Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
Vascular repair after firearm injury is associated with increased morbidity a...anomwiradana
This study analyzed data from 648,662 patients with firearm injuries between 1993-2014 using the National Inpatient Sample database. The key findings were:
1) 9.9% (63,973) of firearm injuries involved a concurrent vascular repair, with these patients more likely to be younger, male, black, on Medicaid, and have lower income.
2) Patients undergoing vascular repair had higher injury severity scores and were more likely to have abdomen/pelvis or extremity injuries from assault.
3) Patients undergoing vascular repair had higher rates of in-hospital mortality (5.51% vs 1.98%), acute renal failure, venous thromboembolic events, pulmonary complications, cardiac complications, sepsis
KMorton Gender dimorphism and its effect on mortality in traumatically brain ...Karissa Morton
This study investigated the effect of gender dimorphism on mortality in 962 patients with traumatic brain injury (TBI) admitted between 2000-2009. The mean age of patients was 41.12 years and males were younger than females. No significant differences in mortality between males and females were found overall or when stratified by age. Females had significantly longer hospital and ICU stays than males. Logistic regression also found no gender to be a significant risk factor for mortality in TBI patients. The study concluded that no association between gender and mortality was identified.
Jennifer Tremmel - Sex Differences In Cardiovascular DiseaseClayman Institute
This document discusses sex differences in cardiovascular disease. It summarizes that historically, heart disease studies primarily enrolled men. Women represent about half of cardiovascular disease patients but were underrepresented in clinical trials. Risk factors like diabetes and obesity confer greater relative risk of cardiovascular events in women than men. Symptom presentation of heart disease can differ between sexes, with women more likely to experience atypical symptoms. Guidelines recommend against menopausal hormone therapy for primary or secondary prevention of cardiovascular disease in women.
The CIBMTR score predicts survival of AML patients undergoing allogeneic tran...Mina Max
This study retrospectively analyzed 523 acute myeloid leukemia patients undergoing allogeneic hematopoietic stem cell transplantation with active disease from 20 Italian centers to validate the CIBMTR pre-transplantation risk score. The CIBMTR score uses 5 pre-transplant variables to stratify patients into groups with 3-year overall survival rates ranging from 42% to 6%. The study found the CIBMTR score predicted survival in this cohort, with hazard ratios confirming worse survival for shorter first complete remission duration, non-sibling donor, higher blast percentage, and lower Karnofsky score. Multivariate analysis validated the CIBMTR score as prognostic for this larger patient population including both myeloabl
Methylenetetrahydrofolate Reductase Gene (MTHFR_677CT) Associated with the de...ijsrd.com
Globally, Depression is widespread neuropsychiatric disorders affecting around 5% of the population and has been described as millennia linked with neurobiology showing association with direct neuro-chemicals and biochemical incredible factors, interact with "gene-gene", "gene-environment" as long as a scaffold potential for better exploration. The aetiology of depression is still unknown but believes to be the interaction between gene and environment including some of the other factors responsible for development of depression. The PCR-RFLP analysis of MTHFR (C677T) gene showed 0.45% in CT (heterozygous) genotype in patients of depression in comparison to controls (0.15%), suggesting increased risk of depression in those individuals. However, the odd ratio was also calculated at 95% confidence interval for MTHFR C677T gene which revealed non- significant difference between cases and control, may be because of small sample size.
Interheart risk modifiable factors in micardio infraction 2004Medicina
This document summarizes the objectives and methods of the INTERHEART study, a large international case-control study designed to assess the importance of cardiovascular risk factors worldwide. The study aimed to enroll approximately 15,000 cases of acute myocardial infarction and a similar number of controls from 52 countries representing all inhabited continents. The study investigated the association between nine modifiable risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption, psychosocial factors) and the risk of myocardial infarction. Standardized questionnaires and physical examinations were used to collect information from all participants. Blood samples were also collected to analyze lipid levels. The results of this large, global study could help determine if cardiovascular risk factors have similar or
Sexual activity after myocardial infarctionTarek Anis
This presentation describes cardiovascular risk of sexual activity as well as recommendation to manage erectile dysfunction in men with coronary artery disease
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
Vascular repair after firearm injury is associated with increased morbidity a...anomwiradana
This study analyzed data from 648,662 patients with firearm injuries between 1993-2014 using the National Inpatient Sample database. The key findings were:
1) 9.9% (63,973) of firearm injuries involved a concurrent vascular repair, with these patients more likely to be younger, male, black, on Medicaid, and have lower income.
2) Patients undergoing vascular repair had higher injury severity scores and were more likely to have abdomen/pelvis or extremity injuries from assault.
3) Patients undergoing vascular repair had higher rates of in-hospital mortality (5.51% vs 1.98%), acute renal failure, venous thromboembolic events, pulmonary complications, cardiac complications, sepsis
KMorton Gender dimorphism and its effect on mortality in traumatically brain ...Karissa Morton
This study investigated the effect of gender dimorphism on mortality in 962 patients with traumatic brain injury (TBI) admitted between 2000-2009. The mean age of patients was 41.12 years and males were younger than females. No significant differences in mortality between males and females were found overall or when stratified by age. Females had significantly longer hospital and ICU stays than males. Logistic regression also found no gender to be a significant risk factor for mortality in TBI patients. The study concluded that no association between gender and mortality was identified.
Jennifer Tremmel - Sex Differences In Cardiovascular DiseaseClayman Institute
This document discusses sex differences in cardiovascular disease. It summarizes that historically, heart disease studies primarily enrolled men. Women represent about half of cardiovascular disease patients but were underrepresented in clinical trials. Risk factors like diabetes and obesity confer greater relative risk of cardiovascular events in women than men. Symptom presentation of heart disease can differ between sexes, with women more likely to experience atypical symptoms. Guidelines recommend against menopausal hormone therapy for primary or secondary prevention of cardiovascular disease in women.
The CIBMTR score predicts survival of AML patients undergoing allogeneic tran...Mina Max
This study retrospectively analyzed 523 acute myeloid leukemia patients undergoing allogeneic hematopoietic stem cell transplantation with active disease from 20 Italian centers to validate the CIBMTR pre-transplantation risk score. The CIBMTR score uses 5 pre-transplant variables to stratify patients into groups with 3-year overall survival rates ranging from 42% to 6%. The study found the CIBMTR score predicted survival in this cohort, with hazard ratios confirming worse survival for shorter first complete remission duration, non-sibling donor, higher blast percentage, and lower Karnofsky score. Multivariate analysis validated the CIBMTR score as prognostic for this larger patient population including both myeloabl
Methylenetetrahydrofolate Reductase Gene (MTHFR_677CT) Associated with the de...ijsrd.com
Globally, Depression is widespread neuropsychiatric disorders affecting around 5% of the population and has been described as millennia linked with neurobiology showing association with direct neuro-chemicals and biochemical incredible factors, interact with "gene-gene", "gene-environment" as long as a scaffold potential for better exploration. The aetiology of depression is still unknown but believes to be the interaction between gene and environment including some of the other factors responsible for development of depression. The PCR-RFLP analysis of MTHFR (C677T) gene showed 0.45% in CT (heterozygous) genotype in patients of depression in comparison to controls (0.15%), suggesting increased risk of depression in those individuals. However, the odd ratio was also calculated at 95% confidence interval for MTHFR C677T gene which revealed non- significant difference between cases and control, may be because of small sample size.
Interheart risk modifiable factors in micardio infraction 2004Medicina
This document summarizes the objectives and methods of the INTERHEART study, a large international case-control study designed to assess the importance of cardiovascular risk factors worldwide. The study aimed to enroll approximately 15,000 cases of acute myocardial infarction and a similar number of controls from 52 countries representing all inhabited continents. The study investigated the association between nine modifiable risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption, psychosocial factors) and the risk of myocardial infarction. Standardized questionnaires and physical examinations were used to collect information from all participants. Blood samples were also collected to analyze lipid levels. The results of this large, global study could help determine if cardiovascular risk factors have similar or
Sexual activity after myocardial infarctionTarek Anis
This presentation describes cardiovascular risk of sexual activity as well as recommendation to manage erectile dysfunction in men with coronary artery disease
Donor Lymphocyte Infusion in Patients with Hematological Malignancies after T...spa718
1. Donor lymphocyte infusion (DLI) is an effective method for treating relapse after hematopoietic stem cell transplantation. Modified DLI (mDLI) using G-CSF mobilized peripheral blood and short-term immunosuppression can reduce acute GVHD rates while maintaining the graft-versus-leukemia effect.
2. Prophylactic mDLI can significantly decrease relapse rates and increase survival in patients with advanced acute leukemia after HLA-identical or haploidentical transplantation.
3. Risk-stratified mDLI based on minimal residual disease monitoring may further reduce relapse and improve outcomes by targeting high-risk MRD-positive patients.
This document summarizes Dr. Chenhua Yan's work establishing and utilizing a modified donor lymphocyte infusion (mDLI) approach for the treatment of relapse after haploidentical hematopoietic stem cell transplantation (HSCT) for hematologic malignancies. The mDLI approach uses G-CSF mobilized peripheral blood stem cells and immunosuppressive agents after infusion to reduce graft-versus-host disease while preserving graft-versus-leukemia effects. Studies showed mDLI improved response rates and survival compared to chemotherapy or standard DLI alone for relapsed disease. Risk-stratified mDLI based on minimal residual disease also reduced relapse rates after transplantation.
Closer look at stroke in maine for maine stroke alliance 2019 finalGillian Gordon Perue
Presented to the leadership of the State of Maine; this presentation describes the epidemiology of patients admitted with stroke in Maine from 2010-2014. It exams independent predictors of mortality.
This document discusses acquired pure red cell aplasia (PRCA), a disorder characterized by severe anemia and absence of erythroblasts in the bone marrow. It reviews treatments for PRCA, including corticosteroids, cyclosporine A, and other immunosuppressive therapies. Cyclosporine A has proven effective at inducing remission in 65-87% of cases, but concerns remain about sustained remission and relapse rates. The document also discusses the importance of evaluating patients for underlying causes of secondary PRCA such as lymphoproliferative disorder of granular lymphocytes.
Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night ShiftsEmergency Live
Know more on http://www.emergency-live.com
Total and Cause-Specific Mortality of U.S.
Nurses Working Rotating Night Shifts
Fangyi Gu, MD, ScD, Jiali Han, PhD, Francine Laden, ScD, An Pan, PhD, Neil E. Caporaso, MD,
Meir J. Stampfer, MD, DrPH, Ichiro Kawachi, MD, PhD, Kathryn M. Rexrode, MD, MPH,
Walter C. Willett,MD, DrPH, Susan E. Hankinson, ScD, Frank E. Speizer,MD, Eva S. Schernhammer,MD, DrPH
Background: Rotating night shift work imposes circadian strain and is linked to the risk of several
chronic diseases.
Purpose: To examine associations between rotating night shift work and all-cause; cardiovascular
disease (CVD); and cancer mortality in a prospective cohort study of 74,862 registered U.S. nurses
from the Nurses’ Health Study.
Methods: Lifetime rotating night shift work (defined as Z3 nights/month) information was
collected in 1988. During 22 years (1988–2010) of follow-up, 14,181 deaths were documented,
including 3,062 CVD and 5,413 cancer deaths. Cox proportional hazards models estimated
multivariable-adjusted hazard ratios (HRs) and 95% CIs.
Results: All-cause and CVD mortality were significantly increased among women withZ5 years of
rotating night shift work, compared to women who never worked night shifts. Specifically, for
women with 6–14 and Z15 years of rotating night shift work, the HRs were 1.11 (95% CI¼1.06,
1.17) and 1.11 (95% CI¼1.05, 1.18) for all-cause mortality and 1.19 (95% CI¼1.07, 1.33) and 1.23
(95% CI¼1.09, 1.38) for CVD mortality. There was no significant association between rotating night
shift work and all-cancer mortality (HRZ15years¼1.08, 95% CI¼0.98, 1.19) or mortality of any
individual cancer, with the exception of lung cancer (HRZ15years¼1.25, 95% CI¼1.04, 1.51).
