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Medscape
3 days ago
- Health
- Medscape
Does Obesity Raise AF Risk Directly or Via Comorbidities?
TOPLINE: Individuals with overweight or obesity have a higher risk for atrial fibrillation (AF) than those with normal weight. Nearly one fourth of the increased risk with obesity is mediated by comorbid conditions, whereas the remaining risk is directly mediated by obesity. METHODOLOGY: Obesity is associated with an increased risk for AF, yet it remains unclear whether this risk stems directly from excess adiposity or is mediated by comorbid conditions. Researchers conducted a retrospective cohort study of patients aged ≥ 40 years with a documented BMI across German general practices between 2005 and 2023. Participants were categorized as underweight (BMI < 18.5), normal weight (18.5-24.9), overweight (25.0-29.9), or obesity (≥ 30). The primary outcome was incident AF within 10 years of the index date. A causal mediation analysis estimated the proportion of AF risk mediated by comorbidities, including type 2 diabetes, hypertension, dyslipidemia, ischemic heart disease, and heart failure. TAKEAWAY: The study included 1 22,464 participants with normal weight (mean age, 58.9 years; 61.6% women), 150,783 with overweight (mean age, 60.7 years; 44.5% women), and 112,674 with obesity (mean age, 60.1 years; 53% women). Over 10 years, AF occurred in 7.2% of participants with normal weight, 10.1% with overweight, and 13.2% with obesity. Compared to those with normal weight, the risk for AF was 43% higher among individuals with obesity (P <.001) and 12% higher among those with overweight (P < .001), with greater risks in men. Mediation analysis revealed that 27% of obesity-related AF risk was mediated by comorbidities, whereas 79% was attributed to direct effects of obesity. IN PRACTICE: "Effective management of hypertension, diabetes and dyslipidaemia could help to achieve a meaningful reduction in the proportion of AF cases attributable to obesity. At the same time, the persistent direct effect of BMI on AF, despite adjustment for comorbidities, indicates that weight reduction must remain a central focus of preventive strategies," the authors wrote. SOURCE: This study was led by Jamschid Sedighi, MD, Justus-Liebig-University in Giessen, Germany. It was published online in Diabetes, Obesity and Metabolism. LIMITATIONS: BMI was measured only at baseline; thus, associations reflect initial BMI rather than changes over time. Confounding factors may have remained. Reliance on diagnostic codes may have underestimated the cases of paroxysmal or asymptomatic AF. DISCLOSURES: No specific study funding was reported. Two authors disclosed receiving speaker/consulting honoraria from AstraZeneca and Pfizer, and one also received honoraria from additional sources including Novartis, Berlin-Chemie, and Lilly. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
23-07-2025
- Health
- Medscape
Low Apgar Scores Predict Poor Outcomes in Premature Infants
TOPLINE: A 5-minute Apgar score < 7 was significantly associated with increased risks for in-hospital mortality, severe intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and prolonged hospital stay among infants born very preterm (VPT). METHODOLOGY: Researchers conducted a prospective population-based cohort study of liveborn infants born VPT from the EPICE-SHIPS cohort. This study included 7900 liveborn infants born VPT between 22 + 0 and 31 + 6 weeks of gestation across 19 regions in 11 European countries. Data on maternal and perinatal characteristics, management, and neonatal outcomes were collected from patient records. Adjusted associations between 5-minute Apgar scores < 7 and adverse neonatal outcomes were analysed; researchers tested for interactions by the country-level prevalence of an Apgar score < 7, categorised as low (14%-16%), medium (19%-22%), and high (28%-40%) groups. Outcomes included in-hospital mortality, severe IVH (> grade 2), cystic periventricular leukomalacia (cPVL), necrotising enterocolitis, late-onset infection, ROP (≥ stage 3), BPD (moderate/severe), and prolonged hospital stay. TAKEAWAY: A 5-minute Apgar score < 7 was observed in 20.2% of infants born VPT, varying widely across countries from 14% to 40%. A low Apgar score (< 7) was strongly associated with a higher risk for in-hospital mortality than a high Apgar score (≥ 7; 35.7% vs 6.9%; adjusted relative risk [RR], 2.24; 95% CI, 1.95-2.58), with consistent risk observed across all country groups. A low Apgar score was associated with increased risks for severe IVH (RR, 1.61; 95% CI, 1.33-1.96), ROP (RR, 1.41; 95% CI, 1.09-1.82), cPVL (RR, 1.40; 95% CI, 1.00-1.96), BPD (RR, 1.35; 95% CI, 1.20-1.51), and prolonged hospital stay (RR, 1.44; 95% CI, 1.26-1.63). Associations with IVH, BPD, and prolonged hospital stay were stronger among countries with a lower prevalence of low Apgar scores (test of interaction P = .04 for IVH, P = .09 for BPD, and P = .43 for prolonged hospital stay). IN PRACTICE: "[Low Apgar scores'] interactions with adverse outcomes demand caution when using the Apgar score in prognostic models for clinical care and research without local validation," the authors wrote. SOURCE: This study was led by Harald Ehrhardt, MD, Department of Pediatrics and Adolescent Medicine, University Medical Centre Ulm, Ulm, Germany. It was published online on July 15, 2025, in BJOG: An International Journal of Obstetrics & Gynaecology. LIMITATIONS: The study's data were collected in 2011-2012, and clinical practices may have evolved since then. Variations in how Apgar scores were assigned across different centres, the lack of data on postnatal resuscitation efforts, and a mostly White European cohort may have limited generalisability. DISCLOSURES: This work was supported by the European Union's (EU's) Seventh Framework Programme and the EU's Horizon 2020 research and innovation programme. Some authors reported receiving funding from the EU and Swedish Foundation related to the study, and others reported receiving unrelated grants and serving unpaid roles in paediatric organisations and advisory boards. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
10-07-2025
- Health
- Medscape
Lipoprotein Exposure Before 40 Predicts Future Heart Risk
