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1.
BMC Cardiovasc Disord ; 21(1): 23, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413093

RESUMO

BACKGROUND: A high prevalence of cardiovascular risk factors including age, male sex, hypertension, diabetes, and tobacco use, has been reported in patients with Coronavirus disease 2019 (COVID-19) who experienced adverse outcome. The aim of this study was to investigate the relationship between cardiovascular risk factors and in-hospital mortality in patients with COVID-19. METHODS: MEDLINE, Cochrane, Web of Sciences, and SCOPUS were searched for retrospective or prospective observational studies reporting data on cardiovascular risk factors and in-hospital mortality in patients with COVID-19. Univariable and multivariable age-adjusted analyses were conducted to evaluate the association between cardiovascular risk factors and the occurrence of in-hospital death. RESULTS: The analysis included 45 studies enrolling 18,300 patients. The pooled estimate of in-hospital mortality was 12% (95% CI 9-15%). The univariable meta-regression analysis showed a significant association between age (coefficient: 1.06; 95% CI 1.04-1.09; p < 0.001), diabetes (coefficient: 1.04; 95% CI 1.02-1.07; p < 0.001) and hypertension (coefficient: 1.01; 95% CI 1.01-1.03; p = 0.013) with in-hospital death. Male sex and smoking did not significantly affect mortality. At multivariable age-adjusted meta-regression analysis, diabetes was significantly associated with in-hospital mortality (coefficient: 1.02; 95% CI 1.01-1.05; p = 0.043); conversely, hypertension was no longer significant after adjustment for age (coefficient: 1.00; 95% CI 0.99-1.01; p = 0.820). A significant association between age and in-hospital mortality was confirmed in all multivariable models. CONCLUSIONS: This meta-analysis suggests that older age and diabetes are associated with higher risk of in-hospital mortality in patients infected by SARS-CoV-2. Conversely, male sex, hypertension, and smoking did not independently correlate with fatal outcome.


Assuntos
/mortalidade , Doenças Cardiovasculares/mortalidade , Mortalidade Hospitalar , Fatores Etários , Análise de Variância , Doenças Cardiovasculares/etiologia , Diabetes Mellitus/mortalidade , Feminino , Humanos , Hipertensão/mortalidade , Masculino , Estudos Observacionais como Assunto , Viés de Publicação , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Fumar/mortalidade
2.
Harm Reduct J ; 18(1): 9, 2021 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-33453726

RESUMO

BACKGROUND: There is a lot of debate about the effects of smoking on COVID-19. A recent fixed-effects meta-analysis found smoking to be associated with disease severity among hospitalized patients, but other studies report an unusually low prevalence of smoking among hospitalized patients. The purpose of this study was to expand the analysis by calculating the prevalence odds ratio (POR) of smoking among hospitalized COVID-19 patients, while the association between smoking and disease severity and mortality was examined by random-effects meta-analyses considering the highly heterogeneous study populations. METHODS: The same studies as examined in the previous meta-analysis were analyzed (N = 22, 20 studies from China and 2 from USA). The POR relative to the expected smoking prevalence was calculated using gender and age-adjusted population smoking rates. Random-effects meta-analyses were used for all other associations. RESULTS: A total of 7162 patients were included, with 482 being smokers. The POR was 0.24 (95%CI 0.19-0.30). Unlike the original study, the association between smoking and disease severity was not statistically significant using random-effects meta-analysis (OR 1.40, 95%CI 0.98-1.98). In agreement with the original study, no statistically significant association was found between smoking and mortality (OR 1.86, 95%CI 0.88-3.94). CONCLUSION: An unusually low prevalence of smoking, approximately 1/4th the expected prevalence, was observed among hospitalized COVID-19 patients. Any association between smoking and COVID-19 severity cannot be generalized but should refer to the seemingly low proportion of smokers who develop severe COVID-19 that requires hospitalization. Smokers should be advised to quit due to long-term health risks, but pharmaceutical nicotine or other nicotinic cholinergic agonists should be explored as potential therapeutic options, based on a recently presented hypothesis.


