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Threefold Increase in Cirrhosis Risk with HCV
Individuals with hepatitis C infection are three times more likely to develop cirrhosis than are those who are hepatitis C negative, and fibrosis progression is pronounced within the first 5 years after infection, a retrospective cohort study has found.
Analysis of 10-year follow-up data from 1,840 individuals in a national database of hepatitis C (HCV) infected veterans, and 1,840 uninfected controls, found 18.4% of HCV+ individuals developed cirrhosis, compared with 6.1% of uninfected individuals, and they had a significantly higher rate of hepatic decompensation events (1.79% vs. 0.33%).
Increasing age, white race, hypertension, anemia, and a history of alcohol abuse were associated with a higher risk of cirrhosis among HCV+ individuals, but baseline or recent history of alcohol abuse or dependence did not significantly impact risk, according to a paper published online in JAMA Internal Medicine (2015;175:178-85 [doi:10.1001/jamainternmed.2014.6502]).
“Our study shows that fibrosis progression after HCV infection starts early and that a substantial proportion of HCV-infected persons develop significant fibrosis or cirrhosis within the first 5-10 years of infection [but] on the other hand, progression of cirrhosis to hepatic decompensation is uncommon in the first 9 years after cirrhosis,” wrote Dr. Adeel A. Butt of the University of Pittsburgh, and colleagues.
The National Institutes of Health and the VA Pittsburgh Healthcare System supported the study. Two authors declared receiving grants and fees from private industry.
Individuals with hepatitis C infection are three times more likely to develop cirrhosis than are those who are hepatitis C negative, and fibrosis progression is pronounced within the first 5 years after infection, a retrospective cohort study has found.
Analysis of 10-year follow-up data from 1,840 individuals in a national database of hepatitis C (HCV) infected veterans, and 1,840 uninfected controls, found 18.4% of HCV+ individuals developed cirrhosis, compared with 6.1% of uninfected individuals, and they had a significantly higher rate of hepatic decompensation events (1.79% vs. 0.33%).
Increasing age, white race, hypertension, anemia, and a history of alcohol abuse were associated with a higher risk of cirrhosis among HCV+ individuals, but baseline or recent history of alcohol abuse or dependence did not significantly impact risk, according to a paper published online in JAMA Internal Medicine (2015;175:178-85 [doi:10.1001/jamainternmed.2014.6502]).
“Our study shows that fibrosis progression after HCV infection starts early and that a substantial proportion of HCV-infected persons develop significant fibrosis or cirrhosis within the first 5-10 years of infection [but] on the other hand, progression of cirrhosis to hepatic decompensation is uncommon in the first 9 years after cirrhosis,” wrote Dr. Adeel A. Butt of the University of Pittsburgh, and colleagues.
The National Institutes of Health and the VA Pittsburgh Healthcare System supported the study. Two authors declared receiving grants and fees from private industry.
Individuals with hepatitis C infection are three times more likely to develop cirrhosis than are those who are hepatitis C negative, and fibrosis progression is pronounced within the first 5 years after infection, a retrospective cohort study has found.
Analysis of 10-year follow-up data from 1,840 individuals in a national database of hepatitis C (HCV) infected veterans, and 1,840 uninfected controls, found 18.4% of HCV+ individuals developed cirrhosis, compared with 6.1% of uninfected individuals, and they had a significantly higher rate of hepatic decompensation events (1.79% vs. 0.33%).
Increasing age, white race, hypertension, anemia, and a history of alcohol abuse were associated with a higher risk of cirrhosis among HCV+ individuals, but baseline or recent history of alcohol abuse or dependence did not significantly impact risk, according to a paper published online in JAMA Internal Medicine (2015;175:178-85 [doi:10.1001/jamainternmed.2014.6502]).
“Our study shows that fibrosis progression after HCV infection starts early and that a substantial proportion of HCV-infected persons develop significant fibrosis or cirrhosis within the first 5-10 years of infection [but] on the other hand, progression of cirrhosis to hepatic decompensation is uncommon in the first 9 years after cirrhosis,” wrote Dr. Adeel A. Butt of the University of Pittsburgh, and colleagues.
The National Institutes of Health and the VA Pittsburgh Healthcare System supported the study. Two authors declared receiving grants and fees from private industry.
Age is greatest risk factor for stroke in AF
Age is the most important risk factor for stroke in patients with atrial fibrillation, and not all stroke risk factors in the CHA2DS2-VASc score carry equal risk, a retrospective, population-based study showed.
Analysis of data from 186,570 Taiwanese patients with atrial fibrillation (AF) found that the risk of ischemic stroke ranged from 1.96% per year for men with vascular diseases to 3.5% per year for those aged 65-74 years. In women, the risk increased from 1.91% per year for women with hypertension to 3.34% per year for those aged 65-74 years, wrote Dr. Tze-Fan Chao of Taipei (Taiwan) Veterans General Hospital and coauthors (J. Am. Coll. Cardiol. 2015;65:635-42 [doi: 10.1016/j.jacc.2014.11.046]).
The study results showed that male AF patients with a CHA2DS2-VASc score of 1 had an annual stroke rate of 2.75%; women with a CHA2DS2-VASc score of 2 had a greater than two-fold increase in stroke risk, compared with women with a score of 1.
“Our study is the first population-based investigation analyzing the risk of ischemic stroke in nonanticoagulated AF male patients with a CHA2DS2-VASc score of 1 and female patients with a CHA2DS2-VASc score of 2, according to the specific covariates composing the CHA2DS2-VASc score,” Dr. Chao wrote.
The investigators cited several limitations. One is that they were unable to determine whether the cause of ischemic stroke was tied to AF-related thromboembolism or atherosclerosis and thrombosis of the cerebral artery. This limitation, however, was common among previous randomized trials, they noted.
The study was partly supported by grants from the National Science Council and Taipei (Taiwan) Veterans General Hospital. One author declared consultancies and speakers fees from private industry. No other conflicts of interest were declared.
The study by Dr. Chao and his colleagues provides important new information supporting the use of anticoagulation for all atrial fibrillation with at least one additional stroke risk factor, equating to a CHA2DS2-VASc score of 0 or 1 for women, according to Dr. Hugh Calkins. But the study is both imperfect and not definitive.
“Considering the safety and efficacy of antithrombotic therapy, it seems clear that we should think long and hard before recommending that patients with a CHA2DS2-VASc score of 1 not receive anticoagulant therapy,” he wrote. He also said, however, that the retrospective data do not warrant updating the American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines.
Dr. Calkins is with the department of cardiology at Johns Hopkins Hospital, Baltimore. These comments are taken from his accompanying editorial (J. Am. Coll. Cardiol. 2015;65:663-64 [http://dx.doi.org/10.1016/j.jacc.2014.12.008]. He reported consultancies for Boehringer Ingelheim, AtriCure, and Daiichi Sankyo.
The study by Dr. Chao and his colleagues provides important new information supporting the use of anticoagulation for all atrial fibrillation with at least one additional stroke risk factor, equating to a CHA2DS2-VASc score of 0 or 1 for women, according to Dr. Hugh Calkins. But the study is both imperfect and not definitive.
“Considering the safety and efficacy of antithrombotic therapy, it seems clear that we should think long and hard before recommending that patients with a CHA2DS2-VASc score of 1 not receive anticoagulant therapy,” he wrote. He also said, however, that the retrospective data do not warrant updating the American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines.
