Strategy for Deployment of Integrated Healthy Aging Regions Based Upon an Evidence-Based Regional Ecosystem-The Styria Model.

In 2013, the European Commission founded the platform European Innovation Partnership on Active and Healthy Aging as a communication and innovation network in this domain. The goal of the current study was the development of an integrated regional ecosystem for active and healthy aging for the region of Styria via a step-by-step co-creation process. A mixed model approach was used to establish an ecosystem for active and healthy aging, which includes macro-, meso- and micro-level stakeholders in the province of Styria, Austria. Based on the results, eight recommendations for the deployment of a healthy aging region were developed. The visibility and accessibility of healthy aging products and services were evaluated as key factors for innovation in active and healthy aging in the region. Health professionals were identified as major drivers of innovation related to active and healthy aging in Styria. The study presented in this article assessed the capacities for healthy aging in the Styria region and identified the need to improve communication pathways between all levels of the public health system and market.

How Bispectral Index Compares to Spectral Entropy of the EEG and A-line ARX Index in the Same Patient.

BACKGROUND: Bispectral index (BIS) monitoring of depth of anesthesia has pioneered the field for more recent monitoring devices like the A-line ARX Index (AAI) or the state (SE) and response entropy (RE) monitoring devices. Following an observational design the present study aimed to simultaneously compare in the same patient recorded BIS, AAI and entropy values. METHODS: Data from patients (n = 32) undergoing minor gynecological operations were analyzed. For all patients, standardized anesthesia was used. Before induction of anesthesia AEP electrodes, BIS and entropy sensors were simultaneously placed on the forehead and recordings were started at 3 minutes before induction and continued until patient transfer to the postanesthesia care unit. Markers were set at defined landmarks. RESULTS: Anesthesia reduced mean BIS, AAI and entropy values. During uneventful, and even more pronounced, during eventful anesthesia BIS/ entropy and BIS/ AAI values showed better correlation than did AAI and entropy values. The prediction probability (Pk) of AAI (0.824 ± 0.036) and RE (0.786 ± 0.040) or SE (0.781 ± 0.040) for preanesthesia awake, postanesthesia awake or anesthesia was comparable and significantly greater than that of BIS (0.705 ± 0.047). However, only 20% of BIS, AAI and entropy values simultaneously categorized the state of the patient as awake, inadequate anesthesia, optimal anesthesia or deep anesthesia. CONCLUSION: The prediction probability (Pk) of entropy and AAI was comparable and better than that of BIS. However, agreement between BIS, AAI and entropy measurements on patient state was poor.

Proposal for a new content model for the Austrian Procedure Catalogue.

The Austrian Procedure Catalogue is used for procedure coding in Austria. Its architecture and content has some major weaknesses. The aim of this study is the presentation of a new potential content model for this classification system consisting of main characteristics of health interventions. It is visualized using a UML class diagram. Based on this proposition, an implementation of an ontology for procedure coding is planned.

The natural history of multiple system atrophy: a prospective European cohort study.

