Likelihood Of All-cause Mortality Research Articles

Cervicocerebral Atherosclerosis Burden Increases Long-Term Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack.

The influence of burden of atherosclerosis in the brain supplying arteries on mortality in patients with acute ischemic stroke or transient ischemic attack is poorly known. We assessed whether total burden of atherosclerosis within cervicocerebral arteries is associated with long-term mortality. A total of 406 patients (median age, 71.8 years; 57.9% male) with acute ischemic stroke or transient ischemic attack were included and their cervicocerebral arteries imaged with computed tomography angiography. The presence of atherosclerotic findings was scored for 25 artery segments and points were summed as a Cervicocerebral Atherosclerosis Burden (CAB) score, analyzed as quartiles. Data on all-cause mortality came from Statistics Finland. After a median follow-up of 7.3 years, 147 (33.5%) patients had died. Compared with surviving patients, those who died had a higher median CAB score (5, interquartile range 2-10 versus 11, 7-16; P<0.001). Cumulative mortality increased from 8.9% (95% CI, 7.0-10.8) in the lowest to 61.4% (95% CI, 55.4-67.4) in the highest quartile of CAB score. Adjusted for demographics, cardiovascular risk factors, secondary preventive medication, and admission National Institute of Health Stroke Scale score, every CAB score point increased probability of death by 3%. Analyzed in quartiles, the highest CAB quartile was associated with a 2.5-fold likelihood of all-cause mortality. The main findings of our study were the increasing mortality with the total burden of computed tomography angiography-defined atherosclerosis in the brain supplying arteries after ischemic stroke or transient ischemic attack and that the CAB score-integrating this pathology-independently increased all-cause mortality.

#840 Kidney cancer, treatment with nephrectomy and survival in chronic kidney disease (CKD)

Abstract Background and Aims People with chronic kidney disease (CKD) have increased incidence of kidney cancer and poorer survival post-diagnosis compared to people without CKD. Nephrectomy, either partial or radical is the primary treatment for many kidney cancers and can be curative even in cases with locally advanced disease or single metastasis. We hypothesised that nephrectomy may be less frequently undertaken in people with kidney cancer and pre-existing CKD and that this might contribute to poorer survival in this group. Method Using data from the prospective research cohort UK Biobank (n = 502,536) linked to cancer registry, participants with available biochemistry and a new diagnosis of kidney cancer during follow-up were identified. Occurrence of nephrectomy was extracted from linked hospital data and all-cause mortality data from death certification records. Estimated glomerular filtration rate (eGFRCr) was calculated by CKD-EPI 2009 formula with race coefficient, as this was the formula recommended for use in the UK at the time of recruitment to UK Biobank. Cox proportional hazards models tested associations between eGFRCr and i) undergoing nephrectomy and ii) all-cause mortality by 10 ml/min/1.73 m2 decline from a reference value of 90 ml/min/1.73 m2. We additionally conducted subgroup analyses for nephrectomy and all-cause mortality within eGFRCr categories &amp;gt;105, 90-105, 75-90 (reference), 60-75, 45-60, 30-45 and &amp;lt;30 ml/min/1.73 m2. Both models were adjusted for age, sex, diabetes mellitus, hypertension, stroke, ischaemic heart disease, body mass index and socioeconomic deprivation. The all-cause mortality model was additionally adjusted for undergoing nephrectomy. Results There were 2053 participants with a new diagnosis of kidney cancer and sufficient biochemical data for inclusion. Of these, 935 (46%) had eGFRCr 60-90 ml/min/1.73 m2 and 139 (7%) had eGFRCr &amp;lt;60 ml/min/1.73 m2. Median time from baseline to kidney cancer diagnosis was 5.8 (IQR 0.9, 8.8) years. Median follow-up time after a diagnosis of kidney cancer was 3.4 (IQR 0.9, 6.6) years. For each 10 ml/min/1.73 m2 decline in eGFRCr below 90 ml/min/1.73 m2, there was no significant difference in likelihood of receiving nephrectomy (HR 1.05, p = 0.08) and no significant difference in likelihood of all-cause mortality (HR 1.03, p = 0.23). People with moderate-advanced CKD had increased hazards of all-cause mortality compared to the reference group (eGFRCr 75-90 ml/min/1.73 m2) when models were run by eGFRCr category (eGFRCr 30-45—HR 1.9 95% CI 1.3-3.0; eGFRCr &amp;lt;30—HR 2.0 95% CI 1.0-4.0). Conclusion In UK Biobank participants with kidney cancer and mild CKD, there was no significant difference in likelihood of nephrectomy or in hazards of all-cause mortality associated with declining eGFRCr as a continuous variable. Moderate to advanced CKD (eGFR &amp;lt;45) was associated with increased all-cause mortality despite adjustment for nephrectomy, suggesting that this finding is not explained by reduced access to surgical treatment.