Dr. Calkins is with the department of cardiology at Johns Hopkins Hospital, Baltimore. These comments are taken from his accompanying editorial (J. Am. Coll. Cardiol. 2015;65:663-64 [http://dx.doi.org/10.1016/j.jacc.2014.12.008]. He reported consultancies for Boehringer Ingelheim, AtriCure, and Daiichi Sankyo.
The study by Dr. Chao and his colleagues provides important new information supporting the use of anticoagulation for all atrial fibrillation with at least one additional stroke risk factor, equating to a CHA2DS2-VASc score of 0 or 1 for women, according to Dr. Hugh Calkins. But the study is both imperfect and not definitive.
“Considering the safety and efficacy of antithrombotic therapy, it seems clear that we should think long and hard before recommending that patients with a CHA2DS2-VASc score of 1 not receive anticoagulant therapy,” he wrote. He also said, however, that the retrospective data do not warrant updating the American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines.
Dr. Calkins is with the department of cardiology at Johns Hopkins Hospital, Baltimore. These comments are taken from his accompanying editorial (J. Am. Coll. Cardiol. 2015;65:663-64 [http://dx.doi.org/10.1016/j.jacc.2014.12.008]. He reported consultancies for Boehringer Ingelheim, AtriCure, and Daiichi Sankyo.
Age is the most important risk factor for stroke in patients with atrial fibrillation, and not all stroke risk factors in the CHA2DS2-VASc score carry equal risk, a retrospective, population-based study showed.
Analysis of data from 186,570 Taiwanese patients with atrial fibrillation (AF) found that the risk of ischemic stroke ranged from 1.96% per year for men with vascular diseases to 3.5% per year for those aged 65-74 years. In women, the risk increased from 1.91% per year for women with hypertension to 3.34% per year for those aged 65-74 years, wrote Dr. Tze-Fan Chao of Taipei (Taiwan) Veterans General Hospital and coauthors (J. Am. Coll. Cardiol. 2015;65:635-42 [doi: 10.1016/j.jacc.2014.11.046]).
The study results showed that male AF patients with a CHA2DS2-VASc score of 1 had an annual stroke rate of 2.75%; women with a CHA2DS2-VASc score of 2 had a greater than two-fold increase in stroke risk, compared with women with a score of 1.
“Our study is the first population-based investigation analyzing the risk of ischemic stroke in nonanticoagulated AF male patients with a CHA2DS2-VASc score of 1 and female patients with a CHA2DS2-VASc score of 2, according to the specific covariates composing the CHA2DS2-VASc score,” Dr. Chao wrote.
The investigators cited several limitations. One is that they were unable to determine whether the cause of ischemic stroke was tied to AF-related thromboembolism or atherosclerosis and thrombosis of the cerebral artery. This limitation, however, was common among previous randomized trials, they noted.
The study was partly supported by grants from the National Science Council and Taipei (Taiwan) Veterans General Hospital. One author declared consultancies and speakers fees from private industry. No other conflicts of interest were declared.
Age is the most important risk factor for stroke in patients with atrial fibrillation, and not all stroke risk factors in the CHA2DS2-VASc score carry equal risk, a retrospective, population-based study showed.
Analysis of data from 186,570 Taiwanese patients with atrial fibrillation (AF) found that the risk of ischemic stroke ranged from 1.96% per year for men with vascular diseases to 3.5% per year for those aged 65-74 years. In women, the risk increased from 1.91% per year for women with hypertension to 3.34% per year for those aged 65-74 years, wrote Dr. Tze-Fan Chao of Taipei (Taiwan) Veterans General Hospital and coauthors (J. Am. Coll. Cardiol. 2015;65:635-42 [doi: 10.1016/j.jacc.2014.11.046]).
The study results showed that male AF patients with a CHA2DS2-VASc score of 1 had an annual stroke rate of 2.75%; women with a CHA2DS2-VASc score of 2 had a greater than two-fold increase in stroke risk, compared with women with a score of 1.
“Our study is the first population-based investigation analyzing the risk of ischemic stroke in nonanticoagulated AF male patients with a CHA2DS2-VASc score of 1 and female patients with a CHA2DS2-VASc score of 2, according to the specific covariates composing the CHA2DS2-VASc score,” Dr. Chao wrote.
The investigators cited several limitations. One is that they were unable to determine whether the cause of ischemic stroke was tied to AF-related thromboembolism or atherosclerosis and thrombosis of the cerebral artery. This limitation, however, was common among previous randomized trials, they noted.
The study was partly supported by grants from the National Science Council and Taipei (Taiwan) Veterans General Hospital. One author declared consultancies and speakers fees from private industry. No other conflicts of interest were declared.
FROM THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Key clinical point: Clinicians should consider oral anticoagulation for AF patients who have one additional risk factor, “given their high risk of ischemic stroke.”
Major finding: The risk of ischemic stroke in men with atrial fibrillation is 3.5% per year in those aged 65-74 years.
Data source: Retrospective population-based study in 186,570 patients with atrial fibrillation.
Disclosures: The study was partly supported by grants from the National Science Council and Taipei (Taiwan) Veterans General Hospital. One author declared consultancies and speakers fees from private industry. No other conflicts of interest were declared.
U-shaped relationship between exercise intensity and cardiovascular health
Strenuous daily exercise actually increased the risk of coronary heart disease, venous thromboembolism, and cerebrovascular disease, compared with moderate physical activity, according to new data from the Million Women Study.
At baseline, the 1.1 million women who participated in the study were 55.9 years old on average, with a mean body mass index of 26 kg/m2. Over the next 9 years, those reporting moderate activity had significantly lower risks of all three conditions than did inactive women, according to a study published online Feb. 16 in Circulation [doi:10.1161/CIRCULATIONAHA.114.010296].
However, women who undertook daily strenuous activity had a 15% increase in their risk of coronary heart disease, a 25% increase in cerebrovascular disease risk, and a 29% increase in venous thromboembolism (VTE) risk, compared with those who exercised strenuously two to three times a week, judging from the findings of Cox regression models that controlled for BMI, smoking, and alcohol consumption.
“Among active women, there was little evidence of progressive reductions in risk with more frequent activity, and even an increase in risk for CHD, cerebrovascular disease, and VTE in the most active group,” wrote Dr. Miranda E. G. Armstrong of the University of Oxford, England, and colleagues.
The study was supported by the UK Medical Research Council, Cancer Research UK, and the BHF Centre of Research Excellence. There were no other conflicts of interest declared.
The Million Women Study has many strengths. By its size and length of follow up, it has been able to overcome the notorious methodologic challenges of how to accurately measure not only the frequency of physical activity but also its type, intensity, and duration as well as variations in activity level over time. And, to its credit, the Million Women Study is one of the few large cohort studies to measure housework and to include it as a form of moderate physical activity.
Its findings may be subject to confounding, nonetheless. Such as data showing that the prevalence of current smokers was 25% in the group that exercised every day and in the group that reported no strenuous exercise – considerably higher than the prevalence estimates for women who did strenuous exercise one to six times per week. Even though the results were adjusted for smoking (and other risk factors), the authors acknowledged that residual confounding may have persisted and, thus, may have explained some of the association between physical activity and vascular risk in the most active women.
