Predictor Of Mortality In Men Research Articles

Editorial Comment on: Current Applications for Prostate-Specific Antigen Doubling Time

Prostate-specific antigen doubling time (PSADT) holds great promise for the prediction of cancer characteristics, such as stage and probability of progression before the delivery of definitive therapy [1–4]. Similarly, PSADT appears to have the ability to predict the probability of prostate cancer (PCa) diagnosis, especially after a previously negative biopsy. Moreover, PSADT was shown to predict progression towards lethal PCa phenotypes after radiation or surgery. Finally, PSADT represents one of the most powerful predictors of PCa-specific mortality in men with androgeninsensitive prostate cancer (AIPC) [5]. PSADT calculators are available at several PCa-oriented Web sites, such as the MSKCC site (www.nomograms.org) or the University of Montreal site (www.nomogram.org). The PSADT calculators allow the clinician to define the PSADT value of the individual patient at a given time. This metric showed promise as an independent predictor of cancer outcomes at different stages of the natural history of treated prostate cancer. Unfortunately, the current reports which showcase the value of PSADT might at times be difficult to interpret and even more difficult to implement. The problem relates to different PSADT cut-offs that are suggested as ‘‘ideal’’ predictors of unfavorable outcome. As a result, the clinician might not be able to derive the full benefit of the information contained within this powerful marker. Svatek et al circumvented the problem related to the interpretation of various PSADT cut-offs and integrated PSADT within a prognostic nomogram for men with AIPC [5]. Of all predictors, PSADT was the most informative, and accomplished its prognostic role for prediction of PCa-specific mortality in noncategorized format. Svatek et al demonstrated that this powerful predictor can result in most accurate predictions and can yield the best calibration, when it was combined with three other informative and significant variables [5]. Most importantly, these researchers proved that PSADT can be used to provide individualized predictions, which can be easily interpreted (prognosis expressed as a probability from 0–100% of dying from PCa at different time points) and can be equally easily accessed by patients and/or physicians (www.nomogram.org). Hopefully, more researchers will reexamine their valuable findings and will attempt to integrate PSADT within prognostic models capable of providing evidence-based, individualized prognostic information. Such measures would certainly result in much wider use of PSADT and would possibly improve patient care.

Reasons for initial PSA (iPSA) and biochemical failure (BF) being poor predictors of prostate cancer (PC) mortality

5153 Background: iPSA and BF are often poor predictors of mortality in men treated for locally advanced PC. We sought to find out why from prospective randomised trial data. Methods: In the TROG 96.01 trial men with T2b,c, 3, 4 N0 PC were randomised to 0, 3 or 6 months maximal androgen deprivation (AD) (goserelin 3.6 mg sc monthly and flutamide 250 mg po tid) prior to 66 Gy to the prostate and seminal vesicles. Failure site was diagnosed prior to salvage hormone therapy (ST) where possible, and type, timing and duration of response to ST recorded. Proportional hazards modeling was used to identify predictors of cause specific and overall survival (CSS, OS) at follow-up landmark points (where p>0.05=NS, <0.01=S, <0.001=H). Results: Between 1996 and 2000, 802 eligible men were randomised. Higher iPSA was found to be a potent predictor of BF (Houston [HF])H but a poor one for of CSSNS and OSNS. Patients having HF and/or clinical failure had unfavourable initial prognostic factors (high iPSAH, stageH, Gleason scoreH or risk groupH) compared to patients who did not fail. However in this cohort poor initial prognostic features did not predict PC death when the relapse characteristics (failure siteH and PSA doubling timeH [PSA DT]) were accounted for. Instead lower iPSA levels were predictive of worse outcome in these modelsS, a finding supported by univariate analyses. PSA DT was found to correlate positively with interval between HF and STH and the likelihoodS and duration of response to STH, and survivalH. Thus lower PSA DTs were associated with earlier intervention but poorer responses and outcomes. Conclusions: Prognosis after BF is related more to tumour biology at relapse than to initial prognostic factors. ST alone is an unsatisfactory treatment for rapid PSA DT relapses. No significant financial relationships to disclose.

