mortality

Importance: Cardiovascular disease (CVD) is the leading cause of mortality in the US, accounting for more than 1 in 4 deaths. Each year, an estimated 605 000 people in the US have a first myocardial infarction and an estimated 610 000 experience a first stroke.

Objective: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD. The systematic review also investigated the effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, as well as the harms (particularly bleeding) associated with aspirin use. The USPSTF also commissioned a microsimulation modeling study to assess the net balance of benefits and harms from aspirin use for primary prevention of CVD and CRC, stratified by age, sex, and CVD risk level.

Population: Adults 40 years or older without signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke) who are not at increased risk for bleeding (eg, no history of gastrointestinal ulcers, recent bleeding, other medical conditions, or use of medications that increase bleeding risk).

Evidence assessment: The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit. The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.

Recommendation: The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. (C recommendation) The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older. (D recommendation).

Author/s:

US Preventive Services Task Force

Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation

Saige Blanchard — Thu, 14 Apr 2022 05:00:00 +0000

Date Added:

April 25, 2022

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

April 19, 2022

URL:

Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M21-4416

Keywords

PMID (1):

35436153

MeSH

Humans

cause of death

Parathyroidectomy

Hyperparathyroidism, Primary

cardiovascular diseases

prospective studies

In mild hyperparathyroidism, surgery did not result in fewer adverse events over 15 years of follow-up. James W. Mold, MD, MPH

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Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with increased risk for fractures, cardiovascular disease, kidney disease, and cancer and increased mortality. In mild PHPT with modest hypercalcemia and without known morbidities, parathyroidectomy (PTX) is debated because no long-term randomized trials have been performed.

Objective: To examine the effect of PTX on mild PHPT with regard to mortality (primary end point) and key morbidities (secondary end point).

Design: Prospective randomized controlled trial. (ClinicalTrials.gov: NCT00522028).

Setting: Eight Scandinavian referral centers.

Patients: From 1998 to 2005, 191 patients with mild PHPT were included.

Intervention: Ninety-five patients were randomly assigned to PTX, and 96 were assigned to observation without intervention (OBS).

Measurements: Date and causes of death were obtained from the Swedish and Norwegian Cause of Death Registries 10 years after randomization and after an extended observation period lasting until 2018. Morbidity events were prospectively registered annually.

Results: After 10 years, 15 patients had died (8 in the PTX group and 7 in the OBS group). Within the extended observation period, 44 deaths occurred, which were evenly distributed between groups (24 in the PTX group and 20 in the OBS group). A total of 101 morbidity events (cardiovascular events, cerebrovascular events, cancer, peripheral fractures, and renal stones) were also similarly distributed between groups (52 in the PTX group and 49 in the OBS group). During the study, a total of 16 vertebral fractures occurred in 14 patients (7 in each group).

Limitation: During the study period, 23 patients in the PTX group and 27 in the OBS group withdrew.

Conclusion: Parathyroidectomy does not appear to reduce morbidity or mortality in mild PHPT. Thus, no evidence of adverse effects of observation was seen for at least a decade with respect to mortality, fractures, cancer, cardiovascular and cerebrovascular events, or renal morbidities.

Author/s:

Pretorius, M., Lundstam, K., Heck, A., Fagerland, M. W., Godang, K., Mollerup, C., Fougner, S. L., Pernow, Y., Aas, T., Hessman, O., Rosen, T., Nordestrom, J., Jansson, S., Hellstrom, M., Bollerslev, J.

Mortality and concurrent use of opioids and hypnotics in older patients: A retrospective cohort study

Saige Blanchard — Fri, 06 Aug 2021 05:00:00 +0000

Date Added:

August 6, 2021

Journal/Publication:

PLoS Medicine

Publication Date:

July 15, 2021

Issue:

Volume:

Pages:

1-17

URL:

Mortality and concurrent use of opioids and hypnotics in older patients: A retrospective cohort study

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1371/journal.pmed.1003709

Keywords

PMID (1):

34264928

MeSH

analgesics, opioid

Trazodone

Benzodiazepines

Hypnotics and Sedatives

sleep initiation and maintenance disorders

Propensity Score

retrospective studies

This large retrospective cohort study found that the combination of benzodiazepines and opioids hastens mortality in older adults.

