Lower All-cause Mortality Research Articles

Metabolic and Bariatric Operation and the Path to Kidney Transplantation.

Obesity is a significant barrier to kidney transplantation for patients with end-stage renal disease (ESRD). We aimed to evaluate the long-term impact of metabolic and bariatric surgery (MBS) on kidney transplantation access and outcomes in individuals with obesity and ESRD patients. A retrospective cohort study using data from 64 US healthcare organizations included 132,989 individuals with obesity (BMI ≥30kg/m²) and ESRD requiring dialysis, of whom 6,263 (4.6%) underwent MBS. Propensity score matching produced 1:1 matched groups of 6,238 patients each, analyzed over 10 years. Primary outcomes included rates of kidney transplant waitlist placement, transplantation, and overall mortality. Secondary outcomes focused on 22,979 transplant recipients, including 1,701 (7.4%) MBS patients, to evaluate post-transplant adverse events. Over a median follow-up of 33.3 months (MBS) and 28.5 months (controls), MBS patients demonstrated higher rates of waitlist placement (19.12% vs 10.53%, HR=1.800, 95%CI=1.636-1.980, p<0.001) and transplantation (27.06% vs 16.09%, HR=1.712, 95%CI=1.584-1.852, p<0.001) at 10 years, with benefits evident within 1-month postoperation. Mortality was lower in the MBS group (30.55% vs 36.44%, HR=0.768, 95%CI=0.723-0.817, p<0.001). In transplant recipients, MBS patients had lower cardiovascular complications (37.3% vs 40.6%, RR=0.92, p=0.007) and all-cause mortality (16.70% vs 20.88%, HR=0.82, p<0.001), with no significant differences in graft rejection or failure. MBS significantly improves access to kidney transplantation and long-term survival for obese ESRD patients. Patients who underwent MBS demonstrated notable improvements in cardiovascular health, potentially leading to a better quality of life and survival.These findings suggest that MBS should be considered as part of the comprehensive care for this high-risk population.

Baricitinib treatment for hospitalized patients with severe COVID-19 on invasive mechanical ventilation: a propensity score-matched and retrospective analysis

IntroductionBaricitinib is a selective inhibitor of Janus kinase (JAK)1 and JAK2, which is associated with clinical improvement in non-severe COVID-19 patients. But in severe COVID-19 patients, the effectiveness of baricitinib is still controversial.MethodsA propensity score-matched and retrospective study was conducted to evaluate the effectiveness of baricitinib in severe COVID-19 patients requiring invasive mechanical ventilation (IMV).ResultsA total number of 48 patients treated with baricitinib were included, and 48 patients were assigned to control group by propensity score matching. The mean ages were high in both group (baricitinib group vs. control group: 78.80 ± 9.04 vs. 82.57 ± 9.27), and most were unvaccinated (62.5% vs. 66.7%. Baricitinib group had a higher proportion of patients with hypertension (73.9% vs. 45.5%, p = 0.006). Control group had higher level of creatine kinase-myocardial band (247.50 vs. 104.50, p = 0.021). Patients in the baricitinib group were more likely to receive nirmatrelvir/ritonavir (39.6% vs. 16.7%, p = 0.017) and intravenous immunoglobin (14.6% vs. 0, p = 0.007). Baricitinib group had significantly lower all-cause 28-days mortality than control group (72.9% vs. 89.6%, p = 0.004).ConclusionThe present study revealed baricitinib reduced 28-days mortality in severe COVID-19 patients on IMV. The effectiveness of baricitinib in treating patients with severe COVID-19 on IMV needs to be further investigated through future studies.

Associations of objectively measured physical activity and sedentary time with all-cause mortality in Japanese older adults: a 10-year prospective study

ObjectiveTo examine the associations of accelerometer-measured physical activity and sedentary time with all-cause mortality in older Japanese adults.MethodsA total of 1723 independent Japanese adults aged ≥65 years were followed from...

Mortality risk among individuals who smoke opioids compared with those who inject: A propensity score-matched cohort analysis of United States national treatment data.