BACKGROUND: Multiple system atrophy (MSA) is a fatal and still poorly understood degenerative movement disorder that is characterised by autonomic failure, cerebellar ataxia, and parkinsonism in various combinations. Here we present the final analysis of a prospective multicentre study by the European MSA Study Group to investigate the natural history of MSA. METHODS: Patients with a clinical diagnosis of MSA were recruited and followed up clinically for 2 years. Vital status was ascertained 2 years after study completion. Disease progression was assessed using the unified MSA rating scale (UMSARS), a disease-specific questionnaire that enables the semiquantitative rating of autonomic and motor impairment in patients with MSA. Additional rating methods were applied to grade global disease severity, autonomic symptoms, and quality of life. Survival was calculated using a Kaplan-Meier analysis and predictors were identified in a Cox regression model. Group differences were analysed by parametric tests and non-parametric tests as appropriate. Sample size estimates were calculated using a paired two-group t test. FINDINGS: 141 patients with moderately severe disease fulfilled the consensus criteria for MSA. Mean age at symptom onset was 56·2 (SD 8·4) years. Median survival from symptom onset as determined by Kaplan-Meier analysis was 9·8 years (95% CI 8·1-11·4). The parkinsonian variant of MSA (hazard ratio [HR] 2·08, 95% CI 1·09-3·97; p=0·026) and incomplete bladder emptying (HR 2·10, 1·02-4·30; p=0·044) predicted shorter survival. 24-month progression rates of UMSARS activities of daily living, motor examination, and total scores were 49% (9·4 [SD 5·9]), 74% (12·9 [8·5]), and 57% (21·9 [11·9]), respectively, relative to baseline scores. Autonomic symptom scores progressed throughout the follow-up. Shorter symptom duration at baseline (OR 0·68, 0·5-0·9; p=0·006) and absent levodopa response (OR 3·4, 1·1-10·2; p=0·03) predicted rapid UMSARS progression. Sample size estimation showed that an interventional trial with 258 patients (129 per group) would be able to detect a 30% effect size in 1-year UMSARS motor examination decline rates at 80% power. INTERPRETATION: Our prospective dataset provides new insights into the evolution of MSA based on a follow-up period that exceeds that of previous studies. It also represents a useful resource for patient counselling and planning of multicentre trials.

[Actual state and perspectives of e-health in Austria and international--an overview]. / Ist-Zustand und Perspektive von e-Health in Österreich und International--ein Überblick.

eHealth will influence the development of the Austrian health and social care significantly. The main part will be the implementation of an electronic health record. There are many hospital and outpatient information systems already implemented and the challenge is to enable a patient-centered communication of all health care providers by defining technical standards and the organizational and legal framework. Within this framework privacy and security have to be guaranteed at the highest possible level. Also, companies offering information systems have to improve the usability of their systems. One very important application is the filtering of relevant information according to a user profile and the optimal presentation in tables and graphs. The stepwise modular implementation and the use of international standards can be considered as a very positive approach to eHealth in Austria.

Screening for NPHS2 mutations may help predict FSGS recurrence after transplantation.

Steroid-resistant focal segmental glomerulosclerosis (FSGS) often recurs after renal transplantation. In this international survey, we sought to identify genotype-phenotype correlations of recurrent FSGS. We surveyed 83 patients with childhood-onset primary FSGS who received at least one renal allograft and analyzed 53 of these patients for NPHS2 mutations. The mean age at diagnosis was 6.7 years, and the mean age at first renal transplantation was 13 years. FSGS recurred in 30 patients (36%) after a median of 13 days (range, 1.5 to 152 days). Twenty-three patients received a second kidney transplant, and FSGS recurred in 11 (48%) after a median of 16 days (range, 2.7 to 66 days). None of the 11 patients with homozygous or compound heterozygous NPHS2 mutations developed recurrent FSGS compared with 45% of patients without mutations. These data suggest that genetic testing for pathogenic mutations may be important for prognosis and treatment of FSGS both before and after transplantation.

Costs of illness and care in Parkinson's disease: an evaluation in six countries.

We investigated the costs of Parkinson's Disease (PD) in 486 patients based on a survey conducted in six countries. Economic data were collected over a 6-month period and presented from the societal perspective. The total mean costs per patient ranged from EUR 2620 to EUR 9820. Direct costs totalled about 60% to 70% and indirect costs about 30% to 40% of total costs. The proportions of costs components of PD vary notably; variations were due to differences in country-specific health system characteristics, macro economic conditions, as well as frequencies of resource use and price differences. However, inpatient care, long-term care and medication were identified as the major expenditures in the investigated countries.

Prospective study of the association of serum gamma-glutamyltransferase with cervical intraepithelial neoplasia III and invasive cervical cancer.