Conclusions: Women working rotating night shifts for Z5 years have a modest increase in allcause
and CVD mortality; those working Z15 years of rotating night shift work have a modest
increase in lung cancer mortality. These results add to prior evidence of a potentially detrimental
effect of rotating night shift work on health and longevity.
(Am J Prev Med 2015;](]):]]]–]]]) & 2015 American Journal of Preventive Medicine. All rights reserved.
Sex after acute myocardial infarctio(Heart attack).
There are fears of having another heart attack or dying during sex. One woman even had to convince her husband that she wasn't going to die in bed. But women also expressed a motivation to return to sex as a way to get back to their normal life and not be stigmatized as a heart patient. We heard that a lot.This presentation solves so many such doubts spread in society.
Association of the HLA-B alleles with carbamazepine-induced Stevens–Johnson s...UniversitasGadjahMada
Carbamazepine (CBZ) is a common cause of life-threatening cutaneous adverse drug reactions such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Previous studies have reported a strong association between the HLA genotype and CBZ-induced SJS/TEN.We investigated the association between the HLA genotype and CBZ-induced SJS/TEN in Javanese and Sundanese patients in Indonesia. Nine unrelated patients with CBZ-induced SJS/TEN and 236 healthy Javanese and Sundanese controls were genotyped for HLA-B and their allele frequencies were compared. The HLA-B*15:02 allele was found in 66.7% of the patients with CBZ-induced SJS/TEN, but only in 29.4% of tolerant control (p = 0.029; odds ratio [OR]: 6.5; 95% CI: 1.2–33.57) and 22.9% of healthy controls (p = 0.0021; OR: 6.78; 95% CI: 1.96– 23.38). These findings support the involvement of HLA-B*15:02 in CBZ-induced SJS/TEN reported in other Asian populations. Interestingly, we also observed the presence of the HLA-B*15:21 allele. HLA-B*15:02 and HLA-B*15:21 are members of the HLA-B75 serotype, for which a greater frequency was observed in CBZ-induced SJS/TEN (vs tolerant control [p = 0.0078; OR: 12; 95% CI: 1.90–75.72] and vs normal control [p = 0.0018; OR: 8.56; 95% CI: 1.83–40]). Our findings suggest that screening for the HLA-B75 serotype can predict the risk of CBZ-induced SJS/TEN more accurately than screening for a specific allele.
Cardiac risk evaluation: searching for the vulnerable patient FELIX NUNURA
The document discusses screening patients for cardiovascular risk factors and disease. It outlines various risk assessment tools like the Framingham Risk Score and SCORE that estimate risk based on factors like age, cholesterol levels, blood pressure, smoking status. It discusses limitations of risk factor-based screening and emphasizes the importance of directly measuring subclinical disease using tests like coronary artery calcium scoring and carotid intima-media thickness to identify vulnerable patients. The document advocates screening for and treating the underlying atherosclerotic disease rather than just risk factors to improve prevention outcomes.
This document outlines a research protocol to study neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as predictors of systemic inflammation and chronic illness in pre-surgery patients. The study will retrospectively analyze data from 1000 patients who attended a preadmission clinic between January and April 2013. Medical history, exam findings, and blood test results will be collected to calculate NLR and PLR ratios and examine their relationship to inflammation and health conditions. The goal is to determine the prevalence of elevated ratios and their ability to predict surgical risk factors.
This study analyzed the causes of stroke in 50 young patients aged 15-35 years at a tertiary hospital in Pakistan. The most common cause of stroke was infective meningitis (34%), predominantly tuberculosis meningitis. The second most common cause was cardioembolism (20%), mainly due to valvular heart disease. Other major causes included hypertension (14%), pregnancy-related conditions (12%), and systemic lupus erythematosus (4%). Infective meningitis, particularly tuberculosis, was found to be the leading cause of stroke in young patients in this study.
We conducted a retrospective study of 178 community dwelling elderly on anemia which was defined as hemoglobin < 13 gm/ dl in males and < 12 gm/dl in females (WHO guidelines).
Methods: This was a retrospective chart review of patients aged ≥ 95 years, who were seen over a two year period at the University of Arkansas for Medical Sciences.
This document provides information about the 7th International Conference on Biotechnology, Bioinformatics, Bio Medical Sciences and Stem Cell Applications that was held from November 11-12, 2016 at the Nanyang Technological University in Singapore. It lists the conference venue and contact information. It also provides details about the plenary speaker, Yoshiko Yamaguchi, and includes the abstract of a study presented on hypertension in Sohag City, Egypt.
Austin Journal of Genetics and Genomic Research is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of research in Genetics and Genomics.
The journal aims to promote research communications and provide a forum for researchers and physicians to find most recent advances in the areas of Genomic Research.
Austin Journal of Genetics and Genomic Research accepts original research articles, review articles, case reports and rapid communication on all the aspects of high-throughput Genomic Research.
The document summarizes the story of Paul Henderson, a Canadian hockey legend known for scoring the winning goal in the 1972 Summit Series. It describes how Henderson was diagnosed with chronic lymphocytic leukemia in 2010 but has seen remarkable progress in his treatment and health since participating in a clinical trial in 2012 for a new drug to treat his cancer. The drug has kept his cancer in check, with only 5-10% of his bone marrow now malignant compared to 83% previously. Henderson attributes his renewed health not just to medical treatment but also his faith, family, and positive mental outlook. He serves as an inspiration for other cancer patients.
Guidelines For Assessment Of C Visk In Rsymptomatic AdultsJuan Menendez
The document provides guidelines for cardiovascular risk assessment in asymptomatic adults from the 2010 ACCF/AHA. It recommends using global risk scores that incorporate multiple traditional risk factors. It recommends obtaining family history of CVD but does not recommend genetic testing. It also does not recommend various tests such as natriuretic peptides, lipid assessments beyond standard profiles, or C-reactive protein in certain groups. It provides recommendations for use of other tests in specific intermediate-risk groups such as carotid intima-media thickness or coronary artery calcium scoring.
1. Peripheral arterial disease (PAD) is a marker for increased risk of myocardial infarction and ischemic stroke, as it often co-exists with atherosclerosis in other arteries.
2. PAD is more common than diagnosed, so proper diagnosis using ankle-brachial pressure index is important. A low index reliably predicts increased risk of ischemic events.
3. Lifestyle changes and antiplatelet drugs like clopidogrel, which provides greater benefit than aspirin, are key for managing PAD patients and reducing cardiovascular risks.
Complication Rates Following Open Reduction and Internal Fixation of Ankle Fr...Ortopedia Chiapas
This study analyzed data from 57,183 patients in California who underwent open reduction and internal fixation surgery for ankle fractures between 1995-2005 to determine short and intermediate-term complication rates. The overall short-term complication rate was low, below 2% for most outcomes. However, open fractures, older age, diabetes, and peripheral vascular disease significantly increased short-term complication risks. The intermediate fracture reoperation rate was also low at below 1% at 1 and 5 years. Trimalleolar fractures and open fractures significantly predicted higher reoperation risks. Hospital procedure volume did not significantly impact complication rates.
This presentation discusses the graft versus tumour effect (GVT) in hematopoietic stem cell transplantation (HSCT). It provides laboratory and clinical evidence that the immune cells from the donor (graft) can induce remissions in hematological malignancies (tumour) after transplant. However, these same graft cells can also cause graft-versus-host disease (GvHD). Recent research aims to separate these effects by using regulatory T-cells to suppress GvHD while preserving the GVT effect.
The document describes a conference on biotechnology, bioinformatics, biomedical sciences and stem cell applications taking place from November 11-12, 2016 in Singapore. It provides the conference schedule, list of speakers, and abstracts of papers being presented on topics related to diabetes, hypertension, cardiovascular disease, cognitive functions and thrombogenesis. The conference will bring together researchers from various universities and institutions in Asia to present and discuss their work in healthcare, life sciences and stem cell applications.
Final PaperThis Final Paper involves the critical review and ana.docxssuser454af01
Final Paper
This Final Paper involves the critical review and analysis of a published epidemiological research study, using the epidemiological concepts covered in Modules 1–6. You do not choose your own study; your Instructor will provide the research study to review and analyze. The audience for this 5–8 page scholarly paper is other epidemiological researchers.
The Final Paper must include, but is not limited to, the following:
Part I. Study Summary (2–3 pages)
(Note: this summary must be in your own words)
· The study objective/research question
· Primary exposure(s) and outcome(s) of interest
· Identification of study design
· Description of study population and the sampling/selection process
· Description of the statistical analysis used and the primary measures of association reported
· Identification of potential confounders (if any) and the technique used to minimize them or analyze their effects
· Identification of potential effect modifiers (if any) and the technique used to analyze their effects
· Summary of major study results
Part II. Critical Analysis (3–5 pages)
· Discussion of random error and how it might have affected the results
· Explanation of possible selection bias and how it might have affected the results, including a discussion of the size and direction of any possible bias
· Explanation of possible misclassification (information) bias and how it might have affected the results, including a discussion of the size and direction of any possible bias
· Evaluation of the other limitations of the study
· Critique of the discussion section of the paper and whether it adequately addresses the strengths and limitations of the study
· Description of the potential generalizability of the study results
· Critique of the authors’ conclusions and whether or not they are appropriate given the study findings
· Descriptions of future studies that would be appropriate given the study findings
Original Contribution
Physical Activity, Sedentary Behavior, and Cause-Specific Mortality in Black and
White Adults in the Southern Community Cohort Study
Charles E. Matthews*, Sarah S. Cohen, Jay H. Fowke, Xijing Han, Qian Xiao, Maciej S. Buchowski,
Margaret K. Hargreaves, Lisa B. Signorello, and William J. Blot
* Correspondence to Dr. Charles E. Matthews, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer
Institute, 9609 Medical Center Drive, Room 6E340, MSC 9704, Bethesda, MD 20892-9704 (e-mail: [email protected]).
Initially submitted November 15, 2013; accepted for publication May 6, 2014.
There is limited evidence demonstrating the benefits of physical activity with regard to mortality risk or the harms
associated with sedentary behavior in black adults, so we examined the relationships between these health behav-
iors and cause-specific mortality in a prospective study that had a large proportion of black adults. Participants
(40–79 years of age) enrolled in the Southern Community ...
This study evaluated the efficacy of colchicine in preventing in-stent restenosis in 90 patients undergoing percutaneous coronary intervention with bare-metal stents. Patients were divided into 3 groups: those receiving a bare-metal stent plus colchicine, bare-metal stent alone, or a drug-eluting stent. After 6 months of follow up, the rates of in-stent restenosis and target vessel revascularization were significantly lower in patients receiving colchicine plus bare-metal stent compared to bare-metal stent alone. There was no difference in stent thrombosis rates between groups. The study suggests that colchicine may be useful for reducing restenosis and need for repeat procedures when
Donor Lymphocyte Infusion in Patients with Hematological Malignancies after T...spa718
1. Donor lymphocyte infusion (DLI) is an effective method for treating relapse after hematopoietic stem cell transplantation. Modified DLI (mDLI) using G-CSF mobilized peripheral blood and short-term immunosuppression can reduce acute GVHD rates while maintaining the graft-versus-leukemia effect.
2. Prophylactic mDLI can significantly decrease relapse rates and increase survival in patients with advanced acute leukemia after HLA-identical or haploidentical transplantation.
3. Risk-stratified mDLI based on minimal residual disease monitoring may further reduce relapse and improve outcomes by targeting high-risk MRD-positive patients.
