Abstract only
Introduction:
While cirrhotic patients increase risk of hemorrhagic and thrombotic events, association of liver stiffness with stroke remaines unclear.
Hypothesis:
Severity of liver ...stiffness is associated with higher prevalence of stroke.
Methods:
A cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 included adult participants aged 21 to 79 years. Association between prevalence of self-reported stroke and liver stiffness stratified for 4 fibrosis scores measured by Fibroscan
™
were analyzed by multivariate logistic regression.
Results:
A total of 8,416 patients with Fibroscan results were identified (mean age 49
+
16 years old; 52% female; 32% white). Overall, 377 patients (4.5%) had a stroke. The number of participants stratified by 4 fibrotic stages of mild (F0F1), moderate (F2), severe fibrosis (F3), and cirhosis (F4) were 6,243 (74.2%), 826 (9.8%), 122 (1.4%), and 155 (1.8%) patients, respectively. In multivariate logistic regression, after controlling for age, race, gender, diabetic status, body mass index (<25 vs
>
25 kg/m
2
), and high systolic blood pressure (
<
130 vs >130 mmHg), individuals with severe fibrotic liver (F3 and F4) were significantly more likely to have a stroke (adjusted odds ratio (OR) 1.64; p= 0.044; 95% confidence interval (CI) 1.01, 2.65; Figure 1). Furthermore, we found that patients with cirrhosis (F4) were the most at risk to have a stroke (adjusted OR 1.91; p= 0.037; 95% CI 1.04, 3.49; Figure 1).
Conclusions:
In this cross-sectional data, there is a graded association between severe fibrotic liver disease measured by Fibroscan
™
and elevated prevalence of stroke. Longitudinal studies including additional risk factors of stroke such as hyperlipidemia, hypertension and atrial fibrillation need to be further evaluated.
Abstract only
Introduction:
Although inadequate sleep is known to associate with cardiovascular (CV) outcomes including stroke, association between sleep duration and stroke is unclear.
Hypothesis:
...Shorter sleep duration is associated with higher risk of stroke.
Methods:
A retrospective cross-sectional analysis of the 2017-2020 National Health and Nutrition Examination Survey (NHANES) included adult participants aged 21 to 79 years with self-reported history of stroke and sleep duration was studied. Association of sleep duration, stratified into short (<6 hours) and normal sleep durations (≥6 hours), and stroke was evaluated by multivariate logistic regression.
Results:
A total of 8,416 participants were identified, of which mean age was 48.25±16 years old, 51.5% were female and mean sleep duration was 7.529 ± 1.651 hours. Overall, 377 patients (4.5%) had a stroke, of which mean sleep duration was 7.545 ± 2.132. Mean sleep duration of non-stroke population was 7.528 ± 1.626. The difference of mean sleep duration between these two groups was statistically significant (0.017 hours; P < 0.001; 95% Cl -0.156,0.189; Figure1). The majority of the study participants reported a normal sleep duration (7426 participants, 88.2%) and the remaining 913 participants (10.8%) had a short sleep duration. Compared with the normal sleep duration group, participants with the short sleep duration had significantly lesser the odds of stroke (adjusted odds ratio 0.574; P < 0.001; 95% CI 0.424,0.777) after adjusted for baseline risk factors including age, gender, ethnicity, body mass index (<25 vs. ≥25 kg/m
2
), history of hypertension and diabetes.
Conclusions:
Contrary to previous reports, this study shows that sleep duration is positively associated with risk of stroke. Further long-term studies that focus on understanding the pathophysiology using non-self-reported method are required to elucidate effect of sleep quality and optimal sleep duration on the adverse CV outcomes.