Epidemiologic studies indicate that elevated levels of gamma-glutamyltransferase (GGT), a key enzyme of glutathione metabolism, might be associated with increased cancer risk. Furthermore, preclinical studies support a role for GGT in tumor invasion and progression. However, the relationship between GGT and risks of cervical intraepithelial neoplasia III (CIN-III) and invasive cervical cancer (ICC) have not been evaluated. We investigated the association of enzymatically determined GGT in blood serum with subsequent incidence of CIN-III and ICC in a prospective population-based cohort of 92,843 women ages 18 to 95, of whom 79% had at least one gynecologic examination including Pap smear testing during follow-up. Cox regression was used to compute adjusted hazard ratios (HR) with 95% confidence intervals for the association of GGT with CIN-III and ICC. During median follow-up of 13.8 years, 702 CIN-III and 117 ICC diagnoses were observed. Compared with normal low GGT (<17.99 units/L), risk of ICC was significantly elevated for all other baseline GGT categories, with adjusted HRs of 2.31 (1.49-3.59) for normal high GGT (18.00-35.99 units/L), 2.76 (1.52-5.02) for elevated GGT (36.00-71.99 units/L), and 3.38 (1.63-7.00) for highly elevated GGT [>72.00 units/L; P trend < 0.0001, HR log unit increase 3.45 (1.92-6.19)]. In contrast, associations between GGT serum levels and CIN-III risk were not statistically significant in the main analysis. Exclusion of the first 2 or 5 years of follow-up did not change the results. Effects did not differ by age, body mass index, or socioeconomic status. Our findings implicate GGT in the progression of premalignant cervical lesions to invasive cancer.

Prospective follow-up of patients with acute hepatitis C virus infection in Brazil.

BACKGROUND: The natural outcome of infection with hepatitis C virus (HCV) varies substantially among individuals. However, little is known about host and viral factors associated with a self-limiting or chronic evolution of HCV infection. METHODS: From 1 January 2001 through 31 December 2008, a consecutive series of 65 patients from Rio de Janeiro, Brazil, with a well-documented diagnosis of acute HCV infection, acquired via various routes, were enrolled in this study. Patients were prospectively followed up for a median of 40 months after the estimated date of HCV infection with serial measurements of serum alanine aminotransferase, HCV RNA, and anti-HCV antibodies. Spontaneous viral clearance (SVC) was defined as undetectable levels of HCV RNA in serum, in the absence of treatment, for 3 consecutive HCV polymerase chain reaction tests within the first 6 months of follow-up. Cox proportional hazards regression was used to identify host and viral predictors of SVC. RESULTS: The cumulative rate of SVC was 44.6% (95% confidence interval, 32.3%-57.5%). Compared with chronic HCV evolution, patients with self-limiting disease had significantly lower peak levels of anti-HCV antibodies (median, 109.0 vs 86.7 optical density-to-cutoff ratio [od/co]; P<.02), experienced disease symptoms more frequently (69.4% vs 100%; P<.001), and had lower viral load at first clinical presentation (median, 4.3 vs 0.0 log copies; P=.01). In multivariate analyses, low peak anti-HCV level (<93.5 od/co) was the only independent predictor for SVC; the hazard ratio compared with high anti-HCV levels (> or =93.5 od/co) was 2.62 (95% confidence interval, 1.11-6.19; P=.03). CONCLUSION: Our data suggest that low levels of anti-HCV antibodies during the acute phase of HCV infection are independently related to spontaneous viral clearance.

Evaluation of 3-5 months' add-on therapy with montelukast in patients with non-controlled asthma in Austria: the STAR open-label, real-world, observational study.