This document summarizes Dr. Chenhua Yan's work establishing and utilizing a modified donor lymphocyte infusion (mDLI) approach for the treatment of relapse after haploidentical hematopoietic stem cell transplantation (HSCT) for hematologic malignancies. The mDLI approach uses G-CSF mobilized peripheral blood stem cells and immunosuppressive agents after infusion to reduce graft-versus-host disease while preserving graft-versus-leukemia effects. Studies showed mDLI improved response rates and survival compared to chemotherapy or standard DLI alone for relapsed disease. Risk-stratified mDLI based on minimal residual disease also reduced relapse rates after transplantation.
Closer look at stroke in maine for maine stroke alliance 2019 finalGillian Gordon Perue
Presented to the leadership of the State of Maine; this presentation describes the epidemiology of patients admitted with stroke in Maine from 2010-2014. It exams independent predictors of mortality.
This document discusses acquired pure red cell aplasia (PRCA), a disorder characterized by severe anemia and absence of erythroblasts in the bone marrow. It reviews treatments for PRCA, including corticosteroids, cyclosporine A, and other immunosuppressive therapies. Cyclosporine A has proven effective at inducing remission in 65-87% of cases, but concerns remain about sustained remission and relapse rates. The document also discusses the importance of evaluating patients for underlying causes of secondary PRCA such as lymphoproliferative disorder of granular lymphocytes.
Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night ShiftsEmergency Live
Know more on http://www.emergency-live.com
Total and Cause-Specific Mortality of U.S.
Nurses Working Rotating Night Shifts
Fangyi Gu, MD, ScD, Jiali Han, PhD, Francine Laden, ScD, An Pan, PhD, Neil E. Caporaso, MD,
Meir J. Stampfer, MD, DrPH, Ichiro Kawachi, MD, PhD, Kathryn M. Rexrode, MD, MPH,
Walter C. Willett,MD, DrPH, Susan E. Hankinson, ScD, Frank E. Speizer,MD, Eva S. Schernhammer,MD, DrPH
Background: Rotating night shift work imposes circadian strain and is linked to the risk of several
chronic diseases.
Purpose: To examine associations between rotating night shift work and all-cause; cardiovascular
disease (CVD); and cancer mortality in a prospective cohort study of 74,862 registered U.S. nurses
from the Nurses’ Health Study.
Methods: Lifetime rotating night shift work (defined as Z3 nights/month) information was
collected in 1988. During 22 years (1988–2010) of follow-up, 14,181 deaths were documented,
including 3,062 CVD and 5,413 cancer deaths. Cox proportional hazards models estimated
multivariable-adjusted hazard ratios (HRs) and 95% CIs.
Results: All-cause and CVD mortality were significantly increased among women withZ5 years of
rotating night shift work, compared to women who never worked night shifts. Specifically, for
women with 6–14 and Z15 years of rotating night shift work, the HRs were 1.11 (95% CI¼1.06,
1.17) and 1.11 (95% CI¼1.05, 1.18) for all-cause mortality and 1.19 (95% CI¼1.07, 1.33) and 1.23
(95% CI¼1.09, 1.38) for CVD mortality. There was no significant association between rotating night
shift work and all-cancer mortality (HRZ15years¼1.08, 95% CI¼0.98, 1.19) or mortality of any
individual cancer, with the exception of lung cancer (HRZ15years¼1.25, 95% CI¼1.04, 1.51).
Conclusions: Women working rotating night shifts for Z5 years have a modest increase in allcause
and CVD mortality; those working Z15 years of rotating night shift work have a modest
increase in lung cancer mortality. These results add to prior evidence of a potentially detrimental
effect of rotating night shift work on health and longevity.
(Am J Prev Med 2015;](]):]]]–]]]) & 2015 American Journal of Preventive Medicine. All rights reserved.
Sex after acute myocardial infarctio(Heart attack).
There are fears of having another heart attack or dying during sex. One woman even had to convince her husband that she wasn't going to die in bed. But women also expressed a motivation to return to sex as a way to get back to their normal life and not be stigmatized as a heart patient. We heard that a lot.This presentation solves so many such doubts spread in society.
Association of the HLA-B alleles with carbamazepine-induced Stevens–Johnson s...UniversitasGadjahMada
Carbamazepine (CBZ) is a common cause of life-threatening cutaneous adverse drug reactions such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Previous studies have reported a strong association between the HLA genotype and CBZ-induced SJS/TEN.We investigated the association between the HLA genotype and CBZ-induced SJS/TEN in Javanese and Sundanese patients in Indonesia. Nine unrelated patients with CBZ-induced SJS/TEN and 236 healthy Javanese and Sundanese controls were genotyped for HLA-B and their allele frequencies were compared. The HLA-B*15:02 allele was found in 66.7% of the patients with CBZ-induced SJS/TEN, but only in 29.4% of tolerant control (p = 0.029; odds ratio [OR]: 6.5; 95% CI: 1.2–33.57) and 22.9% of healthy controls (p = 0.0021; OR: 6.78; 95% CI: 1.96– 23.38). These findings support the involvement of HLA-B*15:02 in CBZ-induced SJS/TEN reported in other Asian populations. Interestingly, we also observed the presence of the HLA-B*15:21 allele. HLA-B*15:02 and HLA-B*15:21 are members of the HLA-B75 serotype, for which a greater frequency was observed in CBZ-induced SJS/TEN (vs tolerant control [p = 0.0078; OR: 12; 95% CI: 1.90–75.72] and vs normal control [p = 0.0018; OR: 8.56; 95% CI: 1.83–40]). Our findings suggest that screening for the HLA-B75 serotype can predict the risk of CBZ-induced SJS/TEN more accurately than screening for a specific allele.
Cardiac risk evaluation: searching for the vulnerable patient FELIX NUNURA
The document discusses screening patients for cardiovascular risk factors and disease. It outlines various risk assessment tools like the Framingham Risk Score and SCORE that estimate risk based on factors like age, cholesterol levels, blood pressure, smoking status. It discusses limitations of risk factor-based screening and emphasizes the importance of directly measuring subclinical disease using tests like coronary artery calcium scoring and carotid intima-media thickness to identify vulnerable patients. The document advocates screening for and treating the underlying atherosclerotic disease rather than just risk factors to improve prevention outcomes.
This document outlines a research protocol to study neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as predictors of systemic inflammation and chronic illness in pre-surgery patients. The study will retrospectively analyze data from 1000 patients who attended a preadmission clinic between January and April 2013. Medical history, exam findings, and blood test results will be collected to calculate NLR and PLR ratios and examine their relationship to inflammation and health conditions. The goal is to determine the prevalence of elevated ratios and their ability to predict surgical risk factors.
This study analyzed the causes of stroke in 50 young patients aged 15-35 years at a tertiary hospital in Pakistan. The most common cause of stroke was infective meningitis (34%), predominantly tuberculosis meningitis. The second most common cause was cardioembolism (20%), mainly due to valvular heart disease. Other major causes included hypertension (14%), pregnancy-related conditions (12%), and systemic lupus erythematosus (4%). Infective meningitis, particularly tuberculosis, was found to be the leading cause of stroke in young patients in this study.
We conducted a retrospective study of 178 community dwelling elderly on anemia which was defined as hemoglobin < 13 gm/ dl in males and < 12 gm/dl in females (WHO guidelines).
Methods: This was a retrospective chart review of patients aged ≥ 95 years, who were seen over a two year period at the University of Arkansas for Medical Sciences.
This document provides information about the 7th International Conference on Biotechnology, Bioinformatics, Bio Medical Sciences and Stem Cell Applications that was held from November 11-12, 2016 at the Nanyang Technological University in Singapore. It lists the conference venue and contact information. It also provides details about the plenary speaker, Yoshiko Yamaguchi, and includes the abstract of a study presented on hypertension in Sohag City, Egypt.
Austin Journal of Genetics and Genomic Research is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of research in Genetics and Genomics.
The journal aims to promote research communications and provide a forum for researchers and physicians to find most recent advances in the areas of Genomic Research.
Austin Journal of Genetics and Genomic Research accepts original research articles, review articles, case reports and rapid communication on all the aspects of high-throughput Genomic Research.
The document summarizes the story of Paul Henderson, a Canadian hockey legend known for scoring the winning goal in the 1972 Summit Series. It describes how Henderson was diagnosed with chronic lymphocytic leukemia in 2010 but has seen remarkable progress in his treatment and health since participating in a clinical trial in 2012 for a new drug to treat his cancer. The drug has kept his cancer in check, with only 5-10% of his bone marrow now malignant compared to 83% previously. Henderson attributes his renewed health not just to medical treatment but also his faith, family, and positive mental outlook. He serves as an inspiration for other cancer patients.
Guidelines For Assessment Of C Visk In Rsymptomatic AdultsJuan Menendez
The document provides guidelines for cardiovascular risk assessment in asymptomatic adults from the 2010 ACCF/AHA. It recommends using global risk scores that incorporate multiple traditional risk factors. It recommends obtaining family history of CVD but does not recommend genetic testing. It also does not recommend various tests such as natriuretic peptides, lipid assessments beyond standard profiles, or C-reactive protein in certain groups. It provides recommendations for use of other tests in specific intermediate-risk groups such as carotid intima-media thickness or coronary artery calcium scoring.
1. Peripheral arterial disease (PAD) is a marker for increased risk of myocardial infarction and ischemic stroke, as it often co-exists with atherosclerosis in other arteries.
2. PAD is more common than diagnosed, so proper diagnosis using ankle-brachial pressure index is important. A low index reliably predicts increased risk of ischemic events.
3. Lifestyle changes and antiplatelet drugs like clopidogrel, which provides greater benefit than aspirin, are key for managing PAD patients and reducing cardiovascular risks.
Complication Rates Following Open Reduction and Internal Fixation of Ankle Fr...Ortopedia Chiapas
This study analyzed data from 57,183 patients in California who underwent open reduction and internal fixation surgery for ankle fractures between 1995-2005 to determine short and intermediate-term complication rates. The overall short-term complication rate was low, below 2% for most outcomes. However, open fractures, older age, diabetes, and peripheral vascular disease significantly increased short-term complication risks. The intermediate fracture reoperation rate was also low at below 1% at 1 and 5 years. Trimalleolar fractures and open fractures significantly predicted higher reoperation risks. Hospital procedure volume did not significantly impact complication rates.
This presentation discusses the graft versus tumour effect (GVT) in hematopoietic stem cell transplantation (HSCT). It provides laboratory and clinical evidence that the immune cells from the donor (graft) can induce remissions in hematological malignancies (tumour) after transplant. However, these same graft cells can also cause graft-versus-host disease (GvHD). Recent research aims to separate these effects by using regulatory T-cells to suppress GvHD while preserving the GVT effect.
The document describes a conference on biotechnology, bioinformatics, biomedical sciences and stem cell applications taking place from November 11-12, 2016 in Singapore. It provides the conference schedule, list of speakers, and abstracts of papers being presented on topics related to diabetes, hypertension, cardiovascular disease, cognitive functions and thrombogenesis. The conference will bring together researchers from various universities and institutions in Asia to present and discuss their work in healthcare, life sciences and stem cell applications.
Final PaperThis Final Paper involves the critical review and ana.docxssuser454af01
Final Paper
This Final Paper involves the critical review and analysis of a published epidemiological research study, using the epidemiological concepts covered in Modules 1–6. You do not choose your own study; your Instructor will provide the research study to review and analyze. The audience for this 5–8 page scholarly paper is other epidemiological researchers.