Opioid smoking is becoming more common in the United States. The aim of this analysis was to estimate relative mortality risk among those who primarily smoke opioids compared with those who inject. Retrospective propensity score-matched cohort analysis. 2006-2021 US treatment episode data from SAMHSA TEDS-D. We matched 287 481 individuals in a substance use treatment program reporting smoking opioids as their primary substance use to an equal weighted number of individuals in a substance use treatment program reporting injecting opioids as their primary substance use. The majority of individuals reporting smoking were male (62.6%), 21-29 years old (47.9%), white (65.7%), independently housed (54.3%) and in the West Census Region (70.3%). Cohort characteristics were closely balanced after matching. The outcome of interest was death during a treatment episode. Variables used for matching were year, opioid category, gender, race/ethnicity, age category, census region, housing status, employment status, number of prior treatment admissions, variables associated with opioid use severity (opioid use frequency, treatment setting intensity, age at first opioid use, use of medication-assisted treatment) and other reported substance use (methamphetamine, alcohol, benzodiazepines, cocaine). The mortality rate was 6.5 [95% confidence interval (CI) =5.9-7.1] per 1000 person-years in the smoking cohort and 9.7 (95% CI = 8.8-10.8) per 1000 person-years in the injection cohort, with a mortality rate ratio of 0.67 (95% CI = 0.58-0.77). Among individuals in substance use treatment in the United States, those who usually smoke opioids appear to have a lower all-cause mortality risk than those who usually inject.

Oxidative stress and retinopathy: evidence from epidemiological studies

BackgroundPrevious studies have suggested oxidative stress may play a key role in the pathogenesis of retinopathy, while evidence from observational studies directly linking oxidative biomarkers to clinically relevant outcomes has been limited. This study aims to investigate the association between oxidative balance score (OBS) and prevalence of retinopathy in a nationally representative sample of U.S. adults, including both those with and without diabetes.MethodsData were obtained from the NHANES 2005–2008, including 3,287 participants. OBS was calculated from 16 dietary and 4 lifestyle components and categorized into tertiles. Weighted logistic regression was used to assess the association between OBS and retinopathy in the overall, diabetic, and non-diabetic populations, and Cox proportional hazards models evaluated the link between OBS and all-cause mortality in those with retinopathy. Restricted cubic spline (RCS) analysis explored the dose-response relationship between OBS and retinopathy. Subgroup analyses and interaction tests were conducted based on age, sex, race, BMI, education level, and diabetes status.ResultsParticipants in the highest OBS tertile had a 28% lower risk of retinopathy compared to those in the lowest tertile (OR 0.72, 95% CI 0.54–0.95, P = 0.023). RCS analysis showed a significant overall association between higher OBS and reduced retinopathy risk, without a nonlinear pattern. In participants with retinopathy, higher OBS was linked to a 60% reduction in all-cause mortality (HR 0.40, 95% CI 0.24–0.66, P < 0.001). Subgroup analysis revealed stronger inverse associations between OBS and retinopathy in younger individuals and those with higher education, with a significant interaction between OBS and age (P for interaction < 0.05).ConclusionOur study provides evidence that higher cumulative antioxidant exposure assessed by OBS is associated with a reduced risk and severity of retinopathy and lower all-cause mortality in U.S. adults with retinopathy, highlighting the importance of maintaining a favorable oxidative balance in retinal health.

Temporal order of atrial fibrillation and acute myocardial infarction and associated prognosis in the Danish Diet, Cancer and Health cohort

BackgroundAtrial fibrillation (AF) and acute myocardial infarction (AMI) share risk factors and are bidirectionally associated. Several studies found higher risks of outcomes in individuals with both conditions. Whether the risks...

The associations of long-term physical activity in adulthood with later biological ageing and all-cause mortality - a prospective twin study.

