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2.
Artigo em Inglês | MEDLINE | ID: mdl-34491362

RESUMO

BACKGROUND: Heart failure (HF) is increasing in prevalence worldwide. We explored whether adults with trace and positive proteinuria were at a high risk for incident HF compared with those with negative proteinuria using a nationwide epidemiological database. METHODS: This is an obserevational cohort study using the JMDC Claims Database collected between 2005 and 2020. This is a population-based sample (n = 1,021,943; median age [interquartile range], 44 [37-52] years; 54.8% men). No participants had a known history of cardiovascular disease. Each participant was categorized into three groups according to the urine dipstick test results: negative proteinuria (n = 902,273), trace proteinuria (n = 89,599), and positive proteinuria (≥1+) (n = 30,071). The primary outcome was HF. The secondary outcomes were myocardial infarction, stroke, and atrial fibrillation. We performed multivariable Cox regression analyses to identify the association between the proteinuria category and incient HF and other cardiovascular disease events. RESULTS: Over a mean follow-up of 1,150 ± 920 days, 17,182 incident HF events occurred. After multivariable adjustment, hazard ratios (HRs) for HF events were 1.09 (95% confidence interval [CI], 1.03-1.15) and 1.59 (95% CI, 1.49-1.70) for trace proteinuria and positive proteinuria vs. negative proteinuria, respectively. This association was present irrespective of clinical characteristics. A stepwise increase in the risk of myocardial infarction, stroke, and atrial fibrillation with proteinuria category was also observed. Our primary results were confirmed in participants after multiple imputation for missing values and in those having no medications for hypertension, diabetes mellitus, and dyslipidemia. Discriminative predictive value for HF events improved by adding the results of urine dipstick test to traditional risk factors (net reclassification improvement 0.0497, 95% CI 0.0346-0.0648, p < 0.001). CONCLUSIONS: Not only positive proteinuria but also trace proteinuria was associated with a greater incidence of HF in the general population. Semiquantitative assessment of proteinuria would be informative for the risk stratification of HF.

3.
Am J Cardiol ; 158: 132-138, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34481589

RESUMO

Onco-cardiology is the emerging field, and the concept of shared risk factor holds an important position in this field. The increasing prevalence of colorectal cancer (CRC) in young adults is a critical epidemiological issue. Although metabolic syndrome, which is a major risk factor for cardiovascular disease, is known to be associated with CRC incidence in middle-aged and elderly individuals, it is unclear whether this association is present in young adults. We assessed whether metabolic syndrome was associated with CRC events in young adults (aged <50 years), and whether the association differed by the definition of metabolic syndrome. We retrospectively analyzed 902,599 adults (20 to 49 years of age) enrolled in the JMDC Claims Database which is a nationwide epidemiological database in Japan between January 2005 and August 2018. Participants who had a history of CRC, colorectal polyps, or inflammatory bowel disease were excluded. Study participants were categorized into 2 groups according to the presence of metabolic syndrome, defined using the Japanese criteria (waist circumference ≥85 cm for men and ≥90 cm for women, and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose). Clinical outcomes were collected between January 2005 and August 2018. The primary outcome was CRC of any stage. Median (interquartile range) age was 41 (37 to 45), and 55.4% were men. Over a median follow-up of 1,008 (429 to 1,833) days, there were 1,884 incidences of CRC. After multivariable adjustment, the hazard ratio (HR) of metabolic syndrome for CRC events was 1.26 (95% confidence interval [CI] = 1.07 to 1.49). Cox regression analysis after multiple imputation for missing values showed that metabolic syndrome was associated with CRC incidence (HR = 1.35, 95% CI = 1.17 to 1.56). Metabolic syndrome was also associated with a higher incidence of CRC in individuals with a follow-up period of ≥365 days (HR = 1.33, 95% CI = 1.10 to 1.60). This association was observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR = 1.30, 95% CI = 1.09 to 1.55) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR = 1.39, 95% CI = 1.12 to 1.72). In conclusion, metabolic syndrome was associated with a higher incidence of CRC among individuals aged <50 years. These results could be informative for risk stratification of subsequent CRC among young adults.

