Incidence Risk Research Articles

Lower creatinine-to-cystatin c ratio associated with increased risk of incident amyotrophic lateral sclerosis in the prospective UK biobank cohort.

Reduced muscle mass has been associated with the progression and prognosis of amyotrophic lateral sclerosis (ALS). However, it remains unclear whether decreased muscle mass is a risk factor for ALS or a consequence of motor neuron degeneration. Recently, serum creatinine-to-cystatin C ratio (CCR) have emerged as promising biomarkers for assessing muscle mass. We aimed to explore the association between CCR and the incidence of ALS using data from the UK Biobank. Between 2006 and 2010, 446,945 participants were included in the baseline. CCR was calculated as the ratio of serum creatinine to cystatin C. Cox regression models were used to analyze the relationship between CCR and ALS incidence. Furthermore, subgroup analyses were conducted to investigate potential covariates in these relationships. After adjusting for all covariates, the multivariate Cox regression analysis revealed a significant association between decreased CCR and an increased risk of ALS (hazard ratio (HR) = 0.990, 95% confidence interval (CI): 0.982-0.999, P = 0.026). Participants were stratified into groups based on CCR tertiles. Compared with participants in the highest tertiles of CCR, those in the lowest (HR = 1.388, 95% CI: 1.032-1.866, P = 0.030) and medium tertiles (HR = 1.348, 95% CI: 1.045-1.739, P = 0.021) had an increased risk of ALS incidence. Subgroup analysis showed that the relationship between CCR and ALS incidence was particularly significant among participants aged < 65years (CCR tertile 1: HR = 1.916, 95% CI: 1.366-2.688, P < 0.001; CCR tertile 2: HR = 1.699, 95% CI: 1.267-2.278, P < 0.001). The present results demonstrate that lower CCR is significantly associated with a higher risk of ALS.

Vertebral Fracture Prediction from MRI-based Vertebral Bone Quality Scores in Postmenopausal Women

Study Design. A longitudinal cohort study Objective. The study aims to assess the lumbar MRI-based vertebral bone quality (VBQ) score and dual energy x-ray absorptiometry (DXA) T score in a longitudinal cohort of postmenopausal women and to evaluate the performance of these scores in predicting VF over 5 years of follow-up. Summary of Background Data. VBQ scores can be used for osteoporosis screening and identification of vertebral fractures (VFs). However, due to limitations in prior cross-sectional studies, definitive conclusions about the causal associations between the VBQ score and incident VF have not been drawn. Methods. Postmenopausal women with baseline DXA and lumbar MRI data were enrolled. Follow-up assessments were conducted over 5 years after the baseline examination; both anteroposterior- and lateral-view thoracolumbar spine radiographs were captured to evaluate incident VF. At baseline, correlation analyses between the VBQ score and osteoporosis or preexisting VF were performed. A Cox regression model for multivariate logistic regression was used to analyze the risk factors for incident VF. The hazard ratio (HR) was calculated. Results. 137 postmenopausal women were included. The VBQ score was moderately correlated with lumbar bone mineral density at baseline (r=0.4, P&lt;0.001). Patients with incident VF had significantly lower T scores (-3.4 vs. -1.87, P&lt;0.001) and higher VBQ scores (4.62 vs. 4.03, P&lt;0.001) at baseline than those without incident VF. After adjusting for age, weight, creatinine clearance, and alkaline phosphatase levels, the HRs for the VBQ score and T score were 1.93 and 0.71, respectively. After adjusting for the T score, an increased VBQ score was independently associated with an increased risk of incident VF, with an HR of 1.87. Conclusion. The VBQ score was moderately correlated with DXA T score and was a predictor of incident VF risk independent of bone mineral density in postmenopausal women.

