Lower Prevalence Of Risk Factors Research Articles

Endovenous laser ablation of great saphenous vein and pharmacotherapy of acute ascending thrombophlebitis: results of a three-month follow-up

Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.

Ventricular–arterial coupling (VAC) in a population-based cohort of middle-aged individuals: The STANISLAS cohort

Background and aimsData exploring normal values of different ventricular–arterial coupling (VAC) parameters and their association with anthropometric and cardiovascular (CV) factors are scarce. We aim to report values of two different methods of VAC assessment according to age and sex and explore their association with CV factors within a large population-based cohort of middle-aged individuals. MethodsFor 1333 (mean age 48 ± 14) individuals participating in the 4th visit of the STANISLAS cohort, VAC was assessed by two methods [1]: arterial elastance (Ea)/end-systolic elastance (Ees) and [2] Pulse wave velocity (PWV)/Global longitudinal strain (GLS). ResultsThe mean values of Ea/Ees and PWV/GLS were 1.06 ± 0.20 and 0.42 ± 0.12, respectively. The two methods of VAC assessment were poorly correlated (Pearson's correlation coefficient r = 0.14 (0.08; 0.19)). Increased PWV/GLS was associated with older age and a higher degree of cardiovascular risk factors (i.e., BMI, blood pressure, LDL, diabetes, hypertension) in the whole population as well as in the parent generation. In contrast, higher Ea/Ees were associated with decreasing age, and lower prevalence of risk factors in the whole cohort but neutrally associated with risk factors in the parent generation. ConclusionsHigher PWV/GLS is significantly associated with CV factors regardless of age. In contrast, worse Ea/Ees is associated with a better CV risk profile when considering individuals aged 30 to 70 but neutrally associated with CV factors when considering only older patients. These results may suggest that PWV/GLS should preferably be used to explore VAC. In addition, age-individualized threshold of Ea/Ees should be used.

Evaluation of an Interventional Health Education Project: Screening of Breast Cancer and Health Education (SHE).

An outcome evaluation of the Educational Interventional project was conducted in a hilly district of Uttarakhand. Twenty Accredited Social Health Activists (ASHA) were identified and trained in breast cancer awareness, the procedure of breast self-examination, and screening methods. These ASHA's further created awareness among study participants (women above 30 years). A structured questionnaire on knowledge and practice was administered before and after educational intervention by ASHA workers. Clinical Breast Examination (CBE) camps were held for women at high risk for breast cancer who were referred to the Division of Breast Surgery, AIIMS Rishikesh, for further management. One thousand sixty-one females participated in health education sessions by ASHAs. There was an improvement in knowledge and practice regarding Breast Self-examination after health education intervention. A low prevalence of risk factors for breast cancer was found among attendees of the CBE camp. 3.2% of participants had abnormalities on breast examination needing further workup. In the pre-test assessment, we found a low awareness and practice regarding breast cancer which increased significantly among women after behavioral change intervention. The prevalence of risk factors for breast cancer was very low. Trained community health workers were found to be effective in raising awareness, selective screening, and prompt referral.

Characteristics of Hospitalized COVID-19 Patients in the Four Southern Regions Under the Proposed Southern Business Unit of Saudi Arabia.