4.
Nutrients ; 13(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34371853

RESUMO

Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38-53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2-24.8) kg/m2). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), or obese (BMI ≥ 30 kg/m2). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0-32.9), 28.1 (27.6-28.5), and 5.5 (5.3-5.7) per 10,000 person-years in men, whereas 25.7 (25.1-26.2), 22.5 (22.0-23.0), and 4.0 (3.8-4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.


Assuntos
Índice de Massa Corporal , AVC Hemorrágico/epidemiologia , Obesidade/complicações , Sobrepeso/complicações , Magreza/complicações , Adulto , Bases de Dados Factuais , Feminino , Fatores de Risco de Doenças Cardíacas , AVC Hemorrágico/etiologia , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais , Magreza/epidemiologia
5.
Int J Cardiol ; 340: 36-41, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34454966

RESUMO

BACKGROUND: Extensive data support the clinical benefit of cardiac rehabilitation (CR) for patients with chronic heart failure (HF). However, whether CR could be beneficial for patients hospitalized for acute heart failure remains unclear. METHODS: We retrospectively analyzed data from the Diagnosis Procedure Combination database, a nationwide inpatient database. We included patients hospitalized for HF, who were aged ≥20 years and with New York Heart Association class ≥II, between January 2010 and March 2018. We excluded patients with length of hospital stay ≤2 days, those undergoing major procedures under general anesthesia, those requiring advanced mechanical supports within 2 days after admission, and those with disturbance of consciousness. Propensity score matching and instrumental variable analyses were conducted to compare clinical outcomes between the patients with and without acute-phase initiation of CR defined as initiation of CR within two days after hospital admission. RESULTS: Among 430,216 eligible patients, 63,470 patients (14.8%) received the acute-phase initiation of CR. Propensity score matching created 63,470 pairs and found that the acute-phase initiation of CR was associated with lower in-hospital mortality (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.73-0.80), shorter hospital stay and lower incidence of 30-day readmission due to HF. The instrumental variable analysis also showed patients with acute-phase initiation of CR was associated with lower in-hospital mortality than those without (OR, 0.73; 95% CI, 0.68-0.79). CONCLUSION: Our analysis suggested a potential benefit of acute-phase initiation of CR for short-term clinical outcomes in hospitalized patients with acute HF.

6.
JMIR Res Protoc ; 10(10): e30725, 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34407925

RESUMO

BACKGROUND: Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. OBJECTIVE: This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. METHODS: Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. RESULTS: The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. CONCLUSIONS: The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. TRIAL REGISTRATION: University Hospital Medical Information Network-Clinical Trials Registry UMIN-CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048983. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30725.

7.
Int Heart J ; 62(4): 837-842, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34334582

RESUMO

Chronic inflammation due to abdominal obesity plays a major role in the development of cardiovascular disease (CVD). Gender differences are well characterized in the development of CVD; however, in the association among abdominal obesity, chronic inflammation, and preclinical atherosclerosis, gender differences in the general population remain to be clarified. We retrospectively analyzed 1,163 subjects who underwent voluntary health checkups at our institute. We defined carotid artery plaque formation as carotid intima-media thickness ≥ 1.1 mm. Multiple regression analysis showed that waist circumference was a major independent predictor of increase in serum C-reactive protein (CRP) level in both men and women. Serum CRP level was significantly increased in men with carotid artery plaque formation, but not in women. Multivariable logistic regression analysis demonstrated that serum CRP level, as well as age and hypertension, was independently associated with carotid artery plaque formation only in men. This result may suggest a potential of gender-specific difference in the association between serum CRP level and the prevalence of carotid artery plaque formation. Further investigations are required to confirm our results and to clarify the underlying mechanism.


