HR For Mortality Research Articles

MP75-04 HIGH RISK CLASSIFICATION ACROSS GUIDELINES (NCCN VS. EAU)

INTRODUCTION AND OBJECTIVE: Different international guideline organisations offer tools to categorise prostate cancer patients into risk groups. These risk groups have great implications on the further management and expected outcomes. Although different guidelines have similar risk categories, they might not reflect similar patient profiles. We assessed the differences in survival, quality of life (QoL) and functional outcomes in high risk prostate cancer according the NCCN and the EAU guidelines. METHODS: A total of 9235 patients treated by RALP between 2009 and 2016 were included in the Be-RALP database, a large, prospective, multicentre database. QoL (QLQ-C30) and functional outcome questionnaires (Incontinence Modular Questionnaire–Urinary Incontinence, ICIQ and International Index of Erectile Function, IIEF-5) were completed on baseline, 1-, 3-, 12- and 24-months post-surgery. Following both NCCN and EAU criteria, two groups were created in which a high and low-intermediate risk group were matched 1:1 using age, year of surgery and centre size as matching criteria. This resulted in 1744 pairs following the NCCN criteria and 2332 pairs in the EAU group. Uni- and Multivariable endpoint analysis investigated the effect on the Quality of Life and functional outcomes 24 months after surgery. Missing values were corrected using the full conditional specification multiple imputation (MI), with 10 imputations per missing value. Survival analysis was performed using Kaplan-Meier plots with log-rank tests and univariable Cox proportional hazard models. RESULTS: When looking into the multivariable analysis, overall survival was lower in the NCCN group in comparison with the groups according the EAU guidelines (HR of overall mortality 2.45 vs. 1.54). QoL (Est 1.31, p=0.31 vs. Est 1.82, p=0.14), ICIQ (Est -0.04, p=0.84 vs. Est -0.19, p=0.48) and IIEF (Est 0.68, p=0.05 vs. Est 0.22, p=0.61) were similar across both guidelines CONCLUSIONS: When investigating survival, quality of life and functional outcomes in both guidelines, similar findings in functional outcomes and a small difference in survival is found. This reflects the interchangeability of these guidelines.Source of Funding: De Wever Foundation - Prostate Cancer

Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

ObjectiveTricuspid regurgitation (TR) severity has known adverse implications, its impact on patients undergoing non-cardiac surgery (NCS) remains unclear. We sought to determine the impact of TR on patient outcomes after...

Association between Pre-Implant Employment Status and Left Ventricular Assist Device Outcomes

Employment status has been linked to worse outcomes in heart failure. Employment status at the time of LVAD evaluation has not been assessed as a predictor of post-LVAD patient outcomes. The study cohort consisted of patients who were implanted with continuous flow LVADs at the University of Minnesota between June 2005 and June 2018 who had complete psychosocial evaluation data available. Patients were classified as employed, retired, or unemployed. Cox and negative binomial regression models were used to measure the association between employment status and post LVAD mortality and number of 1 year all cause admission, respectively. The study cohort included 428 patients. Patient were almost equally distributed among the three groups with 157 (37%) unemployed, 135 retired (33%), and 136 employed (32%). Patients who were employed leading up to LVAD implantation had higher socioeconomic status, lower BMIs, and lower reported smoking history (table). Being employed (vs. retired/unemployed) at the time of LVAD evaluation was associated with lower HR for mortality (unadjusted HR 0.50, 95% CI 0.34 - 0.73, P<0.001 - adjusted HR 0.62, 95% CI 0.39 - 0.98, P=0.042). Employed status was also associated with a reduced incidence rate of 1 year readmission (adjusted 27 reduction in incidence rate ratio (IRR) 95% CI 8 % - 63 % reduction, P=0.010). When excluding the retired population, employed vs. unemployed status was not statistically associated with mortality (adjusted HR 0.71, 95 % CI 0.44- 1.11, p = 0.16) however was associated with reduced incidence rates of hospitalization on LVAD support (adjusted 31 % reduction, 95 % CI 11-47 % reduction). Patients who were employed at the time of LVAD evaluation had improved survival and lower rates of hospitalization on LVAD support even after adjustment for socioeconomic and clinical variables in this single center analysis.