Further perplexing is the fact that even its sedentary participants were far from inactive. Current guidelines for the level of exercise needed to maintain cardiovascular health call for at least 30 minutes of moderate-intensity aerobic activity at least 5 days per week in bouts of 10 minutes of more moderate or 25 minutes of vigorous aerobic activity at least 3 days per week, or a combination thereof. In total, this amount of activity would equate to approximately 8-12 MET-hrs per week. Thus, it is puzzling that the women in the Million Women Study, even women who reported doing no physical activity at study baseline, still accrued over 15 excess MET-hrs per week (after excluding housework), predominantly through walking and gardening.
Dr. Rachel Huxley, D.Phil., is from the University of Queensland in Herston, Australia. She did not disclose whether she had any financial conflicts of interest. Her remarks were distilled from an editorial (Circulation 2015 Feb. 16 [doi: 10.1161/CIRCULATIONAHA.115.014721] accompanying the research report.
The Million Women Study has many strengths. By its size and length of follow up, it has been able to overcome the notorious methodologic challenges of how to accurately measure not only the frequency of physical activity but also its type, intensity, and duration as well as variations in activity level over time. And, to its credit, the Million Women Study is one of the few large cohort studies to measure housework and to include it as a form of moderate physical activity.
Its findings may be subject to confounding, nonetheless. Such as data showing that the prevalence of current smokers was 25% in the group that exercised every day and in the group that reported no strenuous exercise – considerably higher than the prevalence estimates for women who did strenuous exercise one to six times per week. Even though the results were adjusted for smoking (and other risk factors), the authors acknowledged that residual confounding may have persisted and, thus, may have explained some of the association between physical activity and vascular risk in the most active women.
Further perplexing is the fact that even its sedentary participants were far from inactive. Current guidelines for the level of exercise needed to maintain cardiovascular health call for at least 30 minutes of moderate-intensity aerobic activity at least 5 days per week in bouts of 10 minutes of more moderate or 25 minutes of vigorous aerobic activity at least 3 days per week, or a combination thereof. In total, this amount of activity would equate to approximately 8-12 MET-hrs per week. Thus, it is puzzling that the women in the Million Women Study, even women who reported doing no physical activity at study baseline, still accrued over 15 excess MET-hrs per week (after excluding housework), predominantly through walking and gardening.
Dr. Rachel Huxley, D.Phil., is from the University of Queensland in Herston, Australia. She did not disclose whether she had any financial conflicts of interest. Her remarks were distilled from an editorial (Circulation 2015 Feb. 16 [doi: 10.1161/CIRCULATIONAHA.115.014721] accompanying the research report.
The Million Women Study has many strengths. By its size and length of follow up, it has been able to overcome the notorious methodologic challenges of how to accurately measure not only the frequency of physical activity but also its type, intensity, and duration as well as variations in activity level over time. And, to its credit, the Million Women Study is one of the few large cohort studies to measure housework and to include it as a form of moderate physical activity.
Its findings may be subject to confounding, nonetheless. Such as data showing that the prevalence of current smokers was 25% in the group that exercised every day and in the group that reported no strenuous exercise – considerably higher than the prevalence estimates for women who did strenuous exercise one to six times per week. Even though the results were adjusted for smoking (and other risk factors), the authors acknowledged that residual confounding may have persisted and, thus, may have explained some of the association between physical activity and vascular risk in the most active women.
Further perplexing is the fact that even its sedentary participants were far from inactive. Current guidelines for the level of exercise needed to maintain cardiovascular health call for at least 30 minutes of moderate-intensity aerobic activity at least 5 days per week in bouts of 10 minutes of more moderate or 25 minutes of vigorous aerobic activity at least 3 days per week, or a combination thereof. In total, this amount of activity would equate to approximately 8-12 MET-hrs per week. Thus, it is puzzling that the women in the Million Women Study, even women who reported doing no physical activity at study baseline, still accrued over 15 excess MET-hrs per week (after excluding housework), predominantly through walking and gardening.
Dr. Rachel Huxley, D.Phil., is from the University of Queensland in Herston, Australia. She did not disclose whether she had any financial conflicts of interest. Her remarks were distilled from an editorial (Circulation 2015 Feb. 16 [doi: 10.1161/CIRCULATIONAHA.115.014721] accompanying the research report.
Strenuous daily exercise actually increased the risk of coronary heart disease, venous thromboembolism, and cerebrovascular disease, compared with moderate physical activity, according to new data from the Million Women Study.
At baseline, the 1.1 million women who participated in the study were 55.9 years old on average, with a mean body mass index of 26 kg/m2. Over the next 9 years, those reporting moderate activity had significantly lower risks of all three conditions than did inactive women, according to a study published online Feb. 16 in Circulation [doi:10.1161/CIRCULATIONAHA.114.010296].
However, women who undertook daily strenuous activity had a 15% increase in their risk of coronary heart disease, a 25% increase in cerebrovascular disease risk, and a 29% increase in venous thromboembolism (VTE) risk, compared with those who exercised strenuously two to three times a week, judging from the findings of Cox regression models that controlled for BMI, smoking, and alcohol consumption.
“Among active women, there was little evidence of progressive reductions in risk with more frequent activity, and even an increase in risk for CHD, cerebrovascular disease, and VTE in the most active group,” wrote Dr. Miranda E. G. Armstrong of the University of Oxford, England, and colleagues.
The study was supported by the UK Medical Research Council, Cancer Research UK, and the BHF Centre of Research Excellence. There were no other conflicts of interest declared.
Strenuous daily exercise actually increased the risk of coronary heart disease, venous thromboembolism, and cerebrovascular disease, compared with moderate physical activity, according to new data from the Million Women Study.
At baseline, the 1.1 million women who participated in the study were 55.9 years old on average, with a mean body mass index of 26 kg/m2. Over the next 9 years, those reporting moderate activity had significantly lower risks of all three conditions than did inactive women, according to a study published online Feb. 16 in Circulation [doi:10.1161/CIRCULATIONAHA.114.010296].
However, women who undertook daily strenuous activity had a 15% increase in their risk of coronary heart disease, a 25% increase in cerebrovascular disease risk, and a 29% increase in venous thromboembolism (VTE) risk, compared with those who exercised strenuously two to three times a week, judging from the findings of Cox regression models that controlled for BMI, smoking, and alcohol consumption.
“Among active women, there was little evidence of progressive reductions in risk with more frequent activity, and even an increase in risk for CHD, cerebrovascular disease, and VTE in the most active group,” wrote Dr. Miranda E. G. Armstrong of the University of Oxford, England, and colleagues.
The study was supported by the UK Medical Research Council, Cancer Research UK, and the BHF Centre of Research Excellence. There were no other conflicts of interest declared.
FROM CIRCULATION
Key clinical point: Higher-intensity exercise is not associated with proportionally greater reductions in the risk of coronary heart disease.
Major finding: Women who undertook daily strenuous activity had a 15% increase in their risk of coronary heart disease, a 25% increase in cerebrovascular disease risk, and 29% increase in venous thromboembolism risk, compared with those who exercised strenuously two to three times a week.
Data source: The Million Women longitudinal cohort study.
Disclosures: The study was supported by the UK Medical Research Council, Cancer Research UK, and the BHF Centre of Research Excellence. There were no other conflicts of interest declared.
