Increased Risk Of Cardiovascular Mortality Research Articles

Estimated Pulse Wave Velocity Predicts All-Cause and Cardiovascular-Cause Mortality in Individuals With Hypertension - Findings From a National Health and Nutrition Examination Study 1999-2018.

This study aimed to investigate the association between estimated pulse wave velocity (ePWV) and mortality outcomes among individuals with hypertension.Methods and Results: Based on the National Health and Nutrition Examination Survey (NHANES) 1999-2018, a total of 14,396 eligible participants with hypertension were enrolled. The ePWV was calculated using the equation based on blood pressure and age. The mortality outcomes of included participants were directly acquired from the National Death Index database. The multivariable Cox regression analysis was used to examine the relationship between ePWV and mortality outcomes. Moreover, the restricted cubic spline (RCS) was also used to explore this relationship. Receiver operating characteristics curves (ROC) were adopted to evaluate the prognostic ability of ePWV for predicting mortality outcomes of patients with hypertension. The median follow-up duration was 10.8 years; individuals with higher an ePWV had higher risks of mortality from both all causes (HR: 2.79, 95% CI: 2.43-3.20) and cardiovascular diseases (HR: 3.41, 95% CI: 2.50-4.64). After adjusting for confounding factors, each 1 m/s increase in ePWV was associated with a 43% increase in all-cause mortality risk (HR: 1.43, 95% CI: 1.37-1.48) and a 54% increase in cardiovascular mortality risk (HR: 1.54, 95% CI: 1.43-1.66). This study indicates that ePWV is a novel prognostic indicator for predicting the risks of mortality among patients with hypertension.

Reduction in systolic pulmonary artery pressure after TAVI is associated with lower cardiovascular mortality in patients with severe aortic stenosis

Abstract Background Elevated systolic pulmonary artery pressure (sPAP), assessed by echocardiography, is associated with increased mortality, irrespective of the aetiology. Purpose The purpose of this study was to explore the association between dynamic change in sPAP after transcatheter aortic valve implantation (TAVI) and cardiovascular mortality in patients with severe aortic stenosis (AS). Methods We screened 688 AS patients who underwent TAVI in our hospital between July 2009 and December 2018. Patients, who performed echocardiography examinations before TAVI (T0) and within 7 days after TAVI (T1), and completed ≥12 months clinical follow-up, were included in this study. Patients who died within 30 days after TAVI were excluded (n=27). Patients with no measurable tricuspid regurgitation for assessment of sPAP were not included. 477 TAVI patients were finally included for further analysis (mean age 81.4±5.9 years, 46.3% male). Primary endpoint was defined as cardiovascular (CV) death up to 5 years after TAVI. Results During 34 (20-55) months follow-up, all-cause mortality and CV mortality was 34.0% and 18.9%, respectively in these patients. 18.7% of patients had COPD, and COPD was identified as a risk factor for increased CV mortality risk (Hazard ratio, HR=2.152, 95% CI 1.376-3.365, P<0.001). Baseline septal trans-mitral early filling velocity to mitral annular early-diastolic velocity ratio (E/E´) was identified as echocardiographic parameter associated with CV mortality (HR=1.028, 95% CI 1.009-1.047, P=0.003). sPAP at 7 days after TAVI was significantly reduced in no CV-death group (median 38.9 vs. 36.0 mmHg, P<0.001), while remained unchanged in CV-death group (40.7 vs. 41.0 mmHg, P=0.966). We further grouped the patients according to sPAP change trend after TAVI: Group 1, sPAP at T0 <40 mmHg and sPAP at T1 <40 mmHg; Group 2, sPAP at T0 ≥40 mmHg and sPAP at T1 <40 mmHg; Group 3 sPAP at T0 <40 mmHg and sPAP at T1 ≥40 mmHg; Group 4, sPAP at T0 ≥40 mmHg and sPAP at T1 ≥40 mmHg. CV mortality was the highest in the group 4 (28.3%), and significantly lower in the group 2 than in the group 4 (13.6% vs. 28.3%, P<0.001, Figure 1). Multivariable Cox regression analysis showed that TAVI patients with a reduction trend in sPAP at 7 days after TAVI (group 2) were independently associated with reduced CV mortality compared to patients with a consistent elevated sPAP (group 4, HR=2.470, 95% CI 1.260-4.832, P=0.008), after adjusted for age, sex, COPD, and septal E/E´. Conclusion TAVI patients with consistently elevated sPAP before and after TAVI are associated with the worst CV outcome. Reduction in sPAP at 7 days after TAVI is associated with reduced CV mortality in patients with severe AS.

