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2.
Medicine (Baltimore) ; 98(34): e16927, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441878

RESUMO

Coronary artery disease (CAD) is a life-threatening medical emergency which needs urgent medical attention. Percutaneous coronary intervention (PCI) is common and necessary for patients with CAD. The effect of hypercholesterolemia and diabetes on long-term outcomes in patients with stable CAD receiving PCI is unclear.In this study, patients with stable CAD who underwent PCI were prospectively divided into 4 groups according to the presence or absence of diabetes or hypercholesterolemia. Clinical characteristics, risk factors, medications, angiographic findings, and outcome predictors were analyzed and long-term outcomes compared between groups.Of the 1676 patients studied, those with hypercholesterolemia and diabetes had the highest all-cause mortality rate after PCI (P < .01); those with diabetes only had the highest cardiovascular (CV) mortality (P < .01). However, the 4 groups did not differ in rates of myocardial infarction (MI) or repeated PCI. In Kaplan-Meier survival analysis, patients with diabetes only had the highest rates of all-cause mortality and CV mortality (both P < .001). In the Cox proportional hazard model, patients with both hypercholesterolemia and diabetes had the highest risk of all-cause mortality (hazard ratio: 1.70), but groups did not differ in rates of MI, CV mortality, and repeated PCI.With or without hypercholesterolemia, diabetes adversely impacts long-term outcomes in patients receiving PCI. Diabetes mellitus seemed to be a more hazardous outcome predictor than hypercholesterolemia. Hypercholesterolemia and diabetes seemed to have an additive effect on all-cause mortality in patients after receiving PCI.


Assuntos
Doença da Artéria Coronariana/mortalidade , Diabetes Mellitus/mortalidade , Hipercolesterolemia/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Estudos de Casos e Controles , Comorbidade , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
3.
High Blood Press Cardiovasc Prev ; 26(3): 227-237, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31228169

RESUMO

INTRODUCTION: Contribution of risk factors for cardiovascular-related deaths in the Eastern Mediterranean Region Organization (EMRO) is not estimated quantitatively. AIM: To determine the avoidable burden of cardiovascular diseases (CVDs) due to hypertension, diabetes, smoking, overweight, and obesity in countries of EMRO of the WHO. METHODS: The comparative risk assessment methodology was used to calculate the potential impact fraction (PIF) and percentage of the avoidable burden of CVD-related death due to associated risk factors. Population exposure levels for CVDs and corresponding measures of association were extracted from published studies. The attributable burden was calculated by multiplying the Disability-Adjusted Life-Years (DALYs) for CVDs by the estimated impact fraction of risk factors. DALYs of the CVDs in all countries of the EMRO were extracted from the GBD official website in 2016. RESULTS: Following reduction of the current prevalence of smoking, obesity, hypertension, diabetes, and overweight to a feasible minimum risk exposure level in Lebanon, about 12.4%, 4.2%, 10.2%, 3.8%, and 5.7% of the burden of CVD-related mortality could be avoidable, respectively. The corresponding values of avoidable burden in selected EMRO countries were 5.1%, 3.5%, 9.4%, 5.9% and 5.3% in Iran and 9.5%, 4.1%, 11%, 8.2% and 5.4% in Egypt. CONCLUSIONS: Findings suggest that health policy makers of all EMRO countries should take into account the attributable burden of CVD-related mortality due to associated risk factors to effectively develop preventive interventions.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , África do Norte/epidemiologia , Ásia/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Estilo de Vida Saudável , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/terapia , Obesidade/diagnóstico , Obesidade/mortalidade , Obesidade/terapia , Prevalência , Serviços Preventivos de Saúde , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Fumar/efeitos adversos , Fumar/mortalidade , Abandono do Hábito de Fumar
4.
Environ Health Prev Med ; 24(1): 38, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153356

RESUMO

OBJECTIVE: Few studies investigating associations between fine particulate air pollution and hemorrhagic stroke have considered subtypes. Additionally, less is known about the modification of such association by factors measured at the individual level. We aimed to investigate the risk of fatal intracerebral hemorrhage (ICH) incidence in case of PM2.5 (particles ≤ 2.5 µm in aerodynamic diameter) exposure. METHODS: Data on incidence of fatal ICH from 1 June 2012 to 31 May 2014 were extracted from the acute stroke mortality database in Shanghai Municipal Center for Disease Control and Prevention (SCDC). We used the time-stratified case-crossover approach to assess the association between daily concentrations of PM2.5 and fatal ICH incidence in Shanghai, China. RESULTS: A total of 5286 fatal ICH cases occurred during our study period. The averaged concentration of PM2.5 was 77.45 µg/m3. The incidence of fatal ICH was significantly associated with PM2.5 concentration. Substantial differences were observed among subjects with diabetes compared with those without; following the increase of PM2.5 in lag2, the OR (95% CI) for subjects with diabetes was 1.26 (1.09-1.46) versus 1.05 (0.98-1.12) for those without. We did not find evidence of effect modification by hypertension and cigarette smoking. CONCLUSIONS: Fatal ICH incidence was associated with PM2.5 exposure. Our results also suggested that diabetes may increase the risk for ICH incidence in relation to PM2.5.