BackgroundThis is the first descriptive and comparative study conducted of COVID-19 inpatients from multi-centers in the four administrative southern regions and proposed Southern Business Unit (Jazan, Najran, Bisha, and Aseer) of the Kingdom of Saudi Arabia (KSA).MethodsParticipants were 809 randomly selected patients admitted to the eight sampled hospitals with confirmed COVID-19 between March 2020 and February 2021. We assessed and compared socio-demographics, clinical characteristics, and clinical outcomes of the four regions.ResultsSocio-demographic and clinical characteristics of the participants are a mean age of 60 ± 17.7 years, 70% Saudi male, the prevalence of diabetes (DM2) 58%, hypertension (HTN) 48%, obesity 43%, cardiac diseases 15%, and immunity or cancer diseases almost 1%. The prevalence of complications during admission were bacterial pneumonia 65%, acquired respiratory distress syndrome (ARDS) 32%, sepsis 20%, multi-organ failure 18%, acute kidney diseases 15%, and arrhythmia 4%. Clinical outcomes were: admitted to intensive care unit (ICU) 52%, mortality rate 25%, referred to other facilities 9%, and mean length of stay (LOS) was 11± 9.5 days. We observed statistically significant variation in many variables among the four regions. Najran and Aseer had a higher prevalence of risk factors for severity including age and comorbidities accompanied by higher rates of complications, ICU admissions, LOS, and mortality. Bisha and Jazan had lower prevalence of risk factors and LOS with lower rates of complications, ICU admissions, and mortality.ConclusionThis study reveals that the geographic region in which the patient was cared for was related to the severity and outcome of COVID-19 infection. Policy makers should search for solutions to regional differences in underlying health conditions such as DM2, HTN, and obesity to plan for improvements in preventive care as well as resource distribution to ensure quality for all Saudi citizens. This study will serve as guidance to begin to form strategies for these improvements as envisioned in the future New Model of Care.

Abstract TMP69: Poor Clinical Outcome Of Patients With Early Neurological Deterioration In Large Vessel Occlusion And Low NIHSS

Introduction: Early neurological deterioration (END) in patients with large vessel occlusion (LVO) stroke with low NIHSS treated with medical management (MM) has been well described. However, the effect of END on 90-day disability outcomes relative to patients presenting with more severe stroke, remains undetermined. Methods: From our multi-center prospective registry across 4 comprehensive stroke centers, we identified patients with LVO (basilar, ICA, M1/2, or P1 identified on CTA or MRA) from January 2018 to June 2020. Low NIHSS was defined as 0-5, and END as a worsening of > 3 points. To determine the effect of END on outcomes, we used propensity score to match patients who presented with low NIHSS who suffered END by age and worsened NIHSS (i.e. subsequent, greater NIHSS) to patients who presented initially with LVO and comparable NIHSS. Results: Among 348 patients with LVO acute ischemic stroke, median age was 67 [IQR 59-76], 46.6% were female. 58 patients (17%) of the cohort had low NIHSS. Compared to the higher NIHSS group, low NIHSS group had less EVT performed (39.7% vs 78.3%, p=<0.001), greater ASPECTS (9 vs 8, p=0.001), fewer M1 occlusions (27.6% vs 51.7%, p<0.001), and lower prevalence of risk factors, such as hypertension, hyperlipidemia, and congestive heart failure (50.0% vs 71.4, p=0.001; 20.7% vs 36.9%, p=0.018; and 0.0% vs 9.3%, p=0.016, respectively). Overall 90-day disability outcomes (mRS 0-2) were better in the low NIHSS group (58.6% vs 44.8%, p=0.055) although it did not reach statistical significance. On the other hand, 41.4% of low NIHSS group did not achieve functional independence. Of 35 patients with initial MM in the low NIHSS group, 7 (20%) suffered END. The median increase in NIHSS was 7 (range 4-15), and only 1 patient achieved 90-day mRS 0-2. In a propensity matching analysis, LVO patients with initially low NIHSS patients followed by END had significantly worse outcomes than the patients who initially presented with comparable NIHSS (Coef=26, p=<0.001). Conclusions: In patients with low NIHSS and LVO, those treated initially with MM who suffer END have worse clinical outcomes when matched to patients with comparable NIHSS post-worsening. These finding suggest that the delaying EVT in this population may lead to worsened outcomes.