Serum amyloid A and risks of all-cause and cardiovascular mortality in chronic kidney disease: a systematic review and dose-response meta-analysis

Backgrounds The available literature on the correlation between serum amyloid A (SAA) and prognosis of chronic kidney disease (CKD) are limited, and the findings from existing studies are inconclusive. This meta-analysis aimed to evaluate the available evidence regarding the link between SAA and risks of all-cause and cardiovascular mortality in CKD patients. Additionally, we aimed to investigate the potential dose-response relationships, provided that adequate data is accessible. Methods Pubmed and Embase were searched for related literature (last update: 12 July 2023). The pooled effect estimates were calculated using random- or fixed-effects models depending on heterogeneity among studies. Results This meta-analysis incorporated 8 studies encompassing 2331 CKD patients. The findings revealed an 85% increase in all-cause mortality risk [hazard risk (HR) 1.85, 95% confidence interval (CI) 1.29–2.65] and a 39% increase in cardiovascular mortality risk (HR 1.07, 95% CI 1.07–1.80) when comparing the highest tertile of baseline SAA levels to the lowest tertile. Furthermore, a positive linear relationship between SAA and all-cause mortality risk was observed (P non-linearity = 0.959), with a 17.7% increase in risk for each 10 mg/L SAA increase (HR 1.177, 95% CI 1.055–1.313). Similarly, a linear relationship between SAA and cardiovascular mortality risk was identified (P non-linearity = 0.477) with a 19.3% increase in risk for each 10 mg/L SAA increase (HR 1.193, 95% CI 1.025–1.388). Conclusions This meta-analysis provided evidence that SAA levels are positively and linearly associated with risks of all-cause and cardiovascular mortality among CKD patients.

Remnant cholesterol predicts cardiovascular mortality beyond low-density lipoprotein cholesterol in patients with peritoneal dialysis

Patients undergoing peritoneal dialysis (PD) are prone to dyslipidemia. However, studies concerning remnant cholesterol (RC) in such patients are limited. We aimed to investigate the association between RC and cardiovascular (CV) mortality in patients on PD. Patients who initiated PD at our center (2006-2018) were retrospectively enrolled. Adjusted Cox models were used to evaluate the independent association between baseline RC levels and CV mortality. We classified patients into 4 concordant/discordant categories according to their baseline lipid profiles. Cox models were then used to determine the association between different low-density lipoprotein cholesterol (LDL-C) and RC levels and CV mortality risk. The study enrolled 2333 individuals, with a mean RC of 33.4mg/dl. RC levels were positively associated with CV mortality risk independent of LDL-C in patients on PD (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 1. 00-1.10). In the concordant/discordant categories, patients with high LDL-C and RC levels had a higher CV mortality risk (HR: 1.52; 95% CI: 1.01-2.28) than those with low LDL-C and RC levels in the entire cohort. Moreover, in older patients, a higher RC level increased CV mortality risk regardless of the LDL-C level (HR: 2.41, 95% CI: 1.22-4.74; HR: 2.15, 95% CI: 1.12-4.14). RC levels are elevated in patients on PD and can predict CV mortality beyond LDL-C levels. RC levels should be considered alongside LDL-C levels when assessing prognostic lipid levels in these patients. More attention should be given to RC than to LDL-C in older patients undergoing PD.