OBJECTIVE: To assess the current state of asthma management in Austria and evaluate improvement of symptoms and quality of life (QoL) in asthma patients by adding the controller substance montelukast to existing therapy. RESEARCH DESIGN AND METHODS: Office-based pneumologists across Austria were invited to participate in an open-label, multicenter observational study. Male and female patients aged from 12-50 years with mild or moderate persistent asthma according to GINA guidelines and FEV(1) > 70% predicted were included if they were on concurrent asthma treatment, but still had persistent symptoms and reduced quality of life. Asthma control was assessed at time of patient anamnesis and subsequent follow-up visits. In addition, a physical examination was performed, lung function (FEV(1)) was measured and two types of validated QoL questionnaires were used: the Juniper Asthma Control Questionnaire was evaluated and documented by the physicians at each study visit and the Asthma Quality of Life Questionnaire was completed by the patients following each visit. RESULTS: A total of 851 patients (343 males, 508 females) were included and 328 patients were eligible for evaluation 3-5 months after completing at least two study visits. QoL rating by patients was available for 263 at baseline and for 216 patients after 3-5 months. The physicians' rating of asthma-related QoL showed improvements between 6.66 and 11.80% in the categories: nocturnal awakening, morning asthma symptoms, reduction of daily activities, wheezing and dyspnoea, but no reduction in the use of short acting ss(2)-agonists (SABA). The QoL judged by the patients by means of the QoL-Q showed statistically significant improvements in 13 of 15 parameters of QoL. The categories: response to cigarette smoke and response to air pollution showed positive trends (not significant) while the improvement of shortness of breath, response to dust, frustration, cough, anxiety, chest pressure, sleep quality, worries about asthma, wheezing, symptoms at heavy and moderate exercise and impairment of daily activities and activities at work reached statistical significance. CONCLUSION: This open-label, multicenter observational study shows significant improvement in six QoL parameters evaluated by the physicians and in 13 out of 15 QoL categories judged by the patients 3-5 months after adding montelukast to the ongoing asthma treatment in patients with mild or moderate persistent asthma. Limitations to these conclusions are the lack of a placebo control group (as this was an open-label study) and the continuing basal asthma therapy, which might contribute to improvement of asthma control.

Social and clinical determinants of quality of life in Parkinson's disease in Austria: a cohort study.

Parkinson's disease (PD) is associated with a reduction of health-related quality of life (HrQoL). Demographic and clinical determinants of HrQoL in PD have been previously investigated, but less is known about its social determinants. Data on HrQoL in Austrian patients with PD are not available. The objective of this cross-sectional survey was to evaluate HrQoL of Austrian patients with PD and to provide a comprehensive analysis of its social and clinical determinants. Outpatients (n = 100) with idiopathic PD were recruited in the Department of Neurology of the University Innsbruck. Clinical status was estimated using the Unified Parkison's Disease Rating Scale (UPDRS). HrQoL was evaluated using a generic instrument, the EuroQol (EQ5D and EQ-VAS). Independent determinants of HrQoL were assessed in multivariate regression analysis. The proportion of PD patients with moderate or severe problems in at least one dimension of the EQ5D was significantly higher than in the general population (90.1 vs. 35.1%, P < 0.001). The mean EQ-VAS score in PD was lower than in the general population (48.9 +/- 19.6 vs. 77.0 +/- 20.8, P < 0.001). Social support (number of household members) was identified as an independent social determinant of HrQoL. Demographic and clinical determinants were age, depression, UPDRS and motor fluctuations. The analysis of determinants of HrQoL showed that a greater attention should be paid to social support and home care. Our data on HrQoL in PD should be considered in the development of new health care programs.

Low serum LDL cholesterol in patients with type 2 diabetes: an analysis on two different patient populations.