Relationship between dietary protein, serum albumin, and mortality in asthmatic populations: a cohort study.

Currently, there is limited research on the correlation between protein levels in the body and asthma. We used data from the NHANES to explore the relationship of dietary protein, serum albumin, with mortality in individuals with asthma to better understand their impact on asthma. This investigation involved 3005 individuals with asthma from the NHANES dataset. Studying potential links between dietary protein, serum albumin, and mortality in asthmatic populations utilized the Cox proportional hazards models, trend test, restricted cubic splines (RCS), and Kaplan-Meier survival analysis. Furthermore, subgroup analyses were carried out to explore these connections within specific populations. After considering all potential variables, multivariate Cox proportional hazard models proved that dietary protein intake did not have an independent connection with all-cause mortality, but serum albumin was inversely linked with all-cause mortality. Each unit rise in serum albumin (g/l) was linked to a 13% decrease in the likelihood of all-cause mortality. RCS confirmed a negative and linear connection of serum albumin with all-cause mortality. The Kaplan-Meier survival curve suggested that asthmatic adults with greater serum albumin levels had a decreased risk of mortality compared to those with lower levels. The investigation proved a negative linear connection of serum albumin with all-cause mortality in asthma patients. However, there was no independent link discovered between dietary protein intake with mortality. This indicates that serum albumin could be a significant factor in predicting long-term outcomes for asthma patients.

Trends in prescribing and outcomes in obese versus non-obese patients receiving rivaroxaban therapy: an observational study using real-world data

PurposeTo investigate real-world prescribing trends and clinical outcomes based on body mass index (BMI) categorization in patients who received rivaroxaban therapy.MethodsThis was a retrospective cohort study involving all patients who received rivaroxaban therapy across all Hamad Medical Corporation (HMC) hospitals from 2015 to 2020.ResultsThe number of patients initiated on rivaroxaban therapy significantly increased from 152 (3.3%) in 2015 to 1342 (28.9%) in 2020 (p <0.001). Within BMI categories, a similar increasing trend was observed in underweight, normal, and overweight patients, while from 2018 to 2020, there was a decreasing trend in rivaroxaban prescribing in all obese classes. The prevalence rate of all-cause mortality differed significantly between the BMI groups, with the highest mortality being among morbidly obese patients (BMI ≥ 40 kg/m2) (p< 0.001). On the other hand, no significant differences were found between the BMI groups in terms of bleeding, pulmonary embolism, deep vein thrombosis and stroke incidences. Multivariate logistic regression analyses showed that the likelihood of all-cause mortality was significantly higher in overweight and all categories of obese patients compared to underweight patients: overweight (OR: 5.3, 95% CI: 2.3–11.9, p< 0.001); obese class 1 (OR: 5.4, 95% CI: 2.3 – 12.2, p< 0.001); obese class 2 (OR: 6.5, 95% CI: 2.7 – 15.6, p< 0.001); and obese class 3 (OR: 3.7, 95% CI: 1.6 – 8.7, p = 0.003).ConclusionsRivaroxaban prescribing has significantly increased over the years across general population, with a noticeable decline in obese population during the last few years (from 2018 onwards). Furthermore, an appreciable association was evident between all-cause mortality and BMI of these patients.

Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments.