The Final Paper must include, but is not limited to, the following:
Part I. Study Summary (2–3 pages)
(Note: this summary must be in your own words)
· The study objective/research question
· Primary exposure(s) and outcome(s) of interest
· Identification of study design
· Description of study population and the sampling/selection process
· Description of the statistical analysis used and the primary measures of association reported
· Identification of potential confounders (if any) and the technique used to minimize them or analyze their effects
· Identification of potential effect modifiers (if any) and the technique used to analyze their effects
· Summary of major study results
Part II. Critical Analysis (3–5 pages)
· Discussion of random error and how it might have affected the results
· Explanation of possible selection bias and how it might have affected the results, including a discussion of the size and direction of any possible bias
· Explanation of possible misclassification (information) bias and how it might have affected the results, including a discussion of the size and direction of any possible bias
· Evaluation of the other limitations of the study
· Critique of the discussion section of the paper and whether it adequately addresses the strengths and limitations of the study
· Description of the potential generalizability of the study results
· Critique of the authors’ conclusions and whether or not they are appropriate given the study findings
· Descriptions of future studies that would be appropriate given the study findings
Original Contribution
Physical Activity, Sedentary Behavior, and Cause-Specific Mortality in Black and
White Adults in the Southern Community Cohort Study
Charles E. Matthews*, Sarah S. Cohen, Jay H. Fowke, Xijing Han, Qian Xiao, Maciej S. Buchowski,
Margaret K. Hargreaves, Lisa B. Signorello, and William J. Blot
* Correspondence to Dr. Charles E. Matthews, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer
Institute, 9609 Medical Center Drive, Room 6E340, MSC 9704, Bethesda, MD 20892-9704 (e-mail: [email protected]).
Initially submitted November 15, 2013; accepted for publication May 6, 2014.
There is limited evidence demonstrating the benefits of physical activity with regard to mortality risk or the harms
associated with sedentary behavior in black adults, so we examined the relationships between these health behav-
iors and cause-specific mortality in a prospective study that had a large proportion of black adults. Participants
(40–79 years of age) enrolled in the Southern Community ...
This study evaluated the efficacy of colchicine in preventing in-stent restenosis in 90 patients undergoing percutaneous coronary intervention with bare-metal stents. Patients were divided into 3 groups: those receiving a bare-metal stent plus colchicine, bare-metal stent alone, or a drug-eluting stent. After 6 months of follow up, the rates of in-stent restenosis and target vessel revascularization were significantly lower in patients receiving colchicine plus bare-metal stent compared to bare-metal stent alone. There was no difference in stent thrombosis rates between groups. The study suggests that colchicine may be useful for reducing restenosis and need for repeat procedures when
This study analyzed cancer-related mortality among 83,282 people with AIDS in the United States from 1980 to 2006. Cancer mortality rates decreased significantly over time, as did AIDS-related mortality rates, due to increased availability of antiretroviral therapy. However, the proportion of deaths due to cancer increased, as other causes of AIDS-related mortality dramatically declined. Non-Hodgkin lymphoma remained the most common cancer cause of death. Lung cancer was the most frequent non-AIDS defining cancer cause of death. Improved cancer prevention and treatment could further reduce mortality among people with AIDS.
Poor short-term outcome in patients with ischaemic stroke.pdfarianiputridevanti
1) Patients with active cancer (AC) who experienced an ischemic stroke were younger, had more severe strokes, and had a higher rate of in-hospital mortality compared to patients with non-active cancer (NAC).
2) AC patients were more likely to have cryptogenic strokes and infarcts in multiple areas of the brain, while NAC patients more often had cardioembolic strokes and small vessel disease.
3) Having AC, a higher NIH Stroke Scale score, and higher C-reactive protein levels were independently associated with in-hospital mortality after experiencing an ischemic stroke.
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
The research team reviewed charts of 351 systemic sclerosis patients from UC Davis to analyze differences in disease manifestations and outcomes by race/ethnicity. They identified 46 patients that met inclusion criteria, 45 of which were included in the analysis. Preliminary results found higher rates of mortality, pulmonary hypertension, and interstitial lung disease in black patients compared to other groups. However, the differences were not statistically significant likely due to small sample sizes. The analysis also found unique serological and clinical features across racial groups.
This document discusses risk stratification strategies for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). It outlines several established risk factors for SCD in HCM including family history of SCD, increased left ventricular wall thickness, unexplained syncope, non-sustained ventricular tachycardia, left ventricular outflow tract obstruction, abnormal blood pressure response to exercise, and late gadolinium enhancement on cardiac MRI. The document also discusses newer risk markers such as left atrial size, atrial fibrillation, systolic dysfunction, and the potential impact of septal reduction therapies on reducing SCD risk in patients with HCM.
1. The study compared cardiovascular disease (CVD) risk factors across five regions of Thailand using data from 2000.
2. Bangkok and central Thailand had higher rates of hypertension, obesity, elevated lipids, and diabetes compared to the north and northeast regions.
3. The northeast region had higher rates of smoking and abnormal lipid levels like low HDL cholesterol and high triglycerides.
The document discusses advances and ongoing disparities in heart failure treatment for African Americans. It summarizes the key findings of the landmark AHEFT trial from 2004, which found that the combination of isosorbide dinitrate and hydralazine reduced mortality and hospitalization rates in African Americans with heart failure compared to placebo. However, the document notes that a decade later, many African American heart failure patients are still not receiving guideline-directed medical therapies. It argues that future clinical trials of novel heart failure drugs need to incorporate background therapies across all demographic groups to truly advance health equity in heart failure care for African Americans through a paradigm shift, rather than just a paradigm drift.
1. Cardiovascular diseases are the leading cause of death globally, accounting for 31% of all deaths in 2016. Accurately assessing CVD risk allows for early prevention efforts.
2. The original Framingham Risk Score from 1998 predicts 10-year risk of coronary heart disease based on age, sex, cholesterol, blood pressure, smoking, and diabetes. However, it does not include other outcomes like stroke and underestimates risk in other populations.
3. Several risk calculators have been developed to address the limitations of FRS, including models that predict overall cardiovascular risk, and diabetes-specific models that incorporate factors like glycemia and duration of diabetes. No single tool is perfect and risk may vary in
1. Cardiovascular diseases are the leading cause of death globally, accounting for 31% of all deaths in 2016. Accurately assessing CVD risk allows for early prevention efforts.
2. The original Framingham Risk Score from 1998 predicts 10-year risk of coronary heart disease based on age, sex, cholesterol, blood pressure, smoking, and diabetes. However, it does not include other outcomes like stroke and underestimates risk in other populations.
3. Several risk calculators have been developed to address limitations of the FRS. Models like SCORE and QRISK2 predict fatal cardiovascular risk and account for additional risk factors like ethnicity and deprivation level respectively.
This summary provides an overview of a document that discusses racial disparities in acute outcomes of life-threatening injury.
The document includes an integrative review of 7 studies that examined the relationship between race/ethnicity and acute outcomes for those with severe injuries requiring intensive care. The findings from the 7 studies were mixed, with 4 studies finding significant relationships between race/ethnicity and worse acute outcomes, while 3 studies found no significant relationships. The review concludes that the inconclusive results indicate a need for more research on racial/ethnic disparities in acute outcomes following life-threatening injuries.
Hepatitis C Risk Assessment, Testing and Referral for Treatment in primary Ca...Real Wellness, LLC
Dr. Robert Winn worked with a team to determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The purpose of the study is to provide information about the database of 1421 adult patients with acute ischemic stroke (IS) developing ≤ 48 hours before admitting, research methods, study protocol, and clinical predictors of the evolving stroke course (EIS).
Methods and Materials: EIS outlined as an increase of NIHSS ≥ 2 points within seven days or in-hospital lethal outcome. Clinical, demographic, instrumental, laboratory data acquisition, as well as the IS course variant and the functional outcome assessment, were carried out prospectively. Statistical analyses were performed using R V.3.2.5 statistical package software and IBM SPSS Statistics 26.0.
Results: The incidence of EIS reached 30.0%. The average age of patients with EIS was 72.6±10.2 years, compare the age of patients without EIS - 68.1±11.3 years; p = 0.005. Female sex increased the odds of EIS (OR, 1.36; 95% CI 1.08-1.73). Total anterior carotid stroke (OR, 7.78; 95% CI 5.91-10.23), the initial NIHSS score > 14 points (OR, 3.74; 95% CI 2.83-4.94), and the right anterior circulation was also associated with EIS (OR, 1.30; 95% CI 1.02-1.66). The odds of EIS were significantly higher in the presence of diabetes mellitus (OR, 1.29; 95% CI 1.01-1.66), cerebral artery stenosis ≥ 70% (OR, 1.96; 95% CI 1.30-2.93), atrial fibrillation (OR, 1.89; 95% CI 1.51-2.39), congestive heart failure (OR, 1.90; 95% CI 1.51-2.39), and peripheral artery disease (OR, 1.69; 95% CI 1.27-2.25). Respiratory (OR, 2.82; 95% CI 2.22-3.59), gastrointestinal (OR, 1.34; 95% CI 1.05-1.70), and urologic diseases (OR, 2.10; 95% CI 1.65-2.66), stroke-associated infection (OR, 3.47; 95% CI 2.09-5.76), and gradual development of initial IS symptoms before admitting increased the odds of progression of the neurological deficit during treatment (OR, 2.37; 95% CI 1.78-3.15)were associated with the evolving clinical course of IS. The patients with the EIS compared with patients without EIS, showed higher serum levels of glucose (p < 0.001), urea (p = 0.001), creatinine (p < 0.001), sodium (p = 0.025), and direct bilirubin (p = 0.015). Potassium level in EIS group was lower than in the group without EIS (p < 0.001). In patients with EIS, a higher amount of RBC (p = 0.030) and WBC (p < 0.001) was found.
Conclusion: The in-hospital database contains information about EIS by the bases subtypes of IS, patient demography, cardiovascular risk factors, comorbid pathology, clinical and laboratory tests, instrumental methods of examination, medications, the severity of neurological deficit, and post-stroke outcome.
This document discusses racial disparities in chronic kidney disease (CKD) and end-stage renal disease (ESRD) between black and white patients. It presents data showing higher rates of CKD and ESRD in black patients across all levels of kidney function. It also summarizes various genetic studies that identified genes like MYH9 and APOL1 that may contribute to these racial disparities by increasing the risk of kidney disease in black populations.
This research article examines whether African Americans with chronic systolic heart failure respond differently to cardiac resynchronization therapy-defibrillator (CRT-D) compared to non-African Americans. The study analyzed data from 212 patients who received CRT-D implants between 2009-2013. Baseline characteristics were similar between the 130 African American patients and 82 non-African American patients. The primary outcome of left ventricular ejection fraction improvement of at least 5% was seen in 62.3% of African Americans and 59.8% of non-African Americans, showing similar response rates. Secondary clinical outcomes like hospitalizations and mortality were also comparable between the groups. Among responders, factors like age, comorbidities, and ech
Copyright 2016 American Medical Association. All rights reservAlleneMcclendon878
Copyright 2016 American Medical Association. All rights reserved.
Association Between Rotating Night Shift Work and Risk
of Coronary Heart Disease Among Women
Céline Vetter, PhD; Elizabeth E. Devore, ScD; Lani R. Wegrzyn, ScD; Jennifer Massa, ScD; Frank E. Speizer, MD;
Ichiro Kawachi, MD, ScD; Bernard Rosner, PhD; Meir J. Stampfer, MD, DrPH; Eva S. Schernhammer, MD, DrPH
IMPORTANCE Prospective studies linking shift work to coronary heart disease (CHD) have
been inconsistent and limited by short follow-up.
OBJECTIVE To determine whether rotating night shift work is associated with CHD risk.
DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 189 158 initially healthy
women followed up over 24 years in the Nurses’ Health Studies (NHS [1988-2012]:
N = 73 623 and NHS2 [1989-2013]: N = 115 535).