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Background: Benzodiazepine hypnotics and the related nonbenzodiazepine hypnotics (z-drugs) are among the most frequently prescribed medications for older adults. Both can depress respiration, which could have fatal cardiorespiratory effects, particularly among patients with concurrent opioid use. Trazodone, frequently prescribed in low doses for insomnia, has minimal respiratory effects, and, consequently, may be a safer hypnotic for older patients. Thus, for patients beginning treatment with benzodiazepine hypnotics or z-drugs, we compared deaths during periods of current hypnotic use, without or with concurrent opioids, to those for comparable patients receiving trazodone in doses up to 100 mg.

Methods and findings: The retrospective cohort study in the United States included 400,924 Medicare beneficiaries 65 years of age or older without severe illness or evidence of substance use disorder initiating study hypnotic therapy from January 2014 through September 2015. Study endpoints were out-of-hospital (primary) and total mortality. Hazard ratios (HRs) were adjusted for demographic characteristics, psychiatric and neurologic disorders, cardiovascular and renal conditions, respiratory diseases, pain-related diagnoses and medications, measures of frailty, and medical care utilization in a time-dependent propensity score-stratified analysis. Patients without concurrent opioids had 32,388 person-years of current use, 260 (8.0/1,000 person-years) out-of-hospital and 418 (12.9/1,000) total deaths for benzodiazepines; 26,497 person-years,150 (5.7/1,000) out-of-hospital and 227 (8.6/1,000) total deaths for z-drugs; and 16,177 person-years,156 (9.6/1,000) out-of-hospital and 256 (15.8/1,000) total deaths for trazodone. Out-of-hospital and total mortality for benzodiazepines (respective HRs: 0.99 [95% confidence interval, 0.81 to 1.22, p = 0.954] and 0.95 [0.82 to 1.14, p = 0.513] and z-drugs (HRs: 0.96 [0.76 to 1.23], p = 0.767 and 0.87 [0.72 to 1.05], p = 0.153) did not differ significantly from that for trazodone. Patients with concurrent opioids had 4,278 person-years of current use, 90 (21.0/1,000) out-of-hospital and 127 (29.7/1,000) total deaths for benzodiazepines; 3,541 person-years, 40 (11.3/1,000) out-of-hospital and 64 (18.1/1,000) total deaths for z-drugs; and 2,347 person-years, 19 (8.1/1,000) out-of-hospital and 36 (15.3/1,000) total deaths for trazodone. Out-of-hospital and total mortality for benzodiazepines (HRs: 3.02 [1.83 to 4.97], p < 0.001 and 2.21 [1.52 to 3.20], p < 0.001) and z-drugs (HRs: 1.98 [1.14 to 3.44], p = 0.015 and 1.65 [1.09 to 2.49], p = 0.018) were significantly increased relative to trazodone; findings were similar with exclusion of overdose deaths or restriction to those with cardiovascular causes. Limitations included composition of the study cohort and potential confounding by unmeasured variables.

Conclusions: In US Medicare beneficiaries 65 years of age or older without concurrent opioids who initiated treatment with benzodiazepine hypnotics, z-drugs, or low-dose trazodone, study hypnotics were not associated with mortality. With concurrent opioids, benzodiazepines and z-drugs were associated with increased out-of-hospital and total mortality. These findings indicate that the dangers of benzodiazepine-opioid coadministration go beyond the documented association with overdose death and suggest that in combination with opioids, the z-drugs may be more hazardous than previously thought.