Assuntos
Poluentes Atmosféricos/análise , Hemorragia Cerebral/mortalidade , Exposição Ambiental/estatística & dados numéricos , Material Particulado/análise , Acidente Vascular Cerebral/mortalidade , Causas de Morte , China/epidemiologia , Diabetes Mellitus/mortalidade , Feminino , Humanos , Incidência , Masculino , Tamanho da Partícula
5.
BMC Public Health ; 19(1): 719, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182076

RESUMO

BACKGROUND: The incidence and associated risk factors for premature death were investigated in a population-based cohort study in Iran. METHODS: A total of 7245 participants (3216 men), aged 30-70 years, were included. We conducted Cox proportional hazards models to identify the risk factors for premature death. For each risk factor, hazard ratio (HR), 95% confidence intervals (95% CI) and population attributable fraction (PAF) were calculated. RESULTS: After a median follow-up of 13.8 years, 262 premature deaths (153 in men) occurred. Underlying causes of premature deaths were cardiovascular disease (CVD) (n = 126), cancer (n = 51), road injuries (n = 15), sepsis and pneumonia (n = 9) and miscellaneous reasons (n = 61). The age-standardized incident rate of premature death was 2.35 per 1000 person years based on WHO standard population. Hypertension [HR 1.40, 95% CI (1.07-1.83)], diabetes (2.53, 1.94-3.29) and current smoking (1.58, 1.16-2.17) were significant risk factors for premature mortality; corresponding PAFs were 12.3, 22.4 and 9.2%, respectively. Overweight (body mass index (BMI): 25-29.9 kg/m2) (0.65, 0.49-0.87) and obesity (BMI ≥30 kg/m2) (0.67, 0.48-0.94) were associated with decreased premature mortality. After replacing general adiposity with central adiposity, we found no significant risk for the latter (0.92, 0.71-1.18). Moreover, when we excluded current smokers, those with prevalent cancer/cardiovascular disease and those with survival of less than 3 years, the inverse association between overweight (0.59, 0.39-0.88) and obesity (0.67, 0.43-1.04), generally remained unchanged; although, diabetes still showed a significant risk (2.62, 1.84-3.72). CONCLUSIONS: Controlling three modifiable risk factors including diabetes, hypertension and smoking might potentially reduce mortality events by over 40%, and among these, prevention of diabetes should be prioritized to decrease burden of events. We didn't confirm a negative impact of overweight and obesity status on premature mortality events.


Assuntos
Mortalidade Prematura/tendências , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/mortalidade , Causas de Morte , Estudos de Coortes , Diabetes Mellitus/mortalidade , Feminino , Humanos , Hipertensão/mortalidade , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Sobrepeso/mortalidade , Pneumonia/mortalidade , Modelos de Riscos Proporcionais , Fatores de Risco , Sepse/mortalidade , Fumar/mortalidade , Ferimentos e Lesões/mortalidade
6.
Eur J Epidemiol ; 34(8): 793-799, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30993509

RESUMO

Chronological age alone is not a sufficient measure of the true physiological state of the body. The aims of the present study were to: (1) quantify biological age based on a physiological biomarker composite model; (2) and evaluate its association with death and age-related disease onset in the setting of an elderly population. Using structural equation modeling we computed biological age for 1699 individuals recruited from the first and second waves of the Rotterdam study. The algorithm included nine physiological parameters (c-reactive protein, creatinine, albumin, total cholesterol, cytomegalovirus optical density, urea nitrogen, alkaline phosphatase, forced expiratory volume and systolic blood pressure). We assessed the association between biological age, all-cause mortality, all-cause morbidity and specific age-related diseases over a median follow-up of 11 years. Biological age, compared to chronological age or the traditional biomarkers of age-related diseases, showed a stronger association with all-cause mortality (HR 1.15 vs. 1.13 and 1.10), all-cause morbidity (HR 1.06 vs. 1.05 and 1.03), stroke (HR 1.17 vs. 1.08 and 1.04), cancer (HR 1.07 vs. 1.04 and 1.02) and diabetes mellitus (HR 1.12 vs. 1.01 and 0.98). Individuals who were biologically younger exhibited a healthier life-style as reflected in their lower BMI (P < 0.001) and lower incidence of stroke (P < 0.001), cancer (P < 0.01) and diabetes mellitus (P = 0.02). Collectively, our findings suggest that biological age based on the biomarker composite model of nine physiological parameters is a useful construct to assess individuals 65 years and older at increased risk for specific age-related diseases.