The association between leisure-time physical activity (LTPA) and a lower risk of mortality is susceptible to bias from multiple sources. We investigated the potential of biological ageing to mediate the association between long-term LTPA and mortality and whether the methods used to account for reverse causality affect the interpretation of this association. Study participants were twins from the older Finnish Twin Cohort (n = 22,750; 18-50 years at baseline). LTPA was assessed using questionnaires in 1975, 1981 and 1990. The mortality follow-up lasted until 2020 and biological ageing was assessed using epigenetic clocks in a subsample (n = 1,153) with blood samples taken during the follow-up. Using latent profile analysis, we identified classes with distinct longitudinal LTPA patterns and studied differences in biological ageing between these classes. We employed survival models to examine differences in total, short-term and long-term all-cause mortality, and multilevel models for twin data to control for familial factors. We identified four classes of long-term LTPA: sedentary, moderately active, active and highly active. Although biological ageing was accelerated in sedentary and highly active classes, after adjusting for other lifestyle-related factors, the associations mainly attenuated. Physically active classes had a maximum 7% lower risk of total mortality over the sedentary class, but this association was consistent only in the short term. After accounting for familial factors and excluding participants reporting prevalent cardiovascular diseases, LTPA exhibited less favourable associations with mortality. The association between LTPA and lower all-cause mortality may be largely due to genetic confounding and reverse causality.

Relationship between oxidative balance score and all-cause mortality in hypertension.

Exploring the association between oxidative balance score (OBS) and all-cause mortality in hypertension (HTN). Data for HTN patients from 2007 to 2018 were extracted from the National Health and Nutrition Examination Survey (NHANES). OBS offers a thorough evaluation of an individual's redox status, with higher score indicates favorable oxidative homeostasis. All-cause mortality was obtained by linkage to National Death Index records through 31 December 2019. Weighted multivariable Cox regression models, Kaplan-Meier curves, receiver operator characteristic (ROC) curve, and random survival forests (RSF) analysis were applied to examine the relationship between OBS and all-cause mortality in HTN. The cohort included 13,130 participants, with 2,132 deaths. Higher OBS was associated with lower all-cause mortality risk (HR=0.77, 95%CI: 0.65-0.91) in HTN. The relationship also existed in subgroups of male, having/haven't chronic kidney disease, and having cardiovascular disease. Kaplan-Meier curves suggested that participants with higher OBS had superior survival rates compared to those with lower intake. The RSF showed a better survival predictive role for physical activity among the components of OBS. Higher OBS was related to lower odds of all-cause mortality in patients with HTN. Adopting a healthy lifestyle and consuming an antioxidant-rich diet may improve the prognosis of patients with HTN.

Moderate full-fat and low-fat yoghurt consumption correlates with reduced mortality risk: a large-scale prospective analysis.

Yoghurt is a commonly consumed fermented food recommended by many guidelines. Yoghurt consumption can contribute to the intake of multiple nutrients and reduce the risk of several diseases. However, prospective evidence is limited on the associations between full/low-fat yoghurt consumption and mortality risk. In this prospective cohort study, we aimed to assess the dose-dependent associations between full/low-fat yoghurt intake and all-cause or cause-specific mortality. We enrolled 186 168 participants from the UK Biobank who had joined the study between 2006 and 2010 and were followed up until 2022. We obtained data on self-reported intake of full/low-fat yoghurt and mortality from all causes and specific causes of death, including cancers and cardiovascular diseases (CVDs). We then used Cox proportional hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) to evaluate the associations between full-fat and low-fat yoghurt intake and mortality. Lastly, we conducted subgroup and sensitivity analyses to examine the robustness of our findings. A total of 9402 deaths occurred during a mean follow-up of 13.4 years, including 1687 CVD-related and 5073 cancer-related deaths. Relative to non-consumers, the HRs (95% CIs) for all-cause mortality risk in participants consuming >0-50, 50-100, and >100 g of full-fat yoghurt a day were 0.82 (95% CI = 0.72, 0.93), 0.97 (95% CI = 0.86, 1.09), and 0.96 (95% CI = 0.84, 1.1) respectively. The corresponding HR estimates relative to non-consumers for participants consuming low-fat yoghurt were 0.88 (95% CI = 0.81, 0.95), 0.91 (95% CI = 0.85, 0.98), and 0.95 (95% CI = 0.89, 1.01), respectively. Subgroup analysis indicated women who had moderate consumption of full-fat yoghurt had lower all-cause mortality risk, while men consuming low-fat yoghurt had lower all-cause mortality risk. Moderate consumption of full-fat and low-fat yoghurt was correlated with decreased all-cause mortality. Future cohort studies are warranted to verify the potential of adopting yoghurt consumption as part of a healthy diet to reduce mortality.

