Change in Body Mass Index and Cardiovascular Outcomes in Patients With Cancer.

OBJECTIVE: To investigate the association between body mass index (BMI) changes and the risk of cardiovascular disease (CVD) in patients with cancer. PATIENTS AND METHODS: This retrospective observational study used data from the JMDC Claims Database obtained between January 2005, and April 2021. We included 52,344 individuals (median [IQR] age, 53 years [46 to 60 years]; 23,584 [45.1%] men) with cancer and no prior CVD. Patients were classified into 3 groups based on the percentage change in BMI from the initial health checkup to the checkup 1 year later: -5.0% or less (BMI loss), -5.0% to 5.0% (stable BMI), and 5.0% or more (BMI gain). The primary end point was composite CVD events including heart failure, atrial fibrillation, ischemic heart disease, and stroke. RESULTS: During a median follow-up period of 763 days (IQR, 369 to 1274 days), 3124 composite CVD events were observed. Compared with stable BMI, the hazard ratios (HRs) of BMI loss and gain for CVD events were 1.16 (95% CI, 1.00 to 1.34) and 1.10 (95% CI, 0.96 to 1.25), respectively. A U-shaped association was observed between the BMI changes and CVD events, particularly for nonatherosclerotic CVD outcomes including heart failure and atrial fibrillation. Compared with stable BMI, both BMI loss and gain increased the risk of heart failure (HR, 1.30; 95% CI, 1.08 to 1.57 and HR, 1.22; 95% CI, 1.02 to 1.47, respectively) and atrial fibrillation (HR, 1.70; 95% CI, 1.18 to 2.45 and HR, 1.55; 95% CI, 1.07 to 2.24, respectively). CONCLUSION: Cancer survivors with BMI loss and gain were at greater risk of CVD. Body mass index loss is associated with a higher risk of CVD.

Risk of cancer history in cardiovascular disease among individuals with hypertension.

Hypertension is the leading risk factor for cardiovascular disease (CVD). Although cancer has recently been increasingly recognized as a novel risk factor for CVD events, little is known about whether co-morbid cancer in individuals with hypertension could further increase the risk of CVD events. We sought to determine the association between the cancer history and the risk of CVD in individuals with hypertension. We retrospectively analyzed a large cohort of 747,620 individuals diagnosed with hypertension from January 2005 through May 2022 using the JMDC Claims Database. Composite CVD events, including myocardial infarction (MI), angina pectoris (AP), stroke, heart failure (HF), and atrial fibrillation (AF), were recorded, and a Cox proportional hazard regression was done to estimate hazard ratios (HR) based on the history of cancer and chemotherapy. 26,531 individuals had a history of cancer. During the mean follow-up period of 1269 ± 962 days, 67,154 composite CVD events were recorded. Compared with individuals without a cancer history, cancer survivors had a higher risk of developing composite CVD events (HR: 1.21, 95% confidence interval [CI]: 1.17-1.26). The HRs (95% CIs) associated with cancer history for MI, AP, stroke, HF, and AF were 1.07 (0.90-1.27), 1.13 (1.06-1.20), 1.14 (1.06-1.24), 1.31 (1.25-1.38), and 1.22 (1.10-1.35), respectively. Lastly, individuals who had received chemotherapy for cancer had a particularly higher risk of developing CVD compared to those who did not undergo chemotherapy. A history of cancer was associated with a greater risk of developing CVD among individuals with hypertension.

Metabolic syndrome and cardiovascular disease in cancer survivors.