Assuntos
/epidemiologia , Pacientes Internados/estatística & dados numéricos , Fumar/epidemiologia , Adulto , China/epidemiologia , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fumar/mortalidade , Estados Unidos/epidemiologia
4.
Interv Neuroradiol ; 26(5): 623-628, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32862753

RESUMO

BACKGROUND: This study evaluates the mortality risk of patients with emergent large vessel occlusion (ELVO) and COVID-19 during the pandemic. METHODS: We performed a retrospective cohort study of two cohorts of consecutive patients with ELVO admitted to a quaternary hospital from March 1 to April 17, 2020. We abstracted data from electronic health records on baseline, biomarker profiles, key time points, quality measures and radiographic data. RESULTS: Of 179 patients admitted with ischemic stroke, 36 had ELVO. Patients with COVID-19 and ELVO had a higher risk of mortality during the pandemic versus patients without COVID-19 (OR 16.63, p = 0.004). An age-based sub-analysis showed in-hospital mortality in 60% of COVID-19 positive patients between 61-70 years-old, 66.7% in between 51-60 years-old, 50% in between 41-50 years-old and 33.3% in between 31-40 years old. Patients that presented with pulmonary symptoms at time of stroke presentation had 71.4% mortality rate. 27.3% of COVID-19 patients presenting with ELVO had a good outcome at discharge (mRS 0-2). Patients with a history of cigarette smoking (p = 0.003), elevated d-dimer (p = 0.007), failure to recanalize (p = 0.007), and elevated ferritin levels (p = 0.006) had an increased risk of mortality. CONCLUSION: Patients with COVID-19 and ELVO had a significantly higher risk for mortality compared to COVID-19 negative patients with ELVO. A small percentage of COVID-19 ELVO patients had good outcomes. Age greater than 60 and pulmonary symptoms at presentation have higher risk for mortality. Other risk factors for mortality were a history of cigarette smoking, elevated, failure to recanalize, elevated d-dimer and ferritin levels.


Assuntos
Arteriopatias Oclusivas/mortalidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mortalidade Hospitalar , Humanos , Pneumopatias/etiologia , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Pandemias , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/mortalidade , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Resultado do Tratamento
5.
PLoS One ; 15(9): e0239866, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986786

RESUMO

INTRODUCTION: First study of social inequalities in tobacco-attributable mortality (TAM) in Spain considering the joint influence of sex, age, and education (intersectional perspective). METHODS: Data on all deaths due to cancer, cardiometabolic and respiratory diseases among people aged ≥35 years in 2016 were obtained from the Spanish Statistical Office. TAM was calculated based on sex-, age- and education-specific smoking prevalence, and on sex-, age- and disease-specific relative risks of death for former and current smokers vs lifetime non-smokers. As inequality measures, the relative index of inequality (RII) and the slope index of inequality (SII) were calculated using Poisson regression. The RII is interpreted as the relative risk of mortality between the lowest and the highest educational level, and the SII as the absolute difference in mortality. RESULTS: The crude TAM rate was 55 and 334 per 100,000 in women and men, respectively. Half of these deaths occurred among people with the lowest educational level (27% of the population). The RII for total mortality was 0.39 (95%CI: 0.35-0.42) in women and 1.61 (95%CI: 1.55-1.67) in men. The SII was -41 and 111 deaths per 100,000, respectively. Less-educated women aged <55 years and men (all ages) showed an increased mortality risk; nonetheless, less educated women aged ≥55 had a reduced risk. CONCLUSIONS: TAM is inversely associated with educational level in men and younger women, and directly associated with education in older women. This could be explained by different smoking patterns. Appropriate tobacco control policies should aim to reduce social inequalities in TAM.


Assuntos
Escolaridade , Fumar/mortalidade , Classe Social , Tabaco/efeitos adversos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Espanha/epidemiologia
6.
Tohoku J Exp Med ; 252(2): 103-107, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32938838

RESUMO

Coronavirus disease 2019 (COVID-19) is a global public health concern that can be classified as mild, moderate, severe, or critical, based on disease severity. Since the identification of critical patients is crucial for developing effective management strategies, we evaluated clinical characteristics, laboratory data, treatment provided, and oxygenation to identify potential predictors of mortality among critical COVID-19 pneumonia patients. We retrospectively utilized data from seven critical patients who were admitted to our hospital during April 2020 and required mechanical ventilation. The primary endpoint was to clarify potential predictor of mortality. All patients were older than 70 years, five were men, six had hypertension, and three ultimately died. Compared with survivors, non-survivors tended to be never smokers (0 pack-years vs. 30 pack-years, p = 0.08), to have higher body mass index (31.3 kg/m2 vs. 25.3 kg/m2, p = 0.06), to require earlier tracheal intubation after symptom onset (2.7 days vs. 5.5 days, p = 0.07), and had fewer lymphocytes on admission (339 /µL vs. 518 /µL, p = 0.05). During the first week after tracheal intubation, non-survivors displayed lower values for minimum ratio of the partial pressure of oxygen to fractional inspiratory oxygen concentration (P/F ratio) (44 mmHg vs. 122 mmHg, p < 0.01) and poor response to intensive therapy compared with survivors. In summary, we show that obesity and lymphopenia could predict the severity of COVID-19 pneumonia and that the trend of lower P/F ratio during the first week of mechanical ventilation could provide useful prognostic information.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Intubação Intratraqueal , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Fumar , Idoso , Betacoronavirus/fisiologia , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Estado Terminal/epidemiologia , Estado Terminal/mortalidade , Feminino , Hospitalização , Humanos , Intubação Intratraqueal/mortalidade , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Prognóstico , Radiografia Torácica , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/mortalidade , Fumar/terapia , Tomografia Computadorizada por Raios X
7.
Artigo em Inglês | MEDLINE | ID: mdl-32679883