Assuntos
Envelhecimento/fisiologia , Biomarcadores/sangue , Adulto , Idade de Início , Idoso , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/mortalidade , Causas de Morte , Creatinina , Diabetes Mellitus/mortalidade , Feminino , Humanos , Longevidade , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Morbidade , Mortalidade , Estudos Prospectivos
7.
Gastroenterology ; 157(1): 119-127.e1, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30940524

RESUMO

BACKGROUND & AIMS: Bariatric surgery might reduce overall mortality from obesity. We investigated whether the survival times of patients who have had bariatric surgery are similar to those of the general population and are longer than of obese individuals who did not receive surgery. METHODS: We performed a population-based cohort study of persons with a diagnosis of obesity listed in nationwide registries from Nordic countries from 1980 through 2012. Bariatric surgery was analyzed in relation to all-cause mortality and the obesity-related morbidities cardiovascular disease, diabetes, cancer, and suicide. Poisson models provided standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). Multivariable Cox regression provided hazard ratios (HRs) for mortality in participants who did and did not have surgery. RESULTS: Among 505,258 participants, 49,977 had bariatric surgery. Overall all-cause SMR was increased after surgery (1.94; 95% CI, 1.83-2.05) and increased with longer follow-up, to 2.28 (95% CI, 2.07-2.51) at ≥15 years after surgery. SMRs were increased for cardiovascular disease (2.39; 95% CI, 2.17-2.63), diabetes (3.67; 95% CI, 2.85-4.72), and suicide (2.39; 95% CI, 1.96-2.92) but not for cancer (1.05; 95% CI, 0.95-1.17); SMRs increased with time. In obese participants who did not have surgery, all-cause SMR was 2.15 (95% CI, 2.11-2.20), which remained stable during follow-up. Compared with obese participants who did not have surgery, patients who had bariatric surgery had decreased overall mortality from all causes (HR, 0.63; 95% CI, 0.60-0.66), cardiovascular disease (HR, 0.57; 95% CI, 0.52-0.63), and diabetes (HR, 0.38; 95% CI, 0.29-0.49) but increased mortality from suicide (HR, 1.68; 95% CI, 1.32-2.14). Cancer mortality was decreased overall (HR, 0.84; 95% CI, 0.76-0.93) but increased at ≥15 years of follow-up (HR, 1.20; 95% CI, 1.02-1.42). CONCLUSIONS: In a study of persons with a diagnosis of obesity listed in nationwide registries of Nordic countries, we found that obese patients who have bariatric surgery have longer survival times than obese individuals who did not have bariatric surgery, but their mortality is higher than that of the general population and increases with time. Obesity-related morbidities could account for these findings.


Assuntos
Cirurgia Bariátrica , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/mortalidade , Mortalidade , Neoplasias/mortalidade , Obesidade/cirurgia , Suicídio/estatística & dados numéricos , Taxa de Sobrevida , Adulto , Estudos de Casos e Controles , Causas de Morte , Dinamarca/epidemiologia , Feminino , Finlândia/epidemiologia , Humanos , Islândia/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Noruega/epidemiologia , Obesidade/mortalidade , Modelos de Riscos Proporcionais , Suécia/epidemiologia
8.
Cardiovasc Diabetol ; 18(1): 52, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014348