BACKGROUND: Patients with type 2 diabetes (T2DM) typically exhibit a pattern of dyslipidemia with high triglycerides, low HDL cholesterol, and small LDL particles. We aimed at investigating whether also LDL cholesterol levels are altered in diabetic patients. METHODS: Lipid panels were obtained in a consecutive series of angiographied coronary patients (n=750), and in a large sample of hypertensive outpatients (n=5949). RESULTS: T2DM patients in the cohort of coronary patients (n=164; 21.9%) had significantly higher triglycerides (203±138 vs. 153±91 mg/dl; p<0.001), lower HDL cholesterol (44±14 vs. 50±14 mg/dl; p<0.001), lower apolipoprotein A1 (140±28 vs. 148±28 mg/dl; p=0.002), lower total cholesterol (211±48 vs. 220±42 mg/dl; p=0.006) and, importantly, lower LDL cholesterol (122±38 vs. 134±35 mg/dl; p<0.001) than non-diabetic subjects. Whereas apolipoprotein B was similar in T2DM patients as in non-diabetic subjects (113±26 vs. 114±25 mg/dl; p=0.648), the LDL cholesterol/apolipoprotein B ratio was significantly lower (1.08±0.24 vs. 1.18±0.21; p<0.001) and LDL particles were significantly smaller (257±7 vs. 259±6 Å; p<0.001) in T2DM patients. Also among the hypertensive subjects, diabetic patients (n=1632; 27.3%) besides higher triglycerides (173±70 vs. 151±65 mg/dl; p<0.001) and lower HDL cholesterol (53±17 vs. 57±19 mg/dl; p<0.001) exhibited lower total cholesterol (216±44 vs. 222±41 mg/dl; p<0.001) and lower LDL cholesterol (127±40 vs. 136±37 mg/dl; p<0.001) than non-diabetic subjects. CONCLUSIONS: Both among angiographied coronary patients and hypertensive outpatients, LDL cholesterol is significantly lower in T2DM patients than in non-diabetic individuals.

[Cost of illness and health service patterns in Morbus Parkinson in Austria]. / Krankheitskosten und Versorgungssituation bei Morbus Parkinson - eine Analyse in Osterreich.

OBJECTIVE: The objective of this study was to analyse the costs and the situation of care in patients with idiopathic Parkinson's disease (PD) in Austria. Continuously increasing healthcare costs and the fact that the prevalence of PD is expected to double in the next 25 years highlight the importance of health-economic evaluation in PD. METHOD: Patient survey with 81 patients with idiopathic Parkinson's disease. A bottom-up approach has been used to calculate direct and indirect costs from a societal perspective. Cost-driving factors were identified by multiple regression analysis. RESULTS: The overall costs from the perspective of society was 9280 per patient within a six-month period and consisted of 60% direct costs (5910 ) and 40% indirect costs (3910 ). The major part (59%) of direct costs was paid by the national healthcare. Co-payments of patients were 810 per six-months. The annual nationwide costs of PD in Austria are estimated to be approximately 320 million . CONCLUSION: PD is an economic challenge for the Austrian healthcare system. Direct costs account for the most part and are on account of the national healthcare system. In addition, patients bear considerable costs by personal contribution.

Relevance and management of methylation data in electronic health records.

In this paper we give an overview of challenges and chances of the integration of methylation data into Electronic Health Records. Perspectives of methylation data in terms of clinical relevance and characteristics of these data are shown. Among several standards OpenEHR, HL7 CG and LOINC are identified as starting point for the representation and communication of methylation data within the clinical context.

Use of penalized splines in extended Cox-type additive hazard regression to flexibly estimate the effect of time-varying serum uric acid on risk of cancer incidence: a prospective, population-based study in 78,850 men.

PURPOSE: We sought to investigate the effect of serum uric acid (SUA) levels on risk of cancer incidence in men and to flexibly determine the shape of this association by using a novel analytical approach. METHODS: A population-based cohort of 78,850 Austrian men who received 264,347 serial SUA measurements was prospectively followed-up for a median of 12.4 years. Data were collected between 1985 and 2003. Penalized splines (P-splines) in extended Cox-type additive hazard regression were used to flexibly model the association between SUA, as a time-dependent covariate, and risk of overall and site-specific cancer incidence and to calculate adjusted hazard ratios with their 95% confidence intervals. RESULTS: During follow-up 5189 incident cancers were observed. Restricted maximum-likelihood optimizing P-spline models revealed a moderately J-shaped effect of SUA on risk of overall cancer incidence, with statistically significantly increased hazard ratios in the upper third of the SUA distribution. Increased SUA (>/=8.00 mg/dL) further significantly increased risk for several site-specific malignancies, with P-spline analyses providing detailed insight about the shape of the association with these outcomes. CONCLUSIONS: Our study is the first to demonstrate a dose-response association between SUA and cancer incidence in men, simultaneously reporting on the usefulness of a novel methodological framework in epidemiologic research.