Assuntos
Aterosclerose/complicações , Inflamação/complicações , Obesidade Abdominal/complicações , Caracteres Sexuais , Idoso , Proteína C-Reativa/metabolismo , Espessura Intima-Media Carotídea , Feminino , Humanos , Inflamação/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Circunferência da Cintura
8.
Artigo em Inglês | MEDLINE | ID: mdl-34378781

RESUMO

CONTEXT: Although diabetes mellitus (DM) was reported to be associated with incident colorectal cancer (CRC), the detailed association between fasting plasma glucose (FPG) and incident CRC has not been fully understood. OBJECTIVE: We assessed whether hyperglycemia is associated with a higher risk for CRC. DESIGN: Analyses were conducted using the JMDC Claims Database [n = 1 441 311; median age (interquartile range), 46 (40-54) years; 56.6% men). None of the participants were taking antidiabetic medication or had a history of CRC, colorectal polyps, or inflammatory bowel disease. Participants were categorized as normal FPG (FPG level < 100 mg/dL; 1 125 647 individuals), normal-high FPG (FPG level = 100-109 mg/dL; 210 365 individuals), impaired fasting glucose (IFG; FPG level = 110-125 mg/dL; 74 836 individuals), and DM (FPG level ≥ 126 mg/dL; 30 463 individuals). RESULTS: Over a mean follow-up of 1137 ± 824 days, 5566 CRC events occurred. After multivariable adjustment, the hazard ratios for CRC events were 1.10 (95% CI 1.03-1.18) for normal-high FPG, 1.24 (95% CI 1.13-1.37) for IFG, and 1.36 (95% CI 1.19-1.55) for DM vs normal FPG. We confirmed this association in sensitivity analyses excluding those with a follow-up of< 365 days and obese participants. CONCLUSION: The risk of CRC increased with elevated FPG category. FPG measurements would help to identify people at high-risk for future CRC.

9.
Am J Cardiol ; 155: 40-44, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34294408

RESUMO

Epidemiological evidence on the relationship of modifiable risk factors and lifestyles with incident atrial fibrillation (AF) in young adults remains insufficient. We aimed to identify the determinants of AF among young adults using a nationwide epidemiological database. Medical records of 286,876 individuals (20-39 years) without prior history of cardiovascular disease were extracted from the JMDC Claims Database. We analyzed the association of modifiable risk factors with the incidence of AF. The median (interquartile range) age was 34 (29-37) years, and 54.4% were men. After a mean follow-up of 1,017 ± 836 days, 267 individuals (0.1%) developed AF. Multivariable Cox regression analysis demonstrated that high waist circumference, hypertension, cigarette smoking, and poor sleep quality as well as age and sex were associated with increased incidence of AF. Kaplan-Meier curves showed that number of modifiable components including high waist circumference, hypertension, cigarette smoking, and poor sleep quality clearly stratified the risk of AF development (Log rank test, p < 0.001). Age- and sex-adjusted Cox regression analyses showed individuals with one (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.13-2.18), two (HR 2.03, 95% CI 1.40-2.95), three (HR 3.48, 95% CI 2.19-5.54), and four (HR 10.78, 95% CI 5.26-22.11) components were associated with an increased incidence of AF compared with individuals with no components. In conclusion, high waist circumference, hypertension, cigarette smoking, and poor sleep quality were associated with the development of AF among young adults, suggesting the importance of maintaining these modifiable factors for the primordial prevention of AF in young adults.