#5768 ASSOCIATION OF HIGH SERUM PHOSPHORUS WITH INCREASED MORTALITY RISK IN PATIENTS ON PERITONEAL DIALYSIS: RESULTS FROM COLOMBIA

Abstract Background and Aims Elevated levels of serum phosphorus (PO4) in patients with kidney failure are associated with complications such as cardiovascular (CV) disease, bone disease and impaired wound healing, and increased mortality in hemodialysis patients. A recent PDOPPS study (Lopes et al NDT 2023) showed that high PO4 is associated with increased mortality also in patients undergoing peritoneal dialysis (PD). We explored PO4 levels in a large cohort of patients undergoing chronic PD in Colombia to determine the association of PO4 levels with mortality. Method In an observational study of 8113 prevalent PD patients treated with APD (n = 2692) or CAPD (n = 5421), PO4 levels together with demographic and clinical data, including dialysate to plasma ratio of creatinine at 240 min (D/PCr240min at peritoneal equilibration test) and body mass index (BMI), were recorded. During follow-up for a median of 1.99 years, 3169 patients died, and 988 patients underwent kidney transplantation (KT). We divided patients into 5 groups (P1 to P5) according to their baseline PO4 levels (first available measurement) with the following cut-off values for groups: up to 3.5, 4.5, 5.5, 6.5, and over 6.5 mg/dL, respectively. The association of baseline PO4 levels with all-cause and CV mortality risk was analyzed with a competing-risk regression model and KT as a competing risk. Results Characteristics of patients classified into groups P1 (16%), P2 (33%), P3 (27%), P4 (13%), and P5 (9%) are presented in Table. P5-patients were in general younger, more often men, less often diabetic (DM), and had lower hemoglobin (Hb) and serum albumin compared to P1-patients. All-cause mortality risk (after adjusting for age, sex, BMI, albumin, Hb, D/PCr240min, residual renal function, DM, and hypertension) was increased in P4- and P5-patients compared with P2-patients, sub-hazard ratio (sHR) of 1.14 (95% Cl: 1.01-1.27) and sHR of 1.27 (95% Cl: 1.10-1.46), respectively. Higher PO4 levels were not associated with significantly increased CV mortality risk for P4-patients, sHR of 1.10 (95% Cl: 0.93-1.31), or for P5-patients, sHR = 1.14 (95% Cl: 0.93-1.39) compared to P2-patients. Conclusion Among 8113 PD patients in Colombia, 49% had baseline PO4 >4.5 mg/dL and 22% PO4 > 5.5 mg/dL. Baseline PO4 levels > 5.5 mg/dL (P4 and P5 groups) were associated with increased all-cause mortality. These results are in agreement with the results of the PDOPPS study and suggest that effective management of hyperphosphatemia is important to improve clinical outcomes in PD patients.

JS-CME-3: EXERCISE IN THE PREVENTION AND TREATMENT OF HYPERTENSION AND ASSOCIATED CARDIOVASCULAR RISK

Arterial hypertension and associated cardiovascular (CV) disease remain a health care challenge. The global prevalence of hypertension is estimated to be in the range of 30–45 %. In Europe, about 25 % of heart attacks have been linked with hypertension. Lifestyle interventions are an essential and established part of hypertension management and provide a most effective means to achieve recommended blood pressure targets. For example, patients with hypertension engaged in regular physical activity have been shown to have a reduced risk for CV mortality (20–60%), as opposed to sedentary patients with a twofold increased CV mortality risk. Independent of the severity of hypertension, lifestyle advice is a first line treatment modality for lowering blood pressure in all of the recent guidelines on management of hypertension. In 2021, the EAPC and ESC Council of Hypertension Consensus Document found consistent evidence from a meta-review that exercise prescription can be refined by recommending type of exercise treatment according to initial blood pressure levels as a more personalized lifestyle intervention. Moreover, the focus on recommendations for the treatment of hypertension may need to shift towards focusing on reduction of overall CV risk. Whereas anti-hypertensive drug treatment primarily lowers blood pressure, exercise treatment, for example, has the potential to beneficially affect most of the associated CV risk factors and thus very effectively reduce overall CV risk as well as prolong health span. Cumulative overall CV risk can be quantified by non-invasive assessment of micro- and macrovascular function. The susceptibility of vascular biomarkers in response to exercise treatment is vital to investigate the effects of exercise interventions on overall CV risk in patients with hypertension.

Relationship between serum uric acid, all-cause mortality and cardiovascular mortality in peritoneal dialysis patients: systematic review and meta-analysis of cohort studies

ObjectivesTo analyse the relationship between serum uric acid (SUA), all-cause and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients to inform clinical practice and future research.DesignA systematic review of observational...