P0073EVALUATION OF BLOOD PRESSURE CONTROL AMONG PATIENTS WITH ANDERSON-FABRY DISEASE

Abstract Background and Aims Anderson-Fabry disease (AFD) is a rare X-linked sphingolipid disorder caused by deficient activity of the enzyme α-galactosidase A leading to a progressive lysosomal accumulation of globotriaosylceramide and a consequent organ failure. Data on blood pressure (BP) values in AFD patients are scanty, however those available have revealed a significant prevalence of high blood pressure, especially in case of moderate to severe kidney impairment, becoming more prevalent with the progression of the renal disease. High blood pressure and hypertension major risk factors prevalence were analysed among a single Fabry cohort. Method Between January 2015 and May 2019, 32 AFD patients, 24 (75%) female and 8 (25%) male, referred to the Fabry Disease Unit, Nephrology Division of San Gerardo Hospital (Monza, Italy), were enrolled. All patients were Caucasian with an average age of 50±12.2 years old. Data regarding hypertension were obtained by 24h ambulatory blood pressure monitoring (ABPM), home self-monitoring, and repeated ambulatory measurements (Table 1). Patients were defined hypertensive according to 2018 ESC/ESH Guidelines. The severity and the stability of AFD were assessed in each patient with the Fabry Stabilization Index (FASTEX). Major risk factors for hypertension were also evaluated (Table 2). Results The 24h ABPM revealed uncontrolled high blood pressure in 6 (18.7%) patients with consensual home and office BP alterations. All patients were female with an average age of 58±9.9 years old. They had mostly a sedentary life-style, half of them had a diagnosis of dyslipidaemia and one was obese (BMI > 30). In the normotensive group, half of the patients were sedentary, less than a half of them was affected by dyslipidaemia and the average BMI was between the normal ranges. Other known risk factors for hypertension were scanty represented between the two groups. No one had history of transient ischemic attack or stroke. In the normotensive group the majority of patients had a normal or near-normal renal function, while in the hypertensive group one-third showed mild proteinuria and renal impairment with a moderate reduction in glomerular filtration rate. The FASTEX index showed that 84.6% of the normotensive group were stable, while 66.6% of the hypertensive group were not. In 9 (34.6%) patients of the normotensive group ACE-inhibitors/angiotensin-receptor blockers were previously introduced for the treatment of proteinuria in normal blood pressure values, while 2 (33.3%) patients of the hypertensive group received antihypertensive drugs. Conclusion In this observational study, the majority of AFD patients were normotensive. The prevalence of hypertensive patients was lower than 20%. Overall patients had a low prevalence of well-known risk factors associated with the development of hypertension. The link between AFD disease and the development of hypertension has not been fully studied yet. Hypertension in AFD patients might be due to Fabry associated vascular or renal disease or because of an associated essential hypertension. Arterial blood pressure seems to be relatively well controlled among AFD patients presenting with a low prevalence of risk factors for hypertension and a mild and stable organ involvement. In contrast, unstable patients with a high prevalence of well-known hypertension risk factors, particularly renal impairment, should be followed carefully, because they have a major risk of developing uncontrolled blood pressure. Further prospective studies with a larger sample size are needed to better investigate the pathophysiology of hypertension in AFD patients.

Cancer in agricultural populations

Agricultural workers can be exposed to a wide variety of agents (e.g. pesticides), some of which may have adverse health effects, such as cancer. To study the health effects of agricultural exposures, an international consortium of agricultural cohort studies, AGRICOH, was established. The present analysis compared cancer incidence between the AGRICOH cohorts and the general population and found lower overall cancer incidence in the AGRICOH cohorts, with some variation across cohorts for specific cancer types. The observed lower cancer incidence may be due to healthy worker bias or lower prevalence of risk factors in the agricultural populations. Further analysis is underway.