Assuntos
Fibrilação Atrial/epidemiologia , Índice de Massa Corporal , Estilo de Vida , Medição de Risco/métodos , Adulto , Distribuição por Idade , Fatores Etários , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
Am J Cardiol ; 152: 150-157, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34140140

RESUMO

Serum uric acid (SUA) was reported to be associated with incident cardiovascular disease (CVD). However, the relationship between SUA and CVD among young adults has not been clarified yet. In this study, we aimed to identify the association of medication naïve SUA with incident CVD including myocardial infarction (MI), stroke, heart failure (HF) and atrial fibrillation (AF) using a nationwide epidemiological database. We analyzed 353,613 participants aged 20-49 years, who were not taking UA lowering medications, and had no prevalent history of cardiovascular disease (CVD) using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018. Median [interquartile range] age was 40 [34-44] years, and 46.9% were men. Over a mean follow-up of 1,176±876 days, 391 (0.1%) incident MI, 1,308 (0.4%) incident stroke, 3,374 (1.0%) incident HF, and 684 (0.2%) incident AF events occurred. Kaplan-Meier curves and the log-rank test showed that there was a significant difference in incident MI, stroke, HF, and AF among the groups based on SUA tertile (all log-rank p< 0.001). Multivariable Cox regression analysis showed that the upper tertile of SUA (SUA ≥ 5.7 mg/dL) was associated with higher incidence of MI (HR 1.45, 95% CI 1.00-2.10), HF (HR 1.13, 95% CI 1.01-1.28), and AF (HR 1.35, 95% CI 1.02-1.78) compared with the first tertile of SUA (SUA < 4.4 mg/dL). SUA as continuous variable was independently associated with incident MI (HR 1.10, 95% CI 1.00-1.20), stroke (HR 1.06, 95% CI 1.00-1.11), HF (HR 1.07, 95% CI 1.03-1.10), and AF (HR 1.11, 95% CI 1.04-1.19). SUA ≥ 7.0 mg/dL was independently associated with incident HF (HR 1.24, 95% CI 1.12-1.38). In conclusion, higher SUA was associated with increased incidence of CVD events in individuals aged< 50 years, suggesting the potential significance of the optimal UA control for the primary CVD prevention even in young adults.


Assuntos
Fibrilação Atrial/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hiperuricemia/epidemiologia , Infarto do Miocárdio/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Ácido Úrico/sangue , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Hiperuricemia/sangue , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-34171093

RESUMO

CONTEXT: Although diabetes mellitus (DM) was reported to be associated with incident colorectal cancer (CRC), the detailed association between fasting plasma glucose (FPG) and incident CRC has not been fully understood. OBJECTIVE: We assessed whether hyperglycemia is associated with a higher risk for CRC. DESIGN: Analyses were conducted using the JMDC Claims Database (n=1,441,311; median age [IQR], 46 [40-54] years; 56.6% men). None of the participants were taking antidiabetic medication or had a history of CRC, colorectal polyps, or inflammatory bowel disease. Participants were categorized as normal FPG, FPG level<100 mg/dL (1,125,647 individuals); normal-high FPG, FPG level=100-109 mg/dL (210,365 individuals); impaired fasting glucose (IFG), FPG level=110-125 mg/dL (74,836 individuals); and DM, FPG level≥126 mg/dL (30,463 individuals). RESULTS: Over a mean follow-up of 1,137±824 days, 5,566 CRC events occurred. After multivariable adjustment, the hazard ratios for CRC events were 1.10 (95% CI,1.03-1.18) for normal-high FPG, 1.24 (95% CI, 1.13-1.37) for IFG, and 1.36 (95% CI, 1.19-1.55) for DM vs. normal FPG. We confirmed this association in sensitivity analyses excluding those with a follow-up of< 365 days, and or with obese participants. CONCLUSION: The risk of CRC increased with elevated FPG category. FPG measurements would help identifying people at high-risk for future CRC.