Risk Factors of Immune-Mediated Hepatotoxicity Induced by Immune Checkpoint Inhibitors in Cancer Patients: A Systematic Review and Meta-Analysis

Immune checkpoint inhibitors (ICIs) significantly improve survival, while immune-mediated hepatotoxicity (IMH) has been reported. To evaluate the incidence and potential risk factors of IMH among cancer patients treated by ICIs, PubMed/Medline, Web of Science, Cochrane, and Embase were searched before 30 March 2024 for systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Quality assessment was completed using the Newcastle–Ottawa scale. Of 1217 articles identified, 24 consisting of 9076 patients were included, with one study being prospective and the rest retrospective. The overall incidence of any grade IMH and grade ≥ 3 secondary to ICIs was 14% and 7%, respectively. The cholestatic pattern was more prevalent than the hepatocellular and mixed patterns. The meta-analysis revealed that ICI treatment was related to reduced risk of IMH in older patients (SMD: −0.18; 95% CI: −0.33 to −0.04), individuals with higher body mass index (WMD: −2.15; 95% CI: −3.92 to −0.38), males (OR: 0.44; 95% CI: 0.27 to 0.72), and patients with lung cancer (OR: 0.58, 95%CI 0.41 to 0.83). On the other hand, patients with liver metastasis (OR: 1.80; 95% CI: 1.47 to 2.20), history of ICI treatment (OR: 3.09; 95% CI: 1.21 to 7.89), diabetes (OR: 2.19; 95% CI: 1.36 to 3.51), chronic HBV (OR: 3.06; 95% CI: 1.11 to 8.46), and concomitant use of ICIs (OR: 8.73; 95% CI: 2.41 to 31.59) increased the risk of developing IMH. This study will provide clinicians with information on potentially high-risk groups for IMH, who need to be cautiously monitored for liver function when receiving immunotherapy.

Association among major adverse cardiovascular events with immune checkpoint inhibitors: A systematic review and meta-analysis.

This meta-analysis aimed to determine the incidence and overall risk of major adverse cardiovascular events (MACEs) related to immune checkpoint inhibitors (ICIs). We systematically searched all cohort studies, including the available MACE data in cancer patients receiving ICIs, in PubMed, Embase, and the Cochrane Library, from their inception to September 5, 2023. The primary outcome was the incidence of MACEs associated with ICI exposure, and the secondary outcome was the overall risk of MACEs associated with ICI exposure versus non-ICI exposure controls. Risk ratios with 95% confidence intervals were used in the random- or fixed-effects models. Overall, 26 cohort studies met the inclusion criteria, involving 109,883 cancer patients. In the median follow-up period ranging from 3.3 to 55.2 months, the incidence of MACEs associated with ICI exposure was 8.22%, ranging from 0.55% to 3.98%, among the nine MACEs, including myocarditis, tachyarrhythmia, pericarditis, pericardial effusions, cardiovascular death, myocardial infarction, heart failure, stroke, and conduction disorder. The incidence of MACE associated with non-ICI exposure was 3.84%, ranging from 0.81% to 4.72%. The risks of all-grade MACEs and pericardial effusions were significantly higher in the ICI group than in the non-ICI controls. ICI treatment, age, male sex, and prior radiation therapy were significantly associated with MACEs. The risk of MACEs during ICI treatment in patients with cancer is more common than is currently recognized. ICI use is closely associated with an increased risk of MACEs. Patients at risk were older, male, and had a history of radiation therapy.

Goal Setting and the Emergence of the Safety-Efficiency Trade-off in Organizations

This article aims to shed light on the trade-off between safety and efficiency that arises in organizations when management sets overly demanding efficiency goals. To explore the dynamics and relationships between management's goal setting and the safety-efficiency trade-off, we have chosen to analyze the extreme and illustrative case of the Herald of Free Enterprise disaster – a ferry that sank on March 6, 1987, resulting in the deaths of 193 passengers and crew members. The case shows how the management's imposition of very tight schedules for embarkation and disembarkation operations at the port of Zeebrugge promoted the emergence of risky practices, namely the regular violation of procedures by the crew. We argue that these violations, aimed at increasing the speed of operations to meet the time goals, were a central factor, though not the only one, in the etiology of the accident. The case provides evidence that when management sets overly strict performance goals, it directs employees' attention and efforts toward efficiency at the expense of safety. As a result, safety is compromised, leading to an increased risk of incidents, which can harm employees' health and cause economic and legal damage to the organization.

Plasma proteomics-based brain aging signature and incident dementia risk.