BACKGROUND: The risk of subsequent cardiovascular disease (CVD) is high in cancer survivors. Although metabolic syndrome is an established risk factor for CVD, its association with cancer survivors has not yet been established. This study aimed to clarify whether metabolic syndrome is associated with subsequent CVD risk in patients with cancer using a nationwide epidemiological dataset. METHODS: We retrospectively analysed 53 510 patients with a history of breast, colorectal, or stomach cancer, which is reportedly a major site for developing cancer in Japan. Study participants were categorized into two groups based on the presence of metabolic syndrome, defined using the Japanese criteria (high waist circumference and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose). The clinical outcomes were collected between 2005 and 2021. The primary endpoint was defined as the composite CVD outcome, including myocardial infarction, angina pectoris, stroke, and heart failure. RESULTS: The median patient age was 54 years, and 37.5% of the patients were men. Metabolic syndrome was observed in 5558 (10.4%) patients. Over a mean follow-up period of 973 ± 791 days, 3085 composite CVD outcomes were recorded. Multivariable Cox regression analyses showed that metabolic syndrome was associated with a greater risk of developing CVD events (HR = 1.29, 95% CI = 1.15-1.45). Metabolic syndrome was also associated with an increased risk of CVD in patients with a follow-up period ≥1 year (HR = 1.33, 95% CI = 1.15-1.53). This relationship was also observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR = 1.34, 95% CI = 1.21-1.49) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR = 1.32, 95% CI = 1.19-1.46). Subgroup analyses showed that the relationship between metabolic syndrome and incident CVD was more pronounced in the non-obese participants than in the obese participants. CONCLUSIONS: Metabolic syndrome is associated with a greater risk of developing CVD, even among cancer survivors.

One-shot screening: Utilization of a two-dimensional convolutional neural network for automatic detection of left ventricular hypertrophy using electrocardiograms.

BACKGROUND AND OBJECTIVE: Left ventricular hypertrophy (LVH) can impair ejection function and elevate the risk of heart failure. Therefore, early detection through screening is crucial. This study aimed to propose a novel method to enhance LVH detection using 12-lead electrocardiogram (ECG) waveforms with a two-dimensional (2D) convolutional neural network (CNN). METHODS: Utilizing 42,127 pairs of ECG-transthoracic echocardiogram data, we pre-processed raw data into single-shot images derived from each ECG lead and conducted lead selection to optimize LVH diagnosis. Our proposed one-shot screening method, implemented during pre-processing, enables the superimposition of waveform source data of any length onto a single-frame image, thereby addressing the limitations of the one-dimensional (1D) approach. We developed a deep learning model with a 2D-CNN structure and machine learning models for LVH detection. To assess our method, we also compared our results with conventional ECG criteria and those of a prior study that used a 1D-CNN approach, utilizing the same dataset from the University of Tokyo Hospital for LVH diagnosis. RESULTS: For LVH detection, the average area under the receiver operating characteristic curve (AUROC) was 0.916 for the 2D-CNN model, which was significantly higher than that obtained using logistic regression and random forest methods, as well as the two conventional ECG criteria (AUROC of 0.766, 0.790, 0.599, and 0.622, respectively). Incorporating additional metadata, such as ECG measurement data, further improved the average AUROC to 0.921. The model's performance remained stable across two different annotation criteria and demonstrated significant superiority over the performance of the 1D-CNN model used in a previous study (AUROC of 0.807). CONCLUSIONS: This study introduces a robust and computationally efficient method that outperforms 1D-CNN models utilized in previous studies for LVH detection. Our method can transform waveforms of any length into fixed-size images and leverage the selected lead of the ECG, ensuring adaptability in environments with limited computational resources. The proposed method holds promise for integration into clinical practice as a tool for early diagnosis, potentially enhancing patient outcomes by facilitating earlier treatment and management.

Benign Prostatic Hyperplasia and Incident Cardiovascular Disease.

BACKGROUND: Data regarding the relationship between benign prostatic hyperplasia (BPH) and incident cardiovascular disease (CVD) are scarce. We aimed to clarify the association of BPH with the risk of developing CVD using a nationwide epidemiological database.Methods and Results: This retrospective observational cohort study analyzed data from the JMDC Claims Database between 2005 and 2022, including 2,370,986 men (median age 44 years). The primary endpoints were myocardial infarction (MI), angina pectoris (AP), stroke, heart failure (HF), and atrial fibrillation (AF), which were assessed separately. BPH was observed in 48,651 (2.1%) men. During a mean (±SD) follow-up of 1,359±1,020 days, 7,638 MI, 52,167 AP, 25,355 stroke, 58,183 HF, and 16,693 AF events were detected. Hazard ratios of BPH for MI, AP, stroke, HF, and AF were 1.04 (95% confidence interval [CI] 0.92-1.18), 1.31 (95% CI 1.25-1.37), 1.26 (95% CI 1.18-1.33), 1.21 (95% CI 1.16-1.27), and 1.15 (95% CI 1.07-1.24), respectively. We confirmed the robustness of our primary findings through a multitude of sensitivity analyses. In particular, a history of BPH was associated with a higher risk of developing CVD, even in participants without obesity, hypertension, diabetes, or dyslipidemia. CONCLUSIONS: Our analysis of a nationwide epidemiological dataset demonstrated that BPH was associated with a greater risk of developing CVD in middle-aged men.