EXPOSURES Lifetime history of rotating night shift work (�3 night shifts per month in
addition to day and evening shifts) at baseline (updated every 2 to 4 years in the NHS2).
MAIN OUTCOMES AND MEASURES Incident CHD; ie, nonfatal myocardial infarction, CHD
death, angiogram-confirmed angina pectoris, coronary artery bypass graft surgery, stents,
and angioplasty.
RESULTS During follow-up, 7303 incident CHD cases occurred in the NHS (mean age at
baseline, 54.5 years) and 3519 in the NHS2 (mean age, 34.8 years). In multivariable-adjusted
Cox proportional hazards models, increasing years of baseline rotating night shift work was
associated with significantly higher CHD risk in both cohorts. In the NHS, the association
between duration of shift work and CHD was stronger in the first half of follow-up than in the
second half (P=.02 for interaction), suggesting waning risk after cessation of shift work.
Longer time since quitting shift work was associated with decreased CHD risk among ever
shift workers in the NHS2 (P<.001 for trend).
Baseline History of Rotating Night Shift Work P Value
for
TrendNone <5 y 5-9 y ≥10 y
NHS cohort
CHD incidence ratea 425.5 435.1 525.7 596.9
HR (95% CI)b 1 [Reference] 1.02 (0.97-1.08) 1.12 (1.02-1.22) 1.18 (1.10-1.26) <.001
First half of follow-up
CHD incidence ratea 367.3 382.4 483.1 494.4
HR (95% CI)b 1 [Reference] 1.10 (1.01-1.21) 1.19 (1.03-1.39) 1.27 (1.13-1.42) <.001
Second half of
follow-up
CHD incidence ratea 436.6 424.8 520.7 556.2
HR (95% CI)b 1 [Reference] 0.98 (0.92-1.05) 1.08 (0.96-1.21) 1.13 (1.04-1.24) .004
NHS2 cohort
CHD incidence ratea 122.6 130.6 151.6 178.0
HR (95% CI)b 1 [Reference] 1.05 (0.97-1.13) 1.12 (0.99-1.26) 1.15 (1.01-1.32) .01
a Age-adjusted rates per 100 000 person-years.
b Multivariable-adjusted hazard ratio (HR).
CONCLUSIONS AND RELEVANCE Among women who worked as registered nurses, longer
duration of rotating night shift work was associated with a statistically significant but small
absolute increase in CHD risk. Further research is needed to explore whether the association
is related to specific work hours and individual characteristics.
JAMA. 2016;315(16):1726-1734. ...
This document summarizes a study comparing clinical characteristics of hypertensive intracerebral hemorrhage (ICH) in young patients versus older patients. The study found that young patients had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions, and a different distribution pattern of ICH locations. Mortality was lower in young patients but they had more disabling outcomes. The findings suggest there are age-related differences in the pathogenesis of hypertensive ICH.
The document discusses cardiovascular risk in HIV patients. It finds that HIV patients have approximately double the risk of heart attacks and myocardial infarction compared to HIV-negative people after adjusting for traditional risk factors. Interrupting antiretroviral therapy, as shown in the SMART study, increases the risk of opportunistic disease, death, and non-AIDS events like cardiovascular or renal disease compared to continuous treatment. Protease inhibitors have been associated with a slightly higher risk of heart attacks than non-nucleoside reverse transcriptase inhibitors.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
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Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
1. DOI: 10.1161/CIRCULATIONAHA.115.021177
Race and Sex Differences in the Incidence and Prognostic Significance of
Silent Myocardial Infarction in the Atherosclerosis Risk in Communities
(ARIC) Study
Running title: Zhang et al.; Silent vs. Clinically Manifest Myocardial Infarction
Zhu-Ming Zhang, MD, MPH1
; Pentti M. Rautaharju, MD, PhD1
; Ronald J. Prineas, MB, BS,
PhD1
; Carlos J. Rodriguez, MD2,3
; Laura Loehr, MD4
, PhD; Wayne D. Rosamond, PhD4
; Dalane
Kitzman, MD2
; David Couper, MD, PhD5
; Elsayed Z. Soliman, MD, MSc, MS1,2
1
Epidemiological Cardiology Research Center (EPICARE), Dept of Epidemiology and
Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-
Salem, NC; 2
Dept of Internal Medicine, Section of Cardiology, Wake Forest School of Medicine,
Winston-Salem, NC; 3
Dept of Epidemiology and Prevention, Division of Public Health Sciences,
Wake Forest School of Medicine, Winston-Salem, NC; 4
Dept of Epidemiology, Gillings School
of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; 5
Gillings
School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Address for Correspondence:
Zhu-Ming Zhang, MD, MPH
Epidemiological Cardiology Research Center (EPICARE)
Wake Forest School of Medicine
Medical Center Blvd
Winston-Salem, NC 27157
Tel: 336-716-0835
Fax: 336-716-0834
E-mail: zmzhang@wakehealth.edu
Journal Subject Terms: Electrocardiology (ECG); Myocardial Infarction
1
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2. DOI: 10.1161/CIRCULATIONAHA.115.021177
Abstract
Background—Race and sex differences in silent myocardial infarction (SMI) are not well-
established.
Methods and Results—The analysis included 9,498 participants from the ARIC study who were
free of cardiovascular disease at baseline (visit-1; 1987-1989). Incident SMI was defined as
ECG-evidence of MI without clinically documented MI (CMI) after the baseline until ARIC
visit-4 (1996-1998). Coronary heart disease (CHD) and all-cause deaths were ascertained starting
from ARIC visit-4 until 2010. During a median follow-up of 8.9 years, 317 (3.3%) participants
developed SMI while 386 (4.1%) developed CMI. The incidence rates of both SMI and CMI
were higher in men (5.08 and 7.96 per 1000-person years, respectively) than in women (2.93 and
2.25 per 1000-person years, respectively); p-value <.0001 for both. Blacks had non-significantly
higher rate of SMI than whites (4.45 vs. 3.69 per 1000-person years; p-value=0.217) but whites
had higher rate of CMI than blacks (5.04 vs. 3.24 per 1000-person years; p-value=0.002). SMI
and CMI (vs. no MI) were associated with increased risk of CHD death (HR(95%CI): 3.06(1.88-
4.99) and 4.74(3.26-6.90), respectively) and all-cause mortality (HR(95%CI):1.34(1.09-1.65)
and 1.55(1.30-1.85), respectively). However, SMI and CMI were associated with increased
mortality among both men and women, with potentially greater increased risk among women
(interaction p-value= 0.089 and 0.051, respectively). No significant interactions by race were
detected.
Conclusions—SMI represents over 45% of incident MIs and is associated with poor prognosis.
Race and sex differences in the incidence and prognostic significance of SMI exist which may
warrant considering SMI in personalized assessment of CHD risk.
Key words: silent myocardial infarction; race; sex; coronary heart disease
were higher in men (5.08 and 7.96 per 1000-person years, respectively) than in wowowomememennn (2(2(2.9.99333 anaa d
2.25 per 1000-person years, respectively); p-value <.0001 for both. Blacks had non-significantly
highhhererer rrratatateee ofofof SMIMIMI than whites (4.45 vs. 3.69 peerrr 10101000-person years; p--v-valaa ue=0.217) but whites
hhahaddd higher ratee ooof CMMMI ttthahahannn blblblaaacksksks (((5.5.5 044 vss... 333.24 peeer 1110000000-0-0-pepepersrsononon yyeaeaearsrr ; p-vvvalalalueueue=0=0=0.0.. 020202)... SSSMIMIMI
annnddd CMCC I (vvs.s.s. noo MMIM ) wewewere aassssoocociatetetedd wiwiwitht iiinnncccreasseddd ririiskkk offf CHCHCHDDD dededeataa hhh ((H( R(R(R(9995%CCCI)I)I): 33.0006(1...88-
444.999999))) anananddd 444.747474(3(3(3 22.2666-666.909090))), rrresesespepepectctctiviivelelely))y) aaandndnd aaallllll-cacacaussuseee momomortrtrtalalalititity (H(H(HR(R(R(959595%C%C%CI)I)I):1:1:1 33.34(4(4(111.090909 11-1 66.65)5)5)
2
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3. DOI: 10.1161/CIRCULATIONAHA.115.021177
Introduction
About 635,000 new cases of coronary heart disease (CHD) occur annually in the United States,
with an additional 155,000 incidentally discovered asymptomatic silent MIs (SMI).1
SMI,
defined as the presence of pathological Q waves in the absence of a history of typical cardiac
symptoms, is one of the important cardiac abnormalities that can be reasonably detected through
electrocardiogram (ECG) screening.2, 3
Given that SMI is characterized by no or mild symptoms, those patients are deprived
from medical treatments that could prevent subsequent adverse outcomes, including a second MI
or even death.4
This underscores the importance of detection of SMI in clinical practice. In
clinical trials evaluating interventions to prevent or treat CHD, detection of unrecognized MI as a
clinical end point has the potential to increase statistical power and allowing decreased sample
sizes or reduced length of follow-up, cost, and potential harm from exposure.4
The reported incidence of SMI ranges from 22% to 60% of the total MI incidence, and
the prognosis of these SMIs has been shown to be similar to, or worse than, clinically recognized
MI 4-27
. However, the current understanding of the epidemiology of SMI is based primarily on
studies in white populations of European ancestry,8, 11-15, 18
or on studies with limited
representation of both sexes.9, 10, 16, 18, 21, 23
The lack of race and sex diversity in these studies is
occasionally complicated by small sample size as well.7, 28
The aim of this study was to examine the race and sex differences in the incidence and
prognostic significance of SMI vs. MI with clinical manifestations (CMI) in the Atherosclerosis
Risk in Communities (ARIC) study, a community-based predominantly biracial cohort study.
clinical trials evaluating interventions to prevent or treat CHD, detection of unrecccogogognininizezezeddd MIMIMI aaas a
clinical end point has the potential to increase statistical power and allowing decreased sampler
izeesss ororor rrredededucucuced llleenength of follow-up, cost, and popopotetetentnn ial harm from exppoposssure.4
The repopoportr eedd iiincncncidididenenencecece oofff SMSMSMIII raaangeees fromm 22%%% ttoto 6660%0%0% offf thththeee totot tal MIMIMI iiincncncidididenenncecece,,, anananddd
hhheee prprprognosisiisss off thheh see SSSMIs hahahasss beeeenene ssshooownnn tooo bee sssimimimilaaar totoo, ororr wwwoororsess ttthaan, cclililinicaaalllllyyy reecooogniiizeed
MIMIMI 4-24 277
. HoHoHoweeweveeverrr, ttthehehe cccurrurrererentntnt undndnderererstststananandididingngng ooofff thththeee epepepidididemememioioiololologyggy ooofff SMSMSMIII isisis bbbasasasededed pppriririmamamariririlylly ooonnn
3
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4. DOI: 10.1161/CIRCULATIONAHA.115.021177
Methods
Study population
The ARIC study was designed to investigate the causes of atherosclerosis and its clinical
outcomes, as well as variation in cardiovascular risk factors, medical care, and disease by race
and sex.29
From 1987 to 1989 (ARIC study baseline), 15 792 adults (55.2% women; age, 45–64
years) from 4 US communities (Washington County, Maryland; suburbs of Minneapolis,
Minnesota; Jackson, Mississippi; and Forsyth County, North Carolina) were enrolled and
underwent a phone interview and clinic visit. Additional examinations were conducted in 1990-
1992 (visit 2), 1993-1995 (visit 3), 1996-1998 (visit 4), and 2011-2013 (visit 5). Participants
were mostly white in the Washington County and Minneapolis sites, exclusively black in
Jackson, and a mix of both in Forsyth County. The study was approved by each study site’s
institutional review board. All participants provided written informed consent.
