Nondiabetic older adults with untreated hypertension in Taiwan: Treatment implication in elderly hypertension

Background

Hypertension is common and often left undiagnosed in the elderly. The main purpose of this study was to evaluate the clinical characteristics of nondiabetic hypertensive older adults.

Methods

Community-living older adults in Taipei City participating in annual health examinations were invited for study. Subjects with diabetes mellitus, whether treated or newly diagnosed, were excluded for further analysis. All participants were classified into three groups: normotension, untreated hypertension (UH), and treated hypertension (TH).

Results

In total, 3244 subjects (mean age: 73.4 ± 5.4 years, 56.2% males) were enrolled. The prevalence of hypertension, chronic kidney disease (CKD), and left ventricular hypertrophy (LVH) was 52.9% (36.1% TH and 16.8% UH), 20.9%, and 6.2%, respectively. Compared with the normotension group, UH subjects were older (73.8 ± 5.5 years vs. 72.9 ± 5.6 years, p = 0.003); having higher body mass index (24.2 ± 3.4 kg/m²vs. 23.6 ± 3.4 kg/m², p = 0.001), fasting glucose (101.7 ± 9.1 mg/dL vs. 100.5 ± 9.0 mg/dL, p = 0.007), total cholesterol (TC) (205.0 ± 37.8 mg/dL vs. 196.5 ± 36.4 mg/dL, p < 0.001), triglyceride (TG) (134.5 ± 84.9 mg/dL vs. 119.4 ± 77.0 mg/dL, p < 0.001); and higher prevalence of overt proteinuria (19.3% vs. 13.5%, p = 0.001), CKD (21.1% vs. 16.6%, p = 0.025), and LVH (8.1% vs. 3.8%, p < 0.001). However, the prevalence of overt proteinuria (19.3% vs. 21.1%, p = 0.378) and LVH (8.1% vs. 8.5%, p = 0.79) between UH and TH groups was similar. Adjusted for age, TC, TG, fasting plasma glucose, and the incidence of LVH, both UH [odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.01–1.66, p = 0.040] and TH (OR = 1.69, 95% CI = 1.39–2.05, p < 0.001) were significant risk factor for CKD. In addition, independent risk factors for CKD included age (OR = 1.07, 95% CI = 1.05–1.09, p < 0.001), body mass index (OR = 1.07, 95% CI = 1.04–1.10, p < 0.001), TC (OR = 1.003, 95% CI = 1.001–1.005, p = 0.021), TG (OR = 1.002, 95% CI = 1.001–1.003, p < 0.001), and hypertension (TH or UH) (OR = 1.44, 95% CI = 1.20–1.72, p < 0.001).

Conclusion

In conclusion, risk of CKD existing along with blood pressure rises among nondiabetic older hypertensive adults, and hypertension (TH or UH) carries a significant risk of CKD after adjustment of other cardiovascular risk factors. Renal protection should be highlighted in the antihypertensive treatment strategy in older hypertensive patients.     

Sustained lifestyle advice and cardiovascular risk factors in 687 biological child-parent pairs: the PEP Family Heart Study

Objective

We examined whether associations between improved cardiovascular risk factors and lifestyle changes persist over 1 year in a real life setting.

Methods

Out of 2690 invited healthy parents and their children, 986 accepted the invitation to participate and completed the 1-year rigorous observational study with general lifestyle advice. Body mass index, waist circumference, waist-to-height ratio, waist-to-hip circumference, skin fold thickness, blood pressure; fasting lipids and glucose, nutrition, physical activity, and tobacco smoke exposition within biological families were assessed. SPSS was used to perform statistical analyses.

Results

After 1 year of sustained advice of healthy lifestyle, the majority of CVD risk factors had improved in parents and their children most beneficially in daughters. In sons and fathers, the prevalence of fasting hyperglycemia decreased from 22.6% to 6.7% respectively from 27.5% to 10.6%. In daughters, the prevalence of hypertension decreased from 21.8% to 10.6% and the lipid profile improved considerably. Daily fat consumption as percentage of kcal as percentage fat significantly (p < 0.05) decreased by 6% and the ratio polyunsaturated to saturated fat and consequently the P/S ratio increased by 11.7% in all participants. The age and gender adjusted changes in parents (using GEE) after 1 year were predictive in children for reduced energy intake (OR 2.3; 95% CI 1.6–3.1), reduced fat consumption (OR 1.9; 95% CI 1.4–2.6) and a higher P/S ratio (OR 2.6; 95% CI 1.9–3.6). Daily leisure time physical inactivity of parents was associated with low HDL-C (OR 2.0; 95% CI 1.0–4.0) in daughters. Tobacco smoke exposition decreased by 19.3% in all participants whereas alcohol intake in parents decreased by 15% after 1 year.

