the relationship between body mass...

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.

Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction

BackgroundNational guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with reduced ejection fraction (HFrEF) and hypertension be maintained below 130 mm Hg. ObjectivesThis study sought to determine associations of SBP <130 mm Hg with outcomes in patients with HFrEF. MethodsOf the 25,345 patients in the Medicare-linked OPTIMIZE-HF registry, 10,535 had an ejection fraction (EF) ≤40%. Of these, 5,615 had stable SBP (≤20 mm Hg admission to discharge variation), and 3,805 (68%) had a discharge SBP <130 mm Hg. Propensity scores for SBP <130 mm Hg, estimated for each of the 5,615 patients, were used to assemble a matched cohort of 1,189 pairs of patients with SBP <130 versus ≥130 mm Hg, balanced on 58 baseline characteristics (mean age 76 years; mean EF 28%, 45% women, 13% African American). This process was repeated in 3,946 patients, after excluding 1,669 patients (30% of 5,615) with a discharge SBP <110 mm Hg and assembled a second matched balanced cohort of 1,099 pairs of patients with SBP 110 to 129 mm Hg versus ≥130 mm Hg. ResultsThirty-day all-cause mortality occurred in 7% and 4% of matched patients with SBP <130 mm Hg versus ≥130 mm Hg, respectively (hazard ratio [HR]: 1.76; 95% confidence interval [CI]: 1.24 to 2.48; p = 0.001). HRs (95% CIs) for all-cause mortality, all-cause readmission, and HF readmission at 1 year, associated with SBP <130 mm Hg, were 1.32 (1.15 to 1.53; p < 0.001), 1.11 (1.01 to 1.23; p = 0.030), and 1.24 (1.09 to 1.42; p = 0.001), respectively. HRs (95% CIs) for 30-day and 1-year all-cause mortality associated with SBP 110 to 129 mm Hg (vs. ≥130 mm Hg) were 1.50 (1.03 to 2.19; p = 0.035), and 1.19 (1.02 to 1.39; p = 0.029), respectively. ConclusionsAmong hospitalized older patients with HFrEF, SBP <130 mm Hg is associated with poor outcomes. This association persisted when the analyses were repeated after excluding patients with SBP <110 mm Hg. There is an urgent need for randomized controlled trials to evaluate optimal SBP reduction goals in patients with HFrEF.

1563-P: Multimorbidity and Its Associations with All-Cause Mortality in People with Type 2 Diabetes: A Prospective Analysis of the UK Biobank

Introduction: The emerging interest in multimorbidity (MM) in people with type 2 diabetes (T2D), which can be concordant (T2D-related) or discordant (unrelated), suggests the need to understand the burden of MM in T2D, and its association with all-cause mortality. We explored associations between MM conditions counts (total, concordant and discordant) and all-cause mortality in people with T2D in the UK Biobank. Methods: We examined data from a longitudinal cohort of 20,569 people with T2D in the UK Biobank recruited between 2006-2010. The number of MM conditions in addition to T2D was the primary independent variable based on self-report and hospital admissions data. All-cause mortality was the primary outcome. Multivariable Cox proportional hazard regression was used to examine associations between each of the MM counts and mortality. Results: A significant association between increasing MM and mortality was found. Compared to those with T2D with no additional chronic conditions, having 1, 2, 3 and 4+ conditions in addition to T2D, the HRs (95% CI) for all-cause mortality were 1.23 (0.90-1.68), 1.84 (1.36-2.49), 1.91 (1.40-2.60), and 3.13 (2.33-4.20), respectively. Both concordant and discordant conditions were significantly associated with mortality. For 1, 2, 3 and 4+ concordant conditions in addition to T2D, the HRs (95% CI) were 1.23 (1.04-1.48), 1.76 (1.46-2.13), 2.78 (2.22-3.48), and 4.25 (3.23-5.59), respectively and for discordant conditions 1.32 (1.13-1.55), 1.46 (1.23-1.74), 1.77 (1.45-2.17), and 2.44 (2.01-2.99), respectively. Conclusions: The association between MM and mortality is significant for total, concordant and discordant condition count, but was strongest for concordant. Our findings emphasize the need for clinical guidelines and future MM measures to consider MM in people with T2D, both concordant and discordant. Disclosure J.I. Chiang: None. P. Hanlon: None. B.D. Jani: None. J.E. Manski-Nankervis: Research Support; Self; Australian National Health and Medical Research Council, Boehringer Ingelheim International GmbH, Diabetes Australia, Eli Lilly and Company. Speaker's Bureau; Self; RACGP. J. Furler: Research Support; Self; Abbott, Sanofi. B.I. Nicholl: None. F.S. Mair: None.

1558-P: BMI and Long-Term Mortality in a Population with Young and Older-Onset Diabetes

