Homocysteine and major coronary events: a prospective population study amongst women

OBJECTIVES: To study serum homocysteine concentration for its prediction of major coronary heart disease events amongst women. DESIGN: A case-control study nested within a follow-up study. Subjects. A total of 74 and 75 major coronary events (coronary deaths or nonfatal myocardial infarction) which occurred in women with and without known heart disease, respectively, during a 13-year follow-up and two individually matched controls per case. Main outcome measure. Major coronary event. RESULTS: Amongst women with baseline heart disease, the relative risk (95% CI) of such events, adjusted for age, smoking, hypertension, diabetes, serum cholesterol and body mass index, was 3.32 (1.05-10.5) in the highest homocysteine quintile compared with the lowest quintile. Amongst women free of heart disease at baseline, the corresponding relative risk value was 0.77 (0.24-2.45). CONCLUSIONS: This prospective study support the hypothesis that homocysteine is a risk factor for coronary events in women with heart disease.     

Allergic rhinitis and dental-supporting tissue diseases in children

The etiology of dental-supporting tissue diseases in children is multi factorial and not merely related to oral hygiene. Therefore, in the present study, we investigated the relationship between children <18 years old with allergic rhinitis (AR) and the risk of dental-supporting tissue diseases.Data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective longitudinal cohort study. The study cohort comprised 378,160 patients with AR (AR group) and 378,160 patients without AR (non-AR group), who were selected through frequency matching based on age, sex, and the index year. The study patients were followed until dental-supporting tissue diseases occurrence, withdrawal from the National Health Insurance program, or December 31, 2013. Cox proportional hazards regression analysis was conducted to calculate the risk of dental-supporting tissue diseases in the AR group after adjustment for age, sex, and relative comorbidities.The adjusted HRs of periodontal, pulp, and periapical diseases in AR children were higher than those in the non-AR controls (1.51, 95% CI: 1.50 to 1.53; 1.06, 95% CI: 1.05 to 1.07, respectively). The AR to non-AR HRs of these inflammatory dental diseases were particularly higher in children <6 years old and in boys. The HRs of periodontal, pulp, and periapical diseases were greatest in those with >5 AR-related medical visits/year (5.57, 95% CI: 5.50 to 5.56; 4.06, 95% CI: 4.00 to 4.12, respectively).Children with AR had a greater risk of inflammatory dental-supporting tissue diseases, particularly those <6 years old with primary teeth, boys, and those with severe persistent AR.     

Associations of visit-to-visit fasting glucose with risk of mortality: A retrospective cohort study of 48,077 people with type 2 diabetes

AimTo investigate the association between mean fasting glucose (FG) and variability in visit-to-visit FG and risk of mortality in people with type 2 diabetes (T2D).MethodsThis retrospective cohort study included 48,077 Chinese men and women with T2D. The yearly mean and coefficient of variation for fasting glucose (mean-FG and FG-CV, respectively) were based on at least two measurements taken each year over a mean duration of 4.5 years. Deaths and their causes were identified using the Shanghai Vital Statistics registry. Mean-FG and FG-CV served as time-dependent variables in Cox models to estimate their associations with risk of mortality; hazard ratios (HRs) were adjusted for baseline risk factors. Potential non-linear associations were examined by restricted cubic splines.ResultsDuring an average 4.5 years of follow-up, 2095 men and 1923 women died. Men with low mean-FG and women with low or high FG were at greater risk of death. Mean-FG was not associated with either cardiovascular disease (CVD) or cancer-specific mortality, whereas higher yearly FG-CV was associated with all-cause and CVD-/cancer-specific mortality in both genders. Compared with a yearly FG-CV of 1.76 (5th percentile), men and women with an FG-CV of 14.14 (75th percentile) had HRs (95% CI) of 1.41 (1.24–1.61) and 1.44 (1.26–1.65), respectively, for all-cause mortality.ConclusionVariability of visit-to-visit FG may be a more sensitive predictor of risk of death than mean-FG in people with T2D.     

Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. a nation-wide study

Objective: To estimate the association between gestational diabetes mellitus (GDM) and adverse pregnancy and neonatal outcomes in Denmark.

Methods: A population-based cohort study including all singleton pregnancies in Denmark from 2004 to 2010 (n?=?403?092). Maternal complications during pregnancy and delivery and fetal complications were classified according to the International Classification of Diseases 10th Revision.

Results: The final study population consisted of 398?623 women. Of these, 9014 (2.3%) had GDM. Data were adjusted for maternal age, parity, smoking, gestational age, birth weight, BMI, gender of the fetus and calendar year. The risk of preeclampsia, caesarean section (both planned and emergency) and shoulder dystocia was increased in women with GDM. In the unadjusted analysis, the risk of thrombosis was increased by a factor 2 in the GDM patients, but in the adjusted analysis this association disappeared. Post-partum hemorrhage was similar in the two groups. The GDM women had an increased risk of giving birth to a macrosomic neonate although the unadjusted analysis did not show any difference between the two groups. Low Apgar score was increased in the GDM, but this association disappeared in the adjusted analysis. Stillbirth was comparable in the two groups.

Conclusions: Women with GDM still have increased incidence of obstetric and neonatal complications, which could imply that treatment of women with GDM should be tightened.     

Reduction in physical function in women after venous thromboembolism

Essentials

• The association of venous thromboembolism (VTE) with subsequent physical function remains unclear.
• We prospectively evaluated this relationship among women from the Nurses’ Health Studies.
• We found a decline in physical function over four years in women with incident VTE.
• This decline was somewhat greater among women specifically reporting a pulmonary embolism.

Summary

Background

Physical function is integral to healthy aging; however, limited research has examined the association of venous thromboembolism(VTE) with subsequent physical function.

Objectives

To prospectively evaluate the relationship between VTE and decline in physical function among 80 836 women from the Nurses’ Health Study(NHS), ages 46–72 in 1992, and 84 304 women from the Nurses’ Health Study II(NHS II), ages 29–48 in 1993.

Methods

Physical function was measured by the Medical Outcomes Short Form‐36 physical function scale, administered every 4 years. We compared change in physical function for women with vs. without an incident VTE in each 4‐year follow‐up period using multivariable linear regression.

Results

We observed a decline in physical function over 4 years when comparing women with vs. those without incident VTE in both older (NHS) and younger (NHS II) women (multivariable‐adjusted mean difference NHS, ?6.5 points [95% CI ?7.4, ?5.6] per 4 years; NHS II, ?3.8 [95% CI ?5.6, ?2.0]). This difference appeared greater among women specifically reporting a pulmonary embolism (NHS, ?7.4 [95% CI ?8.7, ?6.1]; NHS II, ?4.8 [95% CI ?6.8, ?2.8]), and was equivalent to 6.2 years of aging. Whereas longer‐term slopes of physical function decline following a VTE were not different from the slopes of decline in women without a VTE, the absolute level of physical function of women with VTE was worse at the end of follow‐up compared to women without VTE.

Conclusions

In this prospective cohort, incident VTE was strongly associated with an acute decline in physical function. These results suggest it may be clinically important to consider approaches to ameliorating functional deficits shortly after VTE diagnosis.