Conclusion

Intra-familial lifestyle behavior and cardiovascular risk factors improve after 1 year of sustained advice in schoolchildren and their parents.     

Race-specific associations of myeloperoxidase with atherosclerosis in a population-based sample: the Dallas Heart Study

Objective

Myeloperoxidase (MPO) is a leukocyte-derived enzyme that appears to be directly involved in atherosclerosis development. We evaluated the association of circulating MPO with coronary and aortic atherosclerosis in a large, multiethnic population.

Methods and results

Plasma levels of MPO were measured in 3294 subjects participating in the Dallas Heart Study, a probability-based population sample. Coronary artery calcification (CAC) was measured by EBCT, and abdominal aorta plaque prevalence (AP) and burden (APB), as well as abdominal aorta wall thickness (AWT) were determined by MRI. Associations between MPO and atherosclerosis phenotypes were assessed in multivariable analyses adjusting for traditional atherosclerosis risk factors. MPO levels in the 4th compared with 1st quartile independently associated with prevalent AP (OR 1.41, 95% CI 1.08–1.84), APB (beta coefficient 0.23, p = 0.02), and AWT (beta coefficient 0.04, p = 0.03), but not with prevalent CAC (OR 0.84, 95% CI 0.61–1.17). MPO remained associated with aortic atherosclerosis phenotypes but not coronary calcification after adjustment for other inflammatory biomarkers. A significant interaction was observed between race/ethnicity, MPO and AP (p_interaction = 0.038), such that MPO levels in the 4th vs 1st quartile associated with prevalent AP in African Americans, (OR 1.81, 95% CI 1.23–2.65) but not in White or Hispanic participants (OR 0.99, 95% CI 0.68–1.44).

Conclusion

Higher levels of MPO associated with aortic but not coronary atherosclerosis, with significant associations limited to African American participants. These findings suggest that MPO might be a novel risk factor contributing to racial disparities in peripheral vascular disease.     

Alcohol intake and risk of stroke: A dose–response meta-analysis of prospective studies

Background

Alcohol intake is inconsistently associated with the risk of stroke morbidity and mortality. The purpose of this study was to summarize the evidence regarding this relationship by using a dose–response meta-analytic approach.

Methods

We performed electronic searches of PubMed, EMBASE, and the Cochrane Library to identify relevant prospective studies. Only prospective studies that reported effect estimates with 95% confidence intervals (CIs) of stroke morbidity and mortality for more than 2 categories of alcohol intake were included.

Results

We included 27 prospective studies reporting data on 1,425,513 individuals. Low alcohol intake was associated with a reduced risk of total stroke (risk ratio [RR], 0.85; 95% CI: 0.75–0.95; P = 0.005), ischemic stroke (RR, 0.81; 95% CI: 0.74–0.90; P < 0.001), and stroke mortality (RR, 0.67; 95% CI: 0.53–0.85; P = 0.001), but it had no significant effect on hemorrhagic stroke. Moderate alcohol intake had little or no effect on the risks of total stroke, hemorrhagic stroke, ischemic stroke, and stroke mortality. Heavy alcohol intake was associated with an increased risk of total stroke (RR, 1.20; 95% CI: 1.01–1.43; P = 0.034), but it had no significant effect on hemorrhagic stroke, ischemic stroke, and stroke mortality.

Conclusions

Low alcohol intake is associated with a reduced risk of stroke morbidity and mortality, whereas heavy alcohol intake is associated with an increased risk of total stroke. The association between alcohol intake and stroke morbidity and mortality is J-shaped.     

Bariatric surgery and its impact on cardiovascular disease and mortality: A systematic review and meta-analysis

Background

Bariatric surgery has been shown to improve cardiovascular risk factors but long term benefits for survival and cardiovascular events are still uncertain.

Methods

We searched MEDLINE and EMBASE for parallel group studies that evaluated the clinical outcomes associated with bariatric surgery as compared to non-surgical treatment. Relevant studies were pooled using random effects meta-analysis for risk of myocardial infarction, stroke, cardiovascular events and mortality.