Investigating brain-enriched proteins with machine learning methods may enable a brain-specific understanding of brain aging and provide insights into the molecular mechanisms and pathological pathways of dementia. The study aims to analyze associations of brain-specific plasma proteomic aging signature with risks of incident dementia. In 45,429 dementia-free UK Biobank participants at baseline, we generated a brain-specific biological age using 63 brain-enriched plasma proteins with machine learning methods. The brain age gap was estimated, and Cox proportional hazards models were used to study the association with incident all-cause dementia, Alzheimer's disease (AD), and vascular dementia. Per-unit increment in the brain age gap z-score was associated with significantly higher risks of all-cause dementia (hazard ratio [95% confidence interval], 1.67 [1.56-1.79], P < 0.001), AD (1.85 [1.66-2.08], P < 0.001), and vascular dementia (1.86 [1.55-2.24], P < 0.001), respectively. Notably, 2.1% of the study population exhibited extreme old brain aging defined as brain age gap z-score > 2, correlating with over threefold increased risks of all-cause dementia and vascular dementia (3.42 [2.25-5.20], P < 0.001, and 3.41 [1.05-11.13], P = 0.042, respectively), and fourfold increased risk of AD (4.45 [2.32-8.54], P < 0.001). The associations were stronger among participants with healthier lifestyle factors (all P-interaction < 0.05). These findings were corroborated by magnetic resonance imaging assessments showing that a higher brain age gap aligns global pathophysiology of dementia, including global and regional atrophy in gray matter, and white matter lesions (P < 0.001). The brain-specific proteomic age gap is a powerful biomarker of brain aging, indicative of dementia risk and neurodegeneration.

Abstract 4132351: Soluble Urokinase Plasminogen Activator Receptor Levels Predict Incident Cardio-Kidney-Metabolic Disease Risk

Introduction: Given the rising global incidence of cardio-kidney-metabolic (CKM) syndrome, there is an urgent need for novel risk prediction strategies for CKM disease. Hypothesis: As soluble urokinase plasminogen activator receptor (suPAR) levels have been associated with the development of cardio-kidney disease, we hypothesized that elevated suPAR levels would predict incident CKM disease risk. Methods: A total of 25,596 UK Biobank participants without CKM disease at enrollment were analyzed for the association of suPAR levels and incident CKM disease. CKM disease was defined as the first occurrence of CVD (heart failure, atrial fibrillation/flutter, coronary heart disease, stroke, and peripheral artery disease), chronic kidney disease (CKD), or metabolic disease (type 2 diabetes mellitus and obesity). Incident CVD, CKD, and metabolic disease were also analyzed separately as secondary outcomes. Kaplan-Meier analysis was performed to visualize the association between suPAR levels and the primary composite CKM outcome. Competing-risk regression, while accounting for competing non-CKM disease death, was performed to examine the association between suPAR levels and the primary composite CKM outcome. Models were adjusted for demographics, traditional risk factors, and CRP levels. Results: The mean age was 56.0 (SD 8.3) years, 44% were male, and 94% were White. suPAR levels were associated with a significantly higher rate of composite CKM events (P&lt;0.001) (Figure 1). During a median follow-up of 13.5 [IQR 1.7] years, 5,012 (20.0%) composite CKM events, 3,599 (8.3%) incident CVD events, 863 (3.4%) incident CKD events, and 1,397 (4.7%) incident metabolic disease events occurred. suPAR levels (per SD) significantly predicted the primary composite CKM outcome (sHR 1.23, 95% CI 1.19-1.27) after adjustment. suPAR levels (per SD) also significantly predicted incident CVD (sHR 1.24, 95% CI 1.19-1.29), incident CKD (sHR 1.41, 95% CI 1.30-1.53), and incident metabolic disease (sHR 1.17, 95% CI 1.10-1.24) after adjustment. Conclusion(s): In this large, longitudinal cohort study of UKB participants, plasma suPAR levels were a significant predictor of CKM disease risk, independent of demographics, traditional risk factors, and CRP levels.

Abstract 4136600: Hypertensive disorders of pregnancy and the risk of Dementia, Alzheimer’s disease, and Vascular Dementia. A Systematic review and Meta-analysis of 25,03,538 women participants.