Author/s:

W. A., Chung, C. P., Murray, K. T., Malow, B. A., Daugherty, J. R., Stein, C. M.

Lung Cancer Screening with Low-Dose CT: a Meta-Analysis

Carly Hughes — Wed, 21 Oct 2020 14:34:36 +0000

Date Added:

October 22, 2020

Journal/Publication:

Journal of General Internal Medicine

Publisher:

Society of General Internal Medicine

Publication Date:

June 24, 2020

Issue:

Volume:

Pages:

3015-3025

URL:

Lung Cancer Screening with Low-Dose CT: a Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1007/s11606-020-05951-7

Keywords

low-dose computed tomography

lung cancer screening

lung neoplasms

meta-analysis

mortality

PMID (1):

32583338

MeSH

lung neoplasms

tomography, x-ray computed

Carcinoma

The abstract of a met-analysis showing that lung cancer screening with low-dose CT reduces the risk of lung cancer deaths with around 8% false positive screens and a very low rate of documented untoward effects of those false positives. James W. Mold, MD, MPH

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Background: Randomized controlled trials have evaluated the efficacy of low-dose CT (LDCT) lung cancer screening on lung cancer (LC) outcomes.

Objective: Meta-analyze LDCT lung cancer screening trials.

Methods: We identified studies by searching PubMed, Google Scholar, the Cochrane Registry, ClinicalTrials.gov , and reference lists from retrieved publications. We abstracted data on study design features, stage I LC diagnoses, LC and overall mortality, false positive results, harm from invasive diagnostic procedures, overdiagnosis, and significant incidental findings. We assessed study quality using the Cochrane risk-of-bias tool. We used random-effects models to calculate relative risks and assessed effect modulators with subgroup analyses and meta-regression.

Results: We identified 9 studies that enrolled 96,559 subjects. The risk of bias across studies was judged to be low. Overall, LDCT screening significantly increased the detection of stage I LC, RR = 2.93 (95% CI, 2.16-3.98), I2 = 19%, and reduced LC mortality, RR = 0.84 (95% CI, 0.75-0.93), I2 = 0%. The number needed to screen to prevent an LC death was 265. Women had a lower risk of LC death (RR = 0.69, 95% CI, 0.40-1.21) than men (RR = 0.86, 95% CI, 0.66-1.13), p value for interaction = 0.11. LDCT screening did not reduce overall mortality, RR = 0.96 (95% CI, 0.91-1.01), I2 = 0%. The pooled false positive rate was 8% (95% CI, 4-18); subjects with false positive results had < 1 in 1000 risk of major complications following invasive diagnostic procedures. The most valid estimates for overdiagnosis and significant incidental findings were 8.9% and 7.5%, respectively.

Discussion: LDCT screening significantly reduced LC mortality, though not overall mortality, with women appearing to benefit more than men. The estimated risks for false positive results, screening complications, overdiagnosis, and incidental findings were low. Long-term survival data were available only for North American and European studies limiting generalizability.

Author/s:

Hoffman, Richard M., Atallah, Rami P., Struble, Roger D., Badgett, Robert G

Does Adding of Hydroxychloroquine to the Standard Care Provide Any Benefit in Reducing the Mortality Among COVID-19 Patients?: A Systematic Review

Brian Desmarais — Fri, 03 Jul 2020 19:31:09 +0000

Date Added:

July 3, 2020

Journal/Publication:

Journal of Neuroimmune Pharmacology

Publication Date:

June 9, 2020

URL:

Does Adding of Hydroxychloroquine to the Standard Care Provide Any Benefit in Reducing the Mortality Among COVID-19 Patients?: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1007/s11481-020-09930-x

Keywords

In case any of you still believe that hydroxychloroquine helps COVID patients, this systematic reviews adds to the literature suggesting it doesn’t. James W. Mold, MD, MPH