Abstract only Background: Abnormal kidney function is one of the risk factors for cardiovascular diseases. Whether the association between a wide range of kidney functions from normal to advanced ...chronic kidney disease and stroke risk is unclear. Methods: A cross-sectional study involving participants (≥ 18 years old) in the 2017 - 2020 NHANES was examined for the association between serum creatinine (SCr) and history of stroke informed by a doctor or other health professional by multiple logistic regression analysis. Results: Of 9,211 participants, the mean±SD age was 51±18 y/o and 52% were female. White accounts for 35% followed by Black (27%), Asian (12%), Mexican American (11%), Hispanic (10%), and others (5%). Up to 485 participants (5%) ever had a stroke. Median (IQR) SCr was 0.84 (0.71 - 1.01) mg/dL. Stratified SCr among 7,865 participants with SCr data into quartile (Q), mean SCr were 0.62, 0.78, 0.92, and 1.34 mg/dL, respectively (Figure 1A). Compared to participants in Q1, strokes were 1.72 and 3.45 times as likely to occur in those in Q3 and Q4, respectively (Q3: 95%CI 1.24, 2.39, P 0.001; Q4: 95%CI 2.55, 4.67, P <0.0001); while participants in Q2 were 1.41 times as likely to have strokes but not statically significant (95%CI 0.99, 2.00, P 0.055; Figure 1B). After adjusting for age, gender, race, BMI, only participants in Q4 were 1.64 times as likely to have a stroke compared to those in Q1 (95%CI 1.09, 2.45, P 0.017); while strokes were 1.158 and 1.21 times as likely to occur among participants in Q2 and Q3, respectively but not statically significant (Q2: 95%CI 0.78, 1.72, P 0.468; Q3: 0.81, 1.80, P 0.348). There were effect modifications between SCr in Q4 and some races (Hispanic, White, and others; P interaction 0.04, 0.013, and 0.011, respectively). Conclusions: SCr was positively associated with the likelihood to have a stroke. Longitudinal cohort studies are required to further elucidate the relationship.
Background:
Higher dietary calcium intake is associated with lower blood pressure. This association among different genders is unclear.
Methods:
A cross sectional study utilizing data from the ...National Health and Nutrition Examination Survey (NHANES) from 2017 to 2018 included participants ≧18 years old. The Association between the quartile of the dietary calcium intake and systolic and diastolic hypertension defined as three average measured systolic blood pressure ≧130 and diastolic blood pressure ≧80 mmHg, respectively was examined by multiple logistic regression.
Results:
Of 11,137 study participants, the mean ± SD age was 50 ± 19 years old and 51% were female. Up to 35% were White followed by Black, Asian, and other races. Median (interquartile range; IQR) dietary calcium intake of quartile 1 to quartile 4 were 21 (13, 33), 120 (83, 183), 233 (220, 293), and 625 (500, 959) mg/day, respectively. Average systolic blood pressure and diastolic blood pressure were 124 ± 19 and 74 ± 12 mmHg, respectively. Systolic and diastolic blood pressure were significantly lower in women compared to men for every quartile 1 and 2 of dietary calcium intake, higher in quartile 3, and not different in quartile 4 (Figure 1A and 1B). Dietary calcium intake in quartiles 3 and 4 were significantly associated with 38% and 55% greater odds of systolic hypertension (odds ratio (OR) Q3 1.375, P 0.006, 95% confidence interval (CI) 1.095, 1.728 and OR Q4 1.550, P < 0.0001, 95%CI 1.249, 1.923), but not with diastolic hypertension. After adjusting for age, gender, race, body mass index, serum creatinine, urine albumin:creatinine ratio, dietary sodium and potassium intakes, and the interaction term between gender and dietary calcium intake, only dietary calcium intake in quartile 3 was significantly associated with 82% lower odds of systolic hypertension (adjusted OR Q3 0.164, P 0.005, 95%CI 0.047, 0.578), while the association was greater and in the same direction for quartile 4, but it was not statistically significant (adjusted OR Q4 0.341, P 0.120, 95%CI 0.087, 1.326). Although there was an inverse association between dietary calcium intake and diastolic hypertension, it was not statistically significant. Gender was identified as an effect modifier, with a stronger positive association between the dietary calcium intake and systolic hypertension observed in female participants (Pinteraction 0.028).
Conclusions:
Dietary calcium intake and systolic hypertension, but not diastolic hypertension is inversely associated with a different magnitude between women and men. Additional longitudinal studies are required to further evaluate this relationship.