Patients who undergo coronary artery bypass grafting (CABG) are known to be at a significant risk of experiencing long-term adverse events, emphasizing the importance of regular assessments. Evaluating health-related quality of life (HRQoL) serves as a direct method to gauge prognosis. Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary (PCS) and Mental Component Summary (MCS) derived from the Short-Form 36 (SF-36) health survey in CABG patients. The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013. SF-36 assessments were conducted during both the hospitalization period and follow-up. The primary endpoint of the study was all-cause mortality, while the secondary outcome was a composite measure including death, myocardial infarction, stroke, and repeat revascularization. We assessed the relationships between the PCS and MCS at baseline, as well as their changes during the first 6 months after the surgery (referred to as ΔPCS and ΔMCS, respectively), and the observed outcomes. The patients were followed for an average of 6.28 years, during which 35 individuals (35/433, 8.1%) died. After adjusting for clinical variables, it was observed that baseline MCS scores (hazard ratio [HR] for a 1-standard deviation [SD] decrease, 1.57; 95% confidence interval [CI], 1.07-2.30) and ΔMCS (HR for a 1-SD decrease, 1.67; 95% CI, 1.09-2.56) were associated with all-cause mortality. However, baseline PCS scores and ΔPCS did not exhibit a significant relationship with all-cause mortality. Notably, there was a dose-response relationship observed between ΔMCS and the likelihood of all-cause mortality (HRs for the 2nd, 3rd and 4th quartiles compared to the 1st quartile, 0.33, 0.45 and 0.11, respectively). Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG. Better mental health status and recovery indicated better prognosis.

Post-liver transplant outcomes in patients with major psychiatric diagnosis in the United States

Introduction and objectivesHigher rates of psychiatric disorders are reported among cirrhotic patients. This study examines the demographic and clinical outcomes post-liver transplant (LT) among cirrhotic patients with a major psychiatric diagnosis (cases) compared to those without psychiatric diagnosis (controls). Materials and methodsRetrospective case control design was used among 189 cirrhotic patients who had undergone LT at Methodist University Hospital Transplant Institute, Memphis, TN between January 2006 and December 2014. Multivariable regression and Cox proportional hazard regression were conducted to compare allograft loss and all-cause mortality. ResultsThe study sample consisted of a matched cohort of 95 cases and 94 controls with LT. Females and those with Hepatic Encephalopathy (HE) were more likely to have psychiatric diagnosis. Patients with hepatocellular carcinoma (HCC) were twice as likely to have allograft loss. Psychiatric patients with HCC had two and a half times (HR 2.54; 95% CI: 1.20–5.37; p = 0.015) likelihood of all-cause mortality. Data censored at 1-year post-LT revealed that patients with psychiatric diagnosis have a three to four times higher hazard for allograft loss and all-cause mortality compared to controls after adjusting for covariates, whereas when the data is censored at 5 year, allograft loss and all-cause mortality have two times higher hazard ratio. ConclusionsThe Cox proportional hazard regression analysis of censored data at 1 and 5 year indicate higher allograft loss and all-cause mortality among LT patients with psychiatric diagnosis. Patients with well-controlled psychiatric disorders who undergo LT need close monitoring and medication adherence.

Racial disparities among Asian Americans with atrial fibrillation: An analysis from the NCDR® PINNACLE Registry

BackgroundThere is paucity of data on Atrial Fibrillation (AF) management and associated clinical outcomes among Asian Americans. This study sought to investigate baseline risk factor profiles, racial disparities in clinical management and adverse clinical outcomes among White and Asian Americans. MethodsWe used National Cardiovascular Data Registry (NCDR®) Practice Innovation and Clinical Excellence (PINNACLE) registry and linked Centers of Medicare and Medicaid Services data to identify Asian and White patients with AF between January 1, 2013–June 30, 2018. We compared rates of baseline risk factors, management strategies (rate versus rhythm control), anticoagulation use and rates of adverse events between racial groups. The two race groups were compared using hierarchical multivariable adjusted regression models to account for site and confounders. ResultsIn total, 1,359,827 patients (18,793 Asians and 1,341,034 Whites) were included in our analysis. Compared to White Americans, Asian Americans were more likely to use a rate control strategy (Odds Ratio [OR]: 1.20, 95% Confidence Interval [CI]: 1.15–1.25) and lower odds of rhythm control strategy (atrial ablations, cardioversions, or use of antiarrhythmic drugs) (OR: 0.83, 95% CI: 0.80–0.87) in adjusted analysis. Use of oral anticoagulants and direct oral anticoagulants were similar. There were no significant race-based differences in likelihood of all-cause mortality, stroke, and bleeding requiring hospitalization. Analyses performed using propensity score matching were consistent with the main results. ConclusionsAsian Americans with AF have a lower likelihood of being managed with rhythm control strategies. Overall use of OAC and AF related adverse events remain similar between the two racial groups.

