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Multivariate Adjustment (multivariate + adjustment)
Selected AbstractsStatin use in Type 2 diabetes mellitus is associated with a delay in starting insulinDIABETIC MEDICINE, Issue 9 2004A. Yee Abstract Aims It has been suggested that HMG Co-A reductase inhibitors (,statins') may reduce the risk of developing Type 2 diabetes mellitus. This study was designed to evaluate whether use of statins would also delay progression to insulin therapy. Methods This was a retrospective cohort study using Saskatchewan Health databases to identify subjects newly started on oral antidiabetic agents from 1991 to 1996. Subjects < 30 years of age or with previous lipid-lowering drug use were excluded. Medications known to influence glycaemic control, co-morbidity, and demographic data were collected. Statin exposure was defined as at least 1 year of use. Primary outcome was starting insulin treatment. Multivariate Cox proportional hazards models were used to examine the association between statin use and starting insulin. Results The final cohort included 10 996 new users of oral antidiabetic agents, of which 484 (4.4%) used statins. Mean age was 64 years and 55% were male. Mean duration of follow-up was 5.1 years; 11.1% (n = 1221) eventually started insulin treatment. Statin users were no less likely than non-users to start insulin treatment eventually (11.6% vs. 11.1%, P = 0.74). After multivariate adjustment, however, statin use was associated with a 10-month delay before newly treated diabetic subjects needed to start insulin treatment (adjusted hazard ratio 0.74; 95% confidence interval 0.56, 0.97, P = 0.028). Conclusion The use of statins is associated with a delay in starting insulin treatment in patients with Type 2 diabetes initially treated with oral antidiabetic agents. Whether this relationship exists for patients at high risk of developing diabetes should be examined in a randomized trial. [source] Spatial QRS-T angle: association with diabetes and left ventricular performanceEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 9 2006Ch. Voulgari Abstract Background, The spatial QRS-T angle obtained by vectorcardiography is a combined measurement of the electrical activity of the heart and predicts cardiovascular morbidity and mortality. Disturbances in repolarization and depolarization are common in diabetes. No data, however, exist on the effect of diabetes on QRS-T angle. In this study we examined differences in QRS-T angle between type 2 diabetic and non-diabetic subjects; in addition, the potential relationship between QRS-T angle and left ventricular performance as well as glycaemic control were also examined. Patients and methods, A total of 74 subjects with type 2 diabetes and 74 non-diabetic individuals, matched for age and sex with the diabetic subjects were examined. All subjects were free of clinically apparent macrovascular complications. Spatial vectorcardiogaphic descriptors of ventricular depolarization and repolarization were reconstructed from the 12-electrocardiographic leads using a computer-based electrocardiogram. Left ventricular mass and performance were measured using M-mode and Doppler echocardiography. Results, QRS-T angle values were higher (by almost 2-fold) in the diabetic in comparison with the non-diabetic subjects (P < 0·001). After multivariate adjustment, QRS-T angle was independently associated with age (P = 0·01), HbA1c (P = 0·003), and low-density lipoprotein cholesterol levels (P = 0·04) in the non-diabetic, and with HbA1c (P = 0·03) as well as Tei index (P = 0·003) in the diabetic subjects. Conclusions, The spatial QRS-T angle is high in subjects with type 2 diabetes and is associated with glycaemic control and left ventricular performance. The prognostic importance of the higher spQRS-T angle values in subjects with diabetes remains to be evaluated in prospective studies. [source] Percutaneous Coronary Intervention, Comorbidities, and Mortality among Emergency Department,Admitted ST-Elevation Myocardial Infarction Patients in FloridaJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2010ELIZABETH BARNETT PATHAK Ph.D., F.A.H.A., M.S.P.H. Background: Risk of mortality following an ST-elevation myocardial infarction (STEMI) can be significantly reduced by prompt percutaneous coronary intervention (PCI). National guidelines specify primary PCI as the preferred recommended treatment for STEMI. In