Abstract P510: Association of Animal and Plant Protein Intake With Mortality Among US Adults: A Prospective Cohort Study

Introduction: Animal protein sources, especially red and processed meat, have been associated with adverse health outcomes. Epidemiological evidence on the isocaloric substitution of plant for animal protein on mortality risk remains limited. Hypothesis: We hypothesized that substituting plant protein for carbohydrates and animal protein would be associated with lower mortality. Method: We included a nationally representative sample of 37 233 US adults ≥20 years with 24-h dietary recall data from eight National Health and Nutrition Examination Survey (NHANES) cycles (1999-2014). Mortality from all causes, heart disease, and cancer were identified through National Death Index linkage (until December 31, 2015). We used Cox proportional hazards regression to estimate the association between plant and animal protein intake and mortality after adjustment for potential confounding factors. Results: During 297 768 person-years of follow-up, 4 866 total deaths occurred, including 849 deaths from heart disease and 1 068 deaths from cancer. After multivariable adjustment, higher intake of total animal protein was not associated with total mortality. Plant protein was associated with lower total mortality; when comparing the lowest with highest quintiles of plant protein intake, the multivariable adjusted HR (95% CIs) of total mortality was 0.73 (0.61, 0.88); P for trend &lt;0.001. The HRs (95% CIs) comparing extreme quintiles were 0.71 (0.48, 1.05) for heart disease mortality, and 0.74 (0.53, 1.04) for cancer mortality. When isocalorically replacing 5% of energy from total animal protein with plant protein, the multivariable HRs were 0.49 (0.32, 0.74) for total mortality, 0.51 (0.28, 0.95) for heart disease mortality, and 0.53 (0.28, 1.00) for cancer mortality. For different food sources of animal protein, isocaloric substitution of 2% of energy from plant protein for protein in unprocessed red meat (0.74, 95% CI: 0.63, 0.87), processed meat (0.68, 95% CI: 0.53, 0.89), total dairy (0.74, 95% CI: 0.58, 0.94), and 1% of energy from plant protein for seafood (0.86, 95% CI: 0.79, 0.93) was each associated with a lower risk of total mortality. Conclusions: Higher plant protein intake was associated with lower total mortality. Isocalorically replacing animal protein with plant protein was associated with lower total mortality.

Effect of resting heart rate on the risk of all-cause death in Chinese patients with hypertension: analysis of the Kailuan follow-up study

ObjectivePrevious studies have shown that an elevated heart rate is associated with a higher risk of cardiovascular events. This study aimed to prospectively examine the relationship between resting heart rate...

Association of hyperlipidaemia with 5-year survival after hospitalisation for acute myocardial infarction: a propensity score matched analysis.

ObjectivesThe primary objective was to examine the association between hyperlipidaemia (HLP) and 5-year survival after incident acute myocardial infarction (AMI). The secondary objectives were to assess the effect of HLP on survival to discharge across patient subgroups, and the impact of statin prescription, intensity and long-term statin adherence on 5-year survival.MethodsRetrospective cohort study of 7071 patients hospitalised for AMI at Mayo Clinic from 2001 through 2011. Of these, 2091 patients with HLP (age (mean±SD) 69.7±13.5) were propensity score matched to 2091 patients without HLP (age 70.6±14.2).ResultsIn matched patients, HLP was associated with higher rate of survival to discharge than no HLP (95% vs 91%; log-rank <0.0001). At year 5, the adjusted HR for all-cause mortality in patients with HLP versus no HLP was 0.66 (95% CI 0.58–0.74), and patients with prescription statin versus no statin was 0.24 (95% CI 0.21 to 0.28). The mean survival was 0.35 year greater in patients with HLP than in those with no HLP (95% CI 0.25 to 0.46). Patients with HLP gained on an average 0.17 life year and those treated with statin 0.67 life year at 5 years after AMI. The benefit of concurrent HLP was consistent across study subgroups.ConclusionsIn patients with AMI, concomitant HLP was associated with increased survival and a net gain in life years, independent of survival benefit from statin therapy. The results also reaffirm the role of statin prescription, intensity and adherence in reducing the mortality after incident AMI.

Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016

ObjectivesIdentify causes and future trends underpinning Scottish mortality improvements and quantify the relative contributions of disease incidence and survival.DesignPopulation-based study.SettingLinked secondary care and mortality records across Scotland.Participants1 967 130 individuals...

Abstract P2-18-09: Effects of diet after early breast cancer treatment: Systematic review and meta-analysis of clinical trials

Abstract Purpose: Randomized clinical trials are inconclusive regarding the role of dietary interventions in anthropometric measurements, quality of life, and survival in breast cancer patients. Our aim was to conduct a systematic review and meta-analysis to assess the effects of diet on these outcomes in women who went through curative treatment of early-stage breast cancer.Methods: Pubmed, Embase, Cochrane Library were searched for randomized clinical trial comparing dietary interventions (individualized dietary counseling, prescription of a specific diet or other) with usual care in women that were treated for breast cancer. Primary outcomes were overall survival and disease-free survival, secondary outcomes were weight loss and change in body mass index.Results: We found 12 clinical trials eligible for analysis. Only two of them reported overall and disease-free survival, whereas six reported data for body mass index and four for weight. The HR for mortality and disease-free survival was 0.91 (95% CI 0.77-1,07, p=0.25) and 0.92 (CI 95% 0.79-1.08, p=0.31) for the intervention group compared to the control group, respectively. Diet intervention was associated with body mass index reduction in those subjects who received a specific diet instead of counseling or other types of intervention (-0.67 CI 95% -1.14 to -0.21). The weight did not differ between intervention and control groups.Conclusions: Despite increasing survival among breast cancer patients there is still a lack of prospective data regarding the effects of dietary interventions in this population. We found positive association between prescription of specific diets in terms of anthropometric measure, but neither difference in overall nor disease-free survival. Citation Format: Henrique AV Träsel, Frederico S Falcetta, Fernando K Almeida, Mariana RR Falcetta, Daniela D Rosa. Effects of diet after early breast cancer treatment: Systematic review and meta-analysis of clinical trials [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-18-09.

Serum uromodulin and risk for cardiovascular morbidity and mortality in the community-based KORA F4 study

Background and aimsSerum uromodulin, a novel biomarker of kidney function and tubular integrity, has been linked to cardiovascular events and total mortality in patients at high cardiovascular risk. Here, we analyze the association of serum uromodulin with cardiovascular morbidity and cardiovascular as well as total mortality in the population-based KORA F4 study stratified by sex. MethodsBaseline serum uromodulin was measured in 1079 participants of the KORA F4 study (age 62–81 years). Using multivariable adjusted Cox proportional hazards models, the associations of serum uromodulin with total mortality and cardiovascular mortality were analyzed after a median follow-up period of 8.6 years, and with non-fatal and fatal stroke and myocardial infarction/coronary death after a median follow-up time of 8.4 years. ResultsSerum uromodulin was significantly inversely associated with total mortality (HR 0.65; 95% CI 0.53–0.79 per standard deviation of logarithmized serum uromodulin; p < 0.001) and cardiovascular mortality (HR 0.70; 95% CI 0.52–0.93) in men, but not in women (HR for all-cause mortality in women 0.98; 95% CI 0.77–1.25, HR for cardiovascular mortality 0.78; 95% CI 0.56–1.11) after adjustment for age, BMI, diabetes and eGFR. In addition, serum uromodulin was significantly inversely associated with incident stroke in men (HR 0.68; 95% CI 0.50–0.92), but not in women (HR 0.96; 95% CI 0.68–1.38) after multivariable adjustment. The association of serum uromodulin with incident myocardial infarction was attenuated and lost significance after multivariable adjustment in both sexes. ConclusionsSerum uromodulin is an independent biomarker for total and cardiovascular mortality in men from the general community aged 62 years or older.

Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China

ObjectivesThe 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline recommended 130/80 mm Hg as blood pressure (BP) target goals. However, the generalisability of this recommendation to populations at...

Mortality Risk Increases With Clustered Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators.

This study sought to examine the adverse prognosis associated with ventricular arrhythmia clusters that falls outside the current electrical storm definition. Electrical storm is most frequently defined as a cluster of≥3 episodes of ventricular arrhythmia (VA) in a 24-h period. This definition has been associated with adverse cardiovascular outcomes and mortality, but the effect of lesser and greater clustering of arrhythmias has not been described. Among all patients in the Resynchronization in Ambulatory HeartFailure trial, 14,515 implantable cardioverter-defibrillator-detected events with data available were rigorously adjudicated in blinded fashion. Arrhythmia incidence was examined for clustering, defined as 2 or more VA events occurring within 3months. The prognostic importance of clustering was analyzed by varying the cluster length and number of events used to define a cluster. Mortality rates of groups with clustered arrhythmias were compared to patients with no arrhythmia or with unclustered arrhythmia. The trial included 1,764 patients, among whom 465 patients had two or more VA episodes within 3months, whereas 406 had unclustered arrhythmias. Compared to patients with no arrhythmia, patients experiencing unclustered VA had increased risk of death (hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.09 to 1.93; p=0.011), whereas the risk was even higher in patients with clustered arrhythmia (HR: 2.68; 95%CI: 2.13 to 3.36; p<0.0001). Mortality risk increased with higher VA burden (number of VAs in a cluster) and shorter cluster length. This was observed in all groups tested, including the cluster with the least VA burden in the longest cluster length tested (2 VA episodes occurring within 3months) (mortality HR: 2.85; 95%CI: 1.95 to 4.17; p<0.0001). Although clustered arrhythmias terminated with antitachycardia pacing were associated with increased mortality, clusters terminated with implantable cardioverter-defibrillator shocks were associated with still higher mortality risk. Significant adverse prognostic association of clustered VAs is observable with even 2 VA events within3months and increases with higher cluster density.

The Impact of Individual Co-Morbidities in Myeloablative Ex Vivo CD34+ Selected Allogeneic Hematopoietic Cell Transplantation

<h3>Background</h3> Co-morbidities are essential for risk-stratification before allogeneic hematopoietic stem cell transplantation (HCT). We hypothesized that only certain components of the co-morbidity index (HCT-CI) are predictive of outcomes, and that their impact is conditioning-regimen dependent. <h3>Methods</h3> This retrospective single-center analysis included 580 adult patients who underwent HCT with ex-vivo CD34+ selection following myeloablative conditioning between 2008 and 2018. <h3>Results</h3> Chemotherapy and total body irradiation (TBI)-based conditioning were given to 75% and 25% of patients, respectively. Common co-morbidities in the population included mild/severe hepatic dysfunction (25%), moderate and severe pulmonary disease (32% and 11%, respectively), prior malignancy (14%), and psychiatric disorders (13%). The median HCT-CI was 2 (IQR 1-3). Among co-morbidities meeting statistical criteria for analysis (prevalence >5% and association with at least 5 outcome events), only severe and moderate pulmonary dysfunction (Figure 1) were associated with decreased overall survival (OS) and increased non-relapse mortality (NRM; HR 1.37, p .023; HR 1.94 p<.001, respectively) in a multivariable Cox model. Using cubic splines, we found that the increase in mortality was mainly attributed to hemoglobin-adjusted DLCO, with an linear increase in mortality risk as DLCO decreases from 80. There was a trend towards poorer OS in the univariate analyses of cardiac disease (p .085) and obesity (p .068). While hepatic dysfunction, defined as either mild or more severe hepatic comorbidity, was not associated with decreased OS in the complete cohort, there was an increased risk in patients conditioned with TBI (HR 2.361, p .004), but not with chemotherapy (HR 0.81, p .234) (Figure 2). Among patients with moderate pulmonary disease, the HR for overall mortality was 1.49 (p .007) in the TBI group and 1.11 (p .170) in the chemotherapy group. <h3>Conclusions</h3> Our findings suggest that, in CD34+ selected HCT, only certain co-morbidities included in the HCT-CI are likely to contribute to the prognostic assessment of transplantation candidates. Reevaluation of the additive role of co-morbidities in this setting is warranted. In addition, the hazard of co-morbidities may be regimen-dependent, introducing another consideration when selecting the conditioning modality.