Background: Hypertensive disorders of pregnancy (HDP) are associated with maternal adverse cardiovascular outcomes. However, their association with maternal Dementia and Alzheimer’s disease is not well established with limited and conflicting results to date. Objective: We sought to evaluate the association between HDP and risk of incidence of Dementia, and Alzheimer’s disease. Methods: We performed a systematic review and meta-analysis of available literature that enrolled women with HDP and women without HDP groups. PubMed, Embase and ClinicalTrials.gov were systematically searched from inspection till May 2024 without any language restrictions. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were pooled using a random-effect model. Results: A total of 8 studies with 2503538 patients (1,51,905 in women with HDP and 23,51,633 in the women without HDP group) were included. Pooled analysis shows that HDP women were having 37% higher risk of dementia (aHR, 1.37(95%CI: 1.27-1.46), P&lt;0.001, I2=0%) when compared with women without HDP. Further pooled analysis showed that women with HDP were having 28% higher risk of Alzheimer’s disease (aHR, 1.28(95%CI: 1.56), P&lt;0.001, I2=53.98%), and 2-fold higher risk of vascular dementia (aHR, 2.49(95%CI: 1.29-3.68), P&lt;0.001, I2=71.51%) when compared with women without HDP. Conclusion: Women with HDP were at higher risk of developing Dementia, and Alzheimer's disease in future.

Abstract 4124281: Dexmedetomidine for junctional ectopic tachycardia in patients undergoing tetralogy of Fallot repair: a meta-analysis of randomized controlled trials

Background: Junctional ectopic tachycardia (JET) occurs in 2 to 22% of patients after cardiac surgery for congenital heart diseases, including tetralogy of Fallot (TOF) repair. Dexmedetomidine emerged as a potential drug to prevent JET in these patients. This systematic review and meta-analysis aimed to evaluate the efficacy of dexmedetomidine in JET in patients undergoing TOF repair. Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the use of dexmedetomidine in patients undergoing TOF repair. We pooled risk ratios (RR) for binary outcomes, and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of incidence of JET. We used R version 4.3.2 and TSA version 0.5.9.10 for statistical analyses. Results: Our meta-analysis included 5 RCTs comprising 546 patients, of whom 268 (49%) were randomized to dexmedetomidine. Compared with control, dexmedetomidine significantly reduced the incidence of JET (RR 0.46; 95% CI: 0.30 to 0.71; p&lt;0.05; Figure A). However, there were no significant differences in mortality (RR 0.45; 95% CI: 0.12 to 1.71; p=0.24; Figure B) between groups. In addition, dexmedetomidine also reduced the length of intensive care unit (ICU) stay (MD -7.75 hours; 95% CI: -15.08 to -0.41; p&lt;0.05; Figure C). There were no significant differences in ionotropic score (MD -0.97 ug.min/Kg; 95 % CI: -1.98 to 0.18; p=0.10; Figure D), and ventilation time (MD -2.29 hours; 95% CI: -8.39 to 2.41; p=0.27; Figure E). For the primary endpoint, TSA suggested a low risk of type 1 error; therefore, this result may be conclusive. Conclusion: In patients undergoing TOF repair surgery, dexmedetomidine significantly reduced the incidence of JET and the length of ICU stay.

Abstract 4145802: Association between Glucagon-like peptide-1 receptor agonists and risk of Arrhythmias or Heart Failure among patients with Type 2 Diabetes: A Meta-Analysis of 29 Randomized Controlled Trials.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown a reduction in major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM). However, their effect on reducing the risk of incidence of arrhythmias and heart failure has not been established, and there is very limited literature to date. Objective: We evaluated the effect of GLP-1 RAs on the incidence of arrhythmias and heart failure among patients with T2DM. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that enrolled patients with type 2 diabetes and compared GLP-1 RAs and control groups. PubMed and ClinicalTrials.gov were systematically searched from inspection till May 2024 without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model. Results: A total of 29 RCTs with 72,868 patients (35,631 in the GLP-1 RA group and 37,237 in the control group) were included in the analysis. Pooled analysis showed that there is no significant association between GLP-1 RAs and incidence of atrial fibrillation (OR, 0.94(95%CI: 0.75-1.18), P=0.60), atrial flutter (OR, 0.87(95%CI: 0.60-1.26), P=0.46), cardiac arrest (OR, 0.79(95%CI: 0.51-1.23), P=0.30), ventricular tachycardia (OR, 1.37(95%CI: 0.90-2.07), P=0.14), and ventricular fibrillation (OR, 0.91 (95%CI: 0.45-1.84), P=0.80) when compared with control group. However, GLP-RAs reduced the incidence of atrioventricular block complete (OR, 0.58 (95%CI: 0.35-0.97), P=0.04), and heart failure (OR, 0.795 (95%CI: 0.634-0.997), P=0.047). Conclusion: This study shows that GLP-1 RAs reduced the incidence of atrioventricular block complete and incidence of heart failure. However, no significant association has been observed for arrhythmias.