Association of baseline hand grip strength and annual change in hand grip strength with mortality among older people

BackgroundClinicians have increasing access to longitudinal data on hand grip strength (HGS), often measured for frailty or sarcopenia assessment, of their older clients. Evidence on the association of change in HGS with mortality is mixed. We investigated whether baseline hand grip strength (HGS) and annual change in HGS are associated with mortality among older Singaporeans. MethodsData from a national longitudinal survey (3 waves: 2009, 2011 and 2015) of older people (≥60 years) in Singapore was utilized. All-cause mortality, until end-December 2015, was assessed primarily from administrative databases. Two datasets, with 4446 (Dataset 1: baseline HGS with mortality) and 2673 (Dataset 2: annual change in HGS with mortality) participants, with maximum follow-up time of 7 and 4.6 years respectively, were derived from the survey data. Associations of interest were assessed using Cox proportional hazard models. Results835 (18.8%) and 317 (11.9%) participants died during follow-up, with mean survival times of 3.6 and 2.6 years, in Dataset 1 and 2 respectively. The likelihood of mortality was lower by 4% (Hazard Ratio [95% Confidence Interval]: 0.96 [0.94-0.97]) for each unit (kilogram) increase in baseline HGS, and by 13% (0.87 [0.82-0.93]) for each kg increase in HGS over 1-year. ConclusionsHigher (alternatively, lower) baseline HGS and an increase (alternatively, decrease) in HGS over 1-year were associated with lower (alternatively, higher) likelihood of all-cause mortality among community-dwelling older people. There is clinical value, for assessing the risk of mortality, of both the cross-sectional and longitudinal measurement of HGS among older people.

Umeclidinium bromide versus placebo for people with chronic obstructive pulmonary disease (COPD).