Diabetes complications in people with alcohol use disorder and type 2 diabetes.

People living with alcohol use disorder (AUD) who develop Type 2 Diabetes (T2DM) may be at higher risk of diabetes-complications. Our aims were to compare diabetes-monitoring and incidence of diabetes-complications between people with and without AUD prior to T2DM diagnosis attending primary care in England. We used the Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality data. The target population was people with incident T2DM diagnosed between 2004-2019. We defined AUD from codes indicating i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm. Outcomes were end stage renal disease (ESRD), lower limb amputation, myocardial infarction (MI), stroke, cardiovascular disease (CVD) mortality and all-cause mortality. We compared yearly HbA1c, creatinine and cholesterol monitoring activities for the first 5 years post T2DM diagnosis. The study population was 543,509 people, of whom 15 237(2.8%) had a code for AUD. Adjusting for measured confounders, people with AUD had higher rates of ESRD (IRR 1.95 95% CI 1.71, 2.23), lower limb amputation (IRR 1.78 95% CI 1.50, 2.21), stroke (IRR 1.35 95% CI 1.25, 1.46), CVD mortality (IRR 1.74 95% 1.63, 1.86) and all-cause mortality (IRR 2.10 95% CI 2.04, 2.17) but not MI (IRR 0.91 95% CI 0.82, 1.00) compared with people without AUD. Laboratory diabetes-monitoring was high in people with (83.5-91.1%) and without (83.7-92.4%) AUD. People with AUD had nearly double the rates of most of the diabetes-complications investigated than people without AUD.

Association between oxidative balance score and all-cause, CVD and respiratory-related mortality in the US older adults of asthma patients with diabetes

BackgroundThis study aims to investigate the correlation between oxidative balance score (OBS) and all-cause, cardiovascular disease (CVD) and respiratory-related mortality within a cohort that includes older asthma patients with diabetes.MethodsData from the National Health and Nutrition Examination Survey (NHANES) spanning from 2001 to 2018, which included 611 participants, were analyzed. Mortality outcomes were determined by linking the data to National Death Index (NDI) records through December 31, 2019. Cox regression modeling was employed to examine the relationship between OBS and all-cause, CVD and respiratory-related mortality. Restricted cubic splines (RCS), subgroup analyses and interaction tests were also conducted in this study.ResultsOver a median follow-up of 78.96 months, there were 216 all-cause deaths and 57 CVD-related deaths. A significant negative association was found between the OBS and all-cause and CVD mortality. We did not observe OBS could reduce respiratory-related mortality in older asthma patients with diabetes. RCS analysis indicated a linear and inverse association between the OBS and all-cause and CVD mortality. Subgroup analyses and interaction tests indicated the negative association between OBS and CVD mortality was significantly influenced by alcohol consumption.ConclusionIn this sample, higher OBS was associated with lower all-cause and CVD mortality risks. These findings stressed the importance of infection status in assessing oxidative balance’s impact on health.

Association of a remote monitoring programme with all-cause mortality and hospitalizations in patients with heart failure: National-scale, real-world evidence from a 3-year propensity score analysis of the TELESAT-HF study.

To examine the association of a remote monitoring programme (RMP) with all-cause mortality and hospital admissions for heart failure (HF) within the French healthcare system. A national-scale, real-world, propensity-weighted cohort study was conducted using the SNDS French database from August 2018 to December 2022 (NCT06312501). Patients receiving standard of care (SoC) were compared with those receiving RMP (Satelia® Cardio, NP Medical). The Satelia® Cardio algorithm adjusted the monitoring frequency based on symptom and weight changes, and provided tailored web-based patient education. The RMP included a digital interface for proficient patients and phone monitoring by nurses for those uncomfortable with digital technology. Data were sourced from over 300 healthcare centres across France. A propensity-weighted Cox regression model was used, supplemented by sensitivity analyses across subgroups. In total, 5357 RMP patients and 13 525 SoC patients were included after weighting. Weighted/adjusted analyses showed lower all-cause mortality for RMP patients (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.59-0.70; p < 0.0001), persisting across hospitalization and/or long-term illness status subgroups (HR 0.52 to 0.75). RMP was neutrally associated with HF hospitalization rates (rate ratio [RR] 0.95; 95% CI 0.89-1.02) but linked to less time in hospital (-2.1%, p < 0.0001) and fewer emergency visits (RR 0.83; 95% CI 0.75-0.92; p = 0.001). In France, RMP with customized monitoring frequencies and educational strategies was associated with lower all-cause mortality, emergency visits, and time spent in hospital in patients with HF which may enhance nationwide HF management.