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Hydroxychloroquine has been promoted for its use in treatment of COVID-19 patients based on in-vitro evidences. We searched the databases to include randomized and observational studies evaluating the effect of Hydroxychloroquine on mortality in COVID-19 patients. The outcome was summarized as odds ratios (OR) with a 95% confidence interval (CI).We used the inverse-variance method with a random effect model and assessed the heterogeneity using I2 test. We used ROBINS-I tool to assess methodological quality of the included studies. We performed the meta-analysis using 'Review manager software version 5.3'. We identified 6 observationalstudies satisfying the selection criteria. In all studies, Hydroxychloroquine was given as add on to the standard care and effect was compared with the standard care alone. A pooled analysis observed 251 deaths in 1331 participants of the Hydroxychloroquine arm and 363 deaths in 1577 participants of the control arm. There was no difference in odds of mortality events amongst Hydroxychloroquine and supportive care arm [1.25 (95% CI: 0.65, 2.38); I2 = 80%]. A similar trend was observed with moderate risk of bias studies [0.95 (95% CI: 0.44, 2.06); I2 = 85%]. The odds of mortality were significantly higher in patients treated with Hydroxychloroquine + Azithromycin than supportive care alone [2.34 (95% CI: 1.63, 3.34); I2 = 0%]. A pooled analysis of recently published studies suggests no additional benefit for reducing mortality in COVID-19 patients when Hydroxychloroquine is given as add-on to the standard care. Graphical Abstract.

Author/s:

Patel, T.K., Barvaliya, M, Kevadiya, B.D., Patel, P.B., Bhalla, H.L.

Impact of Diabetes Medications on Cardiovascular Events and Mortality

John Bayhi — Thu, 02 Apr 2020 17:49:16 +0000

Date Added:

April 2, 2020

Publication Date:

April 2, 2020

Type:

Clinical Decision Aids

Format:

Poster

Keywords

diabetes

cardiovascular events

mortality

risk

medication

A table showing the size of the risks and risk reductions of several classes of diabetes medications on cardiovascular events. The data was derived from 232 meta-analyses in Zhu J, Zheng Y, et al in Lancet Diabetes Endocrinol 2020; 8(3): 192-205. James W. Mold, MD, MPH.

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No abstract available.

Author/s:

Mold, James W.

Integrated Surveillance of Covid-19 in Italy

Brian Desmarais — Mon, 16 Mar 2020 14:54:40 +0000

Date Added:

March 25, 2020

Journal/Publication:

Istituto Superiore di Sanità - Coronavirus webpage

Publisher:

Istituto Superiore di Sanità

Publication Date:

March 16, 2020

URL:

Integrated Surveillance of Covid-19 in Italy

Type:

Public Health Announcements

Keywords

2019 novel coronavirus

MeSH

severe acute respiratory syndrome coronavirus 2

This chart shows the mortality rates for COVID-19 by age group from Italy.

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Author/s:

Istituto Superiore di Sanità

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

John Bayhi — Fri, 03 Jan 2020 17:30:23 +0000

Date Added:

January 3, 2020

Journal/Publication:

BMC Cardiovascular Disorders

Publisher:

BioMed Central Ltd

Publication Date:

December 2, 2019

Issue:

Volume:

URL:

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

Type:

Clinical Research Results

DOI (1):

10.1186/s12872-019-1269-y

Keywords

heart failure

mortality

secondhand smoke

PMID (1):

31791236

MeSH

Adult

Humans

self report

Proportional Hazards Models

risk factors

Tobacco Smoke Pollution

Nutrition Surveys

cardiovascular diseases

follow-up studies

Odds Ratio

health status

Surveys and Questionnaires

Prognosis

heart failure

Socioeconomic Factors

Second-hand smoke exposure appears to hasten death in patients with CHF. James W. Mold, MD, MPH

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BACKGROUND:

Secondhand smoke (SHS) exposure is a well-established cardiovascular risk factor, yet association between SHS and prognosis of heart failure remains uncertain.