Continuous Metabolic Syndrome Score as a Predictor of Mortality in Men with Metabolic Syndrome

0086 The metabolic syndrome is defined as having at least 3 of the following 5 characteristics: abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose. As the definition of metabolic syndrome is a dichotomous, examining the potential benefits of interventions for metabolic syndrome is crude and imprecise. A research measure (variable) responsive to small changes in the various components of the syndrome could be a valuable tool in examining metabolic syndrome targeted interventions. PURPOSE: To create a continuous metabolic syndrome score and to examine the relationship between this score and mortality in men with metabolic syndrome. METHODS: In this study we examined all cause and cardiovascular disease (CVD) deaths in men across quartiles of Z scorebased metabolic syndrome variable. In order to weight each variable equally, the Z-scores of waist girth, systolic blood pressure, HDL cholesterol, fasting glucose and triglycerides were summed for each individual to create a continuous Z-score-based metabolic syndrome variable. Study participants were 4070 men with metabolic syndrome (mean age 46.3 ± 9.6 years) who received a clinical evaluation between 1979 and 1996, with mortality follow-up through December 31, 1996. RESULTS: A total of 145 deaths occurred during 8.9 ± 5.1 years of follow-up. In the proportional hazards model adjusted for age, smoking, previous CVD and year of examination, the risk of all-cause mortality was 0.9 (0.6–1.6), 1.4 (0.9–2.3) and 1.8 (1.2–2.9), respectively, for the second, third and fourth quartiles of the continuous Z-score-based metabolic syndrome variable (P for trend < 0.001). Similar results were seen for CVD mortality, the relative risk was 0.9 (0.4–2.1), 1.3 (0.6–2.8) and 2.5 (1.3–4.9), respectively (P for trend < 0.001). CONCLUSIONS: Among men with metabolic syndrome, the continuous Z-score-based metabolic syndrome variable was predictive of all-cause and CVD mortality. This continuous variable may be useful to evaluate the effectiveness of interventions for metabolic syndrome. Supported in part by NIH Grant AG06945

Continuous Metabolic Syndrome Score as a Predictor of Mortality in Men with Metabolic Syndrome

Continuous Metabolic Syndrome Score as a Predictor of Mortality in Men with Metabolic Syndrome

CHD: a major burden in type 2 diabetes.

Patients with type 2 diabetes have a two- to four-fold greater risk of cardiovascular mortality than non-diabetic individuals. In order to prevent coronary events in the diabetic population, it is important to treat modifiable cardiovascular risk factors. Data from the Multiple Risk Factor Intervention Trial (MRFIT) show that serum cholesterol level, systolic blood pressure level and cigarette smoking were significant predictors of cardiovascular disease mortality in men with and without diabetes. At every risk factor level, the absolute risk of age-adjusted coronary death rate was three times greater for diabetic men than non-diabetic men (p<0.0001). Patients with diabetes have an abnormal (dyslipidaemic) lipoprotein profile with high levels of very low density lipoprotein cholesterol and triglycerides, and a low level of high density lipoprotein cholesterol. Although levels of total cholesterol or low density lipoprotein (LDL) cholesterol do not differ significantly between patients with and without diabetes, those with diabetes have higher levels of atherogenic small dense LDL particles. MRFIT data show that at any serum cholesterol level, diabetes confers two-three times the risk for a coronary event. These findings constitute the rationale for considering hypolipaemic therapy, e.g. with HMG-CoA reductase inhibitors (statins), in diabetic patients with dyslipidaemia, particularly in those with evidence of coronary heart disease. Evidence shows that statins significantly lower cholesterol, exhibit beneficial effects on many components of atherosclerosis, and can significantly reduce the incidence of stroke.