12.
Am J Hypertens ; 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34008020

RESUMO

BACKGROUND: We aimed to explore the association between the blood pressure (BP) classification defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the prevalence of retinal atherosclerosis. METHODS: This study was a retrospective observational cross-sectional analysis using the JMDC Claims Database. We analyzed 280,599 subjects not taking any antihypertensive medications. According to the 2017 ACC/AHA guideline, each subject was categorized as having normal BP (n=159,524), elevated BP (n=35,603), stage 1 hypertension (n=54,795), or stage 2 hypertension (n=30,677) using the BP value at the initial health check-up. Retinal photographs were assessed according to the Keith-Wagener-Barker system. RESULTS: The median age was 46 years, and 50.4% subjects were men. Retinal atherosclerosis, defined as Keith-Wagener-Barker system grade ≥1, was observed in 3.2% in normal BP, 5.2% in elevated BP, 7.7% in stage 1 hypertension, and 18.7% in stage 2 hypertension. Compared with normal BP, elevated BP (OR;1.30, 95% CI;1.23-1.38), stage 1 hypertension (OR;1.71, 95% CI;1.64-1.79), and stage 2 hypertension (OR;4.10, 95% CI;3.93-4.28) were associated with a higher prevalence of retinal atherosclerosis. Among 92,121 subjects without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol consumption, elevated BP (OR;1.34, 95% CI;1.19-1.51), stage 1 hypertension (OR;1.79, 95% CI;1.61-1.98), and stage 2 hypertension (OR;4.42, 95% CI;4.00-4.92) were associated with a higher prevalence of retinal atherosclerosis. This association was observed in all subgroups stratified by age or sex. CONCLUSIONS: Our investigation suggests that retinal atherosclerosis could start even in individuals with elevated BP and stage 1 hypertension.

13.
Circulation ; 143(23): 2244-2253, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-33886370

RESUMO

BACKGROUND: Heart failure (HF) and atrial fibrillation (AF) are growing in prevalence worldwide. Few studies have assessed to what extent stage 1 hypertension in the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines is associated with incident HF and AF. METHODS: Analyses were conducted with a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018 (n=2 196 437; mean age, 44.0±10.9 years; 58.4% men). No participants were taking antihypertensive medication or had a known history of cardiovascular disease. Each participant was categorized as having normal BP (systolic BP <120 mm Hg and diastolic BP <80 mm Hg; n=1 155 885), elevated BP (systolic BP 120-129 mm Hg and diastolic BP <80 mm Hg; n=337 390), stage 1 hypertension (systolic BP 130-139 mm Hg or diastolic BP 80-89 mm Hg; n=459 820), or stage 2 hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg; n=243 342). Using Cox proportional hazards models, we identified associations between BP groups and HF/AF events. We also calculated the population attributable fractions to estimate the proportion of HF and AF events that would be preventable if participants with stage 1 and stage 2 hypertension were to have normal BP. RESULTS: Over a mean follow-up of 1112±854 days, 28 056 incident HF and 7774 incident AF events occurred. After multivariable adjustment, hazard ratios for HF and AF events were 1.10 (95% CI, 1.05-1.15) and 1.07 (95% CI, 0.99-1.17), respectively, for elevated BP; 1.30 (95% CI, 1.26-1.35) and 1.21 (95% CI, 1.13-1.29), respectively, for stage 1 hypertension; and 2.05 (95% CI, 1.97-2.13) and 1.52 (95% CI, 1.41-1.64), respectively, for stage 2 hypertension versus normal BP. Population attributable fractions for HF associated with stage 1 and stage 2 hypertension were 23.2% (95% CI, 20.3%-26.0%) and 51.2% (95% CI, 49.2%-53.1%), respectively. The population attributable fractions for AF associated with stage 1 and stage 2 hypertension were 17.4% (95% CI, 11.5%-22.9%) and 34.3% (95% CI, 29.1%-39.2%), respectively. CONCLUSIONS: Both stage 1 hypertension and stage 2 hypertension were associated with a greater incidence of HF and AF in the general population. The American College of Cardiology/American Heart Association BP classification system may help identify adults at higher risk for HF and AF events.