Association of Cancer and Its Interaction with Conventional Risk Factors on Cardiovascular Disease Risk.

Introduction We sought to examine the association of cancer history with the incidence of individual cardiovascular disease events and to clarify whether the history of cancer modifies the relationship between conventional cardiovascular risk factors and incident cardiovascular disease. Methods This retrospective cohort study used the JMDC Claims Database, including 3,531,683 individuals. The primary endpoint was the composite cardiovascular disease outcome, which included myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation. Results During a follow-up, 144,162 composite endpoints were recorded. Individuals with a history of cancer had a higher risk of developing composite cardiovascular disease events (HR 1.26, 95% CI 1.22-1.29). The HRs for myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation were 1.11 (95% CI 0.98-1.27), 1.15 (95% CI 1.10-1.20), 1.11 (95% CI 1.05-1.18), 1.39 (95% CI 1.34-1.44), and 1.22 (95% CI 1.13-1.32), respectively. Individuals who required chemotherapy for cancer had a higher risk of developing cardiovascular disease. Although conventional risk factors (e.g., overweight/obesity, hypertension, and diabetes) were associated with incident composite cardiovascular disease even in individuals with a history of cancer, the total population-attributable fractions of conventional risk factors were less in individuals with a history of cancer. Conclusion Individuals with a history of cancer (particularly those requiring chemotherapy) have a higher risk of cardiovascular disease. Traditional risk factors are important in the development of cardiovascular disease in individuals with and without a history of cancer. In individuals with a history of cancer, however, the total population-attributable fractions of conventional risk factors decreased.

Familial hypercholesterolemia is related to cardiovascular disease, heart failure and atrial fibrillation. Results from a population-based study.

BACKGROUND: Familial hypercholesterolemia (FH) is associated with atherosclerotic cardiovascular disease (ASCVD). However, the prevalence of FH among a general population remains unknown, and it is unclear if FH is associated with other cardiovascular complications, including heart failure (HF) and atrial fibrillation (AF). METHODS: Analyses were conducted on individuals without a prior history of cardiovascular disease using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2022 (n = 4,126,642; median age, 44 years; 57.5% men). We defined FH as either LDL cholesterol ≥250 mg/dL or LDL cholesterol ≥175 mg/dL under the lipid-lowering medications under the assumption that lipid-lowering medications reduced LDL cholesterol by 30%. We assessed the associations between FH and composite outcomes, including, ASCVD (myocardial infarction, angina pectoris, and stroke), HF, and AF using Cox proportional hazard model. RESULTS: We identified 11,983 (.29%) FH patients. In total, 181,150 events were recorded during the mean follow-up period of 3.5 years. The status FH was significantly associated with composite outcomes after adjustments (hazard ratio [HR]; 1.38, 95% confidence interval [CI]: 1.30-1.47, p < .001). Interestingly, the status FH was significantly associated with HF (HR: 1.48, 95% CI: 1.36-1.61, p < .001) and AF (HR: 1.33, 95% CI: 1.08-1.64, p < .001) in addition to angina pectoris (HR: 1.45, 95% CI: 1.33-1.58, p < .001) and stroke (HR: 1.19, 95% CI: 1.04-1.36, p < .001). CONCLUSION: We found that the prevalence of FH was .29% in a general population. FH was significantly associated with a higher risk of developing cardiovascular disease, HF and AF. LAY SUMMARY: We sought to identify the prevalence of FH among a general population, and to clarify whether FH increases the risk of not only ASCVD but also HF and AF.

Cryoballoon ablation for paroxysmal atrial fibrillation mildly improves lung function: An observational study.