RESUMO

BACKGROUND: Despite revascularisation, a large proportion of acute coronary syndrome (ACS) patients continue to experience major adverse cardiovascular events (MACEs), which are worsened by diabetes mellitus (DM). Fibrinogen (FIB) is a risk factor for MACEs in coronary artery disease and often elevated in DM. However, the relationships between FIB, glucose metabolism (haemoglobin A1c [HbA1c] and fasting blood glucose [FBG]) and MACEs following percutaneous coronary intervention (PCI) in DM, non-DM or whole patients with ACS remains unknown. METHODS: A total of 411 ACS patients undergoing PCI were enrolled in this study. We compared baseline FIB levels between DM (n = 103) and non-DM (n = 308) patients and divided participants into three groups according to FIB level, i.e. FIB-L, FIB-M and FIB-H, to compare baseline characteristics and MACEs. Linear regression analysis of the relationship between glucose metabolism and FIB, Cox regression, survival and landmark analyses of MACEs were also performed over a median of 27.55 months of follow-up. RESULTS: Patients with DM had higher FIB levels than non-DM patients (3.56 ± 0.99 mg/dL vs. 3.34 ± 0.80 mg/dL, P < 0.05). HbA1c and FBG were significantly positively correlated with FIB in whole and DM patients but not in non-DM patients (all P < 0.05). Compared with the FIB-L group, the FIB-M (hazard ratio [HR] 1.797, 95% CI 1.117-2.892, P = 0.016) and FIB-H (HR 1.664, 95% CI 1.002-2.763, P = 0.049) groups were associated with higher MACEs in whole; the FIB-M (HR 7.783, 95% CI 1.012-59.854, P = 0.049) was associated with higher MACEs in DM patients. FIB was not associated with MACEs in non-DM patients. During landmark analysis, FIB showed better predictive value for MACEs after PCI in the first 30 months of follow up than in the subsequent period. CONCLUSION: In this study from China, FIB was positively associated with glucose metabolism (HbA1c and FBG) in whole and DM populations with ACS. Moreover, elevated baseline FIB levels may be an important and independent predictor of MACEs following PCI, especially amongst those with DM. However, as the follow-up period increased, the baseline FIB levels lost their ability to predict MACEs.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Diabetes Mellitus/sangue , Fibrinogênio/análise , Hemoglobina A Glicada/análise , Intervenção Coronária Percutânea/efeitos adversos , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Idoso , Biomarcadores/sangue , Glicemia/análise , China , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Cardiovasc Diabetol ; 18(1): 47, 2019 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961600

RESUMO

BACKGROUND: The cardiovascular (CV) safety in terms of heart failure among different classes of treatment remains largely unknown. We sought to assess the comparative effect of these agents on heart failure outcomes. METHODS: This study was registered in the International Prospective Register of Systematic Reviews (CRD 42016042063). MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched. For the primary outcomes reported previously, studies between Jan 1, 1980 and June 30, 2016 were screened, and subsequently updated till Jan 24, 2019. We performed network meta-analysis to obtain estimates for the outcomes of heart failure, in particular by rankograms for ranking of heart failure risk as well as by pairwise comparisons among all classes of anti-diabetic medications. RESULTS: A total of 91 trials were included, among which were 171,253 participants and 4163 reported cases of heart failure events. As for rankograms, the surface under the cumulative ranking curves (SUCRA) of sodium-glucose co-transporters 2 and thiazolidinediones were 93.4% and 4.3%, respectively, signifying the lowest and highest risk of heart failure, respectively. As for pairwise comparisons in the network, sodium-glucose co-transporters 2 were significantly superior to insulin (OR: 0.75, 95% CI 0.62-0.91), dipeptidyl peptidase 4 inhibitors (OR: 0.68, 95% CI 0.59-0.78), glucagon-like peptide-1 receptor agonists (OR: 0.65, 95% CI 0.54-0.78), and thiazolidinediones (OR: 0.46, 95% CI 0.27-0.77) in terms of heart failure risk. Furthermore, in an exploratory analysis among subjects with underlying heart failure or at risk of heart failure, the superiority of sodium-glucose co-transporters 2 was still significant. CONCLUSIONS: In terms of heart failure risk, sodium-glucose co-transporters 2 were the most favorable option among all classes of anti-diabetic medications.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Humanos , Hipoglicemiantes/efeitos adversos , Incretinas/uso terapêutico , Substâncias Protetoras , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Resultado do Tratamento
10.
Cardiovasc Diabetol ; 18(1): 25, 2019 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-30851731

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains challenging even with modern drug-eluting stents (DES) due to high rates of repeat revascularization. Everolimus-eluting bioresorbable scaffolds (EE-BRS) might allow for repeat intervention prolonging the time interval of percutaneous treatment options. METHODS: The ABSORB DM Benelux Study is a dedicated prospective, international study to evaluate the midterm safety and efficacy of EE-BRS in DM patients. All DM patients that received ≥ 1 EE-BRS for any indication were enrolled and prospectively followed. Study endpoints were major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction (MI) and ischemic-driven target vessel revascularization (TVR); target lesion failure (TLF): a composite of cardiac death (CD), target vessel MI, and ischemic-driven target lesion revascularization (TLR), as well as definite or probable scaffold thrombosis (ScT). RESULTS: Between April 2015 till March 2017, 150 DM patients and 188 lesions were treated and followed up to 3 years. Device implantation success was 100%. MACE occurred in 15.2% (event rate of 8.8 per 100 PY). TLF was reported in 11.7% (7.0 events per 100 PY). CD, target vessel MI, ischemic-driven TLR occurred in 3.4%, 3.6% and 5.5% respectively, while ScT was observed in 1.4%. There were no occurrences of late or very late ScT. CONCLUSION: EE-BRS treatment in DM patients shows comparable midterm safety and efficacy outcomes when historically compared with modern DES. New-generation EE-BRS might offer an attractive alternative to metallic DES in treatment of fast progressing atherosclerosis population as in DM patients. Trial registration NTR5447. Registered 05 October 2015, retrospectively registered.