40 Long-term clinical outcome of functional tricuspid regurgitation

Abstract Background Significant functional tricuspid regurgitation (TR) has been associated with higher risk for adverse cardiovascular outcomes. Left-sided heart disease (LHD) is a potentially important confounder of this association because it is strongly linked to both TR and to clinical outcome. Methods We studied 5886 patients who were followed for a period of 10-years after the index echocardiographic examination. The relationship between TR severity and the composite endpoint of admission for heart failure or cardiovascular mortality was analyzed using a Cox model. An additional analysis included a propensity-score-matching. To simplify the modeling of the severity of LHD, we calculated an additive score summing the number of LHD components as follows: reduced LVEF, LA enlargement ≥moderate, aortic or mitral valve disease (regurgitation or stenosis ≥moderate) and PASP≥50 mmHg. Results Higher TR grade was associated with markers of LHD including left ventricular systolic dysfunction, valvular heart disease ≥moderate, left atrial enlargement and pulmonary hypertension (All P &amp;lt; 0.001). There was a significant interaction between TR and the presence of LHD with regard to the endpoint of heart failure in the model for admission for heart failure (P = 0.01) and the combined endpoint of heart failure and cardiovascular mortality (P = 0.02). In both models, moderate/severe TR was associated with higher risk for heart failure (hazard ratio [HR] 3.13; 95% CI 2.49–3.93, P &amp;lt; 0.0001) and the combined endpoint of heart failure or cardiovascular mortality (HR 2.61; 95% CI 1.33–5.13, P = 0.005) only in patients without LHD. The interaction plot (Figure) demonstrates that when LHD is present, TR is not a predictor of clinical outcome. Propensity score matching yielded 350 patient pairs, of which 88% had LHD. The HR for heart failure or cardiovascular mortality at 10-years was 0.78 (95% CI 0.56–1.08, P = 0.14) in the moderate/severe TR as compared with the trivial/mild TR. Conclusions Moderate or severe functional TR portends an increased risk for heart failure and cardiovascular mortality only when isolated, without concomitant LHD. Abstract 40 Figure. Interaction plot

Blood Pressure Variability and Outcomes in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis

Objective: Previous studies have suggested that blood pressure variability (BPV) is associated with an increased risk of mortality and cardiovascular events in patients on dialysis. However, the results are inconsistent. A comprehensive literature review was conducted to analyze the association between BPV and outcomes in patients on dialysis. Methods: Articles in Embase, Medline, and Web of Science from the date of inception through January 1, 2020, were identified. The outcomes were all-cause and cardiovascular mortality and cardiovascular events. The risk of bias was assessed using the Newcastle-Ottawa scale tool. Random effects models were used to pool the overall effect sizes. Two reviewers extracted the data independently. Meta-regression and subgroup analyses were performed to explore potential heterogeneity. Results: Fifteen eligible studies were included, and all enrolled hemodialysis recipients only. The overall risk of bias for the included studies was low. A 1-SD increase in systolic BPV was associated with higher risks of all-cause mortality (HR = 1.18; 95% CI 1.11–1.26, I² = 53.8%), cardiovascular mortality (HR = 1.23; 95% CI 1.10–1.37, I² = 57.2%), and cardiovascular events (HR = 1.27; 95% CI 1.07–1.51, I² = 69.3%). Likewise, a 1-SD increase in diastolic BPV was associated with higher HR for all-cause and cardiovascular mortality (HR = 1.14; 95% CI 1.05–1.23, I² = 0.0%, and HR = 1.14; 95% CI 0.94–1.38, I² = 0.0%, respectively). Conclusions: A greater BPV is associated with higher risks of cardiovascular and mortality outcomes in patients on hemodialysis. Further research is required to determine whether BPV may be useful either as a marker enabling individualized treatment of cardiovascular risk or as a treatment target in its own right.