RESUMO

Very few studies have examined the association between light cigarette smoking (i.e., ≤5 cigarettes per day) and mortality. The aim of this study was to examine the association of light cigarette smoking with all-cause and cause-specific mortality among adults in the United States. Data were from 13 waves of the National Health Interview Survey (1997 to 2009) that were linked to the National Death Index records through December 31, 2011. A total of 329,035 participants aged ≥18 years in the United States were included. Deaths were from all cause, cancer, cardiovascular disease (CVD) and respiratory disease and were confirmed by death certification. During a median follow-up of 8.2 years, 34,862 participants died, of which 8415 were from cancer, 9031 from CVD, and 2040 from respiratory disease. Compared with never-smokers, participants who smoked 1-2 (hazard ratios (HR) = 1.94, 95%CI = 1.73-2.16) and 3-5 cigarettes (HR = 1.99, 1.83-2.17) per day were at higher risk of all-cause mortality after adjustment for demographic variables, lifestyle factors and physician-diagnosis of chronic disease. The associations were stronger for respiratory disease-specific mortality, followed by cancer-specific mortality and CVD-specific mortality. For example, the HRs (95% CIs) of smoking 1-2 cigarettes per day were 9.75 (6.15-15.46), 2.28 (1.84-2.84) and 1.93 (1.58-2.36), respectively, for these three cause-specific mortalities. This study indicates that light cigarette smoking increases risk of all-cause and cause-specific mortality in US adults.


Assuntos
Doenças Cardiovasculares , Fumar Cigarros , Adulto , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Fumar Cigarros/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Masculino , Fatores de Risco , Fumar/efeitos adversos , Fumar/mortalidade , Estados Unidos/epidemiologia
8.
JAMA Netw Open ; 3(6): e206436, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32492162

RESUMO

Importance: An increasing proportion of US smokers smoke at low intensity and not every day. Some nondaily smokers have always had this pattern, whereas others previously smoked daily. The effect of reducing the level of smoking from daily to nondaily smoking and the dose response at low smoking levels are poorly understood. Objective: To evaluate risk of all-cause and cause-specific mortality among nondaily and daily cigarette smokers, by cigarettes per month, years after reducing from daily to nondaily smoking, and years since quitting. Design, Setting, and Participants: A prospective cohort study using harmonized data from multiple cycles of the Tobacco Use Supplements to the Current Population Survey (TUS-CPS), linked to the National Death Index, were analyzed during the period from 2018 to 2020. Adults completed the 1992-1993, 1995-1996, 1998-1999, 2000, 2001-2002, 2003, 2006-2007, or 2010-2011 TUS-CPS. Cigarette smokers were classified as daily or nondaily users; current nondaily smokers were further categorized by whether they previously smoked every day. Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for risks of mortality vs never smoking. Age was the underlying time metric, adjusted for sex, race/ethnicity, education, survey year, and household income. Results: Among 505 500 participants (aged 18-103 years), approximately 47 000 deaths occurred. The median number of cigarettes smoked per month was 600 (interquartile range, 300-600) (20 cigarettes per day [interquartile range, 10-20 cigarettes per day]) for daily cigarette smokers and 40 (interquartile range, 15-90) for lifelong nondaily smokers. Nevertheless, both current daily (HR, 2.32; 95% CI, 2.25-2.38) and lifelong nondaily (HR, 1.82; 95% CI, 1.65-2.01) smokers had higher all-cause mortality risks than never smokers. Associations were observed for 6 to 10 cigarettes per month and increased with greater-intensity use. Nondaily smokers who previously smoked every day had lower mortality risks than daily smokers, with similar HRs after 10 or more years of nondaily smoking as lifelong nondaily smokers (HR vs never smokers, 1.73; 95% CI, 1.56-1.92). Yet, their risks were higher than former smokers who quit 10 or more years before (HR vs never smokers, 1.18; 95% CI, 1.15-1.22). Conclusions and Relevance: Although reducing smoking from daily to nondaily was associated with decreased mortality risk, cessation was associated with far greater benefit. Lifelong nondaily smokers have higher mortality risks than never smokers, even among those smoking 6 to 10 cigarettes per month. Thus, all smokers should quit, regardless of how infrequently they smoke.