People with chronic obstructive pulmonary disease (COPD) have poor quality of life, reduced survival, and accelerated decline in lung function, especially associated with acute exacerbations, leading to high healthcare costs. Long-acting bronchodilators are the mainstay of treatment for symptomatic improvement, and umeclidinium is one of the new long-acting muscarinic antagonists approved for treatment of patients with stable COPD. To assess the efficacy and safety of umeclidinium bromide versus placebo for people with stable COPD. We searched the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov, the World Health Organization (WHO) trials portal, and the GlaxoSmithKline (GSK) Clinical Study Register, using prespecified terms, as well as the reference lists of all identified studies. Searches are current to April 2017. We included randomised controlled trials (RCTs) of parallel design comparing umeclidinium bromide versus placebo in people with COPD, for at least 12 weeks. We used standard Cochrane methodological procedures. If we noted significant heterogeneity in the meta-analyses, we subgrouped studies by umeclidinium dose. We included four studies of 12 to 52 weeks' duration, involving 3798 participants with COPD. Mean age of participants ranged from 60.1 to 64.6 years; most were males with baseline mean smoking pack-years of 39.2 to 52.3. They had moderate to severe COPD and baseline mean post-bronchodilator forced expiratory volume in one second (FEV1) ranging from 44.5% to 55.1% of predicted normal. As all studies were systematically conducted according to prespecified protocols, we assessed risk of selection, performance, detection, attrition, and reporting biases as low.Compared with those given placebo, participants in the umeclidinium group had a lesser likelihood of developing moderate exacerbations requiring a short course of steroids, antibiotics, or both (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.46 to 0.80; four studies, N = 1922; GRADE: high), but not specifically requiring hospitalisations due to severe exacerbations (OR 0.86, 95% CI 0.25 to 2.92; four studies, N = 1922, GRADE: low). The number needed to treat for an additional beneficial outcome (NNTB) to prevent an acute exacerbation requiring steroids, antibiotics, or both was 18 (95% CI 13 to 37). Quality of life was better in the umeclidinium group (mean difference (MD) -4.79, 95% CI -8.84 to -0.75; three studies, N = 1119), and these participants had a significantly higher chance of achieving a minimal clinically important difference of at least four units in St George's Respiratory Questionnaire (SGRQ) total score compared with those in the placebo group (OR 1.45, 95% CI 1.16 to 1.82; three studies, N = 1397; GRADE: moderate). The NNTB to achieve one person with a clinically meaningful improvement was 11 (95% CI 7 to 29). The likelihood of all-cause mortality, non-fatal serious adverse events (OR 1.33; 95% CI 0.89 to 2.00; four studies, N = 1922, GRADE: moderate), and adverse events (OR 1.06, 95% CI 0.85 to 1.31; four studies, N = 1922; GRADE: moderate) did not differ between umeclidinium and placebo groups. The umeclidinium group demonstrated significantly greater improvement in change from baseline in trough FEV1 compared with the placebo group (MD 0.14, 95% CI 0.12 to 0.17; four studies, N = 1381; GRADE: high). Symptomatic improvement was more likely in the umeclidinium group than in the placebo group, as determined by Transitional Dyspnoea Index (TDI) focal score (MD 0.76, 95% CI 0.43 to 1.09; three studies, N = 1193), and the chance of achieving a minimal clinically important difference of at least one unit improvement was significantly higher with umeclidinium than with placebo (OR 1.71, 95% CI 1.37 to 2.15; three studies, N = 1141; GRADE: high). The NNTB to attain one person with clinically important symptomatic improvement was 8 (95% CI 5 to 14). The likelihood of rescue medication usage (change from baseline in the number of puffs per day) was significantly less for the umeclidinium group than for the placebo group (MD -0.45, 95% CI -0.76 to -0.14; four studies, N = 1531). Umeclidinium reduced acute exacerbations requiring steroids, antibiotics, or both, although no evidence suggests that it decreased the risk of hospital admission due to exacerbations. Moreover, umeclidinium demonstrated significant improvement in quality of life, lung function, and symptoms, along with lesser use of rescue medications. Studies reported no differences in adverse events, non-fatal serious adverse events, or mortality between umeclidinium and placebo groups; however, larger studies would yield a more precise estimate for these outcomes.

Abstract P192: Metabolomic Profiles Associated with Total and CVD Mortality in Women

Background: Using novel metabolomic markers to identify individuals at increased risk for total and cardiovascular mortality may help inform therapeutic or prevention strategies. Methods: A total of 2306 women in the Women’s Health Initiative (WHI) Observational Study (WHI-OS) and Hormone Trials (WHI-HT) had 370 plasma metabolites measured at baseline by liquid chromatography tandem mass spectroscopy. The analysis cohort included 2298 women (943 WHI-OS; 1355 WHI-HT) with complete covariate data. Multivariate cox proportional hazards models were constructed to examine the association of metabolites with mortality, adjusting for age, body mass index, systolic blood pressure, hypertension treatment, diabetes, smoking, total and HDL cholesterol. The WHI-OS data were used for discovery analyses; metabolites with a multivariate-adjusted false discovery rate (FDR) adjusted p value &lt;0.05 were considered significant. These candidate metabolites were included for backwards selection (p for exclusion &gt; 0.05) to identify independent metabolites for inclusion in a composite score. The score of these significant mutually-adjusted metabolites was created based on the quartile score for each metabolite, with higher values indicating higher likelihood of all cause mortality and was tested in the WHI-HT cohort. Results: During a median follow-up of 16.7 years, 1,102 women died (417 WHI-OS; 685 WHI-HT), with 601 cardiovascular deaths. At baseline, the median age was 68 years (interquartile range 62-72) and median time to death was 9.9 years. In the WHI-OS discovery cohort, 56 metabolites were significantly associated with multivariate-adjusted total mortality (FDR p&lt; 0.05). When all 56 metabolites were mutually adjusted in the same model and subjected to backwards selection, 15 metabolites remained significantly associated with total mortality after multivariate adjustment and were used to create a composite score. In the separate WHI-HT validation cohort, women in the highest score quartile had a hazards ratio (HR) of 2.36 (95% CI: 1.88-3.21) for death. The mortality score was also associated with CVD death (HR 3.27 [2.54-4.22] highest vs. lowest quartile) for the combined WHI-OS and WHI-HT sample. Six metabolites were significantly associated with mortality in both samples with multivariate mutual adjustment; docosatrienoic acid an omega-3 fatty acid, histamine a pro-inflammatory compound , and the alpha-amino acids histidine and tryptophan were protective while 3-ureidopropionic acid an intermediate in the metabolism of uracil, and 18:1 cholesterol ester were associated with increased risk. Conclusions: Using a robust discovery and validation design, metabolite profiles were associated with significantly increased total and CVD mortality, even after adjustment for traditional risk factors.