Atrial fibrillation (AF) is the most common arrhythmia and a major public health burden. Catheter ablation (CA) is an effective treatment of AF. Although radiofrequency catheter ablation (RFCA) is the standard practice, cryoballoon ablation (CBA) has become increasingly popular. Pulmonary dysfunction is also associated with AF. As CA targets the pulmonary vasculature, it poses a risk to lung function. However, the effect of CA on respiration in patients with paroxysmal atrial fibrillation (PAF) post-ablation has not yet been assessed. We assessed pulmonary function after CA in a cohort of patients with AF. This prospective, single-center study included 26 patients with symptomatic PAF and 18 patients without PAF. CA techniques include RFCA, CBA, hot balloon ablation, and laser balloon-mediated ablation. Spirometry parameters included vital capacity (VC), forced vital capacity (FVC), forced expiratory volume (FEV1), and peak expiratory flow, which were all measured 6 months post-ablation. AF ablation significantly improved VC (P = .04), FVC (P = .01), and peak expiratory flow (P = .006) in all the patients. In the patients with PAF, we observed a significant increase in FEV1 (P = .04). CBA significantly improved VC (P = .012) and FVC (P = .013). A significant improvement in these pulmonary parameters was achieved, specifically in patients with PAF treated with an ablation protocol with CBA, but not with RFCA or hot balloon ablation. A significant decrease in FEV1 was observed with hot balloon ablation (P = .035). Significant improvement in pulmonary parameters was observed specifically in patients with PAF who underwent CBA. CBA may be a more suitable treatment strategy for patients with PAF, particularly those with compromised pulmonary function.

The estimated glomerular filtration rate predicts pacemaker-induced cardiomyopathy.

Clinical predictors for pacemaker-induced cardiomyopathy (PICM) (e.g., a wide QRS duration and left bundle branch block at baseline) have been reported. However, factors involved in the development of PICM in patients with preserved left ventricular ejection fraction (LVEF) remain unknown. This study aimed to determine the risk factors for PICM in patients with preserved LVEF. The data of 113 patients (average age: 71.3 years; men: 54.9%) who had echocardiography before and after pacemaker implantation (PMI) among 465 patients undergoing dual-chamber PMI were retrospectively analyzed. Thirty-three patients were diagnosed with PICM (18.0/100 person-years; 95% CI 12.8-25.2). A univariate Cox regression analysis showed that an estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 (HR 3.47; 95% CI 1.48-8.16) and a past medical history of coronary artery disease (CAD) (HR 2.76; 95% CI 1.36-5.60) were significantly associated with the onset of PICM. After adjusting for clinical variables, an eGFR ≤ 30 mL/min/1.73 m2 (HR 2.62; 95% CI 1.09-6.29) and a medical history of CAD (HR 2.32; 95% CI 1.13-4.80) were independent risk factors for developing PICM. A medical history of CAD and low eGFR are independent risk factors for PICM in patients with preserved LVEF at baseline. These results could be helpful in predicting a decreased LVEF by ventricular pacing before PMI. Close follow-up by echocardiography is recommended to avoid a delay in upgrading to physiological pacing, such as cardiac resynchronization therapy or conduction system pacing.

Association of four health behaviors in Life's Essential 8 with the incidence of hypertension and diabetes mellitus.

BACKGROUND: The association between health behaviors and the risk of developing hypertension and diabetes is not fully understood. We aimed to examine the association between four health behaviors involved in Life's Essential 8, the American Heart Association's key measures for improving and maintaining cardiovascular health, and the incidence of hypertension and diabetes. METHODS: This observational cohort study used the JMDC Claims Database between 2005 and 2021, which is a health check-up and claims database. We analyzed 2,912,183 participants without a history of hypertension, diabetes, cardiovascular disease, or renal failure. Non-ideal health behaviors included smoking, slow gait speed, eating fast, and poor sleep quality. RESULTS: During 1140 ± 877 days, 201,385 hypertension and 142,156 diabetes events were recorded. In a multivariable Cox regression analysis, the risk of hypertension and diabetes increased with an increasing number of non-ideal health behaviors. The hazard ratios (HRs) (95% confidence interval [CI]) per 1-point increase in non-ideal health behavior components for hypertension and diabetes were 1.11 (1.10-1.11) and 1.08 (1.08-1.09), respectively. Each health behavior was independently associated with the incidence of hypertension and diabetes. A 1-point improvement in health behaviors was associated with a lower risk of developing hypertension (HR 0.94, 95% CI 0.93-0.95) and diabetes (HR 0.95, 95% CI 0.94-0.96). CONCLUSION: Factors that can be substituted for the four health behaviors involved in Life's Essential 8 can stratify the risk of hypertension and diabetes, and improving these health behaviors is useful in preventing hypertension and diabetes in general population.