Rheumatoid arthritis: Extra-articular manifestations and comorbidities.

Although synovitis is the pathological hallmark of rheumatoid arthritis (RA), many extra-articular manifestations (EMs) and comorbidities likely occur due to the complex, chronic, inflammatory, and autoimmune features of RA. Cardiovascular (CV) disease is the most common cause of death in patients with RA. Compared to the general population, patients with RA have twice the risk of myocardial infarction and up to 50% increased CV mortality risk. Severe and prolonged disease activity, genetics, and inflammation (e.g. CRP, ACPA, cytokines, matrix-degrading enzymes) play important roles in CV disease and atheroscleroticdamage. The second major cause of death in patients with RA is respiratory disease, which occurs in 30-40% of patients. RA may affect the lung interstitium, airways, and pleurae, while pulmonary vascular involvement is less frequent. Central and peripheral nervous system involvement is usually due to small vessel vasculitis, joint damage, or drug toxicity. There is also evidence that microvascular cerebral damage caused by systemic inflammation is associated with the development of Alzheimer's disease and vascular dementia. Some observational studies have hinted how Disease Modified Anti-Rheumatic Drugs and biologics could reduce the incidence of dementia. Primary gastrointestinal and renal involvements are rare and often relate to drug therapy. To minimize morbidity and mortality, physicians must manage RA disease activity (treat-to-target) and monitor risk factors and concomitant conditions (e.g. smoking cessation; weight regulation; monitoring blood pressure, lipids, thyroid hormone, folic acid and homocysteine; screening for depression, anxiety, atlantoaxial instability, and atherosclerosis). This article aims to provide an overview of the most prevalent and important EMs and comorbidities associated with RA.

Validation and Comparison of the 2003 and 2016 Diastolic Functional Assessments for Cardiovascular Mortality in a Large Single-Center Cohort

The prognostic performance of the diastolic dysfunction (DD) algorithms published by the Mayo Clinic research group in 2003 and the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) in 2016 in association with cardiovascular (CV) mortality was compared in this study. A retrospective hospital cohort comprising 57,630 adults who had undergone comprehensive echocardiographic examinations between 2008 and 2016 was analyzed. All echocardiographic parameters were measured according to appropriate guidelines, and dates of CV death were verified using the national mortality database. The prognostic performance of the Mayo 2003 and ASE/EACVI 2016 algorithms in association with 3-year CV mortality was systematically investigated. The adjusted hazard ratio (aHR) for severe DD defined by Mayo 2003 (1.64; 95% CI, 1.02-2.64; P=.04) was less than that defined by ASE/EACVI 2016 (aHR, 2.46; 95% CI, 1.58-3.84; P<.001) compared with patients with normal diastolic function. According to the ASE/EACVI 2016 algorithm, the cumulative 3-year CV mortality rate was 2.4% (95% CI, 1.8%-3.0%) for normal diastolic function, 4.7% (95% CI, 4.0%-5.4%) for mild DD, 5.8% (95% CI, 5.0%-6.7%) for moderate DD, 8.3% (95% CI, 6.1%-10.5%) for severe DD, and 3.8% (95% CI, 2.8%-4.8%) for indeterminate DD, respectively (P<.001). The dose-mortality patterns following DD severity were observed only in the ASE/EAVCI 2016 classification. The risk for 3-year CV mortality in patients with concomitant left ventricular ejection fraction < 40% and severe DD was 7 times (aHR, 7.81 [95% CI, 3.81-16.0; P<.05] for Mayo 2003; aHR, 7.67 [95% CI, 4.61-12.8; P<.05] for ASE/EACVI 2016) higher than that inpatients with left ventricular ejection fractions≥60% and normal diastolic function. The absolute number of patients who were correctly reclassified by ASE/EAVCI 2016 was 23,181, corresponding to 42% of the absolute net reclassification index. DD and impaired left ventricular ejection fraction increased CV mortality risk in a mutually independent manner. The severity of DD on the basis of ASE/EACVI 2016 has a graded relationship with CV mortality in a large population cohort.

Cardiorespiratory fitness and cardiovascular mortality after prolonged androgen deprivation therapy for prostate cancer.