Abstract 15154: T1-mapping and Outcomes in Non-ischemic Cardiomyopathies- An Investigator-led Multicenter Observational Longitudinal Study

Introduction: Nonischemic cardiomyopathy (NICM) is a recognised cause of poor clinical outcome. NICM is characterised by intrinsic myocardial impairment, which is driven by interstitial myocardial fibrosis in a considerable majority of NICM. The lack of accurate and noninvasive characterisation of interstitial myocardial fibrosis limits recognition of disease and effective clinical management in NICM. Hypothesis: T1 mapping by CMR is a novel non-invasive imaging application with a recognized potential to significantly improve the management of patients with NICM, supporting characterization of interstitial myocardial disease, assessment of severity of disease, risk stratification as well as development of targeted therapies. Comparative prognostic relevance of T1-mapping parameters in subjects with NICM for adverse outcome is unknown. Methods: an investigator-led multicenter observational longitudinal study in patients with NICM. We standardized imaging acquisition based on the modified Look-Locker sequence (MOLLI) (3(3)3(3)5) and post-processing approach of T1 mapping, and transferred the methodology to several other centres. We determined reference ranges for T1 mapping values and provided proof of concept studies in NICM in discrimination between health and disease. The primary endpoint was all-cause mortality. Results: 805 consecutive patients (mean age (years) 50±16; males: n=499, 62%) with NICM underwent contrast-enhanced CMR with T1-mapping. During a median follow-up period of 17 months (range 36 months), we observed a total of 26 deaths (18 cardiac). Native T1, ECV and extent of LGE were strongly associated with an increased likelihood of all-cause mortality (p&lt;0.001). In multivariate analyses, native T1 was the sole independent predictor of all-cause and cardiac mortality, over and above ECV and LGE. Native T1 was also superior in correctly classifying subjects and adverse events over a 17-months period. Conclusions. In patients with NICM, non-invasive measures of interstitial myocardial fibrosis are useful in prediction of outcome. Native T1 is an independent predictor over and above conventional markers of risk, providing a basis for a novel algorithm of risk stratification in NICM.

Abstract P356: Relationship between Serum Cystatin C, Body Mass Index and All-Cause Mortality in Adults with Normal Renal Function

Background: Cystatin C (Cys-C) is a sensitive biomarker of renal function and an independent predictor of all-cause mortality (ACM) in patients with chronic kidney and cardiovascular disease (CVD). Although higher levels of Cys-C are associated with increased body mass index (BMI), the interplay between serum Cys-C, BMI and ACM in adults with normal renal function is unknown. Methods: Utilizing data from the National Health and Nutrition Examination Survey (1999-2002), analysis was conducted on participants (≥18 years) with normal renal function [glomerular filtration rate (GFR) ≥90 ml/min)]. BMI (kg/m2) was categorized as Normal (BMI:18.5-24.9); Overweight (BMI:25-29.9); Obese (BMI &gt;30), while Cys-C (mg/L) was categorized into weight based quartiles [Q1:&lt;0.72(ref); Q2: ≥0.72-0.80; Q3: ≥0.80-0.89; Q4: ≥0.89]. Mortality information was obtained from the National Death Index using probabilistic matching. Cox proportional hazards models (and associated 95% CI’s) estimated the likelihood of ACM by Cys-C quartiles in each BMI category. Results: The mean(±) age and GFR of 2649 participants (51% females) was 50±20 years and 123±28 mL/min, while the median (IQR) of CRP and Cys-C was 0.19(0.07-0.44) mg/dL and 0.80(0.72-0.89) mg/L, respectively. Approximately, 33% of the cohort was normal, 34% overweight, and 33% were obese. After a mean(SD) follow up of 5.9(1.3) years, 213 deaths (all-cause) were observed. Cys-C levels increased with increasing BMI (p trend &lt;0.05), however, significant difference was only seen in obese when compared with normal weight adults (p&lt;0.05). Within each BMI category, increasing Cys-C was associated with increased risk of ACM (p trend &lt;0.05), however, the hazard ratio were statistically significant only at elevated Cys-C levels (Q4 vs.Q1) in normal and overweight adults (both p values &lt;0.05). Conclusions: Independent of traditional CVD risk factors, elevated Cys-C levels predicts risk of ACM in normal and overweight but not in obese adults who have normal renal function based on GFR.