Obesity is a dominant risk factor for type 2 diabetes, but its relation with mortality among those with pre-existing chronic illnesses like diabetes, regardless of type, is controversial. Using the Southern Community Cohort Study, we conducted a mortality follow-up (2002-2014) of a cohort of mostly low income black and white participants aged 40-79 with young-onset (diagnosed &amp;lt; age 30, n=1,378) and older onset (diagnosed ≥ 30, n= 15,707) diabetes. Cox analysis with age as the time scale was used to compute HRs (95% CIs) for all-cause mortality by BMI at cohort entry. Mean baseline age and diabetes duration were 50.1 and 29.4 years and 55.3 and 7.7 years among those with young and older onset diabetes, respectively. During an average of 9.4 years of follow-up, 24% of the patients died. Regardless of age at diabetes onset, excess mortality was observed in the underweight, but the overweight or obese had lower death rates than those of normal weight. In analyses controlling for diabetes duration, sex, race, use of insulin, hyperlipidemia and cholesterol meds, hypertension, a history of stroke/tia, coronary heart disease, education, income, and health insurance coverage, compared to a normal BMI of 18-&amp;lt;25 kg/m2,, HRs (95% CIs) were 4.13 (1.48-11.54), 0.56 (0.41-0.77), 0.71 (0.51-0.97), 0.46 (0.31-0.67), 0.59 (0.40-0.86) for BMI categories &amp;lt;18.5, 25-&amp;lt;30, 30-&amp;lt;35, 35-&amp;lt;40, 40+ kg/m2 among those with young-onset diabetes, with similar estimates observed for both blacks and whites. For older onset diabetes, corresponding HRs (95% CIs) were 1.96 (1.42-2.71), 0.70 (0.62-0.78), 0.65 (0.58-0.73), 0.72 (0.64-0.81), 0.99 (0.88-1.12); however, some differences by race (p interaction= 0.01) emerged, with increased risk of mortality for those with a BMI ≥ 40 among whites (HR=1.36, 1.07-1.71) but not blacks (HR=0.89, 0.76-1.03). Among this indigent population of blacks and whites with diabetes, overweight and obesity appear to be protective against mortality, particularly among those with young-onset diabetes and among blacks with older-onset diabetes. Disclosure B. Conway: None. W.J. Blot: None. Funding National Cancer Institute

Association of fatty liver disease with mortality outcomes in an Eastern Finland male cohort

ObjectiveFatty liver disease (FLD) has been associated with extrahepatic morbidity outcomes. However, reports on the association of FLD, assessed using fatty liver index (FLI), with mortality outcomes have been inconsistent....

Serial sodium values and adverse outcomes in heart failure with preserved ejection fraction

ObjectiveThe purpose of our study is to examine whether serial measurements of serum sodium values after diagnosis identify a higher-risk subset of patients with heart failure with preserved ejection fraction. MethodsWe identified 50,932 subjects with HFpEF with 759,577 recorded sNa measurements (mean age 72 ± 11 years) using a validated algorithm in the VA national database from 2002 to 2012. We examined the association of repeated measures of sNa with mortality using a multivariable Cox proportional hazards model. ResultsAfter a median follow-up of 2.9 years (IQR: 1.2–5.4), 19,011 deaths occurred. After adjusting for age, sex, race, BMI, glomerular filtration rate, potassium, coronary artery disease, hypertension, hyperlipidemia, atrial fibrillation, pulmonary disease, diabetes, anemia, and medications, we found J-shaped associations of serum sodium with mortality. HRs for all-cause mortality were 2.48 (95% CI: 2.38–2.60) for the sNA 115.00–133.99 category; and 1.40 (95% CI: 1.35–1.46) for the sNA 143.00–175.00 category compared to the 137.01–140.99 category (ref). We used generalized estimating equation-based negative binomial regression to compute the incidence density ratios (IDR) to examine days hospitalized for heart failure and for all causes. There were a total of 1,275,614 days of all-cause hospitalization and 104,006 days of heart-failure hospitalization. The IDRs for the lowest sNA group were 2.03 (95% CI: 1.90–2.18) for all-cause hospitalization and 1.73 (95% CI: 1.39–2.16) for heart-failure hospitalization. ConclusionsOur findings suggest that monitoring of serum sodium values during longitudinal follow-up can identify HFpEF patients at risk of adverse outcomes.

Chronic kidney disease, cardiovascular risk markers and total mortality in older men: cystatin C versus creatinine

BackgroundIt remains uncertain whether cystatin C is a superior marker of renal function than creatinine in older adults. We have investigated the association between estimated glomerular filtration rate (eGFR) using...

Influence of age on the effect of reduced renal function on outcomes in patients with coronary artery disease

BackgroundAgeing is a risk factor for both coronary artery disease (CAD) and reduced renal function (RRF), and it is also associated with poor prognosis in patients with CAD or RRF. However, little is known about whether the impact of RRF on clinical outcomes are different in CAD patients at different age groups. This study aimed to investigate whether ageing influences the effect of RRF on long-term risk of death in patients with CAD.MethodsA retrospective analysis was conducted using data from a single-center cohort study. Three thousand and two consecutive patients with CAD confirmed by coronary angiography were enrolled. RRF was defined as an estimated glomerular filtration rate (eGFR) of less than 60 ml/min. The primary endpoint in this study was all-cause mortality.ResultsThe mean follow-up time was 29.1 ± 12.5 months and death events occurred in 275 cases (all-cause mortality: 9.2%). The correlation analysis revealed a negative correlation between eGFR and age (r = − 0.386, P < 0.001). Comparing the younger group (age ≤ 59) with the elderly one (age ≥ 70), the prevalence of RRF increased from 5.9 to 27.5%. Multivariable Cox regression revealed that RRF was independently associated with all-cause mortality in all age groups, and the relative risks in older patients were lower than those in younger ones (age ≤ 59 vs. age 60–69 vs. age ≥ 70: hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.04–6.37 vs. HR 2.00, 95% CI 1.17–3.42 vs. HR 1.46, 95% CI 1.06–2.02). There was a significant trend for HRs for all-cause mortality according to the interaction terms for RRF and age group (RRF*age [≤59] vs. RRF*age [60–69] vs. RRF*age [≥70]: HR 1.00[reference] vs. HR 0.60, 95% CI 0.23–1.54 vs. HR 0.32, 95% CI 0.14–0.75; P for trend = 0.010).ConclusionsRRF may have different impacts on clinical outcomes in CAD patients at different age groups. The association of RRF with the risk of all-cause mortality was attenuated with ageing.