Twofold Increase in Mortality with Mental Illness
Individuals with any mental disorder have a more than twofold increase in all-cause mortality, compared with the general population, with around 14.3% deaths worldwide – approximately 8 million deaths each year – attributable to mental illness, a meta-analysis has concluded.
Analysis of data from 148 studies showed that the relative risk of all-cause mortality was highest among individuals with psychoses (relative risk, 2.54; 95% confidence interval, 2.35-2.75), mood disorders (RR, 2.08; 95% CI, 1.89-2.30) and bipolar disorder (RR, 2; 95% CI, 1.70-2.34), but lowest among those with anxiety.
While natural mortality was 80% higher among individuals with mental disorders, mortality from unnatural causes was seven times higher than the comparison population, and the researchers estimated a median of 10 years of potential life lost to mental illness, according to data published online in JAMA Psychiatry (2015; Feb.11 [doi:10.1001/jamapsychiatry.2014.2502]).
“Differential mortality in people with mental disorders most likely stems from a number of causes, including behavioral and lifestyle factors, access to and quality of health care, and social determinants of health, such as poverty and social connectedness,” wrote Elizabeth Reisinger Walker, Ph.D., and her colleagues from Emory University in Atlanta.
The study was supported by the Institutional Research and Academic Career Development Award issued jointly by the National Institutes of Health and National Institute of General Medical Sciences and an award from the National Institute of Mental Health. There were no other conflicts of interest declared.
Individuals with any mental disorder have a more than twofold increase in all-cause mortality, compared with the general population, with around 14.3% deaths worldwide – approximately 8 million deaths each year – attributable to mental illness, a meta-analysis has concluded.
Analysis of data from 148 studies showed that the relative risk of all-cause mortality was highest among individuals with psychoses (relative risk, 2.54; 95% confidence interval, 2.35-2.75), mood disorders (RR, 2.08; 95% CI, 1.89-2.30) and bipolar disorder (RR, 2; 95% CI, 1.70-2.34), but lowest among those with anxiety.
While natural mortality was 80% higher among individuals with mental disorders, mortality from unnatural causes was seven times higher than the comparison population, and the researchers estimated a median of 10 years of potential life lost to mental illness, according to data published online in JAMA Psychiatry (2015; Feb.11 [doi:10.1001/jamapsychiatry.2014.2502]).
“Differential mortality in people with mental disorders most likely stems from a number of causes, including behavioral and lifestyle factors, access to and quality of health care, and social determinants of health, such as poverty and social connectedness,” wrote Elizabeth Reisinger Walker, Ph.D., and her colleagues from Emory University in Atlanta.
The study was supported by the Institutional Research and Academic Career Development Award issued jointly by the National Institutes of Health and National Institute of General Medical Sciences and an award from the National Institute of Mental Health. There were no other conflicts of interest declared.
Individuals with any mental disorder have a more than twofold increase in all-cause mortality, compared with the general population, with around 14.3% deaths worldwide – approximately 8 million deaths each year – attributable to mental illness, a meta-analysis has concluded.
Analysis of data from 148 studies showed that the relative risk of all-cause mortality was highest among individuals with psychoses (relative risk, 2.54; 95% confidence interval, 2.35-2.75), mood disorders (RR, 2.08; 95% CI, 1.89-2.30) and bipolar disorder (RR, 2; 95% CI, 1.70-2.34), but lowest among those with anxiety.
While natural mortality was 80% higher among individuals with mental disorders, mortality from unnatural causes was seven times higher than the comparison population, and the researchers estimated a median of 10 years of potential life lost to mental illness, according to data published online in JAMA Psychiatry (2015; Feb.11 [doi:10.1001/jamapsychiatry.2014.2502]).
“Differential mortality in people with mental disorders most likely stems from a number of causes, including behavioral and lifestyle factors, access to and quality of health care, and social determinants of health, such as poverty and social connectedness,” wrote Elizabeth Reisinger Walker, Ph.D., and her colleagues from Emory University in Atlanta.
The study was supported by the Institutional Research and Academic Career Development Award issued jointly by the National Institutes of Health and National Institute of General Medical Sciences and an award from the National Institute of Mental Health. There were no other conflicts of interest declared.
FROM JAMA PSYCHIATRY
Twofold increase in mortality with mental illness
Individuals with any mental disorder have a more than twofold increase in all-cause mortality, compared with the general population, with around 14.3% deaths worldwide – approximately 8 million deaths each year – attributable to mental illness, a meta-analysis has concluded.
Analysis of data from 148 studies showed that the relative risk of all-cause mortality was highest among individuals with psychoses (relative risk, 2.54; 95% confidence interval, 2.35-2.75), mood disorders (RR, 2.08; 95% CI, 1.89-2.30) and bipolar disorder (RR, 2; 95% CI, 1.70-2.34), but lowest among those with anxiety.
While natural mortality was 80% higher among individuals with mental disorders, mortality from unnatural causes was seven times higher than the comparison population, and the researchers estimated a median of 10 years of potential life lost to mental illness, according to data published online in JAMA Psychiatry (2015; Feb.11 [doi:10.1001/jamapsychiatry.2014.2502]).
“Differential mortality in people with mental disorders most likely stems from a number of causes, including behavioral and lifestyle factors, access to and quality of health care, and social determinants of health, such as poverty and social connectedness,” wrote Elizabeth Reisinger Walker, Ph.D., and her colleagues from Emory University in Atlanta.
The study was supported by the Institutional Research and Academic Career Development Award issued jointly by the National Institutes of Health and National Institute of General Medical Sciences and an award from the National Institute of Mental Health. There were no other conflicts of interest declared.
Individuals with any mental disorder have a more than twofold increase in all-cause mortality, compared with the general population, with around 14.3% deaths worldwide – approximately 8 million deaths each year – attributable to mental illness, a meta-analysis has concluded.
Analysis of data from 148 studies showed that the relative risk of all-cause mortality was highest among individuals with psychoses (relative risk, 2.54; 95% confidence interval, 2.35-2.75), mood disorders (RR, 2.08; 95% CI, 1.89-2.30) and bipolar disorder (RR, 2; 95% CI, 1.70-2.34), but lowest among those with anxiety.
While natural mortality was 80% higher among individuals with mental disorders, mortality from unnatural causes was seven times higher than the comparison population, and the researchers estimated a median of 10 years of potential life lost to mental illness, according to data published online in JAMA Psychiatry (2015; Feb.11 [doi:10.1001/jamapsychiatry.2014.2502]).
“Differential mortality in people with mental disorders most likely stems from a number of causes, including behavioral and lifestyle factors, access to and quality of health care, and social determinants of health, such as poverty and social connectedness,” wrote Elizabeth Reisinger Walker, Ph.D., and her colleagues from Emory University in Atlanta.
The study was supported by the Institutional Research and Academic Career Development Award issued jointly by the National Institutes of Health and National Institute of General Medical Sciences and an award from the National Institute of Mental Health. There were no other conflicts of interest declared.
Individuals with any mental disorder have a more than twofold increase in all-cause mortality, compared with the general population, with around 14.3% deaths worldwide – approximately 8 million deaths each year – attributable to mental illness, a meta-analysis has concluded.
Analysis of data from 148 studies showed that the relative risk of all-cause mortality was highest among individuals with psychoses (relative risk, 2.54; 95% confidence interval, 2.35-2.75), mood disorders (RR, 2.08; 95% CI, 1.89-2.30) and bipolar disorder (RR, 2; 95% CI, 1.70-2.34), but lowest among those with anxiety.