Assuntos
Implantes Absorvíveis , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus/epidemiologia , Everolimo/administração & dosagem , Intervenção Coronária Percutânea/instrumentação , Idoso , Fármacos Cardiovasculares/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Trombose Coronária/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Europa (Continente)/epidemiologia , Everolimo/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
J Affect Disord ; 249: 20-25, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30743018

RESUMO

BACKGROUND: Diabetes is a leading cause of death in the US. Adverse childhood experiences (ACEs) have also been linked to increased mortality. ACEs are associated with the development of diabetes however the amplified effect on mortality has not been studied. METHODS: Data from Midlife development in the United States (MIDUS), from 1995 to 1996 (Wave 1), 2004-2006 (Wave 2), and 2011-2014 (Wave 3) were used with a total of 3023 participants. Survey Cox proportional hazards regression models were used to calculate all-cause mortality. Univariate and multivariable Cox models were performed for the four combinations of diabetes and ACE categories, with estimation of hazard ratio completed for each. RESULTS: After adjusting for covariates and comorbidity burden, 'ACE only' was not significantly different in mortality compared to 'no diabetes and no ACE'. 'Diabetes only' had a 78% higher mortality (HR 1.78, 95% CI 1.04-3.04) compared to 'no diabetes and no ACE'. 'Diabetes and ACE' had a 132% higher mortality (HR 2.32, 95% CI 1.64-3.28) compared to 'no diabetes and no ACE'. LIMITATIONS: ACE and diabetes measures are self-report, and while longitudinal a temporal relationship cannot be established. Therefore, future research should collect prospective data to investigate mechanisms for this association based on observational data. CONCLUSIONS: Results showed a strong association between 'diabetes and ACE' and mortality with a pronounced difference between both 'ACE only' and 'diabetes only' after 20-year follow-up. These results suggest an amplified effect of diabetes and ACE on mortality for adults who have experienced ACEs.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Diabetes Mellitus/mortalidade , Adulto , Idoso , Causas de Morte , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
12.
Crit Care ; 23(1): 50, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777119

RESUMO

BACKGROUND: Recent studies have reported that preadmission metformin users had lower mortality than non-metformin users in patients with sepsis and diabetes mellitus; however, these results are still controversial. Therefore, we conducted a systematic review and meta-analysis of published observational cohort data to determine the association between preadmission metformin use and mortality in septic adult patients with diabetes mellitus. METHODS: The MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched from their inception to September 30, 2018. Cohort studies that evaluated the use of metformin in septic adult patients with diabetes mellitus were included. The quality of outcomes was evaluated using the Newcastle-Ottawa Scale (NOS). The inverse variance method with random effects modelling was used to calculate the pooled odds ratios (ORs) and 95% CIs. RESULTS: Five observational cohort studies (1282 patients) that were all judged as having a low risk of bias were included. In this meta-analysis, metformin use was associated with a significantly lower mortality rate (OR, 0.59; 95% CI, 0.43-0.79, P = 0.001). CONCLUSIONS: This meta-analysis indicated an association between metformin use prior to admission and lower mortality in septic adult patients with diabetes mellitus. This finding suggested that the possible effect of metformin should be evaluated in future clinical trials.


Assuntos
Diabetes Mellitus/mortalidade , Metformina/efeitos adversos , Admissão do Paciente/estatística & dados numéricos , Sepse/mortalidade , Mortalidade Hospitalar , Humanos , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Estudos Observacionais como Assunto
13.
Rev Saude Publica ; 53: 24, 2019 Feb 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30810661

RESUMO

OBJECTIVE: To describe diabetes mellitus mortality according to sex and age in a municipality in the state of São Paulo, in the period ranging from 2010 to 2014. METHODS: This was a temporal series ecological study carried out in Ribeirão Preto, state of São Paulo. The data was comprised of information on 583 deaths of Ribeirão Preto residents - regardless of the place of death - from 2010 to 2014. The data source was the electronic system of the Epidemiological Surveillance of the Municipal Health Department of the evaluated municipality. Sex, age group, premature death and year of death were chosen as variables. Subsequently, age-standardized mortality rates were calculated using the World Health Organization's standard population, in addition to total and average per death potential years of life lost. RESULTS: Mortality due to diabetes mellitus in the municipality increased during the studied period. There was a higher occurrence of female deaths, especially in the ≥ 80 years age group. The highest rates of age-standardized mortality were male. For both sexes, there was an annual mean increase of 9% in premature mortality during the studied period. Diabetes decreased life expectancy by 10 years. CONCLUSIONS: As a diagnosis of local health care, the significant increase in age-standardized mortality rates, premature mortality and potential years of life lost in the studied municipality point to the need for improvements in health promotion and disease prevention measures. It is our hope that the results presented in this study contribute to the monitoring of mortality rates in the coming years.