this study, we examined same-day PCI as an independent predictor of in-hospital mortality, after adjustment for comorbidities, other patient factors, and hospital PCI-volume using unselected surveillance data from Florida. Methods: We analyzed hospital discharge data for adults, 18+ years old, with a primary diagnosis of STEMI who were admitted to PCI-capable hospitals through the emergency department during 2001,2005 (n = 43,849). Hierarchical (multilevel) logistic regression models were used for analysis. Results: Overall, 4,143 STEMI patients (9.4%) did not survive to hospital discharge. In late 2005, the in-hospital mortality rates were 1.9% for those who received same-day PCI versus 13.0% for those who did not. After adjustment for multiple patient factors, same-day PCI was a significant predictor of in-hospital survival with a strong protective effect (adjusted OR = 0.35, 95% CI 0.31,0.38 P < 0.0001). Restriction of the analysis to those patients who survived the first day of admission did not appreciably change this result (adjust OR = 0.37, 95% CI 0.33,0.42, P < 0.0001). Hospital PCI-volume did not significantly impact mortality risk. Conclusions: Same-day PCI markedly reduced the risk of in-hospital mortality among STEMI patients after multivariate adjustment. Serious comorbidities and complications, older age, and female gender continued to predict elevated risk of mortality after control for treatment status. Our results provide additional evidence in support of national clinical recommendations and aggressive treatment of STEMI. (J Interven Cardiol 2010;23:205,215) [source] Association Between the Functional Polymorphism of Catechol- O -Methyltransferase Gene and Alcohol Consumption Among Social DrinkersALCOHOLISM, Issue 2 2000Jussi Kauhanen Background: A common functional genetic polymorphism in the catechol- O -methyltransferase (COMT) gene (Val158 Met) results in 3- to 4-fold differences in COMT enzyme activity and dopamine inactivation rate. Previous studies have shown that type I alcoholism is more common among subjects with low activity COMT genotype (LL), compared with high activity (HH) or heterozygotic (LH) genotypes. Methods: We studied alcohol consumption and the COMT genotype in middle-aged Finnish men (n= 896), who represented an unselected ethnically homogenous population sample and reported using alcohol during the past year. Average alcohol use in pure ethanol (grams per week) was compared between subjects with LL genotype and subjects with LH or HH genotypes. Results: Men with LL genotype (30% of all subjects) reported 27% higher weekly alcohol consumption compared with the two other genotype groups (p < 0.05). The difference remained statistically significant after a multivariate adjustment for sociodemographic factors and prior or existing diseases (p= 0.031). Conclusions: The results indicate that COMT polymorphism may contribute significantly to alcohol intake not only in alcoholics but also in a general male population. [source] Body mass index and mortality in patients with acute venous thromboembolism: findings from the RIETE registryJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2008R. BARBA Summary.,Background:,There is little information on the influence of body mass index (BMI) on mortality in patients with acute venous thromboembolism (VTE). Patients and methods:,RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We examined the association between BMI and mortality during the first 3 months of therapy. Results:,Of the 10 114 patients enrolled as of March 2007: 153 (1.5%) were underweight (BMI < 18.5); 2882 (28%) had a normal weight (BMI 18.5,24.9); 4327 (43%) were overweight (BMI 25.0,30); and 2752 (27%) were obese (BMI > 30). The overweight and obese patients were significantly older, and were less likely to have had cancer, recent immobility or renal insufficiency. After 3 months of therapy their death rates were 28%, 12%, 6.2% and 4.2%, respectively. In multivariate analysis, the relative risks for death after adjusting for confounding variables including age, cancer, renal insufficiency or idiopathic VTE were: 2.1 (95% CI, 1.5,2.7); 1.0 (reference); 0.6 (95% CI, 0.5,0.7); and 0.5 (95% CI, 0.4,0.6), respectively. The rates of fatal pulmonary embolism (2.0%, 2.1%, 1.2% and 0.8%, respectively) also decreased with BMI. There were no differences in the rate of fatal bleeding, but patients who were underweight had an increased incidence