14.
Open Heart ; 8(1)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33846222

RESUMO

OBJECTIVE: The current status of surgical treatment for infective endocarditis (IE) among very elderly people is unclear. METHODS: We extracted data on patients in Japan with community-acquired IE who were admitted and discharged between April 2010 and February 2018 using a nationwide inpatient, the Diagnosis Procedure Combination database. We divided patients into three groups: non-elderly (<65 years), elderly (65-79 years) and very elderly (≥80 years). A 1:1 propensity score matching was performed to compare proportions of surgical treatment and in-hospital mortality among the groups. RESULTS: We identified 20 667 eligible patients (median age 70 years, 61.0% men). The proportion of very elderly patients significantly increased (19.1% in 2010 to 29.7% in 2018). The proportion of surgical treatment was significantly lower, and in-hospital mortality was significantly higher in very elderly patients. This tendency was more pronounced among patients with in-hospital complications such as heart failure, stroke or embolism. Surgical treatment was significantly associated with lower in-hospital mortality even in very elderly patients, both in an unmatched (OR 0.61; 95% CI 0.47 to 0.78) and a propensity score matched cohort (OR 0.61; 95% CI 0.43 to 0.85). CONCLUSIONS: The proportion of very elderly patients with IE was increasing, and very elderly patients had higher in-hospital mortality. The proportion of surgical treatment for IE among very elderly patients was low, but it was associated with lower in-hospital mortality. Further studies are needed to establish the optimal strategy for IE among very elderly patients.


Assuntos
Envelhecimento , Endocardite/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Pontuação de Propensão , Infecções Relacionadas à Prótese/cirurgia , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Gerenciamento de Dados , Endocardite/mortalidade , Seguimentos , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Prognóstico , Infecções Relacionadas à Prótese/mortalidade , Estudos Retrospectivos , Fatores de Tempo
15.
Circ J ; 85(6): 914-920, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-33551397

RESUMO

BACKGROUND: Obesity and metabolic disorders frequently coexist, and both are established risk factors for cardiovascular disease (CVD). Although the phenotype of obesity without metabolic disorders, referred to as metabolically healthy obesity (MHO), is attracting clinical interest, the pathophysiological impact of MHO remains unclear.Methods and Results:Using the Japan Medical Data Center database, we studied 802,288 subjects aged ≥20 years without any metabolic disorders or a prior history of CVD. MHO, defined as obesity (body mass index ≥25 kg/m2) with no metabolic disorders, was observed in 9.8% of the study population. The subjects' mean (±SD) age was 42.8±9.4 years and 44.7% were men. The mean follow-up period was 1,126±849 days. Multivariable Cox regression analysis showed that MHO alone did not significantly increase the risk of any CVD. However, abdominal obesity alone increased the risk of heart failure and atrial fibrillation. Moreover, the coexistence of MHO and abdominal obesity increased the risk of myocardial infarction, angina pectoris, heart failure, and atrial fibrillation. The incidence of stroke was not associated with the presence of MHO and abdominal obesity. CONCLUSIONS: Among individuals with no metabolic disorders, MHO alone did not significantly increase the subsequent CVD risk. However, individuals with comorbid MHO and abdominal obesity had a higher risk of myocardial infarction, angina pectoris, heart failure, and atrial fibrillation, suggesting the prognostic importance of abdominal obesity in subjects with MHO.