Cancer incidence in agricultural cohorts

TPS 791: Occupational health 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background/Aim. An international consortium of agricultural cohort studies, AGRICOH, was established to study cancer and other health outcomes in relation to agricultural exposures. The present analysis aimed to compare the cancer incidence rates between AGRICOH cohorts and the general population. Methods. The analysis included eight AGRICOH cohorts from six different countries. These cohorts varied in size and types of workers included: active and retired agricultural workers, farm owners, and pesticide applicators. From each cohort, information on primary incident cancers (excluding non-melanoma skin cancer), person-years of follow-up, and national/regional cancer rates was obtained. With this information, cohort- and sex-specific standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated for each cancer site and all cancers combined. Random effects meta-analysis of SIR was then performed when five or more cases were observed in at least four (women) or five (men) of the cohorts. Results. During >3,000,000 person-years, 26,054 cancers were diagnosed. Overall, the meta-SIR was 0.70 (95% CI=0.57-0.84) in women and 0.74 (95% CI=0.66-0.82) in men. A lower incidence rate was observed for cancers of breast (meta-SIR=0.67, 95% CI=0.47-0.86), colorectum (meta-SIR=0.80, 95% CI=0.61-0.99), and lung (meta-SIR=0.68, 95% CI=0.43-0.92) in women and for cancers of bladder (meta-SIR=0.54, 95% CI=0.39-0.68), larynx (meta-SIR=0.49, 95% CI=0.41-0.57), lung (meta-SIR=0.54, 95% CI=0.41-0.68), oesophagus (meta-SIR=0.62, 95% CI=0.44-0.81), and pancreas (meta-SIR=0.73, 95% CI=0.65-0.81) in men as compared to the general population. Non-significantly increased meta-SIRs were found for melanoma in women (meta-SIR=1.19, 95% CI=0.67-1.72) and non-Hodgkin lymphoma in men (meta-SIR=1.19, 95% CI=0.78-1.60). Conclusions. The overall cancer incidence rate was lower in AGRICOH than in the general population. The observed lower cancer incidence may be due to healthy worker bias, lower prevalence of risk factors, such as smoking in the agricultural populations, or other reasons. Further analysis is underway to explore any heterogeneity in SIR of cancer across cohorts.

EPIDEMIOLOGIC RESEARCH ON CARDIOVASCULAR DISEASES AND THEIR RISK FACTORS IN THE LARGE EASTERN SIBERIAN REGION

Objective: As a part of the Epidemiological Survey of Cardiovascular Diseases in Different Regions of the Russian Federation, we estimated the prevalence of the basic cardiovascular risk factors and its associations with sociodemographic factors in the large region of Eastern Siberia. Design and method: With the multistage randomization, we enrolled 1603 inhabitants of our region aged 25–64. Each study participant underwent a detailed questionnaire, office blood pressure monitoring, anthropometry, and blood analysis (lipid spectrum, glucose, and uric acid levels). Results: In 49.4% of people, we found hypertension. Smoking was present in 28.4% of the population. The borderline blood glucose levels (5.6–5.9 mmol/l) was found in 25.7% of all cases and 7.3 % of people had diabetes mellitus. Table 1 shows the group disparities of the risk factors prevalence.Conclusions: The percentage of hypertension, dyslipidemia, and hyperglycemia increased in older age while smoking was more prevalent in younger people. Females had a larger percentage of obesity while males had a higher prevalence of hyperuricemia and hyperglycemia. The higher education level was associated with a significantly lower prevalence of risk factors.

Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer.

The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there is increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45-75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance were associated with adenoma detection. In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.

Different Clinical Phenotypes of Embolic Stroke of Undetermined Source: A Subgroup Analysis of 86 Patients

Introduction and Study AimEmbolic strokes of undetermined source (ESUS) represent a rather recent diagnostic entity under clinical research for relapse prevention in cryptogenic stroke patients. Despite strict diagnostic criteria, ESUS definition ignores major clinical and radiological aspects, so including heterogeneous cases and probably influencing trial results. This study researches clinically relevant phenotypes among ESUS patients. Patients and MethodsWe evaluated ESUS patients admitted at Trento Stroke Unit over a 4-year period. Vascular risk factors (RFs), neurological deficit severity, presence of potential embolic sources, and ASCOD phenotype were recorded. Ischemic lesions were categorized considering their extension in 4 groups. Subgroup comparisons by predefined differences in age, amount of RFs, history of previous stroke, deficit severity, and stroke lesion extension were done. ResultsESUS cases were 86. Patients younger than 50 years old (n = 17) had a lower prevalence of RFs, left atrial enlargement, left ventricle diastolic dysfunction, a higher proportion of ASCOD score A0 (P < .05). Patients without RFs (n = 18) differed from those with greater than or equal to 3 RFs (n = 23) for a younger age and a lower prevalence of potential causes of embolism (P < .05). Patients without a previous stroke (n = 70) were younger, had a lower prevalence of RFs, left ventricle diastolic dysfunction, a higher prevalence of ASCOD score A0 (P < .05). No differences were observed comparing minor and major clinical and radiological strokes. Discussion and ConclusionsESUS patients can be distinguished in 2 opposite phenotypes defined by a lower and a higher load of atherosclerotic pathology. They may suggest possible underlying pathogenic mechanisms and support interpretation of ongoing trials results.