Feelings of being disabled as a predictor of mortality in men 10 years after percutaneous coronary transluminal angioplasty

Objective: To examine the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in male and female patients 10 years following percutaneous transluminal coronary angioplasty (PTCA). Methods: The HPPQ, which measures well-being, feelings of being disabled, despondency, and social inhibition, was administered to 356 patients (23% women) post-PTCA. The patients were followed for a median of 10 years. Clinical and demographic variables were sampled from medical records. Results: During the follow-up period, 104 patients (29%) had died. Women scored significantly worse on all psychological subscales compared with men. Fifty-nine (72%) women and 92 (34%) men had a score indicating at least mild to moderate feelings of being disabled. Men scoring high on feelings of being disabled were at increased risk of mortality compared with men having a low score, adjusted for other cardiac risk factors ( χ 2=7; P=.008). No differences were found between women with low or high scores on feelings of being disabled (relative risk (RR): 1.2; 95% confidence interval (CI): 0.5–3.3). None of the other HPPQ subscales were related to mortality. Conclusion: Feelings of being disabled measured at least 1 year after hospital discharge is a significant predictor of mortality in men 10 years post-PTCA, but not in women. This finding adds to the increasing knowledge that psychosocial variables influence morbidity and mortality in cardiac patients.

Cardiovascular fitness as a predictor of mortality in men.

To examine the relations of cardiorespiratory fitness, as measured by maximal oxygen uptake and exercise test duration at the initiation of the study, with overall, cardiovascular disease (CVD)-related, and non-CVD-related mortality. A population-based cohort study of 1294 men with no CVD, pulmonary disease, or cancer at baseline in Kuopio and surrounding communities in eastern Finland. During an average follow-up of 10.7 years, there were 124 overall, 42 CVD-related, and 82 non-CVD-related deaths. The relative risk of overall death in unfit men (maximal oxygen uptake <27.6 mL/kg per minute) was 2.76 (95% confidence interval, 1.43-5.33) (P =.002), and the relative risk of CVD-related death was 3.09 (95% confidence interval, 1.10-9.56) (P =.05), compared with fit men (maximal oxygen uptake >37.1 mL/kg per minute) after adjusting for age, examination years, smoking, and alcohol consumption. The relative risk of non-CVD-related death in unfit men was almost the same magnitude as for overall death. Furthermore, adjustment for serum lipid levels, blood pressure, plasma fibrinogen level, diabetes, and fasting serum insulin level did not weaken these associations significantly. Exercise test duration also had a strong inverse relation to overall, CVD-related, and non-CVD-related mortality. Poor cardiorespiratory fitness was comparable with elevated systolic blood pressure, smoking, obesity, and diabetes in importance as a risk factor for mortality. Cardiorespiratory fitness had a strong, graded, inverse association with overall, CVD-related, and non-CVD-related mortality. Maximal oxygen uptake and exercise test duration represent the strongest predictors of mortality.

Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes.

Although physical activity is recommended as a basic treatment for patients with diabetes, its long-term association with mortality in these patients is unknown. To evaluate the association of low cardiorespiratory fitness and physical inactivity with mortality in men with type 2 diabetes. Prospective cohort study. Preventive medicine clinic. 1263 men (50+/-10 years of age) with type 2 diabetes who received a thorough medical examination between 1970 and 1993 and were followed for mortality up to 31 December 1994. Cardiorespiratory fitness measured by a maximal exercise test, self-reported physical inactivity at baseline, and subsequent death determined by using the National Death Index. During an average follow-up of 12 years, 180 patients died. After adjustment for age, baseline cardiovascular disease, fasting plasma glucose level, high cholesterol level, overweight, current smoking, high blood pressure, and parental history of cardiovascular disease, men in the low-fitness group had an adjusted risk for all-cause mortality of 2.1 (95% CI, 1.5 to 2.9) compared with fit men. Men who reported being physically inactive had an adjusted risk for mortality that was 1.7-fold (CI, 1.2-fold to 2.3-fold) higher than that in men who reported being physically active. Low cardiorespiratory fitness and physical inactivity are independent predictors of all-cause mortality in men with type 2 diabetes. Physicians should encourage patients with type 2 diabetes to participate in regular physical activity and improve cardiorespiratory fitness.