Assuntos
Fumantes/educação , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/mortalidade , Uso de Tabaco/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos Prospectivos , Medição de Risco , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Fumar/tendências , Abandono do Hábito de Fumar/métodos , Inquéritos e Questionários , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia
9.
Aliment Pharmacol Ther ; 52(2): 319-328, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32583929

RESUMO

BACKGROUND: The long-term natural history of microscopic colitis remains uncertain. AIM: To describe the mortality in a large unselected cohort of patients with microscopic colitis. METHODS: All Danish patients above 18 years with an incident diagnosis of microscopic colitis from 2001 to 2018 were identified from nationwide registries and compared to age- and sex-matched controls (variable 1:10 ratio). Patients were categorised according to subtypes: lymphocytic colitis and collagenous colitis. The relative risk of death by any cause was analysed with Cox regression models estimating both crude and comorbidity-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Cause-specific death was evaluated with cumulative incidence functions. An E-value was calculated to address the impact of unmeasured confounding. RESULTS: The final cohort consisted of 14 024 patients with microscopic colitis. The mean follow-up was 5.8 (standard deviation SD, 2.9) years and the mean age at diagnosis was 61.1 (SD 13.9) years, 70% were women and 41% were diagnosed with lymphocytic colitis. The main results showed a 25% increased risk of all-cause death in patients with microscopic colitis; however, the relative risk was attenuated to 9% when adjusting for comorbidities (95% CI, 1.05-1.14). The E-value indicates that unmeasured confounding could explain the residual observed increased all-cause mortality. Mortality was significantly increased in patients with both lymphocytic colitis (HR 1.15; 95% CI, 1.08-1.23) and collagenous colitis (HR 1.06; 95% CI, 1.01-1.12) in fully adjusted analyses. The absolute difference in death between patients with microscopic colitis and matches was 0.9% at 1 year, 2.8% at 5 years, 5.0% at 10 years and 3.0% at 15 years. Cumulative incidence functions showed that patients with microscopic colitis were more likely to die due to smoking-related diseases including ischemic heart and lung diseases, but had a significant decreased risk of death due to colorectal cancers (P < 0.0001). CONCLUSION: In an unselected large nationwide cohort of patients with microscopic colitis, the risk of death was significantly increased compared to the background population. However, the increased mortality seemed to be associated to a high burden of comorbidities and unmeasured life-style factors including smoking and not microscopic colitis per se.


Assuntos
Colite Colagenosa/mortalidade , Colite Linfocítica/mortalidade , Adolescente , Adulto , Idoso , Causas de Morte , Criança , Pré-Escolar , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fumar/mortalidade , Adulto Jovem
10.
J Stroke Cerebrovasc Dis ; 29(8): 104896, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32417238

RESUMO

INTRODUCTION: The mortality and morbidity rates of stroke in men and women have been reported differently and its effective factors have been discussed. The purpose of this study was to investigate sex differences in 28-day mortality of ischemic stroke and its associated factors. MATERIALS AND METHODS: This is a prospective cohort study conducted from June 2018 to September 2019 in patients with ischemic stroke referred to Firoozgar, Shariati and Sina hospitals in Tehran. Demographic data, risk factors, disease history, drug use, severity of stroke, and patient functional status were recorded in the hospital. The patients' functional status and severity of stroke were measured using the Modified Ranking Scale (MRS) and the National Institutes of Health Stroke Scale (NIHSS). After 28 days, the patients' survival status was monitored. Logistic regression was used to analyze the data. RESULTS: In this study, 703 patients were enrolled; of them, 260 (37.00%) were female and 443 (63.00%) were male. After 28 days, 21 female cases (8.17%) and 26 male (6.08%) ones died (P = 0.299). Functional status (OR = 4.65; 95%CI: 2.09 to 10.38), diastolic blood pressure (OR = 0.91; 95%CI: 0.85 to 0.96), warfarin use (OR = 0.15; 95%CI: 0.04 to 0.55), and hemoglobin (OR = 1.17; 95%CI: 1.02 to 1.35) were associated with 28-day mortality. Poor functional status in men had a greater association with 28-day mortality than women (OR 4.65 vs. 1.64). High diastolic blood pressure had a negative association with the 28-day mortality of cases and this association is more in women than in men (OR 0.88 vs. 0.91). High hemoglobin is a risk factor in men and a protective factor in 28-day mortality in women (OR 1.73 vs. 0.73). Smoking also had a greater association with 28-day mortality in women than men (OR 2.67 vs. 1.2). DISCUSSION: Twenty eight-day mortality was more in women than in men, but this difference was not significant. Women were older, had more severe stroke and poorer functional status than men. Variables including functional status, diastolic blood pressure, hemoglobin level, and smoking had interaction with sex, and their association with 28-day mortality rate was different between men and women. Sex differences should be considered, so that we can better manage stroke patients.