of major bleeding complications (7.2% vs. 2.7%; odds ratio, 2.7; 95% CI, 1.4,5.1). Conclusions:,Obese patients with acute VTE have less than half the mortality rate when compared with normal BMI patients. This reduction in mortality rates was consistent among all subgroups and persisted after multivariate adjustment. [source] Impact of Renal Function on Survival in Patients with Implantable Cardioverter-DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2007MINTU P. TURAKHIA M.D. Background:Although chronic renal insufficiency (CRI) is associated with increased cardiac and noncardiac mortality, there is limited data on the relationship between CRI and survival in patients with implantable cardioverter-defibrillators (ICDs), particularly across a wide range of renal function. Methods:We studied 507 consecutive patients receiving first-time ICDs from 1993,2003 at a single center. Preimplant serum creatinine measurements were used to determine glomerular filtration rate (GFR) and stage of chronic kidney disease (CKD). The primary outcome was time to death. Results:During a mean follow-up of 4 years, all-cause mortality through completion of follow-up increased stepwise by GFR stage (I: 16%, II: 20%, III: 35%; IV: 40%; V: 50%; P < 0.001 for trend). After multivariate adjustment, CRI was independently associated with death (HR = 1.7, P = 0.02), as were a serum creatinine ,2.0 mg/dL (HR 2.5, P = 0.003) and the presence of end-stage renal disease (HR 6.8; P < 0.001). For every 10-unit decrease in GFR, the adjusted hazard of death increased 12% (P = 0.04). Conclusion:The presence of CRI prior to implant is independently associated with increased mortality in patients receiving ICDs. The risk is proportional to the degree of renal dysfunction and is apparent even when GFR is only mildly reduced. Differences in mortality are observed within the first year of implant, and patients on dialysis are at highest risk. Because randomized trials of ICDs have not included large numbers of patients with moderate or severe renal disease, our findings may have important implications in prognosis and case selection of patients who otherwise meet current indications for ICD implantation. [source] A prospective study of cardiovascular risk factors and incident hearing loss in men,,THE LARYNGOSCOPE, Issue 9 2010Josef Shargorodsky MD Abstract Objectives/Hypothesis: Hearing loss is the most common sensory disorder in the United States, affecting more than 36 million people. Cardiovascular risk factors have been associated with the risk of hearing loss in cross-sectional studies, but prospective data are currently lacking. Study Design: Prospective cohort study. Methods: We prospectively evaluated the association between diagnosis of hypertension, diabetes mellitus, hypercholesterolemia, smoking, or body mass index (BMI) and incident hearing loss. Participants were 26,917 men in the Health Professionals Follow-up Study, aged 40 to 74 years at baseline in 1986. Study participants completed questionnaires about lifestyle and medical history every 2 years. Information on self-reported professionally diagnosed hearing loss and year of diagnosis was obtained from the 2004 questionnaire, and cases were defined as hearing loss diagnosed between 1986 and 2004. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox proportional hazards regression models. Results: A total of 3,488 cases of hearing loss were identified. History of hypertension (HR 0.96; 95% confidence interval [CI], 0.88-1.03), diabetes mellitus (HR 0.92; 95% CI, 0.78,1.08), or obesity (HR 1.02; 95% CI, 0.90,1.15 for BMI ,30 compared to normal range of 19,24.9) was not significantly associated with hearing-loss risk. Hypercholesterolemia (HR 1.10; 95% CI, 1.02,1.18) and past smoking history (HR 1.09; 95% CI, 1.01,1.17) were associated with a significantly increased risk of hearing loss after multivariate adjustment. Conclusions: A history of hypertension, diabetes mellitus, or obesity is not associated with increased risk of hearing loss; a history of past smoking or hypercholesterolemia has a small but statistically significant association with increased risk of hearing loss in adult males. Laryngoscope, 2010 [source] Radiation Response Genotype and Risk of Differentiated Thyroid Cancer: A Case-Control Analysis,THE LARYNGOSCOPE, Issue 6 2005Erich M. Sturgis MD Abstract Background: Radiation is the only clear etiologic agent for differentiated thyroid