Assessing the Prevalence of Risk Factors for Neglected Tropical Diseases in Brazos County, Texas.

Introduction:Although more than one billion people live at risk of neglected tropical diseases (NTDs) in areas of Asia, sub-Saharan Africa, and Latin America, the degree to which they burden countries like the U.S. is unclear. Even though many NTDs such as dengue, leishmaniasis, and Chagas disease are typically not endemic to the U.S., the possibility of their emergence is noteworthy, especially in states like Texas with high levels of poverty, large immigrant populations, geographic proximity to endemic areas, and a climate amenable to the vectors for these diseases. Despite the health threat that emerging NTDs may pose, little is known about the prevalence of risk factors for NTDs in the U.S.Methods:We tested the Community Assessment for Public Health Emergency Response (CASPER) method to assess the prevalence of risk factors for NTDs in Brazos County, Texas.Results: We found relatively low prevalence of risk factors related to travel (5.2% of respondents visited an endemic area in the previous 3 months); however, few respondents reported adherence to mosquito prevention, such as wearing long sleeves and long pants (14.1%, 95% CI: 13.9,14.4) and repellant containing DEET (13.5%, 95% CI: 13.2,13.7). Between 5.4% and 35.8% of respondents had a visible container (e.g., pet water dishes, flower pots, bird baths) that could support mosquito breeding.Discussion:CASPER findings present public health authorities with potential avenues for implementing health education and other interventions aimed at reducing exposure to risk factors for NTDs among Texas residents.

Decline in risk of recurrent cardiovascular events in the period 1996 to 2014 partly explained by better treatment of risk factors and less subclinical atherosclerosis.

To quantify the decline in recurrent major cardiovascular events (MCVE) risk in patients with clinically manifest vascular disease between 1996 and 2014 and to assess whether the improvements in recurrent MCVE-risk can be explained by reduced prevalence of risk factors, more medication use and less subclinical atherosclerosis. The study was conducted in the Second Manifestations of ARTerial disease (SMART) cohort in patients entering the cohort in the period 1996-2014. The prevalence of risk factors and subclinical atherosclerosis was measured at baseline. Incidence rates per 100person-years for recurrent MCVE (including stroke, myocardial infarction, retinal bleeding, retinal infarction, terminal heart failure, sudden death, fatal rupture of abdominal aneurysm) were calculated, stratified by the year of study enrolment. For the attributable risk of changes in risk factors, risk factor treatment, and subclinical atherosclerosis on the incidence rates of recurrent MCVE, adjusted rate ratios were estimated with Poisson regression. 7216 patients had a median follow-up of 6.5years (IQR 3.4-9.9). The crude incidence of recurrent MCVE declined by 53% between 1996 and 2014 (from 3.68 to 1.73 events per 100person-years) and by 75% adjusted for age and sex. This improvement in vascular prognosis was 36% explained by changes in risk factors, medication use and subclinical atherosclerosis. The risk of recurrent MCVE in patients with clinically manifest vascular disease has strongly declined in the period between 1996 and 2014. This is only partly attributable to lower prevalence of risk factors, improved medication use and less subclinical atherosclerosis.

Genetic Investigation Into the Differential Risk of Atrial Fibrillation Among Black and White Individuals.