For the purpose of this analysis, we included all ARIC participants with good quality and
complete ECG data at visits 1 to 4 as well as outcome events after visit 4. We excluded the
follwing partcipants: 47 with reported race other than African-American or white, 136 with poor
quality ECG, 3,775 with missing ECG in any of the ARIC first 4 visits (including 871 who died
before visit 4), 429 with ECG diagnosis of bundle branch block, external pacemaker or Wolff-
Parkinson-White pattern, and 201 with missing one or more of baseline cardiovascular disease
(CVD) risk factors. We also excluded 1,706 participants with history of CVD at baseline which
was defined as the presence of ECG evidence of MI, or a self-reported history of physician-
diagnosed MI, coronary artery bypass surgery, coronary angioplasty, heart failure, or stroke.
After all exclusions (n=6,294), 9,498 remained and were included in the analysis.
were mostly white in the Washington County and Minneapolis sites, exclusively bbblalalackckck iiinnn
Jackson, and a mix of both in Forsyth County. The study was approved by each study site’s
nstitittutututioioionananalll rerr viiiewewew board. All participants providididededed written informed ccoconnnsent.
For the purururpopop seee ooof thththisisis aaanananalylylysisisis,ss wwwee inclccluududed alll ARARARICICIC ppparartititiciciipapapantntntsss wwithhh gogogoododod qqquauaualililityyy aaandndnd
cooompmpmplete ECGCGCG dddattta attt vvvisits 1 tototo 4 aaass wewewelll aaasss oooutcommme evvvennnttts aaftftf ererer visisi it 4. WWWeee excllludududedd thhhe
fofofollllllwiiwingngng pppararartctctcipipipananantststs::: 474747 wititithhh rererepopoportrtrtededed rrracacaceee otototheheherrr thththananan AAAfrfrfricicicananan AA-Amememeririricacacannn ororor whihihitetete, 131313666 wiiwiththth pppoooooorrrr
4
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5. DOI: 10.1161/CIRCULATIONAHA.115.021177
Silent MI
Incident SMI was defined as ECG evidence of new MI at ARIC visit 2, visit 3 or visit 4 that was
not present at the baseline visit (visit 1) in the absence of documented CMI. Participants with
both SMI and CMI between ARIC visit 1 and visit 4 were considered as having CMI. Identical
electrocardiographs (MAC PC, Marquette Electronics Inc., Milwaukee, Wisconsin) were used at
all clinical sites, and resting 10-second standard simultaneous 12-lead ECGs were recorded in all
participants using strictly standardized procedures. All ECGs were processed in a central ECG
laboratory (initially at Dalhousie University, Halifax, Nova Scotia, Canada and later at the
EPICARE Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA),
where all ECGs were visually inspected for technical errors and quality. ECG evidence of MI
was defined by new appearance of Minnesota Code ECG Classifications as a major Q/QS wave
abnormality (MC 1.1 or MC 1.2), or minor Q/QS waves abnormality (MC 1.3) plus major ST-T
abnormality (MC 4.1, MC 4.2, MC 5.1 or MC 5.2).30, 31
Traditional serial change comparisons30
were not used.
CHD death and all-cause mortality
CHD death and all-cause mortality were ascertained after ARIC visit 4 (1996-1998) through
December 31, 2010 from death certificates. Deaths and hospitalization events were ascertained in
each clinical center during an annual follow-up phone interview or through review of community
hospital discharge indexes. Incident CHD events included definite or probable hospitalized MI
(clinical myocardial infarction, i.e. CMI in this analysis) or definite CHD death. All CHD events
classification and specific criteria including the adjudication process have been previously
described.32-34
CMI was based on physician review and adjudication of chest pain, cardiac
biomarkers/enzymes from hospitalizations, ECG evidence including a new pathological Q wave,
where all ECGs were visually inspected for technical errors and quality. ECG evidididenenencecece ooofff MIMIMI
was defined by new appearance of Minnesota Code ECG Classifications as a major Q/QS wave
abnooormrmrmalalalititityyy (M(( CCC 1.11 1 or MC 1.2), or minor Q/QQSSS waww ves abnormality (MMMCCC 1.3) plus major ST-Tr
abababnnon rmality ((MCMCMC 44.111, MCMCMC 444.222,, MCMCMC 55.1.11 oor MCMCM 5.22).30, 3111
TTTrararadididitiiionononalalal sserereriiiall chhhananangegege cccomomompapapariiisososonsnn 303
weweereee not useeed.dd
CHCHCHDDD dededeatatathhh anananddd alalallll-cacacaussuseee momomortrtrtalalalititity
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CHD history, the underlying cause of death from death certificates, and other associated
information. All eligible hospitalized events were classified as either definite, probable, suspect,
or no MI. Definite or probable MI was combined to define a clinically manifest MI (CMI) in this
analysis. The definite hospitalized CMI met one or more of the following criteria: 1) Evolving
diagnostic ECG pattern; 2) Diagnostic ECG pattern and abnormal enzymes; 3) Cardiac pain and
abnormal enzymes plus evolving ST-T pattern or equivocal ECG pattern. The probable
hospitalized MI met one or more of the following criteria in the absence of sufficient evidence
for definite hospitalized MI: 1) Cardiac pain and abnormal enzymes; 2) Cardiac pain and
equivocal enzymes and either evolving ST-T pattern or diagnostic ECG pattern. 3) Abnormal
enzymes and evolving ST-T pattern. Criteria for each of these diagnostic elements in the
algorithm remained constant over the study period and are described in detail in the ARIC Study
Surveillance Manual.31, 33, 34
Covariates
Baseline age, sex, race, education level, income, and smoking status were determined by self-
report. Body mass index at baseline was calculated as weight in kilograms divided by height in
meters squared. Blood samples were obtained after an 8-hour fasting period. Baseline diabetes
mellitus was defined as a fasting glucose level 126 mg/dL (or nonfasting glucose 200 mg/dL),
a self-reported physician diagnosis of diabetes mellitus, or the use of diabetes medications.
Baseline hypertension was defined as systolic blood pressure 140 mm Hg, diastolic blood
pressure 90 mm Hg, or the use of blood pressure–lowering medications. At each study visit,
medication history was obtained by self-report of medication intake during last 2 weeks and by
reviewing medications brought by the participants to their visits. Each medication was coded by
trained and certified interviewers with the use of a computerized medication classification
enzymes and evolving ST-T pattern. Criteria for each of these diagnostic elementststs iiinnn thththeee
algorithm remained constant over the study period and are described in detail in the ARIC Study
Survvveieieillllllananancecece MManananuuual.31, 33, 34
CCCovvav riates
BaBaaseseelill ne agegege,,, sexx,x raceee, educccatititionoo llleveve eeel, ini cocoommme, anannd smsmsmokokiiinggg ststs aaatuusus wweeeree dedeeteeerminnnededed byyy selff---
eeepopoportrtrt. BoBoBodyddy mmmasasassss ininindededex atatat bbbasasaselelelininineee waawasss cacacalclclcullulatatatededed aaasss weeweigigighththt iiinnn kkkilililogogograraramsmsms dddiviividididededed bbby heheheigigighththt iiinnn
6
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7. DOI: 10.1161/CIRCULATIONAHA.115.021177
system. Prevalent stroke and peripheral arterial disease were identified by self-reported history of
a previous physician diagnosis. Prevalent heart failure was identified by the Gothenburg criteria
or self-reported history of heart failure medication use in the past 2 weeks.
Statistical methods
Frequency distributions of the variables used in analyses were first inspected to rule out
anomalies and outliers. Descriptive statistics were used to determine mean values, standard
deviations, and percentile distributions for continuous variables, and frequencies and percentages
for categorical variables.
During the period from visit 1 to visit 4, incidence rates of SMI and CMI were calculated
per 1000 person-years and compared in all ARIC participants as well as stratified by age, sex and
race/ethnicity.
Cox proportional hazards analysis was used to examine the associations of SMI and CMI
(vs. no MI) occurring from visit 1 to visit 4 with CHD death and all-cause mortality occurring
after visit 4. The follow up time included the time elapsed between the identification of SMI or
CMI plus the time from visit 4 to the event. Non-CHD deaths were treated as censored. Models
were incrementally adjusted as follows: Model 1 adjusted for baseline demographics (age, sex
and race), and Model 2 adjusted for variables in Model 1 plus study field center, body mass
index, income, education, smoking status, systolic blood pressure, blood pressure lowering
medications, diabetes mellitus, ratio of total cholesterol/high density lipoprotein cholesterol, use
of cholesterol lowering medications, use of aspirin, family history of CHD and serum creatinine
(all variables measured at baseline). Interactions by sex and race were examined in Model 2. We
examined the assumption of proportional hazards by computation of Schoenfeld residuals and
inspection of log ( log [survival function]) curves, and they were met.
per 1000 person-years and compared in all ARIC participants as well as stratifieddd bbbyyy agagage,e,e, sssexexex aaand
ace/ethnicity.
CoCoCoxxx prpp oppporrrtional hazards analysis was usussededed to examine the assoocociaii tions of SMI and CMI
vvvs... no MI) occucucurrrinnggg rfrfromomom vvvisisisititit 111 tttooo vivivisiit 444 wiwiwith CCHHHD dddeeeaththth aaandndnd aaallllll cc-cauauause mmmororortatatalililitytyty occccccurrrririringngng
affftetet rrr viv sit 4.. TTThee foolo lowww up ttimimimeee inclclcludududeddd thehehe tttimee eeelapppseeed bbebetwtwtweeeennn ththhe iddentitit fifificationonon off SMMI oroor
CMCMCMIII plplplussus ttthehehe tttimimimeee frfrfromomom visisisititit 444 tttooo thththeee eveevenenenttt. NNNononon CC-CHDHDHD dddeaeaeathththsss weewererere tttrerereatatatededed aaasss cececensnsnsorororededed. MMModododelelelsss
7
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All analyses were performed with SAS version 9.3 (SAS Institute Inc., Cary, North
Carolina). A 2-sided p <0.05 was considered significant. However, because the interactions tests
were used for only screening for effect modification (interactions) by sex and race and not
testing a hypothesized effect modification, we used a more relaxed p-value of 0.10 to define
significance to detect interaction.35
Results
This analysis included 9,498 participants (age at baseline 54.0 (+ 5.7) years, 56.9% women, and
20.3% African American). From baseline through the 4th
ARIC visit, 317 participants developed
SMI while 386 developed CMI. Table 1 shows the baseline characteristics of the study
participants stratified by MI status.
Table 2 shows the incidence rate (per 1000 person-years) of SMI and CMI, overall and
stratified by sex and race. Overall, the incidence rate of CMI was slightly higher than SMI.
However, sex and race differences in the incidence of SMI and CMI were observed. The
incidence rates of both SMI and CMI were higher in men compared to women (p-value <.0001).
On the other hand, blacks had non-significantly higher rate of SMI than whites (p-value= 0.217)
but white had higher rate of CMI than blacks (p-value=0.002). Figure 1 shows the incidence
rates of SMI and CMI in white men, black men, white women and black women. As shown, the
incidence rate of SMI was higher than CMI in black women, which is the opposite of what is
observed in white men in whom CMI was more common than SMI. On the other hand, the
incidence rates of SMI were comparable to those of CMI in white women and black men.
During a median follow up of 13.2 years follow-up, 1,833 all-cause mortality cases were
detected of which 189 were CHD deaths. Figure 2 and Figure 3 show the event (CHD death and
SMI while 386 developed CMI. Table 1 shows the baseline characteristics of theee ssstututudydydy
participants stratified by MI status.ff
TaTaTablblbleee 2 ssshohohows the incidence rate (per 1000000000 person-years) of SMIMIMI and CMI, overall and
tttraaattified by sexxx anndd rararacecece. OvOvOverereraallllll, thththee innciidededennnce rrattte ooofff CMCMCMIII wawasss slslsliigighththtlyy higiggheheher thththananan SSSMIMIMI.