cancer (DTC). Understanding the factors affecting sensitivity to gamma radiation and susceptibility to DTC will be critical to early detection and prevention of DTC. Hypothesis: Germline variants of double-strand break repair genes are markers of DTC risk. Objective: Determine the frequency of common single nucleotide polymorphisms of genes of the double-strand break repair pathway in patients with DTC and cancer-free controls. Study Design: Case-control study. Methods: This study included 134 patients with DTC, 79 patients with benign thyroid lesions, and 166 cancer-free control subjects. To avoid ethnic confounding, all subjects were non-Hispanic whites. Genotype analyses were performed on DNA isolated from peripheral blood lymphocytes. Multivariate logistic regression analyses were performed to estimate the risk of DTC associated with each variant genotype. Results: The XRCC3 18067T polymorphic allele was found significantly more commonly among the DTC cases than for the control subjects (P = .006). After multivariate adjustment, having the XRCC3 18067T allele was associated with an increased risk of DTC (adjusted odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3 to 3.4; P = .004). In addition, there was a suggestion that the XRCC3 18067T polymorphic allele was more common among the patients with benign thyroid disease (P = .054), and the homozygous polymorphic genotype was associated with risk for benign thyroid disease (adjusted OR = 2.1; 95% CI = 0.9,4.9; P = .078). Conclusions: In this case-control analysis, the XRCC3 18067T polymorphism is associated with DTC risk. However, such work needs confirmation in larger studies. [source] Decongestant use during pregnancy and its association with preterm deliveryBIRTH DEFECTS RESEARCH, Issue 9 2010Rohini K. Hernandez Abstract BACKGROUND Despite the frequent intake of decongestants during pregnancy, only one study to date has evaluated the association of decongestants with preterm delivery, and it identified a reduced risk. We examined this association in more detail. METHODS Using a population-based random sample of 3271 Massachusetts live-born births without major malformations, we categorized decongestant exposure according to timing, frequency of use, route, and indication. Preterm birth was defined as a gestational age of <37 completed weeks. We estimated hazard ratios and examined confounding by indication by examining various strata of women and through multivariate adjustment. RESULTS Compared to nonexposed women, those who took decongestants during the second or third trimester only were less likely to experience preterm delivery (HR, 0.42; 95% CI, 0.21,0.84). This association was observed only for women without preeclampsia. CONCLUSIONS A protective association between decongestant use and preterm delivery has now been observed in two studies; however, the possibility of confounding by underlying condition remains. Birth Defects Research (Part A), 2010. © 2010 Wiley-Liss, Inc. [source] Mononuclear cell infiltration in clear-cell renal cell carcinoma independently predicts patient survivalCANCER, Issue 1 2006W. Scott Webster MD Abstract BACKGROUND The impact of mononuclear cell infiltration on renal cell carcinoma (RCC) biology has been controversial, previously reported to be associated with either a favorable or unfavorable prognosis. The objective of the current study was to evaluate associations between mononuclear cell infiltration in routinely prepared paraffin-embedded specimens with survival in patients with clear-cell RCC. METHODS A total of 306 patients were identified treated with nephrectomy for clear-cell RCC between 1990 and 1994. A single urologic pathologist, blinded to patient outcome, reviewed the specimens and quantified the extent of mononuclear cell infiltration as absent, focal, moderate, or marked. Cancer-specific survival was estimated using the Kaplan,Meier method. Associations of mononuclear cell infiltration with death from RCC were assessed using Cox proportional hazards regression models. RESULTS At last follow-up, 173 of the 306 patients studied had died, including 96 patients who died from RCC. Mononuclear cell infiltration was absent in 165 (54%), focal in 70 (23%), moderate in 53 (17%), and marked in 18 (6%). Univariately, patients with specimens that had mononuclear cell infiltration were over 2 times more likely to die from RCC compared with patients whose specimens exhibited no