Assuntos
Isquemia Encefálica/mortalidade , Disparidades nos Níveis de Saúde , Acidente Vascular Cerebral/mortalidade , Fatores Etários , Idoso , Biomarcadores/sangue , Pressão Sanguínea , Isquemia Encefálica/diagnóstico , Feminino , Nível de Saúde , Hemoglobinas/metabolismo , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/efeitos adversos , Fumar/mortalidade , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
12.
PLoS Comput Biol ; 16(4): e1007768, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32302299

RESUMO

Mediation analysis with high-dimensional DNA methylation markers is important in identifying epigenetic pathways between environmental exposures and health outcomes. There have been some methodology developments of mediation analysis with high-dimensional mediators. However, high-dimensional mediation analysis methods for time-to-event outcome data are still yet to be developed. To address these challenges, we propose a new high-dimensional mediation analysis procedure for survival models by incorporating sure independent screening and minimax concave penalty techniques for variable selection, with the Sobel and the joint method for significance test of indirect effect. The simulation studies show good performance in identifying correct biomarkers, false discovery rate control, and minimum estimation bias of the proposed procedure. We also apply this approach to study the causal pathway from smoking to overall survival among lung cancer patients potentially mediated by 365,307 DNA methylations in the TCGA lung cancer cohort. Mediation analysis using a Cox proportional hazards model estimates that patients who have serious smoking history increase the risk of lung cancer through methylation markers including cg21926276, cg27042065, and cg26387355 with significant hazard ratios of 1.2497(95%CI: 1.1121, 1.4045), 1.0920(95%CI: 1.0170, 1.1726), and 1.1489(95%CI: 1.0518, 1.2550), respectively. The three methylation sites locate in the three genes which have been showed to be associated with lung cancer event or overall survival. However, the three CpG sites (cg21926276, cg27042065 and cg26387355) have not been reported, which are newly identified as the potential novel epigenetic markers linking smoking and survival of lung cancer patients. Collectively, the proposed high-dimensional mediation analysis procedure has good performance in mediator selection and indirect effect estimation.


Assuntos
Biologia Computacional/métodos , Modelos Estatísticos , Análise de Sobrevida , Adulto , Idoso , Idoso de 80 Anos ou mais , Metilação de DNA/genética , Epigenômica , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Pessoa de Meia-Idade , Fumar/genética , Fumar/mortalidade
13.
J Cardiovasc Pharmacol Ther ; 25(5): 418-424, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32338045

RESUMO

BACKGROUND: The benefit of cytochrome P450 (CYP450) enzyme system metabolized medications, especially clopidogrel, was reported more pronounced in smoking than nonsmoking patients, but limited evidence was available from Asian patients. We analyzed data from a large registry-based study of Chinese patients with acute myocardial infarction (AMI) to understand if the above finding could be reproduced. METHODS: A total of 14 658 patients with AMI were prospectively recruited from 101 hospitals across China. Generalized estimating equation was applied to assess the association between CYP450 enzyme system metabolized medications (clopidogrel, statins, calcium channel blockers) and in-hospital death in smoking and nonsmoking patients, separately, adjusting for hospital clustering effects and propensity score of using the medication in question. RESULTS: There were 86%, 93%, and 10% of study patients who received clopidogrel, statins, and calcium channel blockers during the hospitalization. Compared with patients not receiving clopidogrel, patients receiving the drug had a significantly lower risk of in-hospital death (adjusted relative risk [RR] = 0.61, 95% confidence interval [CI]: 0.40-0.91) in current smokers but an insignificant lower risk (adjusted RR = 0.85, 95% CI: 0.71-1.01) in nonsmokers, and the P for interaction was <.01. The corresponding adjusted RR was 0.45 (95% CI: 0.24-0.86) in current smokers and 0.94 (95% CI: 0.68-1.29) in nonsmokers (P for interaction <.01) for statins use and 1.00 (95% CI: 0.53-1.89) in current smokers and 0.66 (95% CI: 0.48-0.90) in nonsmokers (P for interaction = .23) for calcium channel blockers use. CONCLUSIONS: Our study in a large cohort of Chinese patients with AMI found that the treatment effect in reducing risk of in-hospital death was significantly larger in smokers than in nonsmokers as for clopidogrel and statins but not for calcium channel blockers.