While natural mortality was 80% higher among individuals with mental disorders, mortality from unnatural causes was seven times higher than the comparison population, and the researchers estimated a median of 10 years of potential life lost to mental illness, according to data published online in JAMA Psychiatry (2015; Feb.11 [doi:10.1001/jamapsychiatry.2014.2502]).
“Differential mortality in people with mental disorders most likely stems from a number of causes, including behavioral and lifestyle factors, access to and quality of health care, and social determinants of health, such as poverty and social connectedness,” wrote Elizabeth Reisinger Walker, Ph.D., and her colleagues from Emory University in Atlanta.
The study was supported by the Institutional Research and Academic Career Development Award issued jointly by the National Institutes of Health and National Institute of General Medical Sciences and an award from the National Institute of Mental Health. There were no other conflicts of interest declared.
FROM JAMA PSYCHIATRY
Key clinical point: Individuals with any mental disorder have a more than twofold increase in all-cause mortality, compared with the general population.
Major finding: The relative risk of all-cause mortality was highest among individuals with psychoses but lowest amongst those with anxiety.
Data source: Meta-analysis of 148 studies.
Disclosures: The study was supported by the National Institutes of Health, National Institute of General Medical Sciences, and National Institute of Mental Health. There were no other conflicts of interest declared.
‘No evidence of disease activity’ has potential as a useful outcome in MS
A longitudinal study of 215 patients with clinically isolated syndrome or relapsing-remitting multiple sclerosis showed that while 46% had achieved no evidence of disease activity at 1 year, only 7.9% maintained it after 7 years.
In the study of patients from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB) cohort who had a minimum of 7 years of prospective MRI and clinical follow-up data, however, having no evidence of disease activity (NEDA) at 2 years had a positive predictive value of 78.3% for no progression at 7 years, according to Dr. Dalia L. Rotstein, then from the Brigham and Women’s Hospital and now with the St. Michael’s Hospital, Toronto, and her coauthors (JAMA Neurol. 2015;72:152-8).
The concept of NEDA is already used in diseases such as cancer and rheumatoid arthritis, but in multiple sclerosis (MS), it is still considered a secondary outcome measure, defined as the absence of new or enlarging T2 lesions or T1 gadolinium-enhancing lesions on MRI and no sustained Kurtzke Expanded Disability Status Scale (EDSS) score progression or clinical relapse, the authors said.
During the course of the study, clinical and MRI indicators of disease progress were dissociated, the investigators found. They reported that the percentage of patients who had no evidence of disease progression on one measure but not another ranged from 42.9% at year 2 to 30.6% at year 7. No MRI disease activity occurred in 23.5% at year 1 and in 14.8% at year 7, but the percentage of those who had no evidence of clinical disease activity stayed at about 15% at both time points.
“Although NEDA has the potential to become not only a key outcome measure of disease-modifying therapy but also a treat-to-target goal, it will require a comprehensive approach that integrates advances in MRI technology, linkage of blood and cerebrospinal fluid biomarkers, and a high degree of cooperation among investigators,” the authors wrote.
The study was partly supported by Merck Serono, and several authors declared grants, consultancies, advisory board positions, and speaking engagements with a range of pharmaceutical companies, including Merck Serono.
Although the study did not explore the impact of different treatment approaches, the ‘no evidence of disease activity’ measure (NEDA) is a necessary – albeit ambitious – benchmark that will likely become an important goal in MS care, according to Dr. Jaime Imitola and Dr. Michael K. Racke.
While the study suggests that NEDA is difficult to maintain long term, at 2 years it does have some prognostic value.
“Neurologists must start discussing the goal of disease activity–free status with their patients to take NEDA from the uniform environment of clinical trials to actual clinical practice,” they wrote.
Dr. Imitola and Dr. Racke are from the comprehensive multiple sclerosis center at Ohio State University, Columbus. Their comments come from an editorial accompanying the study on NEDA (JAMA Neurol. 2015;72:145-7). They reported having no relevant financial conflicts.
Although the study did not explore the impact of different treatment approaches, the ‘no evidence of disease activity’ measure (NEDA) is a necessary – albeit ambitious – benchmark that will likely become an important goal in MS care, according to Dr. Jaime Imitola and Dr. Michael K. Racke.
While the study suggests that NEDA is difficult to maintain long term, at 2 years it does have some prognostic value.
“Neurologists must start discussing the goal of disease activity–free status with their patients to take NEDA from the uniform environment of clinical trials to actual clinical practice,” they wrote.
Dr. Imitola and Dr. Racke are from the comprehensive multiple sclerosis center at Ohio State University, Columbus. Their comments come from an editorial accompanying the study on NEDA (JAMA Neurol. 2015;72:145-7). They reported having no relevant financial conflicts.
Although the study did not explore the impact of different treatment approaches, the ‘no evidence of disease activity’ measure (NEDA) is a necessary – albeit ambitious – benchmark that will likely become an important goal in MS care, according to Dr. Jaime Imitola and Dr. Michael K. Racke.
While the study suggests that NEDA is difficult to maintain long term, at 2 years it does have some prognostic value.
“Neurologists must start discussing the goal of disease activity–free status with their patients to take NEDA from the uniform environment of clinical trials to actual clinical practice,” they wrote.
Dr. Imitola and Dr. Racke are from the comprehensive multiple sclerosis center at Ohio State University, Columbus. Their comments come from an editorial accompanying the study on NEDA (JAMA Neurol. 2015;72:145-7). They reported having no relevant financial conflicts.
A longitudinal study of 215 patients with clinically isolated syndrome or relapsing-remitting multiple sclerosis showed that while 46% had achieved no evidence of disease activity at 1 year, only 7.9% maintained it after 7 years.
In the study of patients from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB) cohort who had a minimum of 7 years of prospective MRI and clinical follow-up data, however, having no evidence of disease activity (NEDA) at 2 years had a positive predictive value of 78.3% for no progression at 7 years, according to Dr. Dalia L. Rotstein, then from the Brigham and Women’s Hospital and now with the St. Michael’s Hospital, Toronto, and her coauthors (JAMA Neurol. 2015;72:152-8).
The concept of NEDA is already used in diseases such as cancer and rheumatoid arthritis, but in multiple sclerosis (MS), it is still considered a secondary outcome measure, defined as the absence of new or enlarging T2 lesions or T1 gadolinium-enhancing lesions on MRI and no sustained Kurtzke Expanded Disability Status Scale (EDSS) score progression or clinical relapse, the authors said.
During the course of the study, clinical and MRI indicators of disease progress were dissociated, the investigators found. They reported that the percentage of patients who had no evidence of disease progression on one measure but not another ranged from 42.9% at year 2 to 30.6% at year 7. No MRI disease activity occurred in 23.5% at year 1 and in 14.8% at year 7, but the percentage of those who had no evidence of clinical disease activity stayed at about 15% at both time points.
“Although NEDA has the potential to become not only a key outcome measure of disease-modifying therapy but also a treat-to-target goal, it will require a comprehensive approach that integrates advances in MRI technology, linkage of blood and cerebrospinal fluid biomarkers, and a high degree of cooperation among investigators,” the authors wrote.