16.
Atherosclerosis ; 320: 79-85, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33581389

RESUMO

BACKGROUND AND AIMS: Epidemiological evidence on the relationship between eating behaviors, including breakfast skipping, late night dinner, and bedtime snacking, and cardiovascular disease (CVD) events among the general population is scarce. We sought to explore the association of eating behaviors with subsequent CVD using a nationwide epidemiological database. METHODS AND RESULTS: Medical records of 1,941,125 individuals without prior history of CVD were extracted from the Japan Medical Data Center contracting with more than 60 insurers from multiple regions in Japan, mainly including employed working-age individuals. Skipping breakfast <3 times per week, late night dinner <3 times per week, and bedtime snacking <3 times per week were defined as optimal eating behaviors. Median age was 45 (interquartile range 39-53) years, and 1,138,676 were men. Median follow-up period was 978 (interquartile range 481-1790) days. Among them, 948,805 individuals (48.9%) had optimal eating behaviors, whereas 647,383 individuals (33.4%), 283,017 individuals (14.6%), and 61,920 individuals (3.2%) had single, double, and triple non-optimal eating behaviors, respectively. Individuals with non-optimal eating behaviors were younger and more likely to be men. Obesity and high waist circumference were more commonly observed in those with non-optimal eating behaviors. Multivariable Cox regression analysis showed that, compared with no non-optimal eating behavior, having non-optimal eating behaviors would have higher risk of myocardial infarction, angina pectoris, stroke, and heart failure. However, the dose-response relationship was not clear in the association between the number of non-optimal eating behaviors and incident CVD. Multivariable Cox regression analysis after multiple imputation for missing values also showed the association between non-optimal eating behaviors and incident CVD. CONCLUSIONS: Using a nationwide epidemiological database, we found a possible relationship between eating behaviors including skipping breakfast, late night dinner, and bedtime snacking, and subsequent cardiovascular events among the general population, suggesting the potential importance of maintaining optimal eating behaviors for the primordial and primary CVD prevention in the general population.


Assuntos
Doenças Cardiovasculares , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Comportamento Alimentar , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Lanches
17.
Int Heart J ; 62(1): 4-8, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518664

RESUMO

Functional mitral regurgitation (FMR) frequently coexists with left ventricular systolic dysfunction and advanced heart failure, and typically has poor clinical outcomes. Although various therapeutic options including cardiac resynchronization therapy and surgical mitral intervention, have been proposed, an optimal treatment strategy for functional mitral regurgitation has not yet been established. Over the last decade, transcatheter mitral valve repair using MitraClip has emerged as a novel alternative therapeutic option for functional mitral regurgitation. In 2018, the COAPT trial demonstrated that MitraClip treatment reduced rehospitalization due to heart failure and all-cause death in patients with functional mitral regurgitation and heart failure. As a consequence, the MitraClip has become a very promising potential treatment for functional mitral regurgitation. In this review, we discuss and summarize the current status and future perspectives of the treatment for functional mitral regurgitation and heart failure.


Assuntos
Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/complicações , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/cirurgia , Humanos , Insuficiência da Valva Mitral/complicações
18.
BMC Cardiovasc Disord ; 21(1): 49, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33494701

RESUMO

BACKGROUND: Hospital volume is known to be associated with outcomes of patients requiring complicated medical care. However, the relationship between hospital volume and prognosis of hospitalized patients with heart failure (HF) remains not fully understood. We aimed to clarify the impact of hospital volume on clinical outcomes of hospitalized HF patients using a nationwide inpatient database. METHODS AND RESULTS: We studied 447,818 hospitalized HF patients who were admitted from January 2010 and discharged until March 2018 included in the Japanese Diagnosis Procedure Combination database. According to the number of patients, patients were categorized into three groups; those treated in low-, medium-, and high-volume centers. The median age was 81 years and 238,192 patients (53%) were men. Patients who had New York Heart Association class IV symptom and requiring inotropic agent within two days were more common in high volume centers than in low volume centers. Respiratory support, hemodialysis, and intra-aortic balloon pumping were more frequently performed in high volume centers. As a result, length of hospital stay was shorter, and in-hospital mortality was lower in high volume centers. Lower in-hospital mortality was associated with higher hospital volume. Multivariable logistic regression analysis fitted with generalized estimating equation indicated that medium-volume group (Odds ratio 0.91, p = 0.035) and high-volume group (Odds ratio 0.86, p = 0.004) had lower in-hospital mortality compared to the low-volume group. Subgroup analysis showed that this association between hospital volume and in-hospital mortality among overall population was seen in all subgroups according to age, presence of chronic renal failure, and New York Heart Association class. CONCLUSION: Hospital volume was independently associated with ameliorated clinical outcomes of hospitalized patients with HF.