Enduring Relevance of the Stages of Change Model for Transforming Lifestyle Behaviors.

BACKGROUND: The applicability of the Stages of Change model for cardiovascular disease-related behaviors, such as smoking, exercise, diet, and sleep quality, is unclear.Methods and Results: Using a large-scale epidemiological dataset, we found that baseline behavior change intention, as per the transtheoretical model, was associated with modifications of unhealthy lifestyles including cigarette smoking, physical inactivity, skipping breakfast, and poor sleep quality. CONCLUSIONS: Our results suggest that an individual's motivation to change assessed by a general questionnaire may contribute to lifestyle modification and potentially prevent subsequent cardiovascular disease.

Subjective Gait Speed and Risk of Developing Cardiovascular Events in 56,589 Cancer Survivors.

Despite having a higher risk of cardiovascular disease (CVD), there are currently limited data for stratifying CVD risk among cancer survivors. The purpose of this study was to uncover the relationship of subjective gait speed with incident CVD among cancer survivors.This retrospective observational cohort study analyzed data from the JMDC Claims Database between 2005 and 2021 including 56,589 patients with a prior history of breast, colorectal, or stomach cancer but no history of CVD. Gait speed was evaluated using information from self-reported questionnaires collected during health checkups. The primary endpoint was composite CVD outcome, which included heart failure, myocardial infarction, angina pectoris, and stroke.The median (interquartile range) age was 54 (48-61) years, and 20,981 (37.1%) were male. Among them, 25,933 patients (45.8%) reported fast gait speed. During a mean follow-up period of 1002 ± 803 days, 3,221 composite CVD outcomes were recorded. In multivariate Cox regression analysis, slow gait speed was associated with a higher risk of developing CVD compared with fast gait speed (hazard ratio, 1.14, 95% confidence interval, 1.06-1.22). This association was consistent across a variety of sensitivity analyses.We demonstrated that subjective slow gait speed was associated with a greater risk of CVD development among cancer survivors. This suggests the potential value of gait speed assessment for the CVD risk stratification of cancer patients as well as the clinical importance of maintaining exercise capacity among patients living with cancer.

Association of cancer with the risk of developing hypertension.

BACKGROUND AND AIMS: Although the importance of hypertension in patients with cancer is widely recognized, little is known about the risk of developing hypertension in patients with a history of cancer. METHODS: This retrospective observational cohort study analyzed data from the JMDC Claims Database between 2005 and 2022, including 78,162 patients with a history of cancer and 3,692,654 individuals without cancer. The primary endpoint was the incidence of hypertension. RESULTS: During a mean follow-up period of 1,208 ± 966 days, 311,197 participants developed hypertension. The incidence of hypertension was 364.6 (95% CI 357.0-372.2) per 10000 person-years among those with a history of cancer, and 247.2 (95% CI 246.3-248.1) per 10000 person-years in those without cancer. Individuals with a history of cancer had an elevated risk of developing hypertension according to multivariable Cox regression analyses (HR 1.17, 95% CI 1.15-1.20). Both cancer patients requiring active antineoplastic therapy (HR 2.01, 95% CI 1.85-2.20), and those who did not require active antineoplastic therapy (HR 1.14, 95% CI 1.12-1.17) had an increased risk of hypertension. A multitude of sensitivity analyses confirmed the robustness of the relationship between cancer and incident hypertension. Patients with certain types of cancer were found to have a higher risk of developing hypertension than those without cancer, with varying risks dependent on the type of cancer. CONCLUSIONS: Our analysis of a nationwide epidemiological database revealed that individuals with a history of cancer have a higher risk of developing hypertension, and that this finding applies to both cancer patients who require active antineoplastic therapy and those who do not.