Mortality risk for women on chronic hemodialysis differs by age.

BackgroundPrevious reports have demonstrated similar survival for men and women on hemodialysis, despite women’s increased survival in the general population.ObjectivesTo examine the effect of age on mortality in women undergoing chronic hemodialysis.DesignA retrospective cohort study using an administrative data registry, the Canadian Organ Replacement Registry (CORR) from Jan. 2001 and Dec. 2009.SettingCanada.Patients28,971 (Women 11,792 (40.7%), Men 17,179 (59.3%)) incident chronic hemodialysis patients who survived greater than 90 days on dialysis.MeasurementsAll-cause mortality.MethodsCox proportional hazards and competing risks models were employed to determine the independent association between sex, age and likelihood of all-cause mortality with renal transplantation as the competing outcome.ResultsDuring the study period, 6060 (51.4%) of women and 8650 (50.4%) of men initiating dialysis died. Younger women experienced higher mortality (Age < 45: Women 22.5%, Men 18.2%, hazard ratio (HR) 1.31 (1.12-1.52)) whereas elderly women experience lower mortality (Age 75–85: Women 65%, Men 67.3%, HR 0.94 95% CI 0.88-0.99, Age > 85: Women 66%, Men 70.2%, HR 0.83 95% CI 0.71-0.97) compared to men. This relationship persisted after accounting for the competing risk of transplantation.LimitationsThe cause of death was unknown.ConclusionsWomen’s survival on chronic hemodialysis varies by age compared to men with a significantly higher mortality in women younger than 45 years old and lower mortality in woman older than 75 years of age.

Abstract 4005: Longterm Survival Among Survivors Of Stroke And Myocardial Infarction In The Third National Health And Nutrition Examination Survey Mortality Follow-up Study.

BACKGROUND: Several studies have demonstrated that the adequacy of secondary prevention is better among survivors of myocardial infarction (MI) compared with the survivors of stroke. We investigated the hypothesis that long-term survival among stroke survivors is lower than survivors of myocardial infarction. METHODS: We identified stroke and MI survivors from a nationally representative sample of 11989 US adults aged 17 to 59 years who participated in the Third National Health and Nutrition Examination Survey Mortality Follow-up Study. We compared the long-term survival between survivors of stroke and MI and those without any cardiovascular disease using Cox proportional hazards analyses. Potential confounding factors in the association between stroke and MI with death (cardiovascular and all cause) included age, sex, race/ethnicity, hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, body mass index, and alcohol use. RESULTS: A total of 485 survivors with stroke and 774 survivors with MI were included in the analysis; 74 stroke related, 128 acute MI related, and 356 ischemic heart disease related deaths and 941 all causes deaths were reported during a mean follow-up period of 8.5+/-5.3 years. After adjusting for differences in age, sex, race/ethnicity, hypertension, diabetes mellitus, cholesterol level, cigarette smoking, body mass index, and alcohol use, there was no difference among stroke survivors in likelihood of all-cause mortality (relative risk [RR], 1.1 ; 95% confidence interval [CI], 0.9 to 1.3) and cardiovascular death (RR, 0.9; 95% CI, 0.7 to 1.2) compared with persons without cardiovascular disease. CONCLUSION: Survivors of stroke face the same reduction in long-term survival as survivors of MI in the community. Therefore, proportionate efforts are required in public education and secondary prevention to improve long-term survival in these patients.