Prospective study of the association of gamma-glutamyltransferase with cancer incidence in women.

Although several epidemiologic studies have shown that gamma-glutamyltransferase (GGT) is associated with cardiovascular disease and all-cause mortality, its relationship with cancer incidence remains widely unexplored. In experimental models the ability of cellular GGT to modulate crucial redox-sensitive functions has been established, and it may thus play a role in tumor progression. In the present study, we investigated the association of GGT with overall and site-specific cancer incidence in a population-based cohort of 92,843 Austrian women with 349,674 serial GGT measurements, prospectively followed-up for a median of 13.5 years. The relationship between GGT and cancer incidence was analyzed using adjusted Cox regression models with age as underlying time metric with age as underlying time metric including GGT concentrations at baseline and incorporating repeated GGT measurements as a time-dependent variable. During follow-up, 4,884 incidence cancers were observed. Compared to normal low GGT (<17.99 U/L), cancer risk was elevated for all other GGT categories (p for trend < 0.0001), with adjusted hazard ratios (95% confidence intervals) of 1.06 (0.99-1.13) for GGT levels between 18.00 and 35.99 U/L (normal high), 1.12 (1.02-1.22) for GGT levels between 36.00 and 71.99 U/L (elevated) and 1.43 (1.28-1.61) for highly elevated GGT (>72.00 U/L). Very similar results were seen when GGT was analyzed as a time-dependent variable. In cancer-site specific models, elevated GGT statistically significantly increased the risk for malignant neoplasms of digestive organs, the respiratory system/intrathoracic organs, breast and female genital organs and lymphoid and haematopoietic cancers (all, p < 0.006). Our study is the first to demonstrate in a large population-based cohort that high GGT levels significantly increased cancer risk in women.

A set of SAS macros for calculating and displaying adjusted odds ratios (with confidence intervals) for continuous covariates in logistic B-spline regression models.

In clinical and epidemiologic research to investigate dose-response associations, non-parametric spline regression has long been proposed as a powerful alternative to conventional parametric regression approaches, since no underlying assumptions of linearity have to be fulfilled. For logistic spline models, however, to date, little standard statistical software is available to estimate any measure of risk, typically of interest when quantifying the effects of one or more continuous explanatory variable(s) on a binary disease outcome. In the present paper, we propose a set of SAS macros which perform non-parametric logistic regression analysis with B-spline expansions of an arbitrary number of continuous covariates, estimating adjusted odds ratios with respective confidence intervals for any given value with respect to a supplied reference value. Our SAS codes further allow to graphically visualize the shape of the association, retaining the exposure variable under consideration in its initial, continuous form while concurrently adjusting for multiple confounding factors. The macros are easily to use and can be implemented quickly by the clinical or epidemiological researcher to flexibly investigate any dose-response association of continuous exposures with the risk of binary disease outcomes. We illustrate the application of our SAS codes by investigating the effect of body-mass index on risk of cancer incidence in a large, population-based male cohort.

Longitudinal change in serum gamma-glutamyltransferase and cardiovascular disease mortality: a prospective population-based study in 76,113 Austrian adults.

OBJECTIVE: The purpose of this study was to investigate the association of longitudinal change in serum gamma-glutamyltransferase (GGT) with mortality from cardiovascular disease (CVD). METHODS AND RESULTS: A population-based cohort of 76,113 Austrian men and women with 455,331 serial GGT measurements was prospectively followed-up for a median of 10.2 years after assessment of longitudinal GGT change during an average period of 6.9 years. Cox proportional hazards regression with time-varying covariates was used to evaluate GGT change as an independent predictor for CVD death. Independently of baseline GGT and other classical CVD risk factors, a pronounced increase in GGT (7-year change >9.2 U/L) was significantly associated with increased total CVD mortality in men (P=0.005); the adjusted hazard ratio (95% confidence interval) in comparison to stable GGT (7-year change -0.7 to 1.3 U/L) was 1.40 (1.09 to 1.81). Similarly, total CVD risk was elevated for increasing GGT in women, although effects were less pronounced and statistically significant only in subanalyses regarding coronary heart disease. Age of participants significantly modified the relation between GGT change and CVD mortality, with markedly stronger associations to be observable for younger individuals. CONCLUSIONS: Our study is the first to demonstrate that a longitudinal increase in GGT, independently of baseline GGT and even within its normal range, significantly increases risk of fatal CVD.