Abstract 4113411: Long Term Outcomes of Hypertension and Antihypertensive Drugs in Young Healthy Adults: A Nationwide Population-based Prospective Cohort Study in Korea

Background: Long term follow-up data on elevated blood pressure (BP) or antihypertensive drugs in young adults are scarce. The effect of hypertension (HTN) and antihypertensive medications on the cardiovascular disease incidence in young healthy adults (20~45 years) was analyzed using a large-scale population medical use database in Korea. Methods: In total, 4,590,597 young Korean adults without comorbidities who underwent regular health examination were included in this study. They were stratified into four groups according to their BP (optimal BP, normal BP, high normal BP, and HTN). The primary outcome was a composite of the incidence of myocardial infarction and ischemic and hemorrhagic stroke, obtained by tracking the medical use data of the first-ever ICD-10 codes. Subgroup analysis was conducted by categorizing the HTN group into two subgroups according to the prescription ratios of the antihypertensive drugs during the follow-up period. Results: The average age was 33.8 years and median follow-up duration was 15.9 years. HTN elevated the incidence risk of major cardiovascular disease by 2.16 times compared to that of the optimal BP group. Dyslipidemia and HTN were the most dominant risk factors for myocardial infarction and stroke, respectively. In the subgroup analysis, antihypertensive medications decreased the incidence of cardiovascular disease by 70% in all diseases. Conclusions: Cardiovascular risk factors, including HTN, contribute to major cardiovascular disease incidence in young adults. The antihypertensive medications decreased the major cardiovascular disease incidence estimates.

Chronic bronchitis and bronchial asthma: the impact of chronic occupational radiation exposure on incidence and mortality of Mayak nuclear workers.

The information about the radiation risk of non-cancer respiratory diseases is inconsistent and mainly corresponds to mortality. Previously, an increased risk of chronic bronchitis incidence was demonstrated in the cohort of workers employed at the first Russian nuclear facility Mayak Production Association who had been chronically exposed to gamma rays (externally) and to alpha-active plutonium aerosols (internally). Within this retrospective study, we performed analyses of incidence of and mortality from chronic bronchitis and bronchial asthma using improved estimates of radiation doses provided by the "Mayak Worker Dosimetry System (MWDS) - 2013". The cohort included 22,377 individuals hired in 1948-1982, and its follow-up was extended by 10 years (to the end of 2018). The excess relative risk of chronic bronchitis incidence per unit radiation dose (ERR/Gy) and the 95% confidence interval (95% CI) were: with the 0-year lag ERR/Gy=0.07 (95% CI -0.01, 0.17) for gamma exposure and ERR/Gy=0.36 (95% CI 0.13, 0.68) for alpha exposure; with the 10-year lag ERR/Gy=0.15 (95% CI 0.04, 0.30) for gamma exposure and ERR/Gy=0.54 (95% CI 0.19, 1.03) for alpha exposure. The chronic bronchitis mortality risk was significantly associated with internal alpha exposure only for certain worker categories: ERR/Gy=4.08 (95% CI 0.59, 14.3) in males; ERR/Gy=7.10 (95% CI 0.31, 70.44) in former smokers; ERR/Gy=7.94 (95% CI 1.71, 30.2) in workers with the smoking index above 20 pack×years. No association was observed in the chronic bronchitis mortality risk with external gamma exposure. No strong evidence was observed for the impact of gamma and alpha exposure on risk of mortality from chronic bronchitis. The study confirmed the significant positive linear association of the chronic bronchitis incidence risk with gamma and alpha radiation doses from occupational chronic external and internal exposure. However, the estimates of ERR/Gy of alpha particles from internal exposure appeared to be almost 2.4-3 times lower than those based on the MWDS-2008. The observed inconsistency requires further clarification. As for bronchial asthma in Mayak workers, no association was demonstrated in the incidence and mortality risks with occupational gamma and alpha radiation exposure.