Impact of anticoagulants in elderly patients who suffer a hip fracture. Should we have a different approach?

Introduction:Hip fracture in the elderly is a frequent problem. Chronic treatment with anticoagulants is common in these patients and may delay surgery.Objectives:To compare time to surgery, hospital stay, in-hospital and 90 days complications between anticoagulated and non-anticoagulated groups.Methods:Retrospective cohort of >64 years-old patients with acute hip fracture. Period June-2014 to December 2019. We estimated crude and adjusted Odds Ratio (95%CI) for in-hospital complications with logistic regression model. We report the crude and adjusted Hazard Ratio for readmission and 90-days mortality with Cox proportional hazards model.Results:Of the 1058 patients, 123 (11%) were anticoagulated. Time to surgery was 26.4 hours (IIQ 13.9-48) in anticoagulated and 24 hours (IIQ 2.3-48) in non-anticoagulated, p 0.001. Hospital stay was 7 days (IIQ 5-9) in anticoagulated and 6 days (IIQ 5-10.5) in non-anticoagulated, p 0,000. In-hospital complications were 17 (14%) in anticoagulated and 81 (9%) in non-anticoagulated, p 0.064. The adjusted OR was 1.53 (95%CI 0.8-2.7) p 0.138. For 90-days readmission, the crude HR was 1.51 (95%CI 0.99-2.29) p 0.053 and the adjusted HR was 1.31 (95%CI 0.85-2.00) p0,09. For 90-days mortality, the crude HR was 0.80 (95%CI 0.45-1.43) p 0.464 and the adjusted HR was 0.70 (95% CI 0.39-1.25) p 0.239.Discussion:While we found differences between groups in time to surgery and hospital statistics these differences may not be clinically relevant. (www.actabiomedica.it)

Prior history of acute pancreatitis predicts worse survival for patients with resectable pancreatic cancer

Presenter: Yitao Gong | Fudan University Shanghai Cancer Center Background: Mounting evidence has suggested that acute pancreatitis (AP) is a risk factor of pancreatic cancer (PC) and may accelerate oncogenesis in PC, but its role in survival in PC patients, especially in patients with resectable pancreatic cancer has not been investigated. The objective was to investigate the association of history of AP with survival among PC patients who have undergone surgical resection in a retrospective cohort-based study. Methods: In this retrospective cohort of 662 pancreatic cancer patients who underwent radical surgical resection, we evaluated survival by acute pancreatitis history prior to PC diagnoses using Kaplan-Meier methods and log-rank tests. Multivariate analyses for mortality were estimated using Cox proportional hazards model, adjusted for age, sex, tumour location, tumour grade, tumour stage, diabetes mellitus status, baseline CA19-9 level, adjuvant chemotherapy and adjuvant radiotherapy. Results: The log-rank tests showed that the patients with history of acute pancreatitis had worse overall survival compared to those without acute pancreatitis history (p = 0.007). The multivariable-adjusted HR for mortality comparing participants with acute pancreatitis to those without was 1.709 (95% CI: 1.187- 2.459, P-value = 0.004). After categorizing patients with history of acute pancreatitis into recent ( < 2 years) and remote history (≥ 2 years) of AP, patients with recent history of AP, rather than patients with remote history of AP, were found to have significantly worse survival (P-value = 0.007) than those without AP history. Conclusion: Our findings indicate that history of acute pancreatitis, especially recent history of acute pancreatitis, is associated with worse survival in resectable pancreatic cancer patients.