Association of tea consumption with all-cause/cardiovascular disease mortality in the chronic kidney disease population: an assessment of participation in the national cohort

Background While there are numerous benefits to tea consumption, its long-term impact on patients with chronic kidney disease (CKD) remains unclear. Method Our analysis included 17,575 individuals with CKD from an initial 45,019 participants in the National Health and Nutrition Examination Survey (NHANES) (1999–2018). Individuals with extreme dietary habits, pregnancy, or non-CKD conditions were excluded. Key cohort demographics revealed a mean age of 62.3 years, with 52.1% female participants, and 57.3% identified as non-Hispanic White. A total of 5,835 deaths were recorded during follow-up, including 1,823 cardiovascular-related deaths. Cox and restricted cubic spline regression was used to examine the linear or nonlinear association of tea consumption with mortality. The substitution analysis explored the effects of replacing a specific type of tea with another type of tea. Subgroup analysis stratified by sex, age, body mass index (BMI), diabetes, cancer, cardiovascular disease (CVD), and urinary albumin. Sensitivity analysis was performed to ensure the reliability of our findings. Results After adjusting for age, sex, race, education level, marital, annual household income, energy intake, total water intake, protein intake, carbohydrate intake, dietary fiber, sugar beverages, milk whole, total monounsaturated fatty acids, total polyunsaturated fatty acids, total saturated fatty acids, smoking, metabolic equivalent of task for physical activity level (MET-PA), BMI, diabetes, hypertension, urinary albumin, estimated glomerular filtration rate (eGFR), CVD, cancer, serum sodium, serum potassium, and serum phosphorus, setting the individuals without tea consumption record as reference. Consuming up to 4 cups of tea per day was significantly associated with lower all-cause mortality compared with that never drinking tea, among CKD patients at 1–2 stages [Hazard Ratio (HR) = 0.89; 95% Confidence Interval (CI) = 0.79, 0.99; p = 0.04], while the association between tea consumption and CVD mortality didn’t reach statistical significance. Dose-response effect was observed, showing that consuming up to three to five cups of tea per day was associated with mitigated risks of all-cause mortality, particularly in early CKD stages (non-linear p > 0.05). A 1 cup per day higher intake of oxidized tea was associated with a 10% lower risk of all-cause mortality in CKD stage 1–2 [HR = 0.90; 95%CI = 0.82, 0.99; p = 0.03]. Replacing 1 cup of green tea with 1 cup of oxidized tea per day was associated with an 8% and 11% lower risk of all-cause mortality [HR = 0.92; 95%CI = 0.86, 0.98; p = 0.01] and CVD mortality [HR = 0.89; 95%CI = 0.80, 1.00; p < 0.05], respectively, in individuals with CKD stages 1–2. Conclusion Tea consumption showed protective effects on all-cause mortality in CKD population, with potential benefits observed in terms of both the cups quantity and types of tea consumed. These findings appeared to be more prominent among early stages CKD population.