HoHoHowewewever, sexexex anndn raceee ddid ffererrennncec s ininin ttthehehe incccidddencce off SMSMMII annnddd CMCMCMII weeeree oobsbsbseree ved.d.d. The
nnncicicidededencncnceee rararatetetesss ofofof bbbototothhh SMSMSMIII anananddd CMCMCMIII weewererere hhhigigigheheherrr ininin mmmenenen cccomomompapaparerereddd tototo womomomenenen (((ppp-vaavalullueee <<<.000000010101))).
8
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9. DOI: 10.1161/CIRCULATIONAHA.115.021177
all-cause mortality, respectively) -free survival curves by MI status (no MI, SMI and CMI).
In multivariable adjusted Cox proportional hazards analysis, both SMI and CMI
(compared to no MI) were associated with increased risk of CHD death (Table 3) and all-cause
mortality (Table 4). However, SMI and CMI were associated with increased risk of mortality
among both men and women, with potentially greater increased risk among women (interaction
p-value=0.089 and 0.051, respectively). No significant interaction by race was detected.
Discussion
In this analysis from the ARIC study, one of the largest community-based biracial cohort studies in
the US, we examined the sex and racial differences in the incidence and prognostic significance of
silent vs. clinically-manifested MI. The three key findings are: 1) SMI is common; about 45% of
the MIs are silent; 2) Both SMI and CMI are associated with poor prognosis with CMI showing
slightly stronger association with risk of death than SMI; 3) There are race and sex differences in
the incidence and prognostic significance of SMI. These findings highlights the importance of
detection of SMI, and the potential impact of such detection on personalized prevention of CHD
that takes into account race and sex. This is further underscored by the known sex and race
disparity in CHD incidence and prognosis,36
and the fact that those with SMI are deprived from
medical attention compared to those with CMI.
Several previous studies have examined the prevalence, incidence and prognostic
significance of SMI.4-26
In literature reviews by Pride et al,4
and by Sheifer et al,37
SMI constituted
up to 44% of the total MIs, and carried a prognosis that was as poor as that for CMIs. The
prevalence and incidence of SMI differed, however, from one study to another. In the
Cardiovascular Health Study (CHS), which is a predominantly white population of elderly aged 65
he US, we examined the sex and racial differences in the incidence and prognosticcc sssigigignninififificacacancncnceee of
ilent vs. clinically-manifested MI. The three key findings are: 1) SMI is common; about 45% of
he MIMIMIsss ararareee sisisilentntnt; 2)22 Both SMI and CMI are assooociciciatata ed with poor prognnosososis with CMI showing
llliggghhtly strongeeerrr asssooociciciattatioioionnn wiwiwiththth rrrisisskkk ofoo ddeaaththt tthannn SSSMIII; 3)3)3) TTTheheh rerere aaarerere rrracacacee anddd sesesexx dididiffff erererenenencececesss innn
hhheee ininincidencceee anddd pprp ogggnooosticc sigigignin fifificacac ncncceee off SSSMMMI. ThThhessse fffindddinnngsgg hhigigighlhlh iggghtts ththhee impopoportrtrtancecee of
dededetetetectctctioioionnn ofofof SSSMIMIMI, anananddd thththeee popopotetetentntntiaiaialll imimimpapapactctct ooofff sussuchchch dddetetetececectititiononon ooonnn pepepersrsrsonononalalaliziizededed ppprerereveeventntntioioionnn ofofof CCCHDHDHD
9
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years and older, SMI accounted for 22% of the prevalent MIs.19
In a similar cohort of elderly
patients aged >75 years, the Bronx Aging Study, SMIs represented 44% of the total MIs.17
On the
other hand, in the Heart and Estrogen/progestin Replacement Study Trial, which included only
women, SMI constituted only 4% of the total MI,38
which is much lower than the Reykjavik Study
in Women in which SMIs represented 33% of the total MIs.10
Similarly, different studies showed
different prognosis of SMI, with some reporting similar or poorer prognosis17, 26
and others
showing better prognosis with SMI compared to CMI.7, 39
Differences in the incidence and prognostic significance among different studies could be
explained by differences in the population studied (e.g. distribution of age, race and sex) and the
method by which SMI is detected (e.g. Q wave in the ECG, myocardial scar in the cardiac
magnetic resonance imaging, or areas of akinesia in the echocardiography). Even within studies
that used ECG to define silent MI there are differences, some used serial Q/ST/T changes26
and
others used MI at each point of time as our study. Regardless of these differences, the overall
incidence and prognostic significance of SMI in these studies generally accord with our results.
However, none of these studies had the large sample size or the ethnically diverse community-
based population with good representation of both sexes as our study. Hence, the race and sex
differences in the incidence and prognostic significance of SMI were not appropriately examined
in previous studies. Therefore, our results expand upon the previous studies and also extend our
previous ARIC report on SMI that examined the incidence but not the prognostic significance of
these MIs.40
Our observations of the race and sex differences in the incidence and prognostic
significance of SMI adds to the accumulating evidence of the sex and racial differences in CVD
outcomes and the potential differences in the impact of risk factors among sexes and races.
method by which SMI is detected (e.g. Q wave in the ECG, myocardial scar in the cacacardrdrdiaiaiaccc
magnetic resonance imaging, or areas of akinesia in the echocardiography). Even within studies
hat uuuseseseddd ECECECGGG tooo dddefine silent MI there are differrrenenenccces, some used serialll QQQ/ST/T changes26
and
oootheeers used MI aaattt eeachchch pppoioiointntnt ooofff tititimememe aass ouur stststuddudy. RReeegarrrdldldlesesssss ofofo ttthehh sesese dddifififfeerencncnceseses, thththeee ovvveree alalallll
nnncicc dededence annnddd progogognosssticcc siggnnnififificac nnncecece ooof SMSMSMIII iinin thessse ssstututuddieseses gggenene eeerrarallllyyy aaacccordrdrd wwwith ououour reesuuults...
HoHoHoweeweveeverrr, nnnonononeee ofofof ttthehehesesese ssstuttudididieseses hhhadadad ttthehehe lllararargegege sssamamamplplpleee sisisizeeze ooorrr thththeee etetethnhnhnicicicalalallylly dddiviivererersesese cccomomommummunininitytty-
10
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11. DOI: 10.1161/CIRCULATIONAHA.115.021177
Because we adjusted for several potential confounders, it is less likely that our observed sex and
racial differences were confounded by differences in MI-associated morbidities. Future
investigation should assess whether genetic background, emerging risk factors, access to health
care, awareness, and adherence to medications contribute to sex and racial differences.
Our results should be read in the context of certain limitations. Our analyses included only
whites and blacks, and hence our results may not be generalizable to other races/ethnicities. Although
we adjusted for several potential confounders in the models examining the association between SMI
and CMI with outcomes, residual confounding remains a possibility as all similar studies. Q-waves
often disappear after MI, and hence the SMI incidence in our study might be underestimated given
the time between visits. Also, the increasing sensitivity of troponin in the past decade probably have
yielded more CMI, and subsequently less SMI in the later stages of ARIC compared to before.
Although this should not impact the race and sex differences, it may impact the trend of SMI over
time. Also, there were no significant changes in the sensitivity of troponin before 1998, the date our
ascertainment of silent MI ended. Despite these limitations, our study was able to document the race
and sex differences in the incidence and prognostic significance of SMI and compare the results to
CMI in a large, well-designed prospective cohort study with long term follow-up; the ARIC study.
Other strengths include standardized ECG procedures and carefully documented outcomes events
ascertained by an independent adjudication committee.
In conclusion, in the ARIC study we showed that SMI is as common as CMI; 45% of the
MIs are silent, and that both SMI and CMI are associated with poor outcomes. However, there are
race and sex differences in the incidence and prognostic significance of SMI. Thus, accidental
ECG finding of MI in persons without a history of MI may warrant enhanced CHD prevention
efforts that take into account sex and race differences.
he time between visits. Also, the increasing sensitivity of troponin in the past decadeee prprprobobobababablylyly hhhavavave
yielded more CMI, and subsequently less SMI in the later stages of ARIC compared to before.
Althhouououghghgh ttthihihisss shouououldll not impact the race and sex dididiffffffeeerences, it may impaactctct the trend of SMI overttt
iiimeee. Also, thherreee wwereree nnnooo sisisigngngnififificicicanannttt chchchanaanges ininin the seeensiiitititinn vivivitytyty ooof trtrt opopopononininin beeforerere 1119999998,8,8, thhheee adaatetete oooururur
assscecec rtrtrtainmennnttt of silllent MMIM endnddededed. DDDesee pipiiteee theeeseee limmittaatiooonnsns, ooouuur sssttudududyy wawawas aablelele tttooo dottt cucucummentntt the raace
anananddd sesesex dididifffffferererenenencececesss ininin ttthhheee ininincicicidededencncnceee anananddd prprprogogognononostststicicic sssigigignininififificacacancncnceee ofofof SSSMIMIMIggg anananddd cococompmpmpararareee thththeee rereresussultltltsss tototo
11
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12. DOI: 10.1161/CIRCULATIONAHA.115.021177
Acknowledgments: The authors thank the staff and participants of the ARIC study for their
important contributions.
Funding Sources: The ARIC Study is carried out as a collaborative study supported by National
Heart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201100005C,
HHSN268201100006C, HHSN268201100007C, HHSN268201100008C,
HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and
HHSN268201100012C).
Conflict of Interest Disclosures: None.
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3833 . Hulley S, Grradady DDD, Bushhh TTT, Furbergrrg C, HeHeHerrinngggton DDD,,, RRRiggggs BBB, Vittttinnghhhofff E. RaRaRanddommmizedeed
riaiaialll ofoo estrooogegeg n plplplus ppprooogestttininin fffor ssseeecononondad ryryry ppprevvennntiooonnn offf corororononnaararyyy heeearrt dididiseeease ininin
posttmememenononopppausalalal wwomomomenen. HeHH arrttt anananddd Estrtrrogogogenenn/p/p/progoogesestititinn ReReReplplplacacacemmenenenttt StStStuddudyyy (HHHERERERS)S)S) Reseeseaearcrcrchhh
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16. DOI: 10.1161/CIRCULATIONAHA.115.021177
Clinical Perspective
This report from the Atherosclerosis Risk in Communities (ARIC) study, one of the largest
community-based biracial cohort studies in the US, shows that presence of asymptomatic or
silent myocardial infarction on screening electrocardiograms is a common finding; about 45% of
the total number of myocardial infarctions in the study were silent. These silent myocardial
infarctions were associated with increased risk of death in a magnitude that is relatively
comparable to myocardial infarctions with clinical manifestations. However, race and sex
differences in the incidence and prognostic significance of silent myocardial infarction were
observed in this study. These findings highlights the importance of detection of silent myocardial
infarctions, and the potential impact of such detection on personalized prevention of coronary
heart disease that takes into account race and sex.
observed in this study. These findings highlights the importance of detection of silililenenenttt mymymyocococararardidd a
nfarctions, and the potential impact of such detection on personalized prevention of coronary
hearrttt dididiseseseasasaseee thatatat tttaka es into account race and sexxx..
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17. DOI: 10.1161/CIRCULATIONAHA.115.021177
Table 1. Baseline (1987-89) Participants Characteristic Stratified by Incident Myocardial
Infarction during follow up (1996-1998).