Cardiovascular events after the initiation of immune checkpoint inhibitors.

We sought to clarify the incidence of major adverse cardiac events (MACE) after the initiation of immune checkpoint inhibitors (ICIs). We analyzed the JMDC Claims Database between 2005 and 2021. The study included 2972 patients with no history of cardiovascular disease and a prescription for an ICI. The primary outcome was the incidence of MACE, including myocarditis, pericarditis, Takotsubo cardiomyopathy, atrio-ventricular block, heart failure, myocardial infarction, and stroke. The median age of study participants was 59 (Q1-Q3 53-65) years, and 2163 participants (72.8%) were male. Lung cancer was the most common cancer site (n = 1603). Among ICIs, programmed cell death-1 (PD-1) was most frequently used, and a combination ICI treatment was conducted in 110 patients (3.7%). During a mean follow-up of 358 ± 327 days, 419 MACE events were recorded. The incidence rate of myocarditis, pericarditis, Takotsubo cardiomyopathy, atrio-ventricular block, heart failure, myocardial infarction, and stroke was 3.4, 142.3, 10.3, 17.2, 1191.2, 55.2, and 278.5 per 10,000 person-years, respectively. The incidence of cardiovascular events was higher within 180 days after the initial prescription of ICI. The continuation rate of ICI after MACE was 38.4%. In conclusion, our analysis of a nationwide epidemiological dataset demonstrated the incidence of MACE after the initiation of ICI treatment. The incidence of heart failure was higher than expected, and the continuation rate of ICI treatment after MACE was low. Our results indicated the importance of monitoring and prevention of cardiovascular events in cancer patients requiring ICI treatment.

Sex-Specific Differences in the Risk of Heart Failure following Anti-HER2 Monoclonal Antibody Therapy.

BACKGROUND: Anti-HER2 monoclonal antibody is associated with a greater risk of heart failure (HF) in female breast cancer patients. In recent years, the indication of anti-HER2 monoclonal antibodies was further expanded to stomach, colorectal, and salivary gland cancers regardless of sex in Japan. However, there have been no data on sex difference in the risk of HF after the anti-HER2 monoclonal antibody treatment. OBJECTIVES: We compared the risk of HF between male and female cancer patients treated with anti-HER2 monoclonal antibody using a nationwide population-based database. METHOD: We analyzed 4,608 cancer patients (230 men, median age; 52 years, breast cancer; 4,333) treated with HER2 monoclonal antibody enrolled in the JMDC Claims Database. The primary outcome was the incidence of HF. RESULTS: Over a mean follow-up of 917 ± 835 days, 559 HF events were documented. Kaplan-Meier curves showed no significant difference in the incidence of HF between men and women. Multivariable Cox regression analysis showed that male sex was not associated with a risk of HF compared with women (HR, 0.76; 95% CI: 0.39-1.49). CONCLUSIONS: Our analysis of a nationwide population-based database firstly revealed that no significant sex difference existed in the risk of HF among cancer patients treated with anti-HER2 monoclonal antibody. Our findings suggest that the use of anti-HER2 monoclonal antibodies in male patients may be associated with similar risks observed in female patients.

Association of weight change and in-hospital mortality in patients with repeated hospitalization for heart failure.