Abstract only Background: Black is among the higher risk of albuminuria, the association between albuminuria and BP in different racial populations with relatively normal kidney function is unclear. ...Methods: A cross-sectional study including participants (>/= 18 years old) in the 2017 - 2020 NHANES was examined for the association between urinary albumin/ creatinine ratio (ACR) and BP by multiple linear regression. Results: Of 11,137 participants, the mean±SD age was 50±19 y/o and 51% were female. White accounts for 35% followed by Black (26%), Asian (12%), Mexican American (12%), Hispanic (10%), and others (5%). Median (IQR) serum creatinine (SCr) was 0.82 (0.68 - 0.98) mg/dL and median ACR was 7.59 (4.86 - 14.90) mg/g of Cr. Three-average measured SBP and DBP were 124±19 and 74±12 mmHg, respectively (Figure 1A and 1B). There was 1.1 and 0.2 mmHg increase in SBP and DBP, respectively for every 100 mg/g of Cr increase in ACR (β SBP 0.011, 95%CI 0.009, 0.012 and β DBP 0.002, 95%CI 0.001, 0.003). After adjusting for age, gender, race, BMI, SCr, dietary sodium and potassium intakes, and the interaction term between ACR and race, every 100 mg/g of Cr increase in ACR was associated with 16 mmHg greater SBP; while only 5 mmHg increase in DBP with no statistical significance (β SBP 0.162, 95%CI 0.020, 0.305 and β DBP 0.050, 95%CI -0.040, 0.140). Race was found to modify the SBP - ACR association with a stronger inverse association among Black (P interaction Black 0.042) but not an effect modifier of the association between DBP and ACR. Conclusions: Albuminuria was associated with higher SBP and DBP, but this association for SBP was attenuated in Back. Studies are required to elucidate the relationship in long-term outcomes.
BACKGROUNDLiver fibrosis leads to liver-related events in patients with chronic hepatitis C (CHC) infection. Although non-invasive tests (NITs) are critical to early detection of the development of ...liver fibrosis, the prognostic role of NITs remains unclear due to the limited types of NITs and liver outcomes explored in previous studies. AIMTo determine the prognostic value of NITs for risk stratification in CHC patients. METHODSThe protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019128176). The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search was performed using MEDLINE and EMBASE databases under a timeframe from the inception of the databases through February 25, 2020. We restricted our search to CHC cohort studies reporting an association between liver fibrosis assessed by NITs and the development of hepatocellular carcinoma, decompensation, or mortality. Pooled hazard ratios (HR) and area under the receiver operating characteristic (AUROC) for each NIT were estimated using a random effects model. Subgroup analyses were performed for NITs assessed at pre-treatment or post-treatment with sustained virologic response (SVR), treatment with either pegylated interferon and ribavirin or direct acting antiviral, Eastern or Western countries, and different cutoff points. RESULTSThe present meta-analysis included 29 cohort studies, enrolling 69339 CHC patients. Fibrosis-4 (FIB-4) index, aspartate aminotransferase to platelet ratio (APRI) score, and liver stiffness measurement (LSM) were found to have hepatocellular carcinoma predictive potential with pooled adjusted HRs of 2.48 95% confidence interval (CI): 1.91-3.23, I 2 = 96%, 4.24 (95%CI: 2.15-8.38, I 2 = 20%) and 7.90 (95%CI: 3.98-15.68, I 2 = 52%) and AUROCs of 0.81 (95%CI: 0.73-0.89, I 2 = 77%), 0.81 (95%CI: 0.75-0.87, I 2 = 68%), and 0.79 (95%CI: 0.63-0.96, I 2 = 90%), respectively. Pooled adjusted HR with a pre-treatment FIB-4 cutoff of 3.25 was 3.22 (95%CI: 2.32-4.47, I 2 = 80%). Pooled adjusted HRs for post-treatment with SVR FIB-4, APRI, and LSM were 3.01 (95%CI: 0.32-28.61, I 2 = 89%), 9.88 (95%CI: 2.21-44.17, I 2 = 24%), and 6.33 (95%CI: 2.57-15.59, I 2 = 17%), respectively. Pooled adjusted HRs for LSM in patients with SVR following direct acting antiviral therapy was 5.55 (95%CI: 1.47-21.02, I 2 = 36%). Pooled AUROCs for post-treatment with SVR FIB-4 and LSM were 0.75 (95%CI: 0.55-0.95, I 2 = 88%) and 0.84 (95%CI: 0.66-1.03, I 2 = 88%), respectively. Additionally, FIB-4 and LSM were associated with overall mortality, with pooled adjusted HRs of 2.07 (95%CI: 1.49-2.88, I 2 = 27%) and 4.04 (95%CI: 2.40-6.80, I 2 = 63%), respectively. CONCLUSIONFIB-4, APRI, and LSM showed potential for risk stratification in CHC patients. Cutoff levels need further validation.
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