TOPLINE: For adults younger than 40 years, higher cumulative exposure to atherogenic lipoprotein particles — apolipoprotein B, low-density lipoprotein particles, and triglyceride-rich lipoprotein particles — was associated with a significant increase in the risk for atherosclerotic cardiovascular disease (ASCVD) after 40 years of age. METHODOLOGY: Researchers analyzed prospective data from a population-based cohort study of US adults (n = 5115; 55% women) to examine whether exposure to atherogenic lipoprotein particles during early adulthood was linked to ASCVD in midlife. They evaluated the levels of atherogenic lipoprotein particles — apolipoprotein B, low-density lipoprotein particles, and triglyceride-rich lipoprotein particles — in 4366 participants aged 18-40 years to calculate the cumulative exposure over 22 years. ASCVD events — fatal and nonfatal myocardial infarction and stroke — occurring after age 40 were tracked over a mean follow-up of 19.3 years. TAKEAWAY: Each SD increase in cumulative exposure to atherogenic lipoprotein particles was associated with a 28%-30% higher risk for ASCVD after age 40; adjusted hazard ratios were 1.30 (95% CI, 1.15-1.46) for apolipoprotein B, 1.28 (95% CI, 1.13-1.44) for low-density lipoprotein particles, and 1.28 (95% CI, 1.13-1.45) for triglyceride-rich lipoprotein particles. The risk for ASCVD increased notably when usual exposure exceeded 75 mg/dL/y for apolipoprotein B, 1000 nmol/L/y for low-density lipoprotein particles, and 135 nmol/L/y for triglyceride-rich lipoprotein particles. The risk for ASCVD after age 40 was generally linear when each atherogenic lipoprotein particle was examined separately. IN PRACTICE: 'Data presented from the current analysis from one US-based cohort study of young adults offer potential clinical thresholds, rather than definitive cutoff values for clinical practice,' the researchers of the study noted. 'While clinical validation is needed, these values could serve as reasonable targets for untreated young adults, and achieving them may require both individual-level interventions — such as lifestyle modification and pharmacotherapy — as well as policy-level strategies, including subsidies for nutritious foods and public health initiatives to promote physical activity,' they added. SOURCE: This study was led by Alexander R. Zheutlin, MD, Northwestern University Feinberg School of Medicine, Chicago. It was published online on July 4, 2025, in the European Heart Journal. LIMITATIONS: Many clinical practices lacked the ability to measure specific subfractions of lipoprotein particles. Children were not included in this study, despite evidence of childhood exposure to lipid particles predicting heart disease risk in adult life. This study was not sufficiently powered to stratify risks based on race and gender. DISCLOSURES: The original cohort study was supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama, Northwestern University, University of Minnesota, and Kaiser Foundation Research Institute. One author reported receiving funding from the National Institutes of Health and personal fees from 3M. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
17-06-2025
- Health
- Medscape
Higher Liothyronine Use in Hypothyroidism With Psych History
Patients with a psychiatric history prior to their diagnosis of autoimmune hypothyroidism were nearly twice as likely to receive liothyronine treatment as those without such a history, with the effect being most pronounced among those with a history of affective or anxiety disorders. METHODOLOGY: Researchers in Sweden conducted a retrospective, population-based cohort study using national registry data to assess the association between prior psychiatric history and subsequent liothyronine use in patients with autoimmune hypothyroidism. They analysed 353,708 adults who filled at least one prescription for thyroid hormone replacement (liothyronine or levothyroxine) between 2006 and 2020, of whom 44.8% had psychiatric morbidity before the first thyroid hormone prescription. Among patients with a history of psychiatric morbidity, 96.7% were exposed to affective or anxiety morbidity and 8.3% had a history of psychotic disorders. The primary endpoint was liothyronine therapy at any point during the median follow-up duration of 63.4 months for patients with prior psychiatric morbidity and 69.2 months for those without. TAKEAWAY: Overall, 3.6% of patients received liothyronine during the study period. Patients with a history of psychiatric morbidity were more likely to receive liothyronine therapy than those without it (adjusted odds ratio [aOR], 1.90; P < .001). < .001). The strongest association with liothyronine therapy was observed in patients with a history of affective and anxiety disorders (aOR, 1.91; P < .001), whereas no significant difference was found between those with a history of psychotic disorders and those without ( P = .11). IN PRACTICE: "This study provides empirical evidence that patients with autoimmune hypothyroidism and a history of psychiatric morbidity are more likely to receive LT3 [liothyronine]-treatment, especially among those with affective or anxiety morbidity," the authors wrote. "This may reflect lingering symptoms that influence treatment decisions of hypothyroidism, either due to symptoms being misinterpreted as treatment-resistant hypothyroidism or actual physiological differences in thyroid disease within this group," they added. SOURCE: This study was led by Fredric Hedberg, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. It was published online on June 07, 2025, in The Journal of Clinical Endocrinology & Metabolism . LIMITATIONS: The retrospective design limited the ability to establish causal relationships. Data on thyroid hormone concentrations and treatment indications were lacking, preventing the determination of whether liothyronine prescriptions were due to laboratory abnormalities, persistent symptoms, or physician preferences. Moreover, information on interferon and immune checkpoint inhibitor therapies was unavailable. DISCLOSURES: This study was supported by grants from the Region Stockholm Drug and Therapeutic Committee and the Lisa and Johan Grönberg Foundation. The authors declared having no competing interests.