Body mass index and alternative indices of obesity in relation to height, triceps skinfold and subsequent mortality: the Busselton health study.

The ideal index for leanness and obesity in epidemiological studies should correlate strongly with body weight and with a direct measure of fat while minimizing the influence of height. The preferred index is expected to show meaningful associations with subsequent mortality. Our aims were to compare weight/height, weight/height(2) (body mass index or BMI), and weight/height(3) as candidates for this index. We analysed cross-sectional data from surveys of 6948 adults (3334 men (mean age 43 y, mean BMI 24.8 kg/m2), and 3614 women (mean age 42 y, mean BMI 24.3 kg/m2)) in Busselton, Australia whose weight, height, triceps skinfold, and cardiovascular risk factors were measured from 1966 through to 1978. In these same subjects we studied the mortality risks of indices of obesity using Cox regression analysis for survival time from first survey to death, or to follow up at the end of December 1995, after adjustment for age. Subjects dying within 5 y of the baseline survey were excluded from the analysis to avoid the bias of concurrent illness. We also studied subgroups including never smokers, subjects with no heart disease, and subjects <60 years of age at first survey. In men, weight/height2 met the criteria for a satisfactory index in that there was a very strong correlation with triceps skinfold, and a negligible correlation with height. For women, weight/height was as good a measure as weight/height2, with both having strong correlations with triceps skinfold, and minimal correlations with height. Weight/height2 as a predictor of mortality in men of all ages showed the typical U-shaped associations that were similar and consistent and of variable statistical significance. The significances of the hazard ratio curves were the strongest for cardiovascular disease deaths (all men P=0.001; men without heart disease at baseline P<0.001; never smoking men P=0.007). In never smoking men there was a near linear positive relationship with all-cause mortality (P=0.018). In women weight/height2 showed no consistent associations with mortality. There was a shallow U-shaped relationship with all-cause mortality (P=0.087), also seen in never smoking women (P=0.075). In assessing 'ideal' weight for height in this population, a weight/height2 of 25 kg/m2 (range 22.5-27.5 kg/m2) is appropriate. Weight/height and mortality showed very similar patterns in men to weight/height2 with quite similar levels of statistical significance. In women much more pronounced U-shaped curves were apparent in all groups and subgroups, with a significant all-cause mortality trend for all women (P=0.029) and never smoking women (P=0.034). In assessing 'ideal' weight for height a weight/height of 42.5 kg/m (range 35-50 kg/m) appears appropriate for men and women. Weight/height2 is an appropriate index of leanness and obesity in males at all ages, whereas weight/height is at least as good an index for females. In mortality studies weight/height2 and weight/height predict mortality similarly in males, but weight/height is a better discriminant of mortality in females. International Journal of Obesity (2000)24, 108-115

Functional health status as a predictor of mortality in men and women over 65

This study evaluated the effect of functional health status on mortality in a sample of community-dwelling older people. White and African-American self-respondents to the 1986 National Health Interview Survey Functional Health Supplement ( n = 5, 320) were included in the study. Functional health status was measured by a ten-item unidimensional activities of daily living-instrumental activities of daily living (ADL-IADL) scale and a three-item cognitive ADL scale. Proportional hazards regression was used to evaluate the effect of increasing score on the ten-item ADL-IADL scale on risk of mortality over a 5-year period while controlling for demographic, social, and health status covariates. In both men and women, increasing score on the ADL-IADL scale was predictive of mortality, adjusting for increasing age, poor self-rated health, low body mass index in women, and being an unmarried man. These findings indicate that a unidimensional scale consisting of both ADL and IADL items is useful in predicting mortality, controlling for the effect of covariates in sex-specific models.

Non-insulin-dependent diabetes and 11-year mortality in Asian Indian and Melanesian Fijians.