Assuntos
Diabetes Mellitus/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
14.
Rev Saude Publica ; 53: 20, 2019 Jan 31.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30726501

RESUMO

OBJECTIVE: To evaluate the impact of the expansion of access to medicines by the Programa Farmácia Popular do Brasil (PFPB - Brazilian Popular Pharmacy Program) on the indicators of hospitalizations and deaths by hypertension and diabetes. METHODS: To estimate the impact of the Brazilian Popular Pharmacy Program, the statistical model of fixed-effect difference in differences was used, considering: the divisions Rede Própria (RP - Proprietary Network) and Rede Conveniada (RC - Partnership Network); the exposure time of the municipality to the program; intramunicipal density, measured by the number of accredited establishments; and the coverage spillover effect into patients from nonparticipating municipalities. Data from 5,566 municipalities were used, for the period from 2003 to 2016, including: (i) administrative records of the PFPB, Sistema de Informações sobre Mortalidade (SIM - Information System on Mortality), and Sistema de Informações Hospitalares (SIH - Hospital Information System); ii) other health data managed by the Departamento de Informática do SUS (DATASUS - Department of Informatics of SUS); iii) sociodemographic data produced by the Brazilian Institute of Geography and Statistics (IBGE); and iv) data from the Relação Anual de Informações Sociais (RAIS - Annual List of Social Information). RESULTS: The expansion of access to medicines for treatment of hypertension and diabetes resulted in a meaningful and statistically significant reduction (p < 0.05) of the number of hospitalizations and deaths by these diseases, in an average annual rate of 27.6% and 8.0%, respectively. The observed impacts were induced by the partnership network, highlighting the density of establishments per 100,000 inhabitants and, above all, the exposure time of the municipality to the program as relevant to the effect. Evidence of a spillover effect and of the maintenance of impacts on different age groups, especially older people, were also observed. CONCLUSIONS: The strategy to expand access to medicines through the PFPB was effective in reducing hospitalizations and deaths by hypertension and diabetes in Brazil during the investigated period. Better understanding the impacts of the program is important to improve the pharmaceutical care policy, to ensure access to cost-effective treatments.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Medicamentos Essenciais/provisão & distribução , Hospitalização/estatística & dados numéricos , Hipertensão/tratamento farmacológico , Programas Nacionais de Saúde , Adulto , Brasil/epidemiologia , Doença Crônica/tratamento farmacológico , Diabetes Mellitus/mortalidade , Controle de Medicamentos e Entorpecentes , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências
15.
Diabetes Res Clin Pract ; 150: 48-56, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30807777

RESUMO

AIMS: To assess the impact of diabetes on the survival of older women, adjusted for other all-cause mortality predictors. METHODS: Data were used from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, when the women were aged 76-81 years at baseline, with linkage to the National Death Index. Survival curves were plotted to compare the survival of women with no diabetes, incident diabetes and prevalent diabetes over 15 years. Cox proportional hazards models were used to examine the association between diabetes and all-cause mortality risks. RESULTS: A total of 972 (11.7%) of 8296 eligible women reported either incident, 522 (6.3%) or prevalent, 450 (5.4%) diabetes. The median survival times were 10.1, 11.4 and 12.7 years among women with prevalent, incident and no diabetes, respectively. The risks of death were 30% [HR: 1.30 (95% CI: 1.16-1.45)] and 73% [HR: 1.73 (CI: 1.57-1.92)] higher for women with incident and prevalent diabetes compared to women without diabetes. These associations were sustained after controlling for demographics, body mass index, smoking status, comorbidities and health care use. CONCLUSIONS: This study revealed that diabetes is associated with reduced survival probabilities for older women with minimal moderation after adjustment for other predictors. Our findings suggest that diabetes management guidelines for older women need to integrate factors such as comorbidities, smoking and being underweight to reduce the risk of mortality.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus/mortalidade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Prevalência , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
16.
Biochimie ; 158: 111-116, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30611879