Assuntos
Clopidogrel/uso terapêutico , Sistema Enzimático do Citocromo P-450/metabolismo , Mortalidade Hospitalar , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Fumantes , Fumar/efeitos adversos , Idoso , Biotransformação , Bloqueadores dos Canais de Cálcio/metabolismo , Bloqueadores dos Canais de Cálcio/uso terapêutico , China/epidemiologia , Clopidogrel/metabolismo , Feminino , Hospitalização , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/metabolismo , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , não Fumantes , Estudos Prospectivos , Antagonistas do Receptor Purinérgico P2Y/metabolismo , Sistema de Registros , Medição de Risco , Fatores de Risco , Fumar/metabolismo , Fumar/mortalidade , Fatores de Tempo , Resultado do Tratamento
15.
PLoS One ; 15(1): e0227692, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945095

RESUMO

BACKGROUND: Life-style interventions, including smoking cessation and weight control are of importance for managing future escalating prevalence of obesity. Smoking habits and obesity have jointly great impact on mortality, however mechanisms behind the effect and variables involved in the obesity paradox is still unknown. OBJECTIVES: This study examines risk factors for all-cause, cardiovascular, and cancer mortality in males and females with high cardiovascular risk, mediated by smoking habits, body mass index (BMI, kg/m2), and serum phosphate (S-P) levels. METHODS: Patients were admitted to the Vindeln Patient Education Center in groups of 30 for a four-week residential comprehensive program (114 hours) focusing on smoking cessation, stress reduction, food preferences and selections, and physical exercise. The follow-up, in years from 1984 to 2014 corresponds to 30 years. This study included 2,504 patients (1,408 females and 1,096 males). Cox regression analysis was used to assess mortality risk associated with smoking habits, low and high BMI, and low and high S-P levels. RESULTS: High BMI (>34,2 kg/m2), current smoking, type 2 diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic blood pressure (SBP, mmHg) were associated with all-cause mortality irrespective of sex. Former and current smoking females had a high all-cause mortality (adjusted hazard ratio [HR] 1.581; 95% CI 1.108-2.256, adjusted hazard ratio [HR] 1.935; 95% CI 1.461-2.562, respectively) while current smoking and high BMI increased risk for cardiovascular mortality (adjusted hazard ratio [HR] 3.505; 95% CI 2.140-5.740 and [HR] 1.536; 95% CI 1.058-2.231, respectively). Neither low nor high levels of S-P predicted all-cause, cardiovascular disease (CVD) and cancer mortality in males or females while low levels of S-P predicted all-cause mortality in smokers (adjusted hazard ratio [HR] 1.713; 95% CI 1.211-2.424). In non-smokers, low BMI (<27.6 kg/m2) was protecting and high BMI a risk for all-cause mortality. In males, ischemic heart disease (IHD), and low serum albumin (S-Alb) were associated with all-cause mortality. In females, an interaction between high BMI and smoking (HbmiSM) decreased the cardiovascular mortality (adjusted hazard ratio [HR] 0.410; 95% CI 0.179-0.937, respectively). CONCLUSIONS: High BMI and current smoking were associated with all-cause mortality in both males and females in the present high cardiovascular-risk cohort. In current smokers and non-smokers, T2DM and high S-Ca were associated with an increase in all-cause mortality, while low S-P was associated with all-cause mortality in smokers. Interaction between high BMI and smoking contribute to the obesity paradox by being protective for cardiovascular mortality in females.


Assuntos
Promoção da Saúde/métodos , Obesidade/mortalidade , Fosfatos/sangue , Fumar/mortalidade , Adulto , Índice de Massa Corporal , Estudos de Coortes , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/terapia , Fatores de Risco , Fumar/sangue , Fumar/terapia , Abandono do Hábito de Fumar , Suécia/epidemiologia , Programas de Redução de Peso
16.
BMC Public Health ; 20(1): 39, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924192

RESUMO

BACKGROUND: Of all lifestyle behaviours, smoking caused the most deaths in the last century. Because of the time lag between the act of smoking and dying from smoking, and because males generally take up smoking before females do, male and female smoking epidemiology often follows a typical double wave pattern dubbed the 'smoking epidemic'. How are male and female deaths from this epidemic differentially progressing in high-income regions on a cohort-by-age basis? How have they affected male-female survival differences? METHODS: We used data for the period 1950-2015 from the WHO Mortality Database and the Human Mortality Database on three geographic regions that have progressed most into the smoking epidemic: high-income North America, high-income Europe and high-income Oceania. We examined changes in smoking-attributable mortality fractions as estimated by the Preston-Glei-Wilmoth method by age (ages 50-85) across birth cohorts 1870-1965. We used these to trace sex differences with and without smoking-attributable mortality in period life expectancy between ages 50 and 85. RESULTS: In all three high-income regions, smoking explained up to 50% of sex differences in period life expectancy between ages 50 and 85 over the study period. These sex differences have declined since at least 1980, driven by smoking-attributable mortality, which tended to decline in males and increase in females overall. Thus, there was a convergence between sexes across recent cohorts. While smoking-attributable mortality was still increasing for older female cohorts, it was declining for females in the more recent cohorts in the US and Europe, as well as for males in all three regions. CONCLUSIONS: The smoking epidemic contributed substantially to the male-female survival gap and to the recent narrowing of that gap in high-income North America, high-income Europe and high-income Oceania. The precipitous decline in smoking-attributable mortality in recent cohorts bodes somewhat hopeful. Yet, smoking-attributable mortality remains high, and therefore cause for concern.