METHOD:

Data were obtained from the US National Health and Nutrition Examination Surveys III from 1988 to 1994. Currently nonsmoking adults with a self-reported history of heart failure were included. Household SHS exposure was assessed by questionnaire. Participants were followed up through December 31, 2011. Cox proportional-hazards models were used to assess the association of household SHS exposure and mortality risk. Potential confounding factors were adjusted.

RESULTS:

Of 572 currently nonsmoking patients with heart failure, 88 were exposed to household SHS while 484 were not. There were totally 475 deaths during follow-up. In univariate analysis, household SHS was not associated with mortality risk (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.76-1.26, p = 0.864). However, after adjustment for demographic variables, socioeconomic variables and medication, heart failure patients in exposed group had a 43% increase of mortality risk compared with those in unexposed group (HR: 1.43, 95% CI: 1.10-1.86, p = 0.007). Analysis with further adjustment for general health status and comorbidities yielded similar result (HR: 1.47, 95% CI: 1.13-1.92, p = 0.005).

CONCLUSION:

Household SHS exposure was associated with increased mortality risk in heart failure patients.

Author/s:

He, X, Zhao, J, He, J, Dong, Y, Liu, C

Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study

John Bayhi — Wed, 18 Sep 2019 17:02:59 +0000

Date Added:

September 18, 2019

Journal/Publication:

BMJ

Publisher:

BMJ Publishing Group Limited

Publication Date:

May 29, 2019

Issue:

I1580

Volume:

365

URL:

Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1136/bmj.l1580

Keywords

proton pump inhibitors

PMID (1):

31147311

MeSH

aged

cardiovascular diseases/mortality

cause of death

cohort studies

female

gastrointestinal neoplasms/mortality

Peptic Ulcer/prevention & control

proton pump inhibitors/therapeutic use

renal insufficiency

chronic/mortality

risk factors

United States/epidemiology

veterans health/statistics & numerical data

Predictably PPIs are not as safe for long term use as we had hoped. It’s not wise to mess with Mother Nature. James W. Mold, MD, MPH

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OBJECTIVE:

To estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs).

DESIGN:

Longitudinal observational cohort study.

SETTING:

US Department of Veterans Affairs.

PARTICIPANTS:

New users of PPIs (n=157 625) or H2 blockers (n=56 842).

MAIN OUTCOME MEASURES:

All cause mortality and cause specific mortality associated with taking PPIs (values reported as number of attributable deaths per 1000 patients taking PPIs).

RESULTS:

There were 45.20 excess deaths (95% confidence interval 28.20 to 61.40) per 1000 patients taking PPIs. Circulatory system diseases (number of attributable deaths per 1000 patients taking PPIs 17.47, 95% confidence interval 5.47 to 28.80), neoplasms (12.94, 1.24 to 24.28), infectious and parasitic diseases (4.20, 1.57 to 7.02), and genitourinary system diseases (6.25, 3.22 to 9.24) were associated with taking PPIs. There was a graded relation between cumulative duration of PPI exposure and the risk of all cause mortality and death due to circulatory system diseases, neoplasms, and genitourinary system diseases. Analyses of subcauses of death suggested that taking PPIs was associated with an excess mortality due to cardiovascular disease (15.48, 5.02 to 25.19) and chronic kidney disease (4.19, 1.56 to 6.58). Among patients without documented indication for acid suppression drugs (n=116 377), taking PPIs was associated with an excess mortality due to cardiovascular disease (22.91, 11.89 to 33.57), chronic kidney disease (4.74, 1.53 to 8.05), and upper gastrointestinal cancer (3.12, 0.91 to 5.44). Formal interaction analyses suggested that the risk of death due to these subcauses was not modified by a history of cardiovascular disease, chronic kidney disease, or upper gastrointestinal cancer. Taking PPIs was not associated with an excess burden of transportation related mortality and death due to peptic ulcer disease (as negative outcome controls).

CONCLUSIONS:

Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.

Author/s:

Xie, Y, Bowe, B, Yan, Y, Xian, H, Li, T, Al-Aly, Z