White persons have a higher risk of atrial fibrillation (AF) compared with black individuals despite a lower prevalence of risk factors. This difference may be due, at least in part, to genetic factors. To determine whether 9 single-nucleotide polymorphisms (SNPs) associated with AF account for this paradoxical differential racial risk for AF and to use admixture mapping to search genome-wide for loci that may account for this phenomenon. Genome-wide admixture analysis and candidate SNP study involving 3 population-based cohort studies that were initiated between 1987 and 1997, including the Cardiovascular Health Study (CHS) (n = 4173), the Atherosclerosis Risk in Communities (ARIC) (n = 12 341) study, and the Health, Aging, and Body Composition (Health ABC) (n = 1015) study. In all 3 studies, race was self-identified. Cox proportional hazards regression models and the proportion of treatment effect method were used to determine the impact of 9 AF-risk SNPs among participants from CHS and the ARIC study. The present study began July 1, 2012, and was completed in 2015. Incident AF systematically ascertained using clinic visit electrocardiograms, hospital discharge diagnosis codes, death certificates, and Medicare claims data. A single SNP, rs10824026 (chromosome 10: position 73661450), was found to significantly mediate the higher risk for AF in white participants compared with black participants in CHS (11.4%; 95% CI, 2.9%-29.9%) and ARIC (31.7%; 95% CI, 16.0%-53.0%). Admixture mapping was performed in a meta-analysis of black participants within CHS (n = 811), ARIC (n = 3112), and Health ABC (n = 1015). No loci that reached the prespecified statistical threshold for genome-wide significance were identified. The rs10824026 SNP on chromosome 10q22 mediates a modest proportion of the increased risk of AF among white individuals compared with black individuals, potentially through an effect on gene expression levels of MYOZ1. No additional genetic variants accounting for a significant portion of the differential racial risk of AF were identified with genome-wide admixture mapping, suggesting that additional genetic or environmental influences beyond single SNPs in isolation may account for the paradoxical racial risk of AF among white individuals and black individuals.

Variation by ethnic group in premature mortality risk following self-harm: a multicentre cohort study in England.

BackgroundIncidence and risk factors for self-harm vary according to ethnicity. People who self-harm have been shown to have increased risk of premature death, but little is known about mortality following self-harm in ethnic minority groups.MethodsA prospective cohort study of self-harm presentations to three English cities (Derby, Manchester, Oxford) between 2000 and 2010. We linked to a national mortality dataset to investigate premature death in South Asian and Black people in comparison with White people to the end of 2012.ResultsEthnicity was known for 72 % of the 28,512 study cohort members: 88 % were White, 5 % were South Asian, and 3 % were Black. After adjusting for age, gender and area-level socioeconomic deprivation, the risk of all-cause mortality was lower in South Asian (hazard ratio [HR] 0.51, 95 % confidence interval [CI] 0.42 – 0.62) and Black people (HR 0.46, 95 % CI 0.39 – 0.55) versus White people. Suicide risk was significantly lower in Black people (HR 0.43, 95 % CI 0.19 – 0.97) than in White people. Prevalence of risk factors for premature death, such as previous self-harm, psychiatric treatment or concurrent alcohol misuse, was lower in South Asian and Black people than in White people.ConclusionsThe risk of death following self-harm is lower in South Asian and Black people than White people in the UK, and they also have lower prevalence of risk factors for premature death. Awareness of both protective and risk factors might help to inform clinical decisions following assessment.