Results

14 studies met the inclusion criteria, which included 29,208 patients who underwent bariatric surgery and 166,200 nonsurgical controls (mean age 48 years, 30% male, follow up period ranged from 2 years to 14.7 years). Four studies were considered at moderate–high risk of bias, whilst ten studies were at moderate or lower risk of bias. Compared to nonsurgical controls there was more than 50% reduction in mortality amongst patients who had bariatric surgery (OR 0.48 95% CI 0.35–0.64, I² = 86%, 14 studies). In pooled analysis of four studies with adjusted data, bariatric surgery was associated with a significantly reduced risk of composite cardiovascular adverse events (OR 0.54 95% CI 0.41–0.70, I² = 58%). Bariatric surgery was also associated with significant reduction in specific endpoints of myocardial infarction (OR 0.46 95% CI 0.30–0.69, I² = 79%, 4 studies) and stroke (OR 0.49 95% CI 0.32–0.75, I² = 59%, 4 studies).

Conclusions

Data from observational studies indicates that patients undergoing bariatric surgery have a reduced risk of myocardial infarction, stroke, cardiovascular events and mortality compared to non-surgical controls. Future randomized studies should investigate whether these observations are reproduced in a clinical trials setting.     

Differentiation of severe coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis

Background

Coronary artery calcium (CAC) scores predict coronary heart disease (CHD) risk. Little is known, however, about the distinctive risk among asymptomatic individuals with very high CAC (≥1000) compared to high CAC (400–999).

Methods and results

We compared CHD risk factors and event rates between participants with very high CAC (n = 257) and high CAC (n = 420) among adults free of clinical CHD in the Multi-Ethnic Study of Atherosclerosis (MESA). CAC was measured at baseline, and participants were followed for a median of 68 months. Very high CAC (≥1000), compared to high CAC (400–999), was associated with male gender (OR 3.10, p < 0.001) and older age (OR 1.42 per 10 year increase, p < 0.001). Chronic kidney disease (CKD) was associated with very high CAC (OR 1.66, p = 0.009) with a greater prevalence of moderate CKD (GFR 30–59) in the ≥1000 group (25% vs. 18%). Those with very high CAC were more likely to develop angina (adjusted HR 1.72 [95% CI 1.03–2.90], p = 0.04), but not more likely to experience myocardial infarction, resuscitated cardiac arrest, or CHD death (adjusted HR 1.17, [95% CI 0.64–2.12] p = 0.61) compared to high CAC. Total CHD event rates were greater for very high CAC (3.7 per 100 person-years) compared to high CAC (2.6 per 100 person-years).

Conclusions

Both high and very high CAC are associated with an elevated risk of CHD events in those without symptomatic CHD at baseline; however, very high CAC is associated with an increased risk of angina, but not CHD death or MI, compared to high CAC.     

Modest alcohol consumption and carotid plaques or carotid artery stenosis in men with non-alcoholic fatty liver disease

Background

Favorable association between modest alcohol consumption and cardiovascular disease had been reported in general population, however, whether observed benefit extend to men with established fatty liver disease remains unknown.

Methods

Cross-sectional study of 10,581 consecutive male participants aged 30 years or older undergoing abdominal ultrasonography and carotid artery ultrasonography were screened. Non-alcoholic fatty liver disease (NAFLD) was diagnosed with ultrasonography and exclusion of secondary causes for fat accumulation or other causes of chronic liver disease. Modest alcohol use was defined as consumption of less than 20 g of alcohol per day.

Results

There were total 2280 men diagnosed with fatty liver, and the mean age was 51.8 years old. Among them, 1797 were modest alcohol drinkers. The prevalence of carotid plaques (55.3% vs. 43.4%, p < 0.001) and carotid artery stenosis (11.0% vs. 5.5%, p < 0.001) was higher in non-drinkers than modest drinkers. Modest alcohol consumption had the independent inverse association with carotid plaques [odd ratio (OR): 0.74, 95% confidence interval (CI): 0.60–0.92] and carotid artery stenosis (OR: 0.62, 95% CI: 0.43–0.90), adjusted for age, smoking and metabolic syndrome.

Conclusions

Modest alcohol consumption had a favorable association with carotid plaque or CAS in men with NAFLD.     

Higher consumption of sugar-sweetened soft drinks increases the risk of hyperuricemia in Korean population: The Korean Multi-Rural Communities Cohort Study

Objective

The clinical implication of sugar-sweetened soft drinks on the risk of hyperuricemia has increased, especially in Western population studies. The aim of this study is to clarify the association between sugar-sweetened soft drinks and fruit drinks made from oranges and apples and the risk of hyperuricemia in the Korean Multi-Rural Communities Cohort.