RESUMO

Half a decade ago, transmembrane protein fibronectin type III domain-containing protein 5 (FNDC5) was found to be cleaved as a novel myokine irisin, which burst into prominence for browning of white adipose tissue during exercise. However, FNDC5, the precursor of irisin, has been paid relatively little attention compared with irisin despite evidence that FNDC5 is associated with the metabolic syndrome, which accounts for one-fourth of the world's adult population and contributes to diabetes, cardiovascular disease and all-cause mortality. Besides N-terminal and C-terminal sequences, the FNDC5 protein contains an irisin domain and a short transmembrane region. FNDC5 has shown to be widely distribute in different tissues and is highly expressed in heart, brain, liver, and skeletal muscle. Clinical studies have demonstrated that FNDC5 is essential for maintaining metabolic homeostasis and dysregulation of FNDC5 will lead to systemic metabolism imbalance and the onset of metabolic disorders. Growing evidence has suggested that FNDC5 gene polymorphisms are related to health and disease in different human populations. Additionally, FNDC5 has been found relevant to the regulation of metabolism and metabolic syndrome through diverse upstream and downstream signaling pathways in experimental studies. The present review summarizes the characteristics, clinical significance, and molecular mechanisms of FNDC5 in metabolic syndrome and proposes a novel concept that FNDC5 is activated by forming a putative ligand-receptor complex. Knowledge about the role of FNDC5 may be translated into drug development and clinical applications for the treatment of metabolic disorders.


Assuntos
Fibronectinas , Síndrome Metabólica , Polimorfismo Genético , Transdução de Sinais/genética , Animais , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/patologia , Diabetes Mellitus/genética , Diabetes Mellitus/metabolismo , Diabetes Mellitus/mortalidade , Fibronectinas/genética , Fibronectinas/metabolismo , Humanos , Síndrome Metabólica/genética , Síndrome Metabólica/metabolismo , Síndrome Metabólica/mortalidade
17.
Diabetes Res Clin Pract ; 148: 169-178, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30641162

RESUMO

AIMS: Deaths attributable to diabetes may be underestimated using an underlying cause of death (COD) approach in U.S. death records. This study sought to characterize the burden of diabetes deaths using a multiple-cause of death approach (underlying and contributing COD) and to identify temporal changes in co-reported causes of death among those with diabetes listed anywhere on their death records. METHODS: COD were identified using data from the National Center for Health Statistics from 2003 to 2016. We calculated age-adjusted mortality rates for diabetes as the underlying or contributing COD by race/ethnicity. We used ICD-10 codes to identify leading causes of death among those with and without diabetes on their death records. We compared temporal changes in deaths due to cardiovascular disease, cerebrovascular disease, cancer, and other causes. RESULTS: The study population included 34,313,964 decedents aged ≥25 from 2003 to 2016. Diabetes was listed as an underlying COD in approximately 3.0% (n = 1,031,000) and 6.7% (n = 2,295,510) of the death records, respectively. Decedents with diabetes listed as an underlying COD experienced a 16% decline in mortality, and the race/ethnicity-specific average annual percentage changes (AAPC) showed significant declining trends for most groups (AAPC ranged from 0.18 to -2.83%). Cardiovascular disease remained the leading underlying COD among diabetes-attributable deaths, although its proportion of deaths fell from 31 to 27% over time. Co-reported COD diversified, and were more likely to include hypertension and hypertensive renal disease among those with diabetes on their death records. CONCLUSIONS: Our findings underscore the importance of using a multiple-cause-of-death approach for more completely characterizing diabetes' contribution to mortality.


Assuntos
Causas de Morte , Diabetes Mellitus/mortalidade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/mortalidade , Causalidade , Causas de Morte/tendências , Grupos de Populações Continentais , Atestado de Óbito , Diabetes Mellitus/etnologia , Grupos Étnicos , Feminino , Disparidades nos Níveis de Saúde , Humanos , Hipertensão/etnologia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade , Estados Unidos/epidemiologia
18.
Diabetes Care ; 42(3): 486-493, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30659073