Combined 25-hydroxyvitamin D concentrations and physical activity on mortality in US stroke survivors: findings from the NHANES

Background25-hydroxyvitamin D [25(OH)D] concentrations and physical activity (PA) are linked and both are associated with changes in mortality. We examined the association of 25(OH)D and PA with all-cause or cause-specific mortality risk in stroke survivors.MethodsThe analysis included 677 stroke survivors from National Health and Nutrition Examination Survey (NHANES) 2007–2008 to 2017–2018. Independent and joint associations of 25(OH)D, PA and mortality among stroke survivors were analyzed using weighted Cox regression.ResultsWe identified 133 all-cause deaths [major adverse cardiovascular events (MACE), 34; non-MACE, 79] with a median follow-up of 5.8 years (interquartile, 2.8–8.9 years). In a range of adjusted models, high 25(OH)D was observed with lower all-cause mortality compared to low 25(OH)D (HR, 0.376; 95% CI, 0.233–0.607) and non-MACE (HR, 0.265; 95% CI, 0.143–0.490) mortality was consistently associated. At the same time, compared with no PA, PA was associated with a lower all-cause (HR, 0.280; 95%CI, 0.107–0.733) and non-MACE (HR, 0.266; 95%CI, 0.087–0.810) was associated with a lower risk of death. In addition, pooled analyses showed that stroke survivors with high 25(OH)D and PA had the lowest risk of all-cause death (HR, 0.132; 95%CI, 0.038–0.460) and non-MACE (HR, 0.092; 95%CI, 0.023–0.363), there is an additive interaction between 25(OH)D and PA in non-MACE.ConclusionIn conclusion, this study found that combining high 25(OH)D levels and PA showed an enhanced protective effect which demonstrated a synergistic effect between them in reducing mortality among stroke survivors. These findings provide new ideas and possibilities for the prevention and treatment of cardiovascular and cerebrovascular diseases, offering a reference for development of clinical practice guidelines in the future.

Glucagon-Like Peptide-1 Receptor Agonists and Liver Outcomes in Patients With MASLD and Type 2 Diabetes.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated long-term liver benefits in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D). However, no direct comparison between these therapies has been conducted. This study aimed to compare major adverse liver outcomes (MALOs) between GLP-1 RAs and SGLT2is in patients with MASLD and T2D. Using the TriNetX Research Network, a multinational and multi-institutional database, we identified adults with MASLD and T2D who received their first prescription for either a GLP-1 RA or an SGLT2i between January 2010 and June 2023. We conducted a propensity score-matched (PSM) cohort study comparing new users of GLP-1 RAs and SGLT2is. The primary outcome was the risk of MALOs, a composite endpoint consisting of decompensated cirrhosis events, hepatocellular carcinoma, and liver transplantation. Secondary outcomes included all-cause mortality and individual components of the primary outcome. This study included 15,176 pairs of patients treated with either a GLP-1 RA or a SGLT2i. The adjusted hazard ratio (HR) for MALO associated with GLP-1 RAs relative to SGLT2is was 0.84 (95% confidence interval [CI]: 0.73-0.97; incidence rate: 88.9 versus 105.3 events per 10,000 person-years), primarily driven by reduction in decompensated cirrhosis events (adjusted HR: 0.83, 95% CI: 0.71-0.96). GLP-1 RAs were associated with lower all-cause mortality (adjusted HR: 0.84, 95% CI: 0.75-0.94). GLP-1 RAs are associated with better long-term liver outcomes compared to SGLT2is in patients with MASLD and T2D.

High and Low Adherence to Mediterranean and DASH Diet Patterns and the Risk of Heart Failure: A Meta-Analysis of Observational Studies.

The relationship between heart failure (HF) and Mediterranean and DASH diets is not well delineated. This meta-analysis aimed to assess the effectiveness of high adherence to Mediterranean and DASH diets compared to low adherence in reducing the risk of incident HF (primary prevention of HF) and reducing all-cause mortality in patients with HF (secondary prevention of HF). The reporting stages of this meta-analysis closely adhered to the PRISMA guidelines. A comprehensive literature search was undertaken for published papers in PubMed, Embase, EBSCO, ICTRP, and the NIH clinical trials databases. A total of 16 reports from 14 studies were included in this paper. A significant inverse association was identified between high adherence to the Mediterranean diet model (compared to low adherence) and the risk of incident HF (OR = 0.77, 95% CI: 0.63-0.93, p = 0.007) among patients without previous diagnosis of HF. Similarly, there was a significant and inverse relationship between high adherence to the DASH diet (compared to low adherence) and the risk of incident HF (OR = 0.83, 95% CI: 0.70-0.98, p = 0.03) among patients without previous diagnosis of HF. High adherence to the Mediterranean diet model (compared to low adherence) was associated with lower all-cause mortality (OR = 0.88, 95% CI: 0.78-0.99, p = 0.03) among patients with HF. This paper demonstrated that high adherence to Mediterranean and DASH diets significantly reduced the risk of incident HF among individuals without a previous diagnosis of HF, whereas only high adherence to the Mediterranean diet was associated with lower all-cause mortality among patients with HF.