Mean± SD or n (%)
No MI
(n=8,795)
SMI
(n=317)
CMI
(n=386) p-value* p-value†
Age (years) 54 ±5.6 55 ±5.9 55 ±5.6 0.289 <.001
Women 5154 (59) 139 (44) 107 (28) <.001 <.001
African-American 1802 (20) 74 (23) 54 (14) 0.001 0.003
Education high school 4483 (51) 161 (51) 227 (59) 0.033 0.011
Current smoker 1814 (21) 80 (25) 120 (31) 0.004 <.001
Body mass index (kg/m2
) 27 ±5.0 29 ±5.7 28 ±4.3 0.063 <.001
Systolic blood pressure (mmHg) 118 ±17 125 ±19 125 ±19 0.783 <.001
Hypertension 2347 (27) 128 (41) 152 (39) 0.783 <.001
Antihypertensive medication 1966 (22) 109 (34) 116 (30) 0.221 <.001
Diabetes 644 (7.4) 53 (17) 64 (17) 0.970 <.001
Ratio of total /HDL cholesterol 4.4 ±1.6 4.8 ±1.7 5.7 ±1.6 <.001 <.001
Cholesterol lowering medication 202 (2.3) 7 (2.2) 12 (3.1) 0.463 0.578
Aspirin use 4016 (46) 144 (46) 166 (43) 0.531 0.579
Family history of coronary heart disease 3462 (39) 138 (44) 199 (52) 0.034 <.001
Serum creatinine (mg/dL) 1.1 ±0.3 1.1 ±0.2 1.2 ±0.2 0.130 <.001
*
p-value for comparison between silent and clinical MI using unpaired student T test and Chi2
for continuous and
categorical variables, respectively
†
p-value for comparison among the three groups using analysis of variance and Chi2
for continuous and categorical
variables, respectively.
Table 2. Incidence of Silent and Clinically Manifest Myocardial Infarction by Sex and Race:
ARIC 1987-89 to 1996-98.
SMI CMI
Events
N (%)
Incidence per
1000 person-years
Events
N (%)
Incidence per
1000 person-years
All population (n=9,498) 317 (3.3) 3.84 (2.84-4.84) 386 (4.1) 4.68 (3.51-5.84)
Men (n=4,098) 178 (4.3) 5.08 (3.34-6.82) 279 (6.8) 7.96 (5.64-10.3)
Women (n=5,400) 139 (2.6) 2.93 (1.77-4.09) 107 (2.0) 2.25 (1.18-3.33)
White (n=7,568) 243 (3.2) 3.69 (2.59-4.79) 332 (4.4) 5.04 (3.69-6.39)
Black (n=1,930) 74 (3.8) 4.45 (2.05-6.84) 54 (2.8) 3.24 (1.13-5.36)
MI= myocardial infarction; SMI= Silent MI; CMI= MI with clinical manifestations.
Ratio of total /HDL cholesterol 4.4 ±1.6 4.8 ±1.7 5.7 ±1.6 <.00111 <.001
Cholesterol lowering medication 202 (2.3) 7 (2.2) 12 (3.1) 0.464646333 0.0.0.5755 8
Aspirin use 4016 (46) 144 (46) 166 (43) 0.53111 0.579
Family history of coronary heart disease 3462 (39) 138 (44) 199 (52) 0.034 <.001
Seruuummm crcrcreaeaeatititininn neee (((mmgm /dL) 1.1 ±0±0±0.3.3.3 1.1 ±0.2 1.2 ±0±0±0.2.. 0.130 <.001
p-p-p-vaaallue for coommmparisson between silent and clinical MI usinng unpaireded studentntnt TTT test and Chi2
for continuous and
aaategggorical variableleles,s rressspepepecttctivivivelelelyyy
p-pp vvavalue for comparrrisoon amommong thhhe tthree grouupupss usinnng ana alyysiiis offf vavavariririaaanccce annnd Chi2
ffforr cononntiiinuousss annnd ccateeegoriiicaal
vaaarir ababables, respepeectcc iveelyy.
Table 2 Incidence of Silent and Clinically Manifest Myocardial Infarction by Sex and Race:
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18. DOI: 10.1161/CIRCULATIONAHA.115.021177
Table 3. Risk of Coronary Heart Disease Death Associated with Silent and Clinically Manifest
Myocardial Infarction by Sex and Race.
Events/1000
person years
Model 1*
HR (95% CI)
Model 2†
HR (95% CI)
Interaction
p-value††
All Population
No MI (n=8,795) 0.7 1 (ref.) 1 (ref.)
Silent MI (n=317) 3.2 4.10 (2.57-6.53) 3.06 (1.88-4.99)
Clinical MI (n=386) 5.5 6.85 (4.78-9.79) 4.74 (3.26-6.90)
N/A
Men
No MI (n=3,641) 1.0 1 (ref.) 1 (ref.)
Silent MI (n=178) 3.6 3.23 (1.79-5.81) 2.77 (1.51-5.10)
Clinical MI (n=279) 5.5 5.49 (3.61-8.34) 4.39 (2.83-6.63)
Women
No MI (n=5,154) 0.4 1 (ref.) 1 (ref.)
Silent MI (n=139) 2.8 6.92 (3.26-14.7) 3.79 (1.65-8.73)
Clinical MI (n=107) 5.5 12.7 (6.66-24.0) 5.67 (2.78-11.6)
0.089
White
No MI (n=6,993) 0.5 1 (ref.) 1 (ref.)
Silent MI (n=243) 2.6 4.01 (2.23-7.24) 3.30 (1.82-6.01)
Clinical MI (n=332) 4.6 6.60 (4.31-10.1) 4.52 (2.92-6.99)
Black
No MI (n=1,802) 1.1 1 (ref.) 1 (ref.)
Silent MI (n=74) 5.4 4.15 (1.93-8.89) 2.62 (1.06-6.48)
Clinical MI (n=54) 11.5 7.22 (3.75-13.9) 5.57 (2.60-11.9)
0.204
HR=hazard ratio; CI=confidence interval; MI= myocardial infarction
*
Model 1 adjusted for age, sex, and race.
†
Model 2 adjusted for variables in model 1 plus study field center, body mass index, education, smoking status,
systolic blood pressure, blood pressure lowering medications, diabetes mellitus, ratio of total cholesterol/high
density lipoprotein, use of cholesterol lowering medications, use of aspirin, family history of coronary heart
disease and serum creatinine (all at baseline).
††
Interactions tested in Model 2.
White
No MI (n=6,993) 0.5 1 (ref.) 1 (ref.)
Silent MI (n=243) 2.6 4.01 (2.23-7.24) 3.30 (1.82-6.01)
Clinical MI (n=332) 4.6 6.60 (4.31-10.1) 4.52 (2.92-6.99)
Blaccckkk
NoNoNo MMI (n=1=1=1,8, 02)) 1.1 1 (((reeef.) 1 (ref.)
Sillel nt MI (n=777444) 555.4.4.4 444.1.. 555 (1..9333-8.8.8.898989))) 2.22 626262 (((11.1 0006--6.4448)8)8)
Clllini ical MI (n==544) 11.5 7.2222 (3..755-13.3.3.9)9)9) 5.555777 (2.6660--1111.999))
0.204
HRRR=h=h=haza ard raatititiooo; CCI=I=I coc nfffididideene ce iiintnn erererval;l;l; MMMI=== mmmyocccarrdrdial infffarccctiooon
Modededelll 111 adadadjujujusteddd ffforor aaagegege, sesexx,x, anddd rrracacace.e.e.
MoMoModededelll 222 adadadjujujustststededed fffororor vvvararariaiaiablblbleseses iiinnn momomodededelll 111 plplplususus ssstututudydydy fffieieieldldld cccenenenteteter,r,r, bbbodododyyy mamamassssss iiindndndexexex,,, edededucucucatatatioioion,n,n, smsmsmokokokinininggg stststatatatususus,,,
ystolic blood pressure blood pressure lowering medications diabetes mellitus ratio of total cholesterol/high
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19. DOI: 10.1161/CIRCULATIONAHA.115.021177
Table 4. Risk of All-cause Mortality Associated with Different Patterns of Myocardial
Infarction.
Events/1000
person years
Model 1*
HR (95% CI)
Model 2 †
HR (95% CI)
Interaction
P-value††
All participants
No MI (n=8,795) 8.4 1 (ref.) 1 (ref.)
Silent MI (n=317) 15.9 1.63 (1.33-1.99) 1.34 (1.09-1.65)
Clinical MI (n=386) 18.7 1.85 (1.56-2.20) 1.55 (1.30-1.85)
N/A
Men
No MI (n=3,641) 11.0 1 (ref.) 1 (ref.)
Silent MI (n=178) 17.3 1.43 (1.11-1.85) 1.23 (0.94-1.60)
Clinical MI (n=279) 18.7 1.65 (1.34-2.02) 1.45 (1.18-1.78)
Women
No MI (n=5,154) 6.6 1 (ref.) 1 (ref.)
Silent MI (n=139) 14.0 2.05 (1.49-2.81) 1.58 (1.13-2.20)
Clinical MI (n=107) 18.9 2.59 (1.89-3.56) 1.83 (1.32-2.54)
0.051
White
No MI (n=6,993) 8.0 1 (ref.) 1 (ref.)
Silent MI (n=243) 14.6 1.50 (1.18-1.90) 1.31 (1.03-1.67)
Clinical MI (n=332) 18.1 1.80 (1.49-2.17) 1.48 (1.22-1.79)
Black
No MI (n=1,802) 9.8 1 (ref.) 1 (Ref.)
Silent MI (n=74) 20.1 2.03 (1.40-2.96) 1.45 (0.96-2.21)
Clinical MI (n=54) 23.0 2.14 (1.41-3.26) 1.97 (1.27-3.05)
0.178
HR=hazard ratio; CI=confidence interval; MI= myocardial infarction
*
Model 1 adjusted for age, sex, and race.
†
Model 2 adjusted for variables in model 1 plus study field center, body mass index, education, smoking status,
systolic blood pressure, blood pressure lowering medications, diabetes mellitus, ratio of total cholesterol/high
density lipoprotein, use of cholesterol lowering medications, use of aspirin, family history of coronary heart
disease and serum creatinine (all at baseline).
††
Interactions tested in Model 2.
White
No MI (n=6,993) 8.0 1 (ref.) 1 (ref.)
Silent MI (n=243) 14.6 1.50 (1.18-1.90) 1.31 (1.03-1.67)
Clinical MI (n=332) 18.1 1.80 (1.49-2.17) 1.48 (1.22-1.79)
Blaccckkk
NoNoNo MI (n(nn===1,8020 ) 9.8 1 (refff.) 1 (Reff.)
SSSilent MI (n(n(n=7=7=744) 222000.11 2.2.2 03 ((1.4000-2-2-2 99.96)6)6) 111.444555 (0(0(0.96---2.2.2.212121)))
CClC inical MI (nnn==54)) 23.33 0 2..14 ((1.411-3-3-3.2.2.2666) 1.97 ((1.2777-333.05)
0.178
HRHRR=h=h=hazard ratititio;oo CI=I=confffididence iiintteere val;;; MMMI=== mmmyocccarrdrdial infffarcccttiooon
Moodededelll 111 adadadjujujusteddd ffforor aaagegege,, seseex,x,x anddd rrracaa e.e.e.
Model 2 adjujj sted for variables in model 1 plpp us studyyy field center,,, bodyyy mass index,,, education,,, smokinggg status,,,
ystolic blood pressure, blood pressure lowering medications, diabetes mellitus, ratio of total cholesterol/high
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Chambilla on May 19, 2016
20. DOI: 10.1161/CIRCULATIONAHA.115.021177
Figure Legends:
Figure 1. Sex-race specific incidence rates (per 1000 person-years) of silent and clinical
myocardial infarctions.
Figure 2. Coronary heart disease survival probability curves by myocardial infarction status.
Figure 3. All-cause mortality survival probability curves by myocardial infarction status.
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