Assuntos
Insuficiência Cardíaca/terapia , Hospitalização , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Japão , Tempo de Internação , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
Atherosclerosis ; 319: 35-41, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33465660

RESUMO

BACKGROUND AND AIMS: Using a nationwide epidemiological database, we aimed to clarify the association of fasting plasma glucose (FPG) with subsequent cardiovascular disease (CVD) risk among young adults. METHODS AND RESULTS: Medical records of 1,180,062 young adults (20-49 years old) without a prior history of CVD and who were not taking antidiabetic medications were extracted from the Japan Medical Data Center. We categorized the study population into four groups: normal, FPG level<100 mg/dL (1,007,747 individuals), normal-high, FPG level of 100-109 mg/dL (126,602 individuals), impaired fasting glucose (IFG), FPG level of 110-125 mg/dL (32,451 individuals), and diabetes mellitus (DM), FPG level ≥126 mg/dL (13,262 individuals). The mean age was 39.7 ± 6.9 years, and 57.0% of the study population were men. Mean follow-up period was 1201 ± 905 days on average. Multivariable Cox regression analysis showed that IFG (hazard ratio [HR]; 1.38) and DM (HR; 2.09) increased the risk of myocardial infarction. Normal-high (HR; 1.11), IFG (HR; 1.18), and DM (HR; 1.59) groups had an elevated angina pectoris risk. DM (HR; 1.31) increased the risk of stroke compared to normal FPG levels. Normal-high levels (HR; 1.10), IFG (HR; 1.22) and DM (HR; 1.58) elevated the risk of heart failure. DM (HR; 1.69) increased the risk of atrial fibrillation. CONCLUSIONS: Our analysis of a nationwide epidemiological database demonstrated a close association of the FPG category with subsequent CVD risk. Our results exemplify the importance of optimal FPG maintenance for the primary prevention of CVD in young adults.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Adulto , Glicemia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Jejum , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Am J Cardiol ; 145: 85-90, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33454342

RESUMO

Extensive data on early nutrition support for patients requiring critical care are available. However, whether early initiation of feeding could be beneficial for patients hospitalized for acute heart failure (HF) remains unclear. We sought to compare outcomes of early and delayed initiation of feeding for hospitalized patients with acute HF using a nationwide inpatient database. We retrospectively analyzed data from the Diagnosis Procedure Combination database. We included patients hospitalized for HF between January 2010 and March 2018. We excluded patients with length of hospital stay ≤2 days, those patients who underwent major procedures under general anesthesia, and those requiring advanced mechanical supports within 2 days after admission including intubation, intra-aortic balloon pumping, and extracorporeal membrane oxygenation. Propensity score matching and instrumental variable analyses were conducted to compare in-hospital mortality, complications and length of stay between the early and delayed feeding groups. Among 432,620 eligible patients, 403,442 patients (93%) received early initiation of feeding (within 2 days after admission) and 29,178 patients (7%) received delayed initiation of feeding. Propensity score matching created 29,153 pairs and delayed initiation of feeding was associated with higher in-hospital mortality (odds ratio 1.32; 95% confidence interval 1.26 to 1.39), longer hospital stay and higher incidence of pneumonia and sepsis. The instrumental variable analysis also showed patients with delayed initiation of feeding had higher in-hospital mortality (odds ratio 1.34; 95% confidence interval 1.28 to 1.40). In conclusion, our analysis suggested a potential benefit of early initiation of feeding for in-hospital outcomes in hospitalized patients hospitalized for acute HF. Further investigations are required to confirm our results and to clarify the underlying mechanisms.


Assuntos
Nutrição Enteral/métodos , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Pneumonia/epidemiologia , Sepse/epidemiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Japão/epidemiologia , Masculino , Pontuação de Propensão , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
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