Methods

A total of 9400 subjects were enrolled in the Korean Multi-Rural Communities Cohort Study, and a cross-sectional analysis was performed. Five quintiles (Q1–Q5) according to consumption of soft drinks and other fruit/fruit juices were classified and then categorized into three groups (Q1–Q3, Q4, and Q5) to assess the risk of hyperuricemia. Information on dietary intake was collected by well-trained interviewers using validated food frequency questionnaires.

Results

Higher consumption of sugar-sweetened soft drinks (Q5) increased the risk of hyperuricemia in males (adjusted OR = 1.35, 95% CI: 1.07–1.71) with a linear trend (p for trend = 0.01) and in females (adjusted OR = 1.40, 95% CI: 1.03–1.90) with no linear trend (p for trend = 0.09), compared to lower consumption (Q1–Q3). However, there were no significant differences of serum uric acid level according to the three categories of soft drink consumption, Q1–Q3, Q3, and Q5, in males (p = 0.21) or in females (p = 0.16), whereas all subjects showed statistical significance of serum uric acid level within the categories (p < 0.001). Estimated amount of soft drink intake was associated with serum uric acid level in males (β = 0.001; p = 0.01) but not in females (β = 0.0005; p = 0.10).

Conclusion

Higher consumption of sugar-sweetened soft drinks increased the risk of hyperuricemia in the Korean population, showing a differential linear trend for hyperuricemia according to gender.     

Smoking, alcohol consumption, and Raynaud's phenomenon in middle age

Background

Data suggest Raynaud’s phenomenon shares risk factors with cardiovascular disease. Studies of smoking, alcohol consumption, and Raynaud’s have produced conflicting results and were limited by small sample size and failure to adjust for confounders. Our objective was to determine whether smoking and alcohol are independently associated with Raynaud’s in a large, community-based cohort.

Methods

By using a validated survey to classify Raynaud’s in the Framingham Heart Study Offspring Cohort, we performed sex-specific analyses of Raynaud’s status by smoking and alcohol consumption in 1840 women and 1602 men. Multivariable logistic regression analyses were used to examine the relationship of Raynaud’s to smoking and alcohol consumption.

Results

Current smoking was not associated with Raynaud’s in women but was associated with increased risk in men (adjusted odds ratio [OR] 2.59, 95% confidence interval [CI], 1.11-6.04). Heavy alcohol consumption in women was associated with increased risk of Raynaud’s (adjusted OR 1.69, 95% CI, 1.02-2.82), whereas moderate alcohol consumption in men was associated with reduced risk (adjusted OR 0.51, 95% CI, 0.29-0.89). In both genders, red wine consumption was associated with a reduced risk of Raynaud’s (adjusted OR 0.59, 95% CI, 0.36-0.96 in women and adjusted OR 0.30, 95% CI, 0.15-0.62 in men).

Conclusions

Our data suggest that middle-aged women and men may have distinct physiologic mechanisms underlying their Raynaud’s, and thus sex-specific therapeutic approaches may be appropriate. Our data also support the possibility that moderate red wine consumption may protect against Raynaud’s.     

Incidence and predictors of 30-day and 6-month stroke after TAVR: Insights from the multicenter OBSERVANT II study

Background

The incidence and predictors of 30-day stroke after transcatheter aortic valve replacement (TAVR) were derived from early studies investigating first-generation devices. The incidence of 6-month stroke and its related predictors are unknown.

Aims

To investigate the incidence and to identify procedural and patient-related predictors of 30-day and 6-month stroke after TAVR.

Methods

Data from 2753 consecutive patients with severe aortic stenosis undergoing TAVR were obtained from the OBSERVANT-II study, an observational, prospective, multicenter cohort study. The study endpoints were symptomatic 30-day and 6-month stroke after TAVR.

Results

The occurrence of a 30-day and 6-month stroke was low (1.3% and 2.4%, respectively) but with significant impact on survival. Aortic valve predilatation (odds ratio [OR]: 2.28, 95% confidence interval [CI]: 1.12–4.65, p = 0.023), diabetes (OR: 3.10, 95% CI: 1.56–6.18, p = 0.001), and left ventricle ejection fraction < 50% (OR: 2.15, 95% CI: 1.04–4.47, p = 0.04) were independent predictors of 30-day stroke, whereas diabetes (sub-distribution hazard ratio [SHR]: 2.07, 95% CI: 1.25–3.42, p = 0.004), pre-existing neurological dysfunction (SHR: 3.92, 95% CI: 1.54–10, p = 0.004), bicuspid valve (SHR: 4.75, 95% CI: 1.44–15.7, p = 0.011), and critical status (SHR: 3.05, 95% CI: 1.21–7.72, p = 0.018) were predictive of 6-month stroke. Conversely, antiplatelet therapy and anticoagulation were protective factors at both 30 days and 6 months.