11576 Background: Androgen deprivation therapy (ADT) plays a pivotal role in management of prostate cancer (PC), with prolonged ADT favored over short-term use in the definitive treatment of high risk PC with radiation. Objectives: To compare cardiorespiratory fitness (CRF) and cardiovascular (CV) mortality among patients with PC with and without ADT exposure, and to explore how duration of ADT exposure influences CRF and CV mortality risk. Methods: This is a retrospective study of patients referred for exercise treadmill testing (ETT) after a diagnosis of PC. PC risk classification was based on Gleason score (GS) at diagnosis: high risk GS ≥ 8, intermediate risk GS= 7, and low risk GS ≤ 6. CRF was categorized according to metabolic equivalents (METs): METs ≥ 8 defined as good CRF and METs &lt; 8 as reduced CRF. ADT exposure was grouped as short-term (≤ 6 months) versus prolonged (&gt; 6 months). Results: 616 patients underwent an ETT a median of 4.8 years (interquartile range: 2.0-7.9) after diagnosis of PC. 150 patients (24.3%) received ADT prior to ETT; 51 with short-term versus 99 with prolonged exposure. 524 (85.1%) patients had ≥ 2 CV risk factors, and 28 CV deaths occurred over 4.2 (interquartile range: 2.3-7.1) years following the ETT. Reduced CRF was more frequent among ADT-exposed versus ADT-naive patients (48.7 versus 32.6%, p&lt; 0.001). Prolonged ADT was associated with reduced CRF (odds ratio (OR): 2.71; 95% confidence interval (CI): 1.31-5.61; p=0.007) and increased CV mortality (hazard ratio (HR): 3.87; 95% CI: 1.16-12.96; p=0.03) in adjusted analyses. In contrast, short-term ADT exposure was not independently associated with either reduced CRF (OR 1.71; 95% CI: 1.00-2.94); p=0.05) or CV mortality (HR: 1.60; 95% CI: 0.51-5.01; p=0.42). Conclusions: Among patients with PC and high baseline CV risk, &gt; 6 months ADT exposure but not less was associated with reduced CRF and increased CV mortality. Reduced CRF may in part mediate increased CV mortality risk. Exercise interventions concurrent with prolonged ADT warrants investigation to potentially offset risk.

2D and 3D Echocardiography-Derived Indices of Left Ventricular Function and Shape: Relationship With Mortality

ObjectivesThis study hypothesized that left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) derived from 3-dimensional echocardiographic (3DE) images would better predict mortality than those obtained by 2-dimensional echocardiographic (2DE) measurements, and that 3DE-based LV shape analysis may have added prognostic value. BackgroundPrevious studies have shown that both LVEF and GLS derived from 2DE images predict mortality. Recently, 3DE measurements of these parameters were found to be more accurate and reproducible because of independence of imaging plane and geometric assumptions. Also, 3DE analysis offers an opportunity to accurately quantify LV shape. MethodsWe retrospectively studied 416 inpatients (60 ± 18 years of age) referred for transthoracic echocardiography between 2006 and 2010, who had good-quality 2DE and 3DE images were available. Mortality data through 2016 were collected. Both 2DE and 3DE images were analyzed to measure LVEF and GLS. Additionally, 3DE-derived LV endocardial surface information was analyzed to obtain global shape indices (sphericity and conicity) and regional curvature (anterior, septal, inferior, lateral walls). Cardiovascular (CV) mortality risks related to these indices were determined using Cox regression. ResultsOf the 416 patients, 208 (50%) died, including 114 (27%) CV-related deaths over a mean follow-up period of 5 ± 3 years. Cox regression revealed that age and body surface area, all 4 LV function indices (2D EF, 3D EF, 2D GLS, 3D GLS), and regional shape indices (septal and inferior wall curvatures) were independently associated with increased risk of CV mortality. GLS was the strongest prognosticator of CV mortality, superior to EF for both 2DE and 3DE analyses, and 2D EF was the weakest among the 4 functional indices. A 1% decrease in GLS magnitude was associated with an 11.3% increase in CV mortality risk. ConclusionsGLS predicts mortality better than EF by both 3DE and 2DE analysis, whereas 3D EF is a better predictor than 2D EF. Also, LV shape indices provide additional risk assessment.