The study was partly supported by Merck Serono, and several authors declared grants, consultancies, advisory board positions, and speaking engagements with a range of pharmaceutical companies, including Merck Serono.
A longitudinal study of 215 patients with clinically isolated syndrome or relapsing-remitting multiple sclerosis showed that while 46% had achieved no evidence of disease activity at 1 year, only 7.9% maintained it after 7 years.
In the study of patients from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB) cohort who had a minimum of 7 years of prospective MRI and clinical follow-up data, however, having no evidence of disease activity (NEDA) at 2 years had a positive predictive value of 78.3% for no progression at 7 years, according to Dr. Dalia L. Rotstein, then from the Brigham and Women’s Hospital and now with the St. Michael’s Hospital, Toronto, and her coauthors (JAMA Neurol. 2015;72:152-8).
The concept of NEDA is already used in diseases such as cancer and rheumatoid arthritis, but in multiple sclerosis (MS), it is still considered a secondary outcome measure, defined as the absence of new or enlarging T2 lesions or T1 gadolinium-enhancing lesions on MRI and no sustained Kurtzke Expanded Disability Status Scale (EDSS) score progression or clinical relapse, the authors said.
During the course of the study, clinical and MRI indicators of disease progress were dissociated, the investigators found. They reported that the percentage of patients who had no evidence of disease progression on one measure but not another ranged from 42.9% at year 2 to 30.6% at year 7. No MRI disease activity occurred in 23.5% at year 1 and in 14.8% at year 7, but the percentage of those who had no evidence of clinical disease activity stayed at about 15% at both time points.
“Although NEDA has the potential to become not only a key outcome measure of disease-modifying therapy but also a treat-to-target goal, it will require a comprehensive approach that integrates advances in MRI technology, linkage of blood and cerebrospinal fluid biomarkers, and a high degree of cooperation among investigators,” the authors wrote.
The study was partly supported by Merck Serono, and several authors declared grants, consultancies, advisory board positions, and speaking engagements with a range of pharmaceutical companies, including Merck Serono.
FROM JAMA NEUROLOGY
Key clinical point: “No evidence of disease activity” in multiple sclerosis is difficult to maintain long term but may have some prognostic value.
Major finding: Nearly half of patients with multiple sclerosis achieved NEDA at 1 year, but only 7.9% maintained it after 7 years.
Data source: A 7-year longitudinal study of 215 patients with clinically isolated syndrome or relapsing-remitting MS.
Disclosures: The study was partly supported by Merck Serono, and several authors declared grants, consultancies, advisory board positions, and speaking engagements with a range of pharmaceutical companies, including Merck Serono.
Threefold increase in cirrhosis risk with HCV
Individuals with hepatitis C infection are three times more likely to develop cirrhosis than are those who are hepatitis C negative, and fibrosis progression is pronounced within the first 5 years after infection, a retrospective cohort study has found.
Analysis of 10-year follow-up data from 1,840 individuals in a national database of hepatitis C (HCV) infected veterans, and 1,840 uninfected controls, found 18.4% of HCV+ individuals developed cirrhosis, compared with 6.1% of uninfected individuals, and they had a significantly higher rate of hepatic decompensation events (1.79% vs. 0.33%).
Increasing age, white race, hypertension, anemia, and a history of alcohol abuse were associated with a higher risk of cirrhosis among HCV+ individuals, but baseline or recent history of alcohol abuse or dependence did not significantly impact risk, according to a paper published online in JAMA Internal Medicine (2015;175:178-85 [doi:10.1001/jamainternmed.2014.6502]).
“Our study shows that fibrosis progression after HCV infection starts early and that a substantial proportion of HCV-infected persons develop significant fibrosis or cirrhosis within the first 5-10 years of infection [but] on the other hand, progression of cirrhosis to hepatic decompensation is uncommon in the first 9 years after cirrhosis,” wrote Dr. Adeel A. Butt of the University of Pittsburgh, and colleagues.
The National Institutes of Health and the VA Pittsburgh Healthcare System supported the study. Two authors declared receiving grants and fees from private industry.
Individuals with hepatitis C infection are three times more likely to develop cirrhosis than are those who are hepatitis C negative, and fibrosis progression is pronounced within the first 5 years after infection, a retrospective cohort study has found.
Analysis of 10-year follow-up data from 1,840 individuals in a national database of hepatitis C (HCV) infected veterans, and 1,840 uninfected controls, found 18.4% of HCV+ individuals developed cirrhosis, compared with 6.1% of uninfected individuals, and they had a significantly higher rate of hepatic decompensation events (1.79% vs. 0.33%).
Increasing age, white race, hypertension, anemia, and a history of alcohol abuse were associated with a higher risk of cirrhosis among HCV+ individuals, but baseline or recent history of alcohol abuse or dependence did not significantly impact risk, according to a paper published online in JAMA Internal Medicine (2015;175:178-85 [doi:10.1001/jamainternmed.2014.6502]).
“Our study shows that fibrosis progression after HCV infection starts early and that a substantial proportion of HCV-infected persons develop significant fibrosis or cirrhosis within the first 5-10 years of infection [but] on the other hand, progression of cirrhosis to hepatic decompensation is uncommon in the first 9 years after cirrhosis,” wrote Dr. Adeel A. Butt of the University of Pittsburgh, and colleagues.
The National Institutes of Health and the VA Pittsburgh Healthcare System supported the study. Two authors declared receiving grants and fees from private industry.
Individuals with hepatitis C infection are three times more likely to develop cirrhosis than are those who are hepatitis C negative, and fibrosis progression is pronounced within the first 5 years after infection, a retrospective cohort study has found.
Analysis of 10-year follow-up data from 1,840 individuals in a national database of hepatitis C (HCV) infected veterans, and 1,840 uninfected controls, found 18.4% of HCV+ individuals developed cirrhosis, compared with 6.1% of uninfected individuals, and they had a significantly higher rate of hepatic decompensation events (1.79% vs. 0.33%).
Increasing age, white race, hypertension, anemia, and a history of alcohol abuse were associated with a higher risk of cirrhosis among HCV+ individuals, but baseline or recent history of alcohol abuse or dependence did not significantly impact risk, according to a paper published online in JAMA Internal Medicine (2015;175:178-85 [doi:10.1001/jamainternmed.2014.6502]).
“Our study shows that fibrosis progression after HCV infection starts early and that a substantial proportion of HCV-infected persons develop significant fibrosis or cirrhosis within the first 5-10 years of infection [but] on the other hand, progression of cirrhosis to hepatic decompensation is uncommon in the first 9 years after cirrhosis,” wrote Dr. Adeel A. Butt of the University of Pittsburgh, and colleagues.
The National Institutes of Health and the VA Pittsburgh Healthcare System supported the study. Two authors declared receiving grants and fees from private industry.
Key clinical point: Individuals with hepatitis C infection are three times more likely to develop cirrhosis than are those who are hepatitis C negative.
Major finding: The incidence of fibrosis in HCV+ individuals was 18.4% compared to 6.1% in uninfected individuals.
Data source: Retrospective cohort study of 1,840 HCV+ individuals.
Disclosures: The National Institutes of Health and the VA Pittsburgh Healthcare System supported the study. Two authors declared receiving grants and fees from private industry.
Rise in reports of pain, depression in last year of life in oncology patients
The extent of pain, depression, and anorexia are rising in the last year of life for oncology patients, based on a survey of their family members.