This study reports 11-year all-cause and cause-specific mortality rates according to baseline glucose tolerance for a population-based sample of adult Melanesian and Indian Fijians (n = 2638), first surveyed in 1980. Risk factors for all-cause and cardiovascular disease (CVD) mortality in subjects with non-insulin-dependent diabetes (NIDDM) are also described. The baseline survey included 75 g oral glucose tolerance tests, measurements of blood pressure, body mass index, and triceps skinfold, assays of plasma cholesterol and triglycerides, electrocardiograms, and details of smoking habits and physical activity. Mortality status was ascertained for 2546 subjects through surveillance of death certificates, medical records and interview of subjects (or relatives). Mortality rates were increased in diabetic men and women of both ethnic groups: relative risks compared to subjects without diabetes at baseline were 1.7 (CI:0.9-3.1) and 2.0 (1.1-3.7) in Melanesian and 4.2 (2.7-6.5), 3.2 (1.9-5.7) in Indian men and women, respectively. A large proportion of mortality among diabetic subjects was attributed to CVD (62%, 66% in Melanesian and 54%, 58% in Indian men and women, respectively). Mortality rates tended to be higher in Melanesians than Indians, except for diabetic men where Indians had higher total and cardiovascular disease rates. In contrast to non-diabetic Fijians, diabetic women of both ethnic groups lost their relative protection from coronary heart disease (CHD). Cox regressions for diabetic subjects showed age and fasting plasma glucose to be independent predictors of all-cause mortality in men, and age, body mass index (inversely) and systolic blood pressure in women, but lipid concentrations, and cigarette smoking were not related. After accounting for conventional CVD risk factors, diabetes conferred significantly increased risk of total, CVD, and CHD mortality. The mortality experience of Melanesian and Indian Fijians with NIDDM is similar to that documented in developed populations, with excess mortality due to cardiovascular causes.

Assessing gender interactions in the prediction of mortality in alcoholic men and women: a 20-year follow-up study.

This study investigates the predictors of mortality in 259 male and female alcoholics who were psychiatrically hospitalized between 1967 and 1968 and followed for > 20 years. The findings showed that, in addition to age, marital status, medical complications, and non-antisocial personality comorbidity were important independent predictors of time to death. Data pointed to gender interactions, in that marital disruption tended to be a stronger predictor of mortality in men, and delirium tremens tended to be a stronger predictor of mortality in women. Knowing and understanding that certain events and processes may differentially affect the survival of male and female alcoholics will allow for the development of more individualized and gender-specific therapeutic interventions.

Is thiazide-produced uric acid elevation harmful? Analysis of data from the Hypertension Detection and Follow-up Program.

Interaction of thiazide diuretics and the serum uric acid and creatinine levels was studied in 3693 stepped care participants in the Hypertension Detection and Follow-up Program not receiving treatment at baseline. Among men grouped into quartiles by their level of uric acid at baseline, the upper quartile (average uric acid, 7.7 mg/dL [458 mumol/L]) had an average serum creatinine level of 1.2 mg/dL (106 mumol/L) and the lowest quartile (uric acid, 4.9 mg/dL [291 mumol/L]) had an average serum creatinine level of 1.1 mg/dL (97 mumol/L). Similar findings were present in women. Therapy with chlorthalidone or other thiazide-type diuretics tended to increase levels of uric acid and creatinine, but the increase in both was less in the upper quartile than in the lower quartile. Among individuals who were prescribed uric acid-lowering drugs, the level of serum creatinine increased just as much as in those whose uric acid level was not pharmacologically lowered. Baseline uric acid level was a weak predictor of mortality in men; the introduction of an interaction term for creatinine suggested that this effect was primarily restricted to those with elevated levels of both uric acid and creatinine at baseline. Change in uric acid level at one year after therapy was inversely correlated with mortality in men. There were few episodes of gout (only 15 recorded in five years among 3693 participants at risk). These results suggest that neither the baseline uric acid level nor the change in uric acid level produced by therapy injures the kidney. These results suggest no reason to lower uric acid levels pharmacologically in the treated hypertensive patient who is not gouty. They leave unanswered whether there is a predictive value to baseline uric acid level not explainable by other correlated cardiovascular risk factors.