Conclusions

Stroke after TAVR was rare. Predilatation was the only procedural factor predictive of 30-day stroke, whereas the remaining were patient-related risk factors, suggesting appropriate risk stratification preoperatively.     

Plasma aldosterone levels and aldosterone-to-renin ratios are associated with endothelial dysfunction in young to middle-aged subjects

Objective

Small clinical studies suggested a role for aldosterone in the development of endothelial dysfunction. We investigated whether the plasma aldosterone concentration (PAC) or the aldosterone-to-renin ratio (ARR) were associated with decreased endothelial function as measured by flow-mediated dilation (FMD) of the brachial artery in the general population.

Methods

Our study population comprised 972 participants from the Study of Health in Pomerania, who were not treated with antihypertensive medication. We performed age-stratified (<50 and ≥50 years) ordinal logistic regression analyses. FMD was categorised as decreased (1st quintile), moderate (2nd–4th quintile), or increased (5th quintile). PAC and ARR were divided into low, moderate, and high values according to age- and sex-specific tertiles. All models were re-calculated for 871 subjects with PAC and ARR within the study-specific reference ranges. Odds ratios (OR) and 95% confidence intervals (CI) are presented.

Results

Subjects <50 years with high PAC (OR 1.60; 95% CI 1.07–2.38) or ARR (OR 1.81; 95% CI 1.21–2.73) had higher odds for decreased FMD than subjects with low PAC or ARR, respectively. Similar results were obtained in analyses restricted to subjects with PAC and ARR within the reference range. High-normal PAC (OR 1.62; 95% CI 1.07–2.47) or ARR (OR 1.62; 95% CI 1.05–2.50) was associated with higher odds for decreased FMD when compared with low-normal PAC or ARR, respectively. These associations were not observed in subjects ≥50 years.

Conclusions

High and high-normal PAC or ARR contribute to an impaired FMD and subsequently the progression of subclinical atherosclerosis in young to middle-aged subjects.     

Alcohol Consumption and Risk of Atrial Fibrillation : A Prospective Study and Dose-Response Meta-Analysis

Background

Although high alcohol consumption has been associated with increased risk of atrial fibrillation (AF), the role of light to moderate drinking remains unclear.

Objectives

The study sought to investigate the association between alcohol consumption and AF risk in a prospective study of Swedish men and women and to conduct a meta-analysis of prospective studies to summarize available evidence.

Methods

We followed 79,019 men and women who, at baseline, were free from AF and had completed a questionnaire about alcohol consumption and other risk factors for chronic diseases. Incident AF cases were ascertained by linkage to the Swedish Inpatient Register. For the meta-analysis, studies were identified by searching PubMed through January 10, 2014, and by reviewing references of pertinent publications. Study-specific relative risks (RRs) were combined using a random effects model.

Results

Over 859,420 person-years of follow-up (1998 to 2009), 7,245 incident AF cases were identified in our own cohort study. The association between alcohol consumption and AF did not differ by sex (p for interaction = 0.74). Compared with current drinkers of <1 drink/week (12 g alcohol/drink), the multivariable RRs of AF were 1.01 (95% confidence interval [CI]: 0.94 to 1.09) for 1 to 6 drinks/week, 1.07 (95% CI: 0.98 to 1.17) for 7 to 14 drinks/week, 1.14 (95% CI: 1.01 to 1.28) for 15 to 21 drinks/week, and 1.39 (95% CI: 1.22 to 1.58) for >21 drinks/week. Results were similar after excluding binge drinkers. In a meta-analysis of 7 prospective studies, including 12,554 AF cases, the RRs were 1.08 (95% CI: 1.06 to 1.10) for 1 drink/day, 1.17 (95% CI: 1.13 to 1.21) for 2 drinks/day, 1.26 (95% CI: 1.19 to 1.33) for 3 drinks/day, 1.36 (95% CI: 1.27 to 1.46) for 4 drinks/day, and 1.47 (95% CI: 1.34 to 1.61) for 5 drinks/day, compared with nondrinkers.

Conclusions

These findings indicate that alcohol consumption, even at moderate intakes, is a risk factor for atrial fibrillation.     

Self-reported habitual snoring and risk of cardiovascular disease and all-cause mortality

Objective

Inconsistent findings have reported the association between self-reported habitual snoring and risk of cardiovascular disease (CVD) and all-cause mortality. We conducted a meta-analysis to investigate whether self-reported habitual snoring was an independent predictor for CVD and all-cause mortality using prospective observational studies.