Adherence to integrated care using the 'Atrial fibrillation Better Care' pathway in asymptomatic patients with atrial fibrillation improves clinical outcomes: A report from the prospective COOL-AF registry.

Identifying asymptomatic patients with atrial fibrillation (AF) poses a challenge, and their optimal management is less certain, despite similar outcomes to symptomatic AF patients. The 'Atrial fibrillation Better Care' (ABC) pathway has been recently proposed as a holistic or integrated care approach for the comprehensive management of symptomatic patients with AF. We aimed to determine the use of the ABC pathway on clinical outcomes in asymptomatic patients with AF. This is a prospective multicenter registry of patients with non-valvular AF in Thailand conducted between 2014 and 2017. Patients were characterized based on AF-related symptoms at enrollment and their adherence or non-adherence to the ABC pathway. Follow-up data were collected for 3 years to examine the composite endpoint (all-cause death, ischemic stroke/transient ischemic attack [TIA]/systemic embolism [SE], and major bleeding), and the impact of adherence to the ABC pathway. Of a total of 3405 patients included in the study, 785 (23%) (mean age 69.0 years, 63.7% male) were asymptomatic at enrollment. Among these asymptomatic patients, 346 (44%) were adherent to the ABC pathway. Adherence to the ABC pathway was associated with a significantly lower rate of composite endpoints compared to non-adherence (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.45-0.90, p=0.01). Adherence to the ABC pathway was also associated with lower all-cause mortality rates (HR 0.55, 95% CI 0.35-0.85, p=0.007). After adjusting for age, gender, and baseline comorbidities, adherence to the ABC pathway remained significantly associated with a lower rate of composite endpoints (HR 0.69, 95% CI 0.49-0.98, p=0.03) and all-cause death (HR 0.58, 95% CI 0.38-0.90, p=0.01) compared to non-adherence. Subgroup analyses based on sex, age, AF type, risk scores, and comorbidities consistently demonstrated lower hazard ratios for the composite endpoint among patients who were adherent to the ABC pathway. In patients with AF who were asymptomatic, adherence to the ABC pathway was associated with a lower composite endpoint of all-cause death, ischemic stroke/TIA/SE, and major bleeding. This benefit was seen irrespective of sex, age, AF type, risk scores, and comorbidities.

A plant-based diet index and all-cause and cause-specific mortality: a prospective study.

Background: A plant-based dietary pattern has been recently suggested to have health benefits. However, its relationship with mortality is not completely consistent in prior studies. We aimed to investigate whether a plant-based diet was associated with a lower death risk in a Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening study. Methods: We included 91 414 participants from the PLCO study. Dietary data were collected using a diet history questionnaire (DHQ). We used three plant-based diet indices including an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard regression model. Results: During a median of 17.1 years of follow-up, we documented 19 456 deaths, including 5489 deaths from cardiovascular disease (CVD) and 6172 deaths from cancer. Comparing the highest versus lowest quintiles of the PDI, the multivariable-adjusted HR of all-cause mortality was 0.83 (95% CI 0.80-0.87, P for trend < 0.001). Those in the highest quintile of the PDI also had lower risks of CVD mortality (HR 0.87, 95% CI 0.80-0.95, P for trend < 0.001) and cancer mortality (HR 0.89, 95% CI 0.82-0.96, P for trend = 0.003) compared to those in the lowest quintile. Participants in the highest quintile of the hPDI had a decreased risk of all-cause and cause-specific mortality, whereas participants with the highest uPDI scores had an increased death risk. Conclusion: Greater adherence to a plant-based dietary pattern was significantly associated with lower all-cause and cause-specific mortality.