mononuclear cell infiltration (risk ratio, 2.63; P<.001). After adjusting for the Mayo Clinic SSIGN (stage, size, grade, and necrosis) score, patients with specimens that had mononuclear cell infiltration exhibited a significantly increased likelihood of dying from RCC compared with patients whose specimens had no mononuclear cell infiltration (risk ratio, 1.61; P = .028). CONCLUSIONS Mononuclear cell infiltration is associated with death from RCC even after multivariate adjustment. Routine documentation of mononuclear cell infiltration is recommended during the pathologic assessment of RCC. Cancer 2006. © 2006 American Cancer Society. [source] A Systematic Review of Gender Differences in Mortality after Coronary Artery Bypass Graft Surgery and Percutaneous Coronary InterventionsCLINICAL CARDIOLOGY, Issue 10 2007Catherine Kim M.D., M.P.H. Abstract Gender differences exist in outcomes, particularly early mortality, for percutaneous interventions (PCI) and coronary artery bypass graft surgery (CABG). Better understanding of this issue may target areas for improvement for all patients undergoing revascularization. Therefore, we summarized the evidence on gender differences in PCI and CABG outcomes, particularly early mortality, and mediators of this difference. Using the key terms "women" or "gender," "revascularization," "coronary artery bypass," "angioplasty," "stent," and "coronary intervention," we searched MEDLINE from 1985 to 2005 for all randomized controlled trials (RCTs) and registries reporting outcomes by gender. Bibliographies and the Web sites of cardiology conferences were also reviewed. The literature was examined to identify gender differences in outcomes and mediators of these differences. We identified 23 studies reporting outcomes by gender for CABG and 48 studies reporting outcomes by gender for PCI. The majority of studies noted greater in-hospital mortality in women than in men, with mortality differences resolving with longer follow-up. Early mortality differences were reduced but not consistently eliminated after adjustment for comorbidities, procedural characteristics, and body habitus. Power to detect gender differences after multivariate adjustment was limited by declining mortality rates and small sample size. Gender was an independent risk factor for complications after both CABG and PCI. Women experience greater complications and early mortality after revascularization. Future exploration is needed of gender differences in quality of care and benefit from combinations of stenting and antiplatelet, and anticoagulant medications in order to optimize treatment. Copyright © 2007 Wiley Periodicals, Inc. [source] Cigarette smoking is an independent risk factor for type 2 diabetes: a four-year community-based prospective studyCLINICAL ENDOCRINOLOGY, Issue 5 2009Nam H. Cho Summary Objectives, We investigated the association between smoking and its additive effects with insulin resistance and ,-cell function on the incidence of type 2 diabetes in a prospective population-based cohort study. Design and method, A total of 10 038 subjects were recruited from rural and urban areas. All subjects underwent 75 g oral glucose tolerance tests and full biochemical assessments at baseline and during 4-year follow-up period. The final analysis was limited to 4041 men due to the low smoking rates in women. Results, The ex- and heavy current smokers had the highest incidence of diabetes of 12·5% and 11·1% respectively, compared with never-smokers (7·9%) during 4 years. After multivariate adjustment by Cox-proportional hazard model, ex- and current smokers reveal a relative risk of 1·60 (95% CI: 1·07,2·39), 2·06 (1·35,3·16, for <20 cigarettes/day) and 2·41 (1·48,3·93, for ,20 cigarettes/day) respectively compared with never smokers. The risk of new onset diabetes was the highest in those with low homeostasis model assessment for beta cell function (HOMA-,) and high homeostasis model assessment for insulin resistance (HOMA-IR) group in both smokers and never smokers. Conclusions, Smoking is an independent risk factor for type 2 diabetes mellitus and showed synergistic interaction with the status of low insulin secretion and high insulin resistance for developing diabetes. Given the high rates of smoking and growing burden of diabetes in the world, cessation of smoking should be considered as one of the key factors for diabetes prevention and treatment programmes. [source] | ||||||||||