Methods

Electronic literature databases (PubMed, Medline, Embase, Cochrane Library, Wanfang database, and China National Knowledge Infrastructure) were searched for publications prior to September 2013. Only prospective studies evaluating baseline habitual snoring and subsequent risk of CVD and all-cause mortality were selected. Pooled adjust hazard risk (HR) and corresponding 95% confidence intervals (CI) were calculated for categorical risk estimates.

Results

Eight studies with 65,037 subjects were analyzed. Pooled adjust HR was 1.26 (95% CI 0.98–1.62) for CVD, 1.15 (95% CI 1.05–1.27) for coronary heart disease (CHD), and 1.26 (95% CI 1.11–1.43) for stroke comparing habitual snoring to non-snorers. Pooled adjust HR was 0.98 (95% CI 0.78–1.23) for all-cause mortality in a random effect model comparing habitual snoring to non-snorers. Habitual snoring appeared to increase greater stroke risk among men (HR 1.54; 95% CI: 1.09–2.17) than those in women (HR 1.22; 95% CI: 1.05–1.41).

Conclusions

Self-reported habitual snoring is a mild but statistically significant risk factor for stroke and CHD, but not for CVD and all-cause mortality. However, whether the risk is attributable to obstructive sleep apnea syndrome or snoring alone remains controversial.     

The association of asthma and atrial fibrillation — A nationwide population-based nested case–control study

Background

Asthma and atrial fibrillation (AF) have been reported to be related to an increased risk of cardiovascular events. However, the relationship between asthma and AF has not been fully elucidated. The purpose of this study was to examine the association between asthma and AF risk.

Methods

We conducted a population-based nested case–control study including a total of 7439 newly-diagnosed adult patients with AF and 10,075 age-, gender-, comorbidity-, and cohort entry date-matched subjects without AF from the Taiwan National Health Insurance database. Exposure to asthma as well as medications including bronchodilators and corticosteroid before the index date was evaluated to investigate the association between AF and asthma as well as concurrent medications.

Results

AF patients were 1.2 times (adjusted OR 1.2, 95% CI 1.109–1.298) more likely to be associated with a future occurrence of asthma independent of comorbidities and treatment with corticosteroids and bronchodilator. In addition, the risks of new-onset AF were significantly higher among current users of inhaled corticosteroid, oral corticosteroids, and bronchodilators. Newly users (within 6 months) have the highest risk (inhaled corticosteroid: OR, 2.13; 95% CI, 1.226–3.701, P = 0.007; oral corticosteroid: OR, 1.932; 95% CI, 1.66–2.25, P < 0.001; non-steroid bronchodilator: OR, 2.849; 95% CI, 2.48–3.273, P < 0.001). A graded association with AF risk was also observed among subjects treated with corticosteroid (inhaled and systemic administration) and bronchodilators. New users (within 6 months) of these medications had the highest risk of AF (ICS: OR, 2.13; 95% CI, 1.226–3.701, P = 0.007; oral corticosteroid: OR, 1.932; 95% CI, 1.66–2.25, P < 0.001; non-steroid bronchodilator: OR, 2.849; 95% CI, 2.48–3.273, P < 0.001). A graded association with AF risk was also observed among subjects treated with ICS or bronchodilator.

Conclusions

Asthma was associated with an increased risk of developing future AF.     

Environmental factors in inflammatory bowel disease: A case-control study based on a Danish inception cohort

Background

The role of environmental factors in development of inflammatory bowel disease (IBD) remains uncertain. The aim of the present study was to assess a number of formerly suggested environmental factors in a case-control study of an unselected and recently diagnosed group of patients with IBD and a control group of orthopaedic patients.

Methods

A total of 123 patients diagnosed with Crohn's disease (CD) and 144 with ulcerative colitis (UC) in Copenhagen (2003–2004) were matched 1:1 on age and gender to 267 orthopaedic controls. Participants received a questionnaire with 87 questions concerning environmental factors prior to IBD/orthopaedic admission. Odds ratios (OR) were calculated by logistic regression.

Results

Being breastfed > 6 months (OR, 0.50; 95% CI, 0.23–1.11) and undergoing tonsillectomy (OR, 0.49; 95% CI, 0.31–0.78) decreased the odds for IBD, whereas appendectomy decreased the odds for UC only (OR, 0.29; 95% CI, 0.12–0.71). Vaccination against pertussis (OR, 2.08; 95% CI, 1.07–4.03) and polio (OR, 2.38; 95% CI, 1.04–5.43) increased the odds for IBD, whereas measles infection increased the odds for UC (OR, 3.50; 95% CI, 1.15–10.6). Low consumption of fibres and high consumption of sugar were significantly associated with development of CD and UC. Smoking increased the risk for CD and protected against UC.