Associations of Circulating Platelet Endothelial Cell Adhesion Molecule-1 Levels With Progression of Cerebral Small-Vessel Disease, Cognitive Decline, and Incident Dementia.

The association between platelet endothelial cell adhesion molecule-1 (PECAM-1) with cerebral small-vessel disease and cognition in dementia-free subjects remains uninvestigated. A prospective cohort of dementia-free subjects was recruited from memory clinics and followed up for 5 years. Annual neurocognitive assessments and twice-yearly brain magnetic resonance imaging scans were performed. Associations of baseline plasma PECAM-1 levels with cerebral small-vessel disease, cognitive decline (Montreal Cognitive Assessment scores and executive function Z scores), and incident dementia were evaluated. Of 213 subjects (aged 70.2±7.7 years, 51.2% men), median PECAM-1 levels were 0.790 (interquartile range, 0.645-0.955 ng/mL). Compared with the highest tertile, subjects within the lowest PECAM-1 tertile had greater cross-sectional white matter hyperintensity volume (β=4.84 [95% CI, 0.67-9.01]; P=0.023), age-related white matter change scores (β=1.39 [95% CI, 0.12-2.67]; P=0.033), and cerebral microbleeds (Adjusted risk ratio, 2.59 [95% CI, 1.19-5.62]; P=0.016). Of the 204 participants with follow-up data (median, 60.0 [interquartile range, 60.0-60.0] months), 24 (11.8%) developed incident dementia. Compared with the highest tertile, subjects within the lower tertiles of PECAM-1 had a higher risk of incident dementia (first tertile: adjusted hazard ratio [AHR], 4.52 [95% CI, 1.35-15.13]; P=0.024; second tertile: AHR, 3.28 [95% CI, 1.02-10.60]; P=0.047). The lowest PECAM-1 tertile was associated with greater progression of white matter hyperintensity volume (β=4.15 [95% CI, 0.06-8.24]; P=0.047), cerebral microbleeds (incident relative risk [IRR], 2.21 [95% CI, 1.05-4.65]; P=0.036), and decline in executive function (β=-0.45 [95% CI, -0.76 to -0.14]; P=0.004), and Montreal Cognitive Assessment (β=-1.32 [95% CI, -2.30 to -0.35]; P=0.008) scores. In dementia-free subjects, lower circulating PECAM-1 levels are associated with greater cerebral small-vessel disease progression and cognitive decline, thus warranting future study as a potential therapeutic target.

Re-evaluating cardiovascular risk in systolic-dominant, diastolic-dominant and parallelly-elevated hypertension: insights from northeast rural cardiovascular health study

BackgroundHypertension is a major risk factor for cardiovascular disease (CVD), with a high prevalence in rural northeastern China. This study assesses the cardiovascular risk associated with different blood pressure patterns: systolic dominant, diastolic dominant, and parallel elevation.MethodsWe analyzed data from the Northeast Rural Cardiovascular Health Study (NCRCHS), which included 8,189 participants aged 35 and above. Baseline surveys from 2012 to 2013 and follow-ups in 2015 and 2018 provided a median follow-up of 4.66 years. Participants were categorized into ten subgroups based on systolic and diastolic blood pressure elevations. Kaplan-Meier curves and Cox regression models were used to examine CVD incidence and cardiovascular risk across these groups.ResultsThe incidence of CVD varied significantly among hypertension categories. Patients with grade 1 hypertension had no significant increase in cardiovascular risk at nearly 5 years. Notably, parallel elevations in systolic and diastolic pressures posed the highest cardiovascular risk, while a predominant rise in diastolic pressure alone did not significantly increase risk. This highlights the importance of analyzing blood pressure comprehensively for cardiovascular risk stratification and suggests rethinking treatment strategies for diastolic dominant hypertension.ConclusionsOur findings call for a nuanced approach to cardiovascular risk assessment in hypertension, taking into account distinct patterns of systolic and diastolic blood pressure. The study supports personalized treatment interventions and reinforces current hypertension treatment guidelines. We advocate for prioritizing non-pharmacological management in grade 1 hypertension and further clinical evaluation of treatment thresholds for diastolic dominant hypertension.