Abstract 12368: Clinical Features, Prognosis and Risk Stratification of Acute Myocardial Infarction Due to Coronary Embolism

Introduction: Coronary embolism (CE) is recognized as an important non-atherosclerotic cause of acute myocardial infarction (AMI). Atrial fibrillation (AF) is associated with systemic thromboembolism, and the CHADS2 and CHA2DS2-VASc scores are known to be useful for risk stratification. Therefore, we investigated the clinical features and prognosis of CE, and assessed the potential usefulness of these scores for predicting CE. Methods: We studied a total of 2,115 consecutive patients with AMI (M/F 1,528/587, age 68±12 [SD] years) hospitalized between 2001 and 2013. CE was diagnosed according to the criteria shown in Figure 1 Results: The overall prevalence of CE in AMI was 2.4% (n=51, M/F 31/20, age 65±14 years). Compared with non-CE AMI patients, CE patients were characterized as lower prevalence of risk factors. Most common cause of CE was AF (73%). However, only 15 (41%) out of 37 AF patients were treated with vitamin K antagonists (VKAs) and their PT-INR was low, 1.42 (range, 0.95-1.80) at the onset of AMI. Importantly, among 28 CE patients with nonvalvular AF, 17 patients (59%) had a CHADS2 score of 0 or 1. When those particular patients were re-evaluated by CHA2DS2-VASc score, 10 out of 17 (59%) were categorized into a higher risk category (≥ 2) that would benefit from VKAs therapy. During a median follow-up of 4.1 years (interquartile range, 1.5-7.0 years), 8 patients (16%) had major adverse cardiovascular events and 5 patients (10%) recurred CE or systemic embolization (Figure 2). Conclusions: AF is the major underlying cause of CE, recurrence of which seems to be not rare. The CHA2DS2-VASc score may provide reliable risk stratification with a superior ability to predict CE.

Is athletic background associated with a future lower prevalence of risk factors for chronic disease?

This cross-sectional study examined whether the prevalence of behavioral and biological risk factors of former elite athletes (both men and women), differed from nonelite athletes and nonathletes. A total of 491 individuals (225 former elite athletes, 168 former nonelite athletes, and 98 nonathletes) participated in this study. Major behavioral and biological risk factors identified in the 2002 World Health Report were assessed. Apart from alcohol consumption, former elite athletes had at least 70% lower likelihood than nonathletes for the other behavioral risk factors. Regarding biological factors, being overweight/obesity seems to be the one where minor differences exist, with a significant odds ratio only among female former elite athletes (0.09, p < 0.001) when compared to nonathletes. In general, the results showed healthy outcomes among former elite athletes. Albeit the results extend to both sexes, women appear to have slightly healthier outcomes. Being a former athlete, especially at an elite level, seems to be associated with decreased risk factors for major chronic diseases.

Early childhood investments substantially boost adult health.

High-quality early childhood programs have been shown to have substantial benefits in reducing crime, raising earnings, and promoting education. Much less is known about their benefits for adult health. We report on the long-term health effects of one of the oldest and most heavily cited early childhood interventions with long-term follow-up evaluated by the method of randomization: the Carolina Abecedarian Project (ABC). Using recently collected biomedical data, we find that disadvantaged children randomly assigned to treatment have significantly lower prevalence of risk factors for cardiovascular and metabolic diseases in their mid-30s. The evidence is especially strong for males. The mean systolic blood pressure among the control males is 143 millimeters of mercury (mm Hg), whereas it is only 126 mm Hg among the treated. One in four males in the control group is affected by metabolic syndrome, whereas none in the treatment group are affected. To reach these conclusions, we address several statistical challenges. We use exact permutation tests to account for small sample sizes and conduct a parallel bootstrap confidence interval analysis to confirm the permutation analysis. We adjust inference to account for the multiple hypotheses tested and for nonrandom attrition. Our evidence shows the potential of early life interventions for preventing disease and promoting health.