Abstract # 1767 Combined influence of depression and systemic inflammation on cardiovascular disease and all-cause mortality: Evidence for differential effects by gender in the English Longitudinal Study of Ageing

The aim of this study was to examine the combined association of depression and inflammation with the risk of cardiovascular disease (CVD) and all-cause mortality. We measured C-reactive protein (CRP) and depressive symptoms in 5328 men and women aged 52–89 years in the English Longitudinal Study of Ageing. Depressive symptoms were measured using the eight-item Centre for Epidemiological Studies Depression Scale. CRP was analysed from peripheral blood. Mortality was ascertained from national registers and associations with depression and inflammation estimated using Cox proportional hazard models. We identified 112 cardiovascular related and 420 all-cause deaths in men and 109 cardiovascular related and 334 all-cause deaths in women over a mean follow-up of 7.7 years. Men with both depression and high CRP (3–20 mg/L) had an increased risk of CVD mortality (hazard ratio; 95% confidence interval: 3.89; 2.04–7.44) and all-cause mortality (2.40; 1.65–3.48) after adjusting for age, socioeconomic variables and health behaviours. This considerably exceeds the risks associated with high CRP alone (CVD 2.43; 1.59–3.71, all-cause 1.49; 1.20–1.84). There was no significant increase in mortality risk associated with depression alone in men. In women, neither depression or inflammation alone or the combination of both significantly predicted cardiovascular or all-cause mortality. The combination of depressive symptoms and increased inflammation confers a considerable increase in cardiovascular mortality risk for men.

Increased Cardiovascular Mortality Risk in Women Discontinuing Postmenopausal Hormone Therapy.

Current guidelines recommend annual discontinuation of postmenopausal hormone therapy (HT) to evaluate whether a woman could manage without the treatment. The impact of HT on cardiovascular health has been widely studied, but it is not known how the withdrawal of HT affects cardiovascular risk. We evaluated the risk of cardiac or stroke death after the discontinuation of HT. Design, Patients, Interventions, and Main Outcome Measures: Altogether 332 202 Finnish women discontinuing HT between 1994 and 2009 (data from National Reimbursement register) were followed up from the discontinuation date to death due to cardiac cause (n = 3177) or stroke (n = 1952), or to the end of 2009. The deaths, retrieved from the national Cause of Death Register, were compared with the expected number of deaths in the age-standardized background population. In a subanalysis we also compared HT stoppers with HT users. Within the first posttreatment year, the risk of cardiac death was significantly elevated (standardized mortality ratio; 95% confidence interval 1.26; 1.16-1.37), whereas follow-up for longer than 1 year was accompanied with a reduction (0.75; 0.72-0.78). The risk of stroke death in the first posttreatment year was increased (1.63; 1.47-1.79), but follow-up for longer than 1 year was accompanied with a reduced risk (0.89; 0.85-0.94). The cardiac (2.30; 2.12-2.50) and stroke (2.52; 2.28-2.77) death risk elevations were even higher when compared with HT users. In women who discontinued HT at age younger than 60 years, but not in women aged 60 years or older, the cardiac mortality risk was elevated (1.94; 1.51-2.48). Increased cardiovascular death risks question the safety of annual HT discontinuation practice to evaluate whether a woman could manage without HT.