Assuntos
Países Desenvolvidos/estatística & dados numéricos , Epidemias , Disparidades nos Níveis de Saúde , Fumar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Humanos , Expectativa de Vida/tendências , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Oceania/epidemiologia , Distribuição por Sexo , Fumar/mortalidade , Análise de Sobrevida
17.
Lancet Diabetes Endocrinol ; 8(2): 125-133, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31924561

RESUMO

BACKGROUND: To reduce their overall substantially increased risk of cardiovascular disease and premature mortality, smoking cessation is especially important for people with diabetes. However, the effect of weight change after quitting smoking on the long-term health consequences of smoking cessation is unclear. We aimed to examine smoking cessation and subsequent weight change in relation to incident cardiovascular disease events and mortality among adults with type 2 diabetes. METHODS: In this population-based cohort study, we analysed data from people with type 2 diabetes from two prospective cohorts in the USA: the Nurses' Health Study (1976-2014) and the Health Professionals Follow-Up Study (1986-2014). We included participants from both cohorts who either had prevalent type 2 diabetes or were diagnosed during the study, and who were either current smokers or never smokers without cardiovascular disease or cancer at diagnosis of diabetes. Information on demographics, newly diagnosed diseases, medical history, and lifestyle factors, including smoking status and weight change, was updated every 2 years through validated questionnaires. We assessed the incidence of cardiovascular disease and all-cause and cause-specific mortality among recent quitters (within 6 years of stopping) and long-term quitters (>6 years) associated with weight change within 6 years of smoking cessation among people with type 2 diabetes. We did a multivariable-adjusted Cox proportional hazard models to estimate hazard ratios (HRs) for the associations of smoking cessation and weight change on the outcomes. FINDINGS: Of 173 229 total cohort participants (121 700 from the Nurses' Health Study and 51 529 from the Health Professionals Follow-Up Study), 10 809 people with type 2 diabetes were included in the incident cardiovascular disease analysis and 9688 were included in the mortality analysis. 2580 incident cases of cardiovascular disease occurred during 153 166 person-years of follow-up, and 3827 deaths occurred during 152 811 person-years of follow-up. Recent quitters (2-6 consecutive years since smoking cessation) without weight gain within the first 6 years of quitting had a significantly lower risk of cardiovascular disease than people who continued to smoke (multivariable-adjusted HR 0·83 [95% CI 0·70-0·99] among all recent quitters, 0·77 [0·62-0·95] among recent quitters without weight gain, 0·99 [0·70-1·41] among recent quitters with weight gain of 0·1-5·0 kg, 0·89 [0·65-1·23] among recent quitters with weight gain of >5·0 kg, and 0·72 [0·61-0·84] among longer-term quitters [>6 consecutive years since smoking cessation]). Weight gain within 6 years after smoking cessation did not attenuate the inverse relation between long-term cessation and all-cause mortality (multivariable-adjusted HR 0·69 [95% CI 0·58-0·82] among long-term quitters without weight gain, 0·57 [0·45-0·71] among long-term quitters with weight gain of 0·1-5·0 kg, and 0·51 [0·42-0·62] among long-term quitters with weight gain of >5·0 kg), with similar results observed for cardiovascular disease and cancer mortality. INTERPRETATION: Smoking cessation without subsequent weight gain is associated with a reduced risk of cardiovascular disease and mortality among smokers with type 2 diabetes. Weight gain after smoking cessation attenuates the reduction in risk of developing cardiovascular disease, but does not attenuate the beneficial effect of smoking cessation with respect to mortality. These findings confirm the overall health benefits of quitting smoking among people with type 2 diabetes, but also emphasise the importance of weight management after smoking cessation to maximise its health benefits. FUNDING: US National Institutes of Health.