Stroke Types in Rural and Urban Northern Portugal: Incidence and 7-Year Survival in a Community-Based Study

Background/Aim: Differences in stroke incidence and mortality between regions could stem from differences in the incidence of particular stroke types and long-term prognosis. The aim of this study was to investigate whether different risk profiles and stroke types underlie the difference in stroke incidence and patient long-term survival in rural and urban populations. Methods: All suspected first-ever-in-a-lifetime strokes occurring between October 1998 and September 2000 in 37,290 residents of rural municipalities and in 86,023 individuals living in the city of Porto were entered into a population-based registry. Standard definitions of stroke types and overlapping comprehensive sources of information were used for patient identification. Patients were examined by neurologists at 3 months, 1 year and 7 years after the index event. Results: From a total of 688 patients included (226 in rural and 462 in urban areas), 76.2% had an ischaemic stroke (IS; 75.3 vs. 77.9%), 16.1% a primary intracerebral haemorrhage (PICH; 16.3 vs. 14.6%) and 3.3% a subarachnoid haemorrhage (SAH; 2.7 vs. 3.7%); in 4.4% (4.9 vs. 4.1%), the stroke type could not be determined. The annual incidence rate per 1,000 was 2.13 (95% CI, 1.95-2.31), 0.45 (95% CI, 0.37-0.53), 0.09 (95% CI, 0.06-0.14) and 0.12 (95% CI, 0.08-0.17), respectively. The age-specific rural/urban incidence rate ratios for IS in the youngest group (<55 years) was 0.27 (95% CI, 0.11-0.69), increasing to 1.47 (95% CI, 1.07-2.01) for those aged 65-74 years and to 1.87 (95% CI, 1.39-2.52) for those between 75 and 84 years. Rural compared to urban patients with an IS were predominantly men, had a prevalence ratio (PR) of 1.28 (95% CI, 1.05-1.56), were 65 years or older (PR = 1.18; 95% CI, 1.08-1.30) and had in general a lower prevalence of risk factors. There was no evidence of rural/urban differences in 28-day case fatality for the stroke types, although IS tended to be less fatal among urban patients (10.3 vs. 13.1%), whereas PICH (33.3 vs. 24.2%) and SAH (35.3 vs. 16.7%) were less fatal among rural patients. Independently of rural/urban residence, predictors of poor survival after the acute phase (28 days) were age >65 years (HR = 3.57; 95% CI, 2.6-4.9), diabetes (HR = 1.5; 95% CI, 1.2-1.9), ischaemic heart disease (HR = 1.8; 95% CI, 1.3-2.6), atrial fibrillation (HR = 1.5; 95% CI, 1.1-2.0) and smoking habits (HR = 1.6; 95% CI, 1.1-2.3). Conclusions: The age pattern of IS incidence marks the difference between rural and urban populations; the youngest urban and the oldest rural residents were at a higher risk. Although patients from rural areas were older, the relatively lower prevalence of simultaneously occurring risk and prognostic factors among them as well as the similar management of rural and urban patients may justify why rurality is not associated with long-term survival.

Características clínicas y evolución hospitalaria de los pacientes con síndrome coronario agudo en función del tabaquismo

Background and objectiveCurrent smoking patients with acute coronary syndromes (ACS) seem to have better prognosis during hospital stay. The objective of this study was to describe the clinical characteristics and complications of patients with ACS according to smoking habits. Patients and methodsObservational, multicentre and nationwide registry. Primary endpoint was hospital mortality and secondary endpoint was the combination of mortality, angina or heart failure.Results: 825 ACS patients were collected. Current smokers were 413 (50.1%) and their mean age was 12years lower than the rest and also had lower prevalence of risk factors or previous cardiovascular disease. Complications and mortality were similar according to smoking habits. Multivariate adjusted analysis identified age > 75 (OR: 12.80, 95% CI 1.35-41.44; p=0.03) and GFR < 60ml/min/1.73 m2 (OR: 10.20, 95% CI 1.06-97.92; p=0.04) independently associated with mortality; age > 75 (OR: 1.72, 95% CI 1.03-2.84; p=0.04), GFR < 60ml/min/1.73 m2 (OR: 1.76, 95% CI 1.08-2.91; p=0.023) and current smoking (OR: 1.05, 95% CI 1.01-1.10; p=0.02) were independently associated with the combined end-point. Elderly current smokers patients had the highest mortality rate (19.0%) followed by elderly former smokers patients (5.8%). ConclusionsCurrent smoker patients with ACS have lower mean age and have similar hospital complications.