RESUMO

OBJECTIVE: The prognostic value of long-term glycemic variability is incompletely understood. We evaluated the influence of visit-to-visit variability (VVV) of fasting blood glucose (FBG) on incident cardiovascular disease (CVD) and mortality. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort analysis including 4,982 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) who attended the baseline, 24-month, and 48-month visits. VVV of FBG was defined as the SD or variability independent of the mean (VIM) across FBG measurements obtained at the three visits. Participants free of CVD during the first 48 months of the study were followed for incident CVD (coronary heart disease [CHD], stroke, and heart failure [HF]) and all-cause mortality. RESULTS: Over a median follow-up of 5 years, there were 305 CVD events (189 CHD, 45 stroke, and 81 HF) and 154 deaths. The adjusted hazard ratio (HR) comparing participants in the highest versus lowest quartile of SD of FBG (≥26.4 vs. <5.5 mg/dL) was 1.43 (95% CI 0.93-2.19) for CVD and 2.22 (95% CI 1.22-4.04) for all-cause mortality. HR for VIM was 1.17 (95% CI 0.84-1.62) for CVD and 1.89 (95% CI 1.21-2.93) for all-cause mortality. Among individuals without diabetes, the highest quartile of SD of FBG (HR 2.67 [95% CI 0.14-6.25]) or VIM (HR 2.50 [95% CI 1.40-4.46]) conferred a higher risk of death. CONCLUSIONS: Greater VVV of FBG is associated with increased mortality risk. Our data highlight the importance of achieving normal and consistent glycemic levels for improving clinical outcomes.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glicemia/metabolismo , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/mortalidade , Hipolipemiantes/uso terapêutico , Visita a Consultório Médico/estatística & dados numéricos , Idoso , Glicemia/análise , Doenças Cardiovasculares/sangue , Causas de Morte , Doença das Coronárias/sangue , Doença das Coronárias/mortalidade , Doença das Coronárias/prevenção & controle , Diabetes Mellitus/sangue , Quimioterapia Combinada , Feminino , Seguimentos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Variações Dependentes do Observador , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo
19.
PLoS One ; 14(1): e0210809, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30668580

RESUMO

This study investigates the effects of the number of medical institutions visited on risk of death. This study conducted a nested case-control design using the National Health Insurance Service-Senior database from 2002 to 2013. Cases were defined as those with death among outpatients who had first diagnosis of diabetes mellitus (E10-E14) after entry into the base cohort and controls were selected by incidence density sampling and matched to cases based on age, and sex. Our main results were presented by conditional logistic regression for nested case-controls design. Of total 55,558 final study samples, there were 9,313 (16.8%) cases and 46,245 (83.2%) controls. With an increase by one point in the number of hospitals per medical utilization, risk of death significantly increased by 4.1% (odds ratio (OR): 1.041, 95% confidence interval [CI]: 1.039-1.043). In both medical utilization and number of hospitals, those with high medical utilization (OR: 1.065, 95% CI: 1.059-1.070) and number of hospitals (OR: 1.049, 95% CI: 1.041-1.058) for risk of death were significantly higher than those with low medical utilization (OR: 1.040, 95% CI: 1.037-1.043) and number of hospitals (OR: 1.029, 95% CI: 1.027-1.032), respectively. The number of medical institution visited was significantly associated with risk of death. Therefore, diabetics should be warned about the potential of risk of death incurred from excessive access to medical utilizations.


Assuntos
Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
20.
Cardiovasc Diabetol ; 18(1): 4, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30634972

RESUMO

BACKGROUND: Diabetes mellitus (DM) is a prevalent metabolic disease characterized by chronic hyperglycemia. A primary burden of DM is related to its long-term complications, which have been shown to impact the course of hospitalization and to influence patients' outcome. AIM: To assess the role of in-hospital glucose control on length of stay, 30-days and 1-year mortality. METHODS: This is a retrospective study that included patients admitted to the cardiac intensive care unit (CICU) of the Edith Wolfson Medical Centre between 01 January, 2010 and 31 December 2013. Blood glucose was measured by glucometer and fed into an interactive database. Glucose status was referred to as controlled when more than 50% of a given patients glucose values were between 71 and 200 mg/dL. Chisquared tests were used to assess the distribution of categorical variables, while the ttest was applied for continuous variables. A multivariate logistic regression model was used to analyze the association between glucose control and mortality. Cox regression was conducted to assess survival and 1-year mortality. RESULTS: 2466 patients were admitted to the CICU over the study period, of which 370 had concomitant diabetes mellitus. Controlled glucose status was associated with shorter length of hospital stay (1.6 ± 1.7 versus 2.6 ± 3.0, p < 0.001), reduced 30-day mortality (0.7% versus 4.6%, p < 0.001), and improved 1-year mortality (2.2% versus 7.5%, p < 0.001). Moreover, attainment of glucose control was independently associated with a significant decrease in 1-year mortality (OR = 0.371, 95% CI 0.140-0.988, p = 0.047). CONCLUSION: In-hospital control of glucose parameters is associated with shorter length of hospital stay, and lowered 30-day and 1-year mortality. An effort to maintain glucose levels within reference ranges is warranted in critically ill patients to reduce mortality.


Assuntos
Glicemia/efeitos dos fármacos , Unidades de Cuidados Coronarianos , Diabetes Mellitus/tratamento farmacológico , Cardiopatias/terapia , Unidades de Terapia Intensiva , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Estado Terminal , Bases de Dados Factuais , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Feminino , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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