Traumatic brain injury, coronary atherosclerosis and cardiovascular mortality

Background: Traumatic-brain-injury (TBI) is a devastating-condition resulting in cerebral edema and ischemia. This study investigates the association of mild-TBI (mTBI) to sub-clinical atherosclerosis and cardiovascular (CV) mortality.Methods: Five hundred and forty-three veterans without known coronary artery disease or diagnosed mental disorder, who underwent coronary artery calcium (CAC) scanning for clinical indications, were followed for a median of 4-years. Veterans' medical diagnoses and neuropsychiatric health status (mTBI vs non-mTBI) were evaluated using VA electronic medical records. CAC was defined as 0, 1–100, 101–400 and 400+.Results: CAC was higher in mTBI, compared to without-mTBI (p < 0.05). TBI was more prevalent with the-severity of CAC (p < 0.05). Regression-analyses revealed that mTBI is an independent-predictor of CAC (p < 0.01). The CV mortality rate was 25% in mTBI and 10.5% in without-mTBI (p = 0.0001). Multivariable survival regression analyses revealed a significant-association between mTBI and CAC, with increased-risk of CV mortality (p < 0.05). The hazard-ratio of CV mortality was 5.25 in mTBI & CAC > 0, compared to without-mTBI & CAC = 0 (p < 0.05). The risk of CV-mortality was 2.25 for mTBI & CAC = 1–100, 4.93 for mTBI & CAC = 101–400 and 7.06 for mTBI & CAC ≥ 400, compared to matched CAC-categories without-mTBI (p < 0.05). The area under ROC curve to predict CV mortality was 0.64 for mTBI, 0.69 for mTBI & PTSD, 0.85 for mTBI & CAC > 0 and 0.92 for the combination. The prognostication of mTBI to predict CV mortality is superior to the Framingham risk score. Also the combination of mTBI & PTSD provided incremental prognostic values to predict CV mortality (p < 0.05).Conclusions: mTBI is associated with the severity of sub-clinical coronary atherosclerosis and independently predicts CV mortality.

Serum Ferritin Predicts Mortality Regardless of Inflammatory and Nutritional Status in Patients Starting Dialysis: A Prospective Cohort Study

Background: The impact of serum ferritin on prognosis in patients starting hemodialysis (HD) is not fully elucidated. Methods: A prospective cohort of 946 incident HD patients from 26 dialysis centers in Korea was selected for this study. Patients were divided into tertiles according to natural logarithm (Ln) ferritin concentrations. Results: During a median follow-up of 39 months, 88 (9.3%) patients died. Multivariate Cox proportional hazard analysis demonstrated that Ln ferritin was independently associated with an increase in cardiovascular mortality risk (hazard ratio (HR) 1.604, 95% CI 1.040-2.474, p = 0.033), infection-related mortality risk (HR 1.916, 95% CI 1.056-3.476, p = 0.032), and all-cause mortality risk (HR 1.547, 95% CI 1.156-2.069, p = 0.003). Conclusion: Serum ferritin levels at the time of HD commencement were a significant independent risk factor for mortality regardless of systemic inflammation and nutritional status. Therefore, elevated serum ferritin levels could be an effective indicator for prognosis.

Threefold Increased Cardiovascular Mortality Risk Found in Patients with Differentiated Thyroid Cancer

Threefold Increased Cardiovascular Mortality Risk Found in Patients with Differentiated Thyroid Cancer

Binge Drinking and Hypertension on Cardiovascular Disease Mortality in Korean Men and Women

The purpose of this study was to examine combined effects of hypertension and binge drinking on the risk of mortality from cardiovascular disease in Koreans. This study followed a cohort of 6100 residents in Kangwha County, aged ≥55 years as of March 1985, for cardiovascular mortality for 20.8 years up to December 31, 2005. We calculated hazard ratios (HRs) for cardiovascular mortality by blood pressure and binge drinking habits using the Cox proportional hazard model. Binge drinkers and heavy binge drinkers were defined as having ≥6 drinks on 1 occasion and ≥12 drinks on 1 occasion. After adjusting for total alcohol consumption, male heavy binge drinkers with Grade 3 hypertension had a 12-fold increased risk of cardiovascular mortality (HR, 12.7; 95% CI, 3.47 to 46.5), whereas male binge drinkers with Grade 3 hypertension had a 4-fold increased risk of cardiovascular mortality (HR, 4.41; 95% CI, 1.38 to 14.1) when compared with nondrinkers with normal blood pressure. However, in considering separate effects of heavy binge drinking and hypertension on the risk of cardiovascular mortality, HRs were rather low (HR of heavy binge drinkers, 1.88, 1.10 to 3.20; HR of hypertensives, 2.00, 1.70 to 2.35) compared with nondrinkers with normal blood pressure. Binge drinkers and heavy binge drinkers with Grade 3 hypertension showed a marked increase in cardiovascular mortality risk. Even after adjusting for total alcohol consumption, the former revealed 4.41 and the latter indicated 12.7 of HR for the risk of cardiovascular mortality.