Assuntos
Diabetes Mellitus Tipo 2/mortalidade , Obesidade/mortalidade , Abandono do Hábito de Fumar , Fumar/mortalidade , Ganho de Peso/fisiologia , Adulto , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Comportamento de Redução do Risco , Estados Unidos/epidemiologia
18.
Eur J Epidemiol ; 35(9): 835-841, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31970573

RESUMO

This article provides a detailed and overarching illustration of the contribution of smoking to sex differences in life expectancy at birth (e0) in Europe, focusing on changes over time and differences between both European countries and European regions. For this purpose, the sex difference in e0 for 31 European countries over the 1950-2014 period was decomposed into a smoking- and a non-smoking-related part, using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex, and a formal decomposition analysis. It was found that smoking-attributable mortality contributed, on average, 3 years (43.5%) to the 7-year life expectancy difference between women and men in 2014. This contribution, was largest in 1995, at 5.2 out of 9.0 years, and subsequently declined in parallel with the average sex difference in life expectancy. The average contribution of smoking-attributable mortality was especially large in North-Western Europe around 1975; in Southern Europe around 1985; and in Eastern Europe around 1990-1995, when smoking-attributable mortality reached maximum levels among men, but was still low among women. The observed parallel decline from 1995 onwards in the sex differences in e0 and the absolute contribution of smoking to this sex difference suggests that this recent decline in the sex difference in e0 can be almost fully explained by historical changes in sex differences in smoking, and, consequently, smoking-attributable mortality. In line with the progression of the smoking epidemic, the sex differences in life expectancy in Europe are expected to further decline in the future.


Assuntos
Expectativa de Vida/tendências , Fumar/mortalidade , Adulto , Causas de Morte , Epidemias , Europa (Continente)/epidemiologia , Europa Oriental/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Prevalência , Distribuição por Sexo , Fumar/efeitos adversos
19.
Am J Respir Crit Care Med ; 201(9): 1099-1109, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31995399

RESUMO

Rationale: Smoking results in at least a decade lower life expectancy. Mortality among current smokers is two to three times as high as never smokers. DNA methylation is an epigenetic modification of the human genome that has been associated with both cigarette smoking and mortality.Objectives: We sought to identify DNA methylation marks in blood that are predictive of mortality in a subset of the COPDGene (Genetic Epidemiology of COPD) study, representing 101 deaths among 667 current and former smokers.Methods: We assayed genome-wide DNA methylation in non-Hispanic white smokers with and without chronic obstructive pulmonary disease (COPD) using blood samples from the COPDGene enrollment visit. We tested whether DNA methylation was associated with mortality in models adjusted for COPD status, age, sex, current smoking status, and pack-years of cigarette smoking. Replication was performed in a subset of 231 individuals from the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) study.Measurements and Main Results: We identified seven CpG sites associated with mortality (false discovery rate < 20%) that replicated in the ECLIPSE cohort (P < 0.05). None of these marks were associated with longitudinal lung function decline in survivors, smoking history, or current smoking status. However, differential methylation of two replicated PIK3CD (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta) sites were associated with lung function at enrollment (P < 0.05). We also observed associations between DNA methylation and gene expression for the PIK3CD sites.Conclusions: This study is the first to identify variable DNA methylation associated with all-cause mortality in smokers with and without COPD. Evaluating predictive epigenomic marks of smokers in peripheral blood may allow for targeted risk stratification and aid in delivery of future tailored therapeutic interventions.


Assuntos
Biomarcadores Tumorais/sangue , Metilação de DNA , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/genética , Doença Pulmonar Obstrutiva Crônica/mortalidade , Fumar/genética , Fumar/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Epigênese Genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
BMC Cardiovasc Disord ; 20(1): 16, 2020 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959121

RESUMO

BACKGROUND: Acute heart failure is a rapid onset of new or worsening of signs and symptoms of heart failure that requires hospitalization or a visit to the emergency department. The aim of this study was to evaluate treatment outcome and determine factors that predict a poor treatment outcome in acute heart failure patients at a Tertiary Care Hospital in Ethiopia. METHODS: A prospective observational study design was used. Data were collected using a structured questionnaire as a tool. Outcome variables were assessed at the time of discharge from the hospital. Bivariate and multivariate logistic regression analyses were used to determine factors that predict in-hospital mortality. A p-value ≤0.05 was considered as statistically significant. RESULTS: Out of the 169 patients, the median age of patients with acute heart failure was 34 years (IQR = 23 to 50) and median hospital stay was 4.0 days (IQR = 3.0 to 6.0). The leading precipitating factor and underlying disease at the time of admission were pneumonia (47.5%) and chronic rheumatic heart disease (48.5%), respectively. The in-hospital mortality was found to be 17.2%. Smoking (adjusted odds ratio (AOR) = 8.7, p = 0.006), diabetes mellitus (AOR = 10.2, p = 0.005), pulmonary hypertension (AOR = 4.3, p = 0.016), and the presence of adverse drug events (AOR = 4.2, p = 0.003) were predictors of in-hospital mortality. CONCLUSION: High in-hospital mortality was observed among acute heart failure patients admitted to a Tertiary Care Hospital in Ethiopia. Smoking, diabetes mellitus, pulmonary hypertension and the presence of adverse drug events were predictors of in-hospital mortality.


Assuntos
Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Centros de Atenção Terciária , Doença Aguda , Adulto , Diabetes Mellitus/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Etiópia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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