Association of gamma-glutamyltransferase and risk of cancer incidence in men: a prospective study.

Although several epidemiologic studies have shown that gamma-glutamyltransferase (GGT) is independently associated with cardiovascular disease and all-cause mortality, its relationship with cancer incidence remains widely unexplored. In several experimental models, the ability of cellular GGT to modulate crucial redox-sensitive functions has been established, and it thus may play a role in tumor progression, as has been repeatedly suggested. We prospectively investigated the association between GGT and risk of overall and site-specific cancer incidence in a large population-based cohort of 79,279 healthy Austrian men with serial GGT measurements. Median follow-up was 12.5 years. Adjusted Cox proportional hazards models were calculated to evaluate GGT as an independent predictor for cancer incidence, and nonparametric regression splines were fitted to flexibly capture the dose-response relationship. Elevated GGT significantly increased overall cancer risk, showing a clear dose-response relationship (P for GGT log-unit increase < 0.0001; P for trend < 0.0001). In comparison with the reference GGT concentration (25 units/L), we found adjusted relative risks (95% confidence intervals) equalling 1.19 (1.15-1.22) for GGT concentrations of 60 units/L, 1.32 (1.28-1.36) for 100 units/L, 1.67 (1.60-1.75) for 200 units/L, and 2.30 (2.14-2.47) for 400 units/L. In cancer site-specific models, GGT was significantly associated with malignant neoplasms of digestive organs, the respiratory system/intrathoracic organs, and urinary organs (all P < 0.0001). Age of participants significantly modified the association of GGT and cancer risk (P < 0.001), revealing markedly stronger associations in participants ages

Serum uric acid is an independent predictor for all major forms of cardiovascular death in 28,613 elderly women: a prospective 21-year follow-up study.

BACKGROUND: The role of serum uric acid (SUA) as a risk factor for cardiovascular disease (CVD) remains controversial. Little is known about its predictive value for mortality from congestive heart failure (CHF) and stroke, particularly in elderly, post-menopausal women. METHODS: The relation of SUA to risk of death from total CVD, CHF, stroke and coronary heart disease (CHD) was examined prospectively in a large cohort of 28613 elderly Austrian women (mean age 62.3 years), followed-up for a median of 15.2 years. Adjusted Cox proportional hazards models were calculated to evaluate SUA as an independent predictor for fatal CVD events. RESULTS: SUA in the highest quartile (>or=5.41 mg/dL) was significantly associated with mortality from total CVD (p<0.0001), showing a clear dose-response relationship; the adjusted hazard ratio (95%CI) in comparison to the lowest SUA quartile was 1.35 (1.20-1.52). In subgroup analyses SUA was independently predictive for deaths from acute and subacute (p<0.0001) and chronic forms (p=0.035) of CHD, yielding adjusted hazard ratios for the highest versus lowest SUA quartile of 1.58 (1.19-2.10) and 1.25 (1.01-1.56), respectively. SUA was further significantly related to fatal CHF (p<0.0001) and stroke (p=0.018); the adjusted hazard ratios for the highest versus lowest SUA quartile were 1.50 (1.04-2.17) and 1.37 (1.09-1.74), respectively. CONCLUSIONS: These findings, for the first time, demonstrate that SUA is an independent predictor for all major forms of death from CVD including acute, subacute and chronic forms of CHD, CHF and stroke in elderly, post-menopausal women.