Autonomic Nervous System Dysfunction and Inflammation Contribute to the Increased Cardiovascular Mortality Risk Associated With Depression

To investigate prospectively whether autonomic nervous system (ANS) dysfunction and inflammation play a role in the increased cardiovascular disease (CVD)-related mortality risk associated with depression. Participants in the Cardiovascular Health Study (n = 907; mean age, 71.3 ± 4.6 years; 59.1% women) were evaluated for ANS indices derived from heart rate variability (HRV) analysis (frequency and time domain HRV, and nonlinear indices, including detrended fluctuation analysis (DFA(1)) and heart rate turbulence). Inflammation markers included C-reactive protein, interleukin-6, fibrinogen, and white blood cell count). Depressive symptoms were assessed, using the 10-item Centers for Epidemiological Studies Depression scale. Cox proportional hazards models were used to investigate the mortality risk associated with depression, ANS, and inflammation markers, adjusting for demographic and clinical covariates. Depression was associated with ANS dysfunction (DFA(1), p = .018), and increased inflammation markers (white blood cell count, p = .012, fibrinogen p = .043) adjusting for covariates. CVD-related mortality occurred in 121 participants during a median follow-up of 13.3 years. Depression was associated with an increased CVD mortality risk (hazard ratio, 1.88; 95% confidence interval, 1.23-2.86). Multivariable analyses showed that depression was an independent predictor of CVD mortality (hazard ratio, 1.72; 95% confidence interval, 1.05-2.83) when adjusting for independent HRV and inflammation predictors (DFA(1), heart rate turbulence, interleukin-6), attenuating the depression-CVD mortality association by 12.7% (p < .001). Autonomic dysfunction and inflammation contribute to the increased cardiovascular mortality risk associated with depression, but a large portion of the predictive value of depression remains unexplained by these neuroimmunological measures.

Diabetes and 15-year Cardiovascular Mortality in a Chinese Population: Differential Impact of Hypertension and Metabolic Syndrome

It remains unclear if the risk for cardiovascular (CV) mortality in patients with diabetes mellitus (DM) is equivalent to that in patients with a history of cardiac disease in Asian populations. The aims of the present study were to investigate whether or not non-heart disease (HD) DM subjects have a similar risk of CV mortality as HD patients without DM (non-DM HD), and whether or not hypertension (HT) or metabolic syndrome (MS) is a CV mortality marker for diabetic subjects identified from a community-based population. We followed 11,058 Chinese people aged > or = 30 years on Kinmen island for a median of 15.0 years. The age-, sex- and smoking-adjusted hazard ratios for CV mortality were 3.56 [95% confidence interval (CI): 1.99-6.36] for DM subjects with HD, 1.64 (95% CI: 1.25-2.16) for DM without HD (non-HD DM) subjects, and 1.63 (95% CI: 1.09-2.44) for non-DM HD patients, when compared with subjects without DM and HD. Among the 827 non-HD DM subjects identified at the baseline survey, the age-, sex- and smoking-adjusted hazard ratios for CV mortality were 2.36 (95% CI: 1.30-4.28) for the presence versus absence of HT, and 1.23 (95% CI: 0.65-2.34) for the presence versus absence of MS. Non-HD DM subjects had a similar risk of CV mortality to non-DM HD subjects in this Chinese population. The presence of HT but not MS substantially increased CV mortality risk in the DM subjects.

The emerging role of phosphate in vascular calcification

Vascular calcification is recognized as a major contributor to cardiovascular disease (CVD) in end stage renal disease (ESRD) patients. Susceptibility to vascular calcification is genetically determined and actively regulated by diverse inducers and inhibitors. One of these inducers, hyperphosphatemia, promotes vascular calcification and is a nontraditional risk factor for CVD mortality in ESRD patients. Vascular smooth muscle cells (SMCs) respond to elevated phosphate levels by undergoing an osteochondrogenic phenotype change and mineralizing their extracellular matrix through a mechanism requiring sodium-dependent phosphate cotransporters. Disease states and cytokines can increase expression of sodium-dependent phosphate cotransporters in SMCs, thereby increasing susceptibility to calcification even at phosphate concentrations that are in the normal range.