Conclusion

Among Danish patients with CD and UC belonging to an unselected cohort, disease occurrence was found to be associated both with well-known factors such as smoking and appendectomy, and with more debated factors including breastfeeding, tonsillectomy, childhood vaccinations, childhood infections, and dietary intake of fibres and sugar.     

Hyperuricemia and risk of stroke: A systematic review and meta-analysis of prospective studies

Introduction

Hyperuricemia may be associated with an increased risk of stroke, but to date results from prospective studies have been inconsistent. This study aimed to evaluate the association between hyperuricemia and risk of stroke incidence and mortality by performing a meta-analysis.

Materials and methods

Studies were identified by searching multiple electronic databases through July 13, 2013, and by reviewing reference lists of obtained articles. Prospective studies reported a multivariate-adjusted estimate, represented as relative risk (RRs) with 95% confidence intervals (CIs) for the association between hyperuricemia and risk of stroke incidence and mortality were eligible. A random-effects model was used to compute the pooled risk estimate.

Results

A total of fourteen articles including results from 15 prospective studies with 22,571 cases of stroke and 1,042,358 participants were included in the meta-analysis. Overall, presence of hyperuricemia was associated with a significantly greater risk of both stroke incidence (RR, 1.22; 95% CI, 1.02–1.46) and mortality (RR, 1.33; 95% CI, 1.24–1.43). In addition, the pooled estimate of multivariate RRs of stroke incidence and mortality were 1.08 (95% CI: 0.85–1.38); 1.26 (95% CI: 1.14–1.40) among men and 1.25 (95% CI: 1.04–1.46); 1.41 (95% CI: 1.31–1.52) among women respectively.

Conclusions

Results from this meta-analysis indicate that hyperuricemia may modestly increase the risks of both stroke incidence and mortality. Future studies should explore whether hyperuricemia is a modifiable risk factor for stroke.     

Arterial stiffness is associated with minimally elevated high-sensitivity cardiac, troponin T levels in a community-dwelling population

Objectives

Arterial stiffness predicts an increased risk of future cardiovascular events, possibly via myocardial damage. Minimally elevated levels of plasma cardiac troponin T (TnT), a marker of cardiomyocyte injury, can be detected by the high-sensitivity TnT (hsTnT) assay. The current study investigated the relationship between plasma hsTnT levels and alterations in arterial stiffness in a community-based population.

Methods

We related levels of plasma hsTnT to measures of arterial stiffness (carotid–femoral pulse wave velocity [PWV], office pulse pressure [PP] and carotid–radial PWV) in 1479 participants (mean age, 62.3 years; 619 men, 860 women) from a community-based population in Beijing, China.

Results

In multiple logistic regression models, carotid–femoral PWV (OR: 1.84; 95% CI: 1.06–3.17; P = 0.028) and office PP (OR: 2.02; 95% CI: 1.31–3.11; P = 0.002) were associated with a higher likelihood of detectable hsTnT. In addition, carotid–femoral PWV (OR: 2.34; 95% CI: 1.03–5.30; P = 0.042) and office PP (OR: 2.30; 95% CI: 1.13–4.66; P = 0.022) were significantly related to elevated hsTnT levels. A subsequent subgroup analysis found that, in subjects aged 60 years and older, the associations between carotid–femoral PWV and office PP and hsTnT levels were strengthened. The associations between hsTnT with any of the arterial stiffness measures were not present in the younger subgroup (<60 years old).

Conclusions

Carotid–femoral PWV and office PP are associated with minimally elevated hsTnT levels in the elderly, indicating a relationship between central artery stiffness and subclinical myocardial damage.     