Moderate or severe pain was experienced for at least a month by over 57% of 7,204 patients in their last year of life, and the incidence of pain appears to have increased between 1998 and 2010, based on data from participants who died during the longitudinal, community-based Health and Retirement study. Patients’ family members also reported that over 51% of patients experienced depression and 64% experienced anorexia in their last year of life.
The data reflect increases in the incidence of moderate to severe pain from nearly 47% in 1998-2000 to nearly 55% in 2008-2010. Increases also were noted in reports of depression and periodic confusion, researchers reported in the Feb. 2 online edition of Annals of Internal Medicine [doi:10.7326/M13-1609]). .
The researchers note other studies indicate that the intensity of treatment and the rate of adverse transitions have been increasing near the end of life. While hospice care is on the rise, it is often “tacked on” to this more intense late-life care; the median hospice stay is less than 3 weeks and such patients may not achieve symptomatic relief. Patients may not have consistent access to palliative services in outpatient, home, and long-term facility settings where most of the course of a terminal illness takes place, wrote Adam E. Singer of the Pardee RAND Graduate School, Santa Monica, Calif., and his colleagues.
The study was supported by the National Institute of Nursing Research and the Medical Scientist Training Program at the University of California.
The extent of pain, depression, and anorexia are rising in the last year of life for oncology patients, based on a survey of their family members.
Moderate or severe pain was experienced for at least a month by over 57% of 7,204 patients in their last year of life, and the incidence of pain appears to have increased between 1998 and 2010, based on data from participants who died during the longitudinal, community-based Health and Retirement study. Patients’ family members also reported that over 51% of patients experienced depression and 64% experienced anorexia in their last year of life.
The data reflect increases in the incidence of moderate to severe pain from nearly 47% in 1998-2000 to nearly 55% in 2008-2010. Increases also were noted in reports of depression and periodic confusion, researchers reported in the Feb. 2 online edition of Annals of Internal Medicine [doi:10.7326/M13-1609]). .
The researchers note other studies indicate that the intensity of treatment and the rate of adverse transitions have been increasing near the end of life. While hospice care is on the rise, it is often “tacked on” to this more intense late-life care; the median hospice stay is less than 3 weeks and such patients may not achieve symptomatic relief. Patients may not have consistent access to palliative services in outpatient, home, and long-term facility settings where most of the course of a terminal illness takes place, wrote Adam E. Singer of the Pardee RAND Graduate School, Santa Monica, Calif., and his colleagues.
The study was supported by the National Institute of Nursing Research and the Medical Scientist Training Program at the University of California.
The extent of pain, depression, and anorexia are rising in the last year of life for oncology patients, based on a survey of their family members.
Moderate or severe pain was experienced for at least a month by over 57% of 7,204 patients in their last year of life, and the incidence of pain appears to have increased between 1998 and 2010, based on data from participants who died during the longitudinal, community-based Health and Retirement study. Patients’ family members also reported that over 51% of patients experienced depression and 64% experienced anorexia in their last year of life.
The data reflect increases in the incidence of moderate to severe pain from nearly 47% in 1998-2000 to nearly 55% in 2008-2010. Increases also were noted in reports of depression and periodic confusion, researchers reported in the Feb. 2 online edition of Annals of Internal Medicine [doi:10.7326/M13-1609]). .
The researchers note other studies indicate that the intensity of treatment and the rate of adverse transitions have been increasing near the end of life. While hospice care is on the rise, it is often “tacked on” to this more intense late-life care; the median hospice stay is less than 3 weeks and such patients may not achieve symptomatic relief. Patients may not have consistent access to palliative services in outpatient, home, and long-term facility settings where most of the course of a terminal illness takes place, wrote Adam E. Singer of the Pardee RAND Graduate School, Santa Monica, Calif., and his colleagues.
The study was supported by the National Institute of Nursing Research and the Medical Scientist Training Program at the University of California.
FROM THE ANNALS OF INTERNAL MEDICINE
Key clinical point: Despite an increase in the use of hospice, moderate or severe pain continues to be a problem at the end of life for over half of patients.
Major finding: In their last year of life, over 57% of cancer patients experienced pain, 51% experienced depression, and 64% experienced anorexia.
Data source: Data from 7,204 deaths in the longitudinal, community-based Health and Retirement study.
Disclosures: The study was supported by the National Institute of Nursing Research (NINR) and the Medical Scientist Training Program at the University of California. Some of the researchers received grants from NINR.
Heavy alcohol consumption in midlife boosts later stroke risk
Heavy alcohol consumption in midlife may shorten the time to a stroke event by 5 years, although the increased risk of stroke in heavy drinkers also decreases with age, researchers have found.
Analysis of data from 11,644 individuals in the population-based Swedish Twin Registry showed that heavy drinkers – those who consumed more than two drinks a day – had a 34% greater risk of stroke, compared with very light drinkers (less than 0.5 drinks per day), and their time to stroke was shorter by more than 5 years, according to data published online Jan. 29 in Stroke [doi:10.1161/STROKEAHA.114.006724].
Age had a significant impact on the effect of alcohol: Increasing age was related to increasing risk of stroke in nondrinkers but a decreasing risk of stroke for heavy drinkers, whose risk of stroke was highest soon after the baseline median age of 50 years and reached almost zero at 85 years.
“Our results show that risk of stroke associated with heavy drinking in midlife is at least comparable with stroke risk associated with risk factors such as diabetes mellitus or hypertension; however, the age when those risk factors are relevant is different,” wrote Pavla Kadlecová, M.Sc., of St. Anne’s Hospital, Brno, Czech Republic, and colleagues.
The study was funded by European Regional Development Fund–FNUSA-ICRC. There were no conflicts of interest disclosed.
Heavy alcohol consumption in midlife may shorten the time to a stroke event by 5 years, although the increased risk of stroke in heavy drinkers also decreases with age, researchers have found.
Analysis of data from 11,644 individuals in the population-based Swedish Twin Registry showed that heavy drinkers – those who consumed more than two drinks a day – had a 34% greater risk of stroke, compared with very light drinkers (less than 0.5 drinks per day), and their time to stroke was shorter by more than 5 years, according to data published online Jan. 29 in Stroke [doi:10.1161/STROKEAHA.114.006724].
Age had a significant impact on the effect of alcohol: Increasing age was related to increasing risk of stroke in nondrinkers but a decreasing risk of stroke for heavy drinkers, whose risk of stroke was highest soon after the baseline median age of 50 years and reached almost zero at 85 years.
“Our results show that risk of stroke associated with heavy drinking in midlife is at least comparable with stroke risk associated with risk factors such as diabetes mellitus or hypertension; however, the age when those risk factors are relevant is different,” wrote Pavla Kadlecová, M.Sc., of St. Anne’s Hospital, Brno, Czech Republic, and colleagues.
The study was funded by European Regional Development Fund–FNUSA-ICRC. There were no conflicts of interest disclosed.
Heavy alcohol consumption in midlife may shorten the time to a stroke event by 5 years, although the increased risk of stroke in heavy drinkers also decreases with age, researchers have found.
Analysis of data from 11,644 individuals in the population-based Swedish Twin Registry showed that heavy drinkers – those who consumed more than two drinks a day – had a 34% greater risk of stroke, compared with very light drinkers (less than 0.5 drinks per day), and their time to stroke was shorter by more than 5 years, according to data published online Jan. 29 in Stroke [doi:10.1161/STROKEAHA.114.006724].