Use of bisphosphonates in chronic kidney disease is associated with cardiovascular death.

Chronic kidney disease (CKD) is associated with increased cardiovascular risk, which may be mediated by vascular calcification. Based on evidence that bisphosphonates inhibit vascular calcification, we hypothesized use of bisphosphonates in CKD would be associated with lower incident cardiovascular disease (CVD), CVD-related mortality, and all-cause mortality. This was a longitudinal observational study including 2,593 Framingham Offspring participants. We used propensity score-adjusted Cox regression models to determine the association between bisphosphonate use and outcomes: time to incident CVD, time to CVD-related mortality, and time to all-cause mortality. The data were stratified by presence or absence of CKD, defined as estimated glomerular filtration rate <60 mL/min/1.73m2. The propensity score included age, sex, hypertension, smoking status, diabetes, total cholesterol, high-density lipoprotein, and self-reported history of fracture. In unadjusted and propensity score-adjusted analyses, those with CKD using bisphosphonates had a trend toward increased incident CVD risk (adjusted hazard ratio (HR) 1.66 (95% CI, 93-2.97)) compared to those with CKD not using bisphosphonates. Those with CKD using bisphosphonates also had increased risk of cardiovascular mortality in the propensity score-adjusted model (adjusted HR 2.20 (95% CI, 1.12-4.32)). There was no significant association between bisphosphonate use and all-cause mortality in participants with CKD. Among individuals without CKD, bisphosphonate use was significantly associated with an increase in all-cause mortality in the propensity-score adjusted analysis (adjusted HR 1.59 (95% CI, 1.27-1.98)). However, there was no significant association between bisphosphonate use and incident CVD events (adjusted HR 0.85 95% CI, 0.63-1.16) or CVD-related death (adjusted HR 0.70 (95% CI 0.36-1.37) in those without CKD. Contrary to our hypothesis, bisphosphonate use was associated with a trend toward increased incident CVD and a two-fold higher risk of CVD mortality in CKD.

Explainable Machine Learning to Predict Treatment Response in Advanced Non-Small Cell Lung Cancer.

Immune checkpoint inhibitors (ICIs) have demonstrated promise in the treatment of various cancers. Single-drug ICI therapy (immuno-oncology [IO] monotherapy) that targets PD-L1 is the standard of care in patients with advanced non-small cell lung cancer (NSCLC) with PD-L1 expression ≥50%. We sought to find out if a machine learning (ML) algorithm can perform better as a predictive biomarker than PD-L1 alone. Using a real-world, nationwide electronic health record-derived deidentified database of 38,048 patients with advanced NSCLC, we trained binary prediction algorithms to predict likelihood of 12-month progression-free survival (PFS; 12-month PFS) and 12-month overall survival (OS; 12-month OS) from initiation of first-line therapy. We evaluated the algorithms by calculating the AUC on the test set. We plotted Kaplan-Meier curves and fit Cox survival models comparing survival between patients who were classified as low-risk (LR) for 12-month disease progression or 12-month mortality versus those classified as high-risk. The ML algorithms achieved an AUC of 0.701 (95% CI, 0.689 to 0.714) and 0.718 (95% CI, 0.707 to 0.730) for 12-month PFS and 12-month OS, respectively. Patients in the LR group had lower 12-month disease progression (hazard ratio [HR], 0.47 [95% CI, 0.45 to 0.50]; P < .001) and 12-month all-cause mortality (HR, 0.31 [95% CI, 0.29 to 0.34]; P < .0001) compared with the high-risk group. Patients deemed LR for disease progression and mortality on IO monotherapy were less likely to progress (HR, 0.53 [95% CI, 0.46 to 0.61]; P < .0001) or die (HR, 0.30 [95% CI, 0.24 to 0.37]; P < .001) compared with the high-risk group. An ML algorithm can more accurately predict response to first-line therapy, including IO monotherapy, in patients with advanced NSCLC, compared with PD-L1 alone. ML may better aid clinical decision making in oncology than a single biomarker.