BACKGROUND: Although weight loss in heart failure (HF) is a detrimental condition known as cachexia, weight gain caused by fluid retention should also be considered harmful. However, studies with sufficient number of patients examining the impact of weight change and its interval on in-hospital mortality in HF have not been conducted thus far. We sought to elucidate the association of weight change with in-hospital mortality in patients with HF. METHODS: This retrospective observational study used data from the Diagnosis Procedure Combination database, a nationwide inpatient health claims database in Japan. In total, 48 234 patients repeatedly hospitalized for HF (median 82 [74-87] years; 46.4% men) between 2010 and 2018 were included. Weight change was derived from body weight at the first and second admissions. RESULTS: The median weight change and interval between two hospitalizations were -3.1 [-8.3 to -1.8] % and 172 [67-420] days, with 66.9% of overall cohort experiencing any weight loss. As a result of multivariable-adjusted logistic regression analysis, weight loss <-5.0% and weight gain >+5.0% were associated with increased in-hospital mortality (adjusted odds ratio [OR] [95% confidence interval]: 1.46 [1.31-1.62], P < 0.001 and 1.23 [1.08-1.40], P = 0.002, respectively) whereas mild weight loss and gain of 2.0-5.0% were not (OR [95% confidence interval]: 0.96 [0.84-1.10], P = 0.57 and 1.07 [0.92-1.25], P = 0.37, respectively), in comparison with patients with a stable weight (fluctuating no more than -2.0% to +2.0%) used as a reference. Restrictive cubic spline models adjusted for multiple background factors illustrated that higher mortality in patients with weight loss was observed across all subgroups of the baseline body mass index (<18.5, 18.5-24.9 and ≥25.0 kg/m2 ). In patients with short (<90 days) and middle (<180 days) intervals between the two hospitalizations, both weight loss and weight gain were associated with high mortality, whereas the association between weight gain and high mortality was attenuated in those with longer intervals. CONCLUSIONS: Both weight loss and weight gain in patients with repeated hospitalization for HF were associated with high in-hospital mortality, especially weight loss and short/middle-term weight gain. Such patients should be treated with caution in a setting of repeated hospitalization for HF.

Association of cardiovascular health metrics with annual incidence of prediabetes or diabetes: Analysis of a nationwide real-world database.

AIMS/INTRODUCTION: Little is known about the relationship between cardiovascular health (CVH) metrics and the risk of developing prediabetes or diabetes. We examined the association of CVH metrics with the annual risk of developing prediabetes or diabetes. MATERIALS AND METHODS: We carried out this study including 403,857 participants aged 18-71 years with available data on fasting plasma glucose (FPG) data for five consecutive years and with normal FPG (<100 mg/dL) at the initial health checkup. We identified the following ideal CVH metrics: non-smoking, body mass index of <25 kg/m2 , maintaining physical activity, taking breakfast, untreated blood pressure of <120/80 mmHg and untreated total cholesterol of <200 mg/dL. We defined the primary end-point as prediabetes (FPG 100-125 mg/dL) or diabetes (FPG ≥126 mg/dL or use of antihyperglycemic medications). We examined the relationship of CVH metrics with the annual incidence of prediabetes or diabetes. Additionally, we examined the association of 1-year changes in CVH metrics with the risk for prediabetes or diabetes. RESULTS: The median age was 44 years, and 65.6% were men. An increasing number of non-ideal CVH metrics was associated with an elevated risk of prediabetes or diabetes. A non-ideal body mass index was most strongly associated with the risk of prediabetes or diabetes. The risk of developing prediabetes or diabetes rose as the number of non-ideal CVH metrics increased over 1 year. CONCLUSIONS: CVH metrics could stratify the risk of the annual development of prediabetes or diabetes. The risk of developing prediabetes or diabetes might be reduced by improving CVH metrics.

Blood Pressure Classification Using the 2017 ACC/AHA Guideline and Heart Failure in Patients With Cancer.

PURPOSE: Despite the growing recognition of the importance of hypertension in patients with cancer, little is known about whether high blood pressure (BP) among patients with cancer is associated with incident heart failure (HF) and other cardiovascular disease (CVD) events and what BP levels are linked to these events. We examined the association of BP classification on the basis of the 2017 American College of Cardiology/American Heart Association BP guideline with the risk of HF and CVD events in patients with cancer. METHODS: We studied 33,991 patients with a history of breast, colorectal, or stomach cancer (median age, 53 years; 34.1% men). Patients receiving treatment with BP-lowering medications or having a history of CVD including HF were excluded. Using BP measurements at baseline, 33,991 participants were categorized as having normal BP (n = 17,444), elevated BP (n = 4,733), stage 1 hypertension (n = 7,502), or stage 2 hypertension (n = 4,312). The primary outcome was HF. RESULTS: Over a mean follow-up of 2.6 ± 2.2 years, 779 HF events were recorded. After multivariable adjustment, the hazard ratios (HRs) for HF were 1.15 (95% CI, 0.93 to 1.44) for elevated BP, 1.24 (95% CI, 1.03 to 1.49) for stage 1 hypertension, and 1.99 (95% CI, 1.63 to 2.43) for stage 2 hypertension. A stepwise increase in risk with BP categories was also observed in other CVD events. This association was observed even in patients undergoing active cancer treatment. The relationship between hypertension and the risk of developing HF in patients with cancer was confirmed in the Korean National Health Insurance Service database. CONCLUSION: Medication-naïve stage 1 and 2 hypertension was associated with a greater risk of HF and other CVD events in patients with cancer. Our results suggest the importance of multidisciplinary collaboration (eg, oncologists and cardiologists) to establish the optimal management strategy for hypertension in patients with cancer.