Alcohol consumption and heart failure in hypertensive US male physicians

Although alcohol drinking increases blood pressure and heavy drinking has been associated with alcoholic cardiomyopathy, little is known about the association between light to moderate drinking and risk of heart failure (HF) in hypertensive subjects. Thus, the association between light to moderate drinking and incident HF in 5,153 hypertensive male physicians who were free of stroke, myocardial infarction, or major cancers at baseline was prospectively examined. Alcohol consumption was self-reported and classified as <1, 1 to 4, 5 to 7, and >or=8 drinks/week. HF was ascertained using follow-up questionnaires and validated using Framingham criteria. Average age was 58 years, and about 70% of subjects consumed 1 to 7 drinks/week. A total of 478 incident HF cases occurred in this cohort during follow-up. Compared with subjects consuming <1 drink/week, hazard ratios for HF were 0.89 (95% confidence interval [CI] 0.70 to 1.12), 0.72 (95% CI 0.57 to 0.91), and 0.38 (95% CI 0.20 to 0.72) for alcohol consumption of 1 to 4, 5 to 7, and >or=8 drinks/week after adjustment for age, body mass index, smoking, randomization group, use of multivitamins, vegetable consumption, breakfast cereal, exercise, and history of atrial fibrillation, respectively (p for trend <0.001). Similar results were obtained for subjects with HF with and without antecedent myocardial infarction and those without diabetes mellitus. In conclusion, our data suggested that light to moderate alcohol consumption was associated with a lower risk of HF in hypertensive male physicians.     

Early intravenous beta-blockers in patients with acute coronary syndrome—A meta-analysis of randomized trials

Background

Intravenous (IV) beta-blockade is currently a Class IIa recommendation in early management of patients with acute coronary syndromes (ACS) without obvious contraindications.

Methods

We searched the PubMed, EMBASE and the Cochrane Register for Controlled Clinical Trials for randomized clinical trials from 1965 through December, 2011, comparing intravenous beta-blockers administered within 12 hours of presentation of ACS with standard medical therapy and/or placebo. The primary outcome assessed was the risk of short-term (in-hospital mortality-with maximum follow up duration of 90 days) all-cause mortality in the intervention group versus the comparator group. The secondary outcomes assessed were ventricular tachyarrhythmias, myocardial reinfarction, cardiogenic shock, and stroke. Pooled treatment effects were estimated using relative risk with Mantel–Haenszel risk ratio, using a random-effects model.

Results

Sixteen studies enrolling 73,396 participants met the inclusion ⁄ exclusion criteria. In- hospital mortality was reduced 8% with intravenous beta-blockers, RR = 0.92 (95% CI, 0.86–1.00; p = 0.04) when compared with controls. Moreover, intravenous beta-blockade reduced the risk of ventricular tachyarrhythmias (RR = 0.61; 95 % CI 0.47–0.79; p = 0.0003) and myocardial reinfarction (RR = 0.73, 95 % CI 0.59–0.91; p = 0.004) without increase in the risk of cardiogenic shock, (RR = 1.02; 95% CI 0.77–1.35; p = 0.91) or stroke (RR = 0.58; 95 % CI 0.17–1.98; p = 0.38).

Conclusions

Intravenous beta-blockers early in the course of appropriate patients with ACS appears to be associated with significant reduction in the risk of short-term cardiovascular outcomes, including a reduction in the risk of all-cause mortality.     

Carotid intima-media thickness in plaque-free site, carotid plaques and coronary heart disease risk prediction in older adults. The Three-City Study

Objectives

We sought to address the respective association between carotid intima-media thickness (IMT) in plaque-free sites and plaques with coronary heart disease (CHD) and their usefulness for CHD risk prediction in the Three-City Study.

Methods

At baseline, 5895 CHD-free adults aged 65–85 years underwent a bilateral ultrasound examination of carotid arteries. Mean IMT was measured in the far wall of the right and left common carotid arteries (CCA) at plaque-free site while the presence of focal plaques was assessed in the near and the far walls of the CCAs, the bifurcations and the origin of the internal carotid arteries.

Results

After a median follow-up of 5.4 years, 223 subjects had a first ever CHD event. In multivariate analysis, carotid plaques were independent predictors of CHD (Hazard ratio (HR)_{plaques at 1 site} = 1.5; 95% confidence interval (CI) = 1.0–2.2; HR_{plaques at ≥2 sites} = 2.2; 95% CI = 1.6–3.1; p_{for trend} < 0.001), contrary to mean CCA-IMT (HR_{fifth vs. first quintile} = 0.8; 95% CI = 0.5–1.2; p_{for trend} < 0.48). Adding carotid plaques to conventional risk factors significantly improved CHD risk prediction as measured by the area under the ROC curve (from 0.728 to 0.745; p = 0.04), the Harrell's c (from 0.748 to 0.762; p < 0.001), and the integrated discrimination improvement (IDI = 0.007; p = 0.002)/net reclassification improvement (NRI = 13.7%; p < 0.001) indices.

Conclusion

Carotid plaques, but not CCA-IMT measured at a plaque-free site, were independent predictors of CHD and improved CHD risk prediction in older adults.