Age had a significant impact on the effect of alcohol: Increasing age was related to increasing risk of stroke in nondrinkers but a decreasing risk of stroke for heavy drinkers, whose risk of stroke was highest soon after the baseline median age of 50 years and reached almost zero at 85 years.
“Our results show that risk of stroke associated with heavy drinking in midlife is at least comparable with stroke risk associated with risk factors such as diabetes mellitus or hypertension; however, the age when those risk factors are relevant is different,” wrote Pavla Kadlecová, M.Sc., of St. Anne’s Hospital, Brno, Czech Republic, and colleagues.
The study was funded by European Regional Development Fund–FNUSA-ICRC. There were no conflicts of interest disclosed.
FROM STROKE
Key clinical point: Heavy alcohol consumption in midlife may shorten the expected time to a stroke event by 5 years.
Major finding: Heavy midlife drinkers have a 34% greater risk of stroke, compared with very light drinkers.
Data source: Analysis of data from 11,644 individuals in the population-based Swedish Twin Registry.
Disclosures: The study was funded by European Regional Development Fund–FNUSA-ICRC. There were no conflicts of interest disclosed.
Patient-led teledermoscopy appears feasible and effective
Patient-administered teledermoscopy using an iPhone-based mobile dermatoscope attachment and app is an effective and feasible method for short-term monitoring of clinically atypical nevi, with the added benefit of improving patient and physician convenience, based on data from a pilot study of 29 patients.
Researchers found a high level of diagnostic concordance (0.87) between dermatoscope images taken and assessed by an office-based dermatologist and those taken by the patient – albeit in the clinic setting – using the mobile dermatoscope and assessed by a teledermatologist.
All but one of the 29 patients with clinically atypical nevi who completed the study were able to acquire evaluable baseline and follow-up images, the researchers noted. In addition, most of the patients reported that the device was easy to use and that it saved them a trip to the doctor’s office. The study findings were published online Jan. 28 in JAMA Dermatology (doi:10.1001/jamadermatol.2014.3837).
“Under our modality of care, patients needing short-term monitoring will have an established relationship with their dermatologists, who will be the ones identifying concerning lesions that need to be monitored and the ones who evaluate the lesions via teledermoscopy and communicate treatment options directly with the patients,” wrote Xinyuan Wu of Memorial Sloan Kettering Cancer Center, New York, and colleagues.
The authors of an accompanying editorial wrote that recommendations for screening and follow-up for melanoma placed considerable burdens on patients, physicians, and the health care system, and that the patient-led mobile teledermoscopy described in the study was one of a number of options being considered to reduce that burden.
“The study by Wu and colleagues in this issue adds significantly to the discussion on whether regular follow-up visits with clinicians could be replaced by patient self-monitoring with remote feedback by a teledermatologist,” wrote Monika Janda, Ph.D., of the Queensland University of Technology in Brisbane, Australia, and colleagues.
One editorial author reported shares and consultancies with e-derm-consult GmbH and MoleMap, but there were no other conflicts of interest declared.
Patient-administered teledermoscopy using an iPhone-based mobile dermatoscope attachment and app is an effective and feasible method for short-term monitoring of clinically atypical nevi, with the added benefit of improving patient and physician convenience, based on data from a pilot study of 29 patients.
Researchers found a high level of diagnostic concordance (0.87) between dermatoscope images taken and assessed by an office-based dermatologist and those taken by the patient – albeit in the clinic setting – using the mobile dermatoscope and assessed by a teledermatologist.
All but one of the 29 patients with clinically atypical nevi who completed the study were able to acquire evaluable baseline and follow-up images, the researchers noted. In addition, most of the patients reported that the device was easy to use and that it saved them a trip to the doctor’s office. The study findings were published online Jan. 28 in JAMA Dermatology (doi:10.1001/jamadermatol.2014.3837).
“Under our modality of care, patients needing short-term monitoring will have an established relationship with their dermatologists, who will be the ones identifying concerning lesions that need to be monitored and the ones who evaluate the lesions via teledermoscopy and communicate treatment options directly with the patients,” wrote Xinyuan Wu of Memorial Sloan Kettering Cancer Center, New York, and colleagues.
The authors of an accompanying editorial wrote that recommendations for screening and follow-up for melanoma placed considerable burdens on patients, physicians, and the health care system, and that the patient-led mobile teledermoscopy described in the study was one of a number of options being considered to reduce that burden.
“The study by Wu and colleagues in this issue adds significantly to the discussion on whether regular follow-up visits with clinicians could be replaced by patient self-monitoring with remote feedback by a teledermatologist,” wrote Monika Janda, Ph.D., of the Queensland University of Technology in Brisbane, Australia, and colleagues.
One editorial author reported shares and consultancies with e-derm-consult GmbH and MoleMap, but there were no other conflicts of interest declared.
Patient-administered teledermoscopy using an iPhone-based mobile dermatoscope attachment and app is an effective and feasible method for short-term monitoring of clinically atypical nevi, with the added benefit of improving patient and physician convenience, based on data from a pilot study of 29 patients.
Researchers found a high level of diagnostic concordance (0.87) between dermatoscope images taken and assessed by an office-based dermatologist and those taken by the patient – albeit in the clinic setting – using the mobile dermatoscope and assessed by a teledermatologist.
All but one of the 29 patients with clinically atypical nevi who completed the study were able to acquire evaluable baseline and follow-up images, the researchers noted. In addition, most of the patients reported that the device was easy to use and that it saved them a trip to the doctor’s office. The study findings were published online Jan. 28 in JAMA Dermatology (doi:10.1001/jamadermatol.2014.3837).
“Under our modality of care, patients needing short-term monitoring will have an established relationship with their dermatologists, who will be the ones identifying concerning lesions that need to be monitored and the ones who evaluate the lesions via teledermoscopy and communicate treatment options directly with the patients,” wrote Xinyuan Wu of Memorial Sloan Kettering Cancer Center, New York, and colleagues.
The authors of an accompanying editorial wrote that recommendations for screening and follow-up for melanoma placed considerable burdens on patients, physicians, and the health care system, and that the patient-led mobile teledermoscopy described in the study was one of a number of options being considered to reduce that burden.
“The study by Wu and colleagues in this issue adds significantly to the discussion on whether regular follow-up visits with clinicians could be replaced by patient self-monitoring with remote feedback by a teledermatologist,” wrote Monika Janda, Ph.D., of the Queensland University of Technology in Brisbane, Australia, and colleagues.
One editorial author reported shares and consultancies with e-derm-consult GmbH and MoleMap, but there were no other conflicts of interest declared.
FROM JAMA DERMATOLOGY
Key clinical point: Patient-administered teledermoscopy using an iPhone-based mobile dermatoscope attachment and app is an effective and feasible method for short-term monitoring of clinically atypical nevi.
Major finding: Researchers found a high level of diagnostic concordance (0.87) between dermatoscope images taken and assessed by the office-based dermatologist and those taken by the patient using an iPhone.
Data source:A prospective cohort study in 34 patients – 29 of whom completed follow-up – with clinically atypical nevi.
Disclosures: One editorial author reported shares and consultancies with e-derm-consult GmbH and MoleMap. No other conflicts of interest were declared.