F2-Isoprostanes Are Associated With Increased Fracture Risk in Type 2 Diabetes.

Fracture risk is higher in type 2 diabetes (T2D) for a given bone mineral density (BMD) level. Increased oxidative stress in T2D induces diabetic complications and may affect T2D bone fragility. To investigate whether the levels of plasma F2-isoprostanes, a reliable oxidative stress marker, are associated with incident clinical fracture risk in older adults with diabetes. An observational cohort study was conducted in a well-characterized cohort from Health, Aging, and Body Composition study. Older black and white ambulatory adults with baseline plasma F2-isoprostanes measurements (baseline age 70-79 years, T2D: N=132; non-diabetes: N=571) were selected from the study cohort of 3075 individuals. Incident clinical fractures. In the Cox proportional hazard model with multivariate adjustments (including BMD, medications, and other risk factors), a 93% increase in incident clinical fracture risk was significantly associated with each SD increase in log plasma F2-isoprostanes in the T2D group (HR: 1.93, 95% CI 1.26-2.95, p=0.002), but there was no evidence of an association in the non-diabetes group (HR: 0.98, 95% CI 0.81-1.18, p=0.79, p for interaction < 0.001). Log plasma F2-isoprostanes were moderately correlated with a decline in baseline total hip BMD (r=-0.25, p=0.003), and with a 4-year decrease in total hip BMD (r=-0.28, p=0.008) in T2D. There was no evidence of correlation between log plasma F2-isoprostanes and circulating glycoxidation markers or bone turnover markers in either group. Plasma F2-isoprostanes levels in individuals with diabetes are associated with increased incident clinical fracture risk independently of baseline BMD.

Incidence Rate and Risk Factors of Malnutrition in Criticall Ill Patients

Incidence Rate and Risk Factors of Malnutrition in Criticall Ill Patients

QTc interval prolongation and risk of atrial fibrillation recurrence: a meta-analysis and observational cohort study

IntroductionCorrected QT interval (QTc) is a ventricular repolarization marker on electrocardiography. Previous studies evaluated its value in predicting atrial fibrillation (AF) occurrence. However, its predictive efficacy for AF recurrence remains controversial.MethodsWe searched PubMed and Google databases for studies before January 2024 evaluating the association between QTc interval and AF incidence. A meta-analysis of the eligible datasets was conducted using Bazett's formula, with subgroup analysis to explore the heterogeneity. Additionally, thirty-eight patients with AF who underwent radiofrequency catheter ablation were enrolled and followed-up for 3–36 months. Univariate and multivariate Cox models were used to calculate the hazard ratios (HRs) and determine the relationship between clinical factors and AF recurrence. Kaplan-Meier survival analysis and ROC curve were conducted to assess the impact and predictive efficacy of individual factors.ResultsEleven datasets from nine eligible studies were enrolled and meta-analysed. We found that patients with prolonged QTc interval was associated with a significantly higher AF incidence risk, and the risk increased with every 10-ms prolongation. However, this association was not significant in the AF recurrence subgroup. In our prospective cohort, the preoperative body mass index, QTc, left atrial diameter (LAD), and uric acid levels influenced AF recurrence. Multivariate Cox regression analysis identified LAD as an independent factor affecting AF recurrence in patients with a high predictive efficiency. Kaplan-Meier survival analysis showed that increased LAD (&amp;gt;4.5 cm) was associated with postoperative AF recurrence.DiscussionTherefore, LAD has better predictive power and can be an indicator for predicting postoperative AF recurrence.