Proteinuria and Risk for Heart Failure in 55,191 Patients Having History of Cancer.

INTRODUCTION: We examined the association of proteinuria with the risk for heart failure (HF) and other cardiovascular disease (CVD) events in patients with prior history of breast, colorectal, or stomach cancer using a nationwide population-based database. METHODS: We conducted this retrospective observation study using the JMDC Claims Database and analyzed 55,191 patients with prior history of breast, colorectal, or stomach cancer. The median age was 54 (48-60) years, and 20,665 participants (37.4%) were men. Using urine dipstick data at baseline, 3,945 and 1,521 participants were categorized as having trace and positive proteinuria, respectively. Using Cox proportional hazards models, we examined the relationship of proteinuria with the incidence of HF and other CVD events. RESULTS: Over a mean follow-up of 2.8 ± 2.2 years, 1,597 HF, 124 myocardial infarction, 1,342 angina pectoris, 719 stroke, and 361 atrial fibrillation events were recorded. Kaplan-Meier curves showed that the cumulative incidence for HF increased with proteinuria category (log-rank p < 0.001). After multivariable adjustment, hazard ratios of trace and positive proteinuria for HF were 1.24 (95% CI, 1.04-1.47) and 1.62 (95% CI, 1.30-2.02), respectively. The presence of proteinuria was also associated with a higher risk for angina pectoris and atrial fibrillation. DISCUSSION: Proteinuria was associated with a greater risk of developing HF and other CVD events in patients with prior history of cancer. The optimal management strategy for patients with proteinuria and cancer needs to be established for the prevention of HF in cancer patients.

Association of Life's Simple 7 with incident cardiovascular disease in 53 974 patients with cancer.

AIMS: Cancer survivors have a greater risk of cardiovascular disease (CVD). Although Life's Simple 7 is used for CVD risk stratification in a general population, its utility in cancer survivors remains unknown. We aimed to clarify the association of Life's Simple 7 with incident CVD among cancer survivors. Furthermore, we analyzed the relationship between the change in Life's Simple 7 and the subsequent CVD risk. METHODS AND RESULTS: This retrospective observational study was conducted using the JMDC Claims Database, and we analyzed 53 974 patients with a prior history of breast, colorectal, or stomach cancer, which is a common cancer site in the Japanese population. The median age was 54 years, and 37.8% were men. We modified the original definition of Life's Simple 7 and identified the following ideal Life's Simple 7 cardiovascular health metrics: non-smoking, body mass index < 25 kg/m2, physical activity at goal, optimal dietary habits, untreated fasting plasma glucose < 100 mg/dL, untreated blood pressure < 120/80 mmHg, and untreated total cholesterol < 200 mg/dL. The primary endpoint was composite CVD outcome, including myocardial infarction, angina pectoris, stroke, and heart failure. Over a mean follow-up period of 975 ± 794 days, 3150 composite CVD outcomes were recorded. The risk of CVD events increased with a greater number of non-ideal Life's Simple 7. The hazard ratio per 1-point increase in non-ideal Life's Simple 7 was 1.15 [95% confidence interval (CI): 1.12-1.18). Furthermore, a 1-point increase in non-ideal Life's Simple 7 over 1 year was associated with subsequent CVD risk (hazard ratio: 1.12, 95% CI: 1.06-1.19). CONCLUSION: Life's Simple 7 could be applicable for CVD risk stratification even among cancer survivors. Optimizing Life's Simple 7 may prevent the development of CVD in cancer survivors.