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Hyponatremia is associated with considerable morbidity and mortality, but causal links have been difficult to establish. Here, we describe the establishment and representativeness of the Stockholm Sodium Cohort (SSC), designed to study etiologies and outcomes of hyponatremia. All residents of Stockholm County undertaking at least one serum sodium test between 2005–2018 were included in the SSC. Individual-level test results from over 100 laboratory parameters relevant to hyponatremia were collected and linked to data on demographics, socioeconomic status, healthcare contacts, diagnoses and dispensed prescription medications using national registers. A total of 1,632,249 individuals, corresponding to 64% of the population of Stockholm County, were included in the SSC. Coverage increased with advancing age, ranging from 32% in children and adolescents (≤18 years) to 97% among the oldest (≥80 years). The coverage of SSC included the vast majority of patients in Stockholm County diagnosed with diabetes mellitus (93%), myocardial infarction (98%), ischemic stroke (97%), cancer (85%), pneumonias requiring inpatient care (95%) and deaths (88%). SSC is the first cohort specifically designed to investigate sodium levels in a large, population-based setting. It includes a wide range of administrative health data and laboratory analyses. The coverage is high, particularly among elderly and individuals with comorbidities. Consequently, the cohort has a large potential for exploration of various aspects of hyponatremia. • Hyponatremia is associated with considerable mortality and morbidity, but the etiology is complex. • The Stockholm Sodium Cohort facilitates studies on the etiology and consequences of hyponatremia. • SSC includes over 1.6 million individuals and a wide range of administrative health data and laboratory analyses. • The coverage of SSC is high, particularly among the elderly and among individuals with comorbidities. [ABSTRACT FROM AUTHOR]

The atherogenic index of plasma (AIP) has been shown to be related to cardiovascular disease risk, but evidence on the longitudinal pattern of AIP during follow-up is limited. We aimed to explore the associations of baseline and long-term AIP with the risk of myocardial infarction (MI). We included 98,861 participants in the Kailuan Study who were free of MI at baseline. AIP was calculated as log (triglyceride/high-density lipoprotein cholesterol). Long-term AIP included the long-term mean AIP (mean AIP from baseline to the first occurrence of MI or the end of follow-up) and number of visits with high AIP (above the cutoff value at the first three visits). The baseline and updated mean AIP were in operationalized as quartiles. Cox proportional hazard models were used to determine the associations between AIP and risk of MI. We excluding all deaths during the follow-up visits in the sensitivity analysis. During a median follow-up of 12.80 years, 1804 participants developed MI. Compared with quartile 1, the adjusted hazard ratios in baseline and updated mean AIP quartile 4 were 1.63 (95% CI, 1.41–1.88) and 1.59 (95% CI, 1.37–1.83), respectively. Compared with participants who did not have a high AIP, the HR among individuals with AIP elevated by three times was 1.94 (95% CI,1.55–2.45). The sensitivity analysis showed similar associations. Elevated levels of both baseline and long-term AIP increased the risk of MI. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to determine incidences, diagnoses, and outcomes of patients with chest pain attended by paramedics using a large population-based sample.Methods: Consecutive emergency medical services (EMS) attendances for non-traumatic chest pain in Victoria, Australia from January 2015 to June 2019 were included. Data were individually linked to emergency, hospital admission and mortality records.Results: During the study period (representing 22,186,930 person-years), chest pain was the reason for contacting EMS in 257,017 of 2,736,570 attendances (9.4%). Overall incidence of chest pain attendances was 1,158 (per 100,000 person-years) with a higher incidence observed with increasing age, among females, among Aboriginal and Torres Strait Islanders, in regional settings, and in socially disadvantaged areas. The most common diagnoses were non-specific pain (46%; 30-day mortality 0.5%), non-ST elevation myocardial infarction (5.3%; mortality 1.3%), pneumonia (3.8%; mortality 3.9%), stable coronary syndromes (3.5%; mortality 0.8%), unstable angina (3.3%; mortality 1.3%), and ST-elevation myocardial infarction (2.8%; mortality 7.0%), while pulmonary embolism (0.7%; mortality 3.2%) and aortic pathologies (0.2%; mortality 22.2%) were rare.Conclusions: Chest pain accounts for one in ten ambulance calls, and underlying causes are diverse. Almost half of patients are discharged from hospital with a diagnosis of non-specific pain and low rates of mortality. [ABSTRACT FROM AUTHOR]