Indoor environmental conditions and likelihood of reported violence and aggression in a purpose-built residential dementia hospital

This study, conducted on purpose-built NHS dementia wards, investigates correlations between patient aggression and indoor temperature and humidity. Temperature and humidity, measured at 3-min intervals, on male and female wards, over 12–15 months, were compared against staff-recorded incidents (n = 299; females n = 100; males n = 199). Linear regression was used to assess potential correlations. Binomial analysis measured relative risk of incidents outside comfortable thermal (22–24 °C) and humidity (30%–60%) ranges. Temperatures ranged from 17 to 27oC and humidity ranged from 16 to 70%. On the male ward, both extremes of temperature were correlated with increased incident likelihood (R2 = 0.473) and relative risk of incidents was 1.89 (p = 0.0015) at temperatures <22oC and 1.73 (p < 0.001) at temperatures >24oC. On the female ward, increasing temperature was correlated with increased incident likelihood (R2 = 0.568) and relative risk of incidents was 1.99 (p < 0.001) at temperatures >24oC. Strong associations between relative humidity levels and incidents were not identified. Extreme temperatures were associated with significantly increased risk of incidents of agitation, suggesting relevance of environmental conditions in the formulation of agitation in dementia.

Relationship between global warming and autism spectrum disorder from 1990 to 2019.

Despite mounting evidence linking neurological diseases with climate change, the link between autism spectrum disorder (ASD) and global warming has yet to be explored. To examine the relationship between the incidence of ASD and global warming from 1990 to 2019 and estimate the trajectory of ASD incidence from 2020 to 2100 globally. We extracted meteorological data from TerraClimate between 1990 and 2019. To estimate the association between global ASD incidence and temperature variation, we adopted a two-stage analysis strategy using a generalised additive regression model. Additionally, we projected future ASD incidence under four representative shared socioeconomic pathways (SSPs: 126, 245, 370 and 585) by bootstrapping. Between 1990 and 2019, the global mean incidence of ASD in children under 5 years old was 96.9 per 100 000. The incidence was higher in males (147.5) than in females (46.3). A 1.0 °C increase in the temperature variation was associated with a 3.0% increased risk of ASD incidence. The association was stronger in boys and children living in a low/low-middle sociodemographic index region, as well as in low-latitude areas. According to the SSP585 scenario, by 2100, the children living in regions between 10 and 20° latitude, particularly in Africa, will experience a 68.6% increase in ASD incidence if the association remains. However, the SSP126 scenario is expected to mitigate this increase, with a less than 10% increase in incidence across all latitudes. Our study highlights the association between climate change and ASD incidence worldwide. Prospective studies are warranted to confirm the association.

Oral Cancer Incidence Among Adult Males With Current or Former Use of Cigarettes or Smokeless Tobacco: Population-Based Study.

Tobacco use has been identified as a risk factor for oral cancer worldwide. However, relative oral cancer incidence among adults who smoke cigarettes, use smokeless tobacco products (ST), have transitioned from cigarettes to ST, quit cigarettes and/or ST ("quitters"), or never used tobacco has not been well studied. We aim to present population-based oral cancer incidence rates for adults who smoke cigarettes, use ST, are former smokers who now use ST, or quit. We estimated cross-sectional incidence rates and incidence rate ratios (IRRs) using data from statewide cancer registries (Colorado, Florida, North Carolina, and Texas) and population counts derived from national surveys using combined data from 2014-2017. A random-effect meta-analysis approach was used to summarize estimates among these groups, based on multiple imputation-based IRR estimates by state and age group while considering potential heterogeneity. A total of 19,536 oral cancer cases were identified among adult males 35 years and older in the study geographies and period. The oral cancer incidence rate among adults who smoke was significantly higher than the ST group (2.6 times higher, 95% CI 2.0-3.3, P<.001), 3.6 (95% CI 3.2-4.1, P<.001) times higher than the never users, and 2.4 (95% CI 1.8-3.1, P<.001) times higher compared to former smokers who now use ST. The IRR among the ST group relative to never users was 1.4 (95% CI 1.1-1.9, P=.02). The IRR between former smokers who now use ST and those who quit was 1.4 (95% CI 1.0-2.1, P=.08). Findings from this population-based study with a large number of oral cancer cases support significantly high oral cancer incidence among adults who smoke and a lower risk of oral cancer incidence among never users, quitters, users of ST, and former smokers who now use ST compared to cigarettes. Future studies with detailed control of tobacco history and other relevant confounders are needed to confirm these findings.