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

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

Origins of disparities in preventable child mortality in England and Sweden: a birth cohort study

ObjectiveTo compare mortality in children aged <5 years from two causes amenable to healthcare prevention in England and Sweden: respiratory tract infection (RTI) and sudden unexpected death in infancy (SUDI).DesignBirth...

Mortality among Patients with Giant Cell Arteritis: A Large-scale Population-based Cohort Study.

Studies regarding mortality among patients with giant cell arteritis (GCA) have yielded conflicting results. Thus in this large population-based study we aimed to examine whether GCA is associated with increased mortality, and if so, the effect of age at diagnosis and sex on the association. We used the medical database of Clalit Health Services for this retrospective cohort study. Followup was from January 1, 2002, and continued until death or end of followup on September 1, 2018. Incident GCA patients were compared with age- and sex-matched controls. Estimated median survival times were calculated using the Kaplan-Meier method. HR for all-cause mortality were obtained by the Cox proportional hazard model, adjusted for sociodemographic variables and cardiovascular risk factors. The study included 7294 patients with GCA and 33,688 controls. The mean age at start of followup was 72.1 ± 9.9 years with 69.2% females. Estimated median survival time was 13.1 years (95% CI 12.6-13.5) in patients with GCA compared with 14.4 years (95% CI 14.1-14.6) in controls (p < 0.001). The multivariate analysis demonstrated increased mortality risk in the first 2 years after diagnosis (HR 1.14, 95% CI 1.04-1.25) and > 10 years after diagnosis (HR 1.14, 95% CI 1.02-1.3). The mortality risk was higher in patients diagnosed at ≤ 70 years of age [HR 1.5 (95% CI 1.14-1.99) 0-2 yrs; HR 1.38 (95% CI 1.1-1.7) > 10 yrs]. Patients with GCA have a minor decrease in longterm survival compared to age- and sex-matched controls. The seen difference is due to excess mortality in the first 2 years, and > 10 years after diagnosis. Patients diagnosed ≤ 70 years of age are at greater risk.

Abstract 132: Predictive Value of Inflammation Markers With Stroke Recurrence and Cardiovascular Mortality

Background: Inflammation markers are associated with the risk of cardiovascular events, however, the relationships of inflammation markers with risk of post-stroke remain controversial. Objects: To investigated association of two clinical recorded inflammation markers, white blood cell count (WBC) and platelet count (PLTC) with first-onset stroke and long-term prognosis of stroke. Methods: A Chinese case-control study was conducted, comprising 2002 stroke cased (885 atherothrombosis, 565 lacunar stroke, 552 hemorrhagic stroke) and 1996 controls. Stroke patients were prospectively followed-up for a median of 4.5 years (range, 0.1-6.0). Results: The WBC and PLTS were higher in stroke patients than controls, however, the ratio of PLTS to WBC was lower in stroke patients than controls. During the follow-up, 369 recurrent strokes and 343 cardiovascular mortality were documented. Adjusted for cardiovascular disease, the increased ration of PLTC to WBC was negatively correlated with stroke recurrence (HR, 0.60, 95%CI 0.44 to 0.81, P =0.001), with no associations for PLTC and WBC. Compared with stroke patients with WBC in the first quartile (2.1-5.6х10 9 /L) , subjects in the fourth quartile (7.8-19.8х10 9 /L) had 2.10-fold risk for cardiovascular mortality (hazard ration [HR],2.10, 95% confidence interval [CI], 1.20 to 2.48, P =0.004), with no associations for PLTC. However, the increased ratio of PLTC to WBC decreased risk of cardiovascular mortality HR was 0.61 in the second quartile (2.09-17.60х10 9 /L), HR was 0.58 in the third quartile (17.61-24.04х10 9 /L) and HR was 0.48 in the fourth quartile (24.05-34.54х10 9 /L) (all P &lt;0.01). Conclusion: Higher WBC and PLTC are associated with poorer prognosis of stroke, and the ration of WBC to PLTC improved the predictive value for cardiovascular mortality and stroke recurrence.