Purpose: There has been considerable debate on the extent to which the decline in coronary heart disease (CHD) mortality has been caused by better control of coronary risk factors in the general population or is the result of invasive coronary interventions in symptomatic individuals.Methods: Using the Myocardial Infarction Data Acquisition System, a statewide database of all cardiovascular hospital admissions in New Jersey, we examined time trends in incidence of death from CHD in the Years 2000-2014 in persons with a history of hospitalization for CHD in the previous 10 years and those without such a history.Results: Over the 10-year study period, there was a marked decline in CHD-related mortality in both persons with a history of CHD and persons without a history of CHD. The decline occurred across all gender, racial, and age groups and was higher in those without a prior history of CHD.Conclusions: This adds more evidence that the decline in CHD was not only because of advanced invasive medical and surgical treatments but also equally because of improved lifestyle, pharmacologic treatment of risk factors for CHD, and public health interventions. [ABSTRACT FROM AUTHOR]

Purpose: Psychosocial factors have been linked to myocardial infarction (MI) outcomes. Whether psychosocial factors affect post-MI long-term adherence to secondary prevention recommendations remains uncertain.Methods: Patients ≤65 years (n = 616) were assessed for optimism, perceived social support (PSS), sense of coherence (SOC), anxiety, and depression at initial hospitalization for acute MI (1992-1993). Adherence to secondary prevention measures was recorded in interviews 3-6 months, 1-2, 5, and 10-13 years after MI. Prevention score (proportion of recommendations met) was developed based on: (1) medication adherence; (2) exercise; (3) nonsmoking; (4) healthy diet; (5) maintaining recommended body weight. Associations between psychosocial factors and prevention scores were estimated using Generalized Estimating Equation models. The role of the prevention score in long-term survival was assessed using time-dependent Cox regression analysis.Results: Average follow-up prevention scores ranged from 0.70 to 0.80 (SD, ≈0.20). After multivariable adjustment, PSS (β = 0.087, P = .002, per 1 SD increase) and SOC (β = 0.082, P = .006, per 1 SD increase) were positively associated with secondary prevention adherence. The prevention score predicted survival over 23-year follow-up (adjusted hazard ratio = 0.79; 95% CI: 0.68-0.91, per 1 SD increase).Conclusions: Psychosocial factors following MI, particularly PSS and SOC, were associated with long-term adherence to secondary prevention measures. [ABSTRACT FROM AUTHOR]

Purpose: Inversed probability weighted (IPW) estimators are commonly used to adjust for time-fixed or time-varying confounders. However, in high-dimensional settings, including all identified confounders may result in unstable weights leading to higher variance. We aimed to develop a visualization tool demonstrating the impact of each confounder on the bias and variance of IPW estimates, as well as the propensity score overlap.Methods: A SAS macro was developed for this visualization tool and we demonstrate how this tool can be used to identify potentially problematic confounders of the association of statin use after myocardial infarction on one-year mortality in a plasmode simulation study using a cohort of 39,792 patients from the UK (1998-2012).Results: Through the tool's output, we can identify problematic confounders (two instrumental variables) and important confounders by comparing the estimated psuedo MSE with that from the fully adjusted model and propensity score overlap plot.Conclusion: Our results suggest that the analytic impact of all confounders should be considered carefully when fitting IPW estimators. [ABSTRACT FROM AUTHOR]

Purpose: This study examined associations of functional limitation due to any health problems and six chronic diseases (arthritis, diabetes, coronary heart disease, heart attack, hypertension, and stroke) with food security among U.S. adults.Methods: The 2011 National Health Interview Survey data for 30,010 adults (≥18 years) were used. Adults were categorized into food secure, low food secure, or very low food secure. Multivariable logistic regressions were used to estimate adjusted odds ratio (OR) and 95% confidence interval (CI) for having functional limitation and chronic diseases while adjusting for sociodemographic and lifestyle factors.Results: The prevalence of functional limitation and the chronic diseases were higher in low-food-secure and very low-food-secure than food-secure adults. The adjusted ORs were significant in both low food secure and very low food secure, respectively, for functional limitation (OR: 1.87; 95% CI: 1.63, 2.14), (OR: 2.20; 95% CI: 1.91, 2.52), inflammatory diseases or joint/muscular pain (OR: 1.42; 95% CI: 1.21, 1.68), (OR: 1.74; 95% CI: 1.49, 2.04), diabetes (OR: 1.26; 95% CI: 1.06, 1.51), (OR: 1.23; 95% CI: 1.02, 1.48), and hypertension (OR: 1.18; 95% CI: 1.04, 1.35), (OR: 1.42; 95% CI: 1.22, 1.65) when compared with food-secure adults.Conclusions: Findings indicate that food insecurity is associated with functional limitation and chronic diseases, whereas directionality is unknown. Besides the traditional food assistance program for food-insecure populations, interventions to prevent or manage chronic diseases may be necessary to help them reduce the risk of the diseases and manage their conditions. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has explored the association between social support (SS), cardiovascular disease, and mortality. Perceived SS (PSS) refers to an individual's attitude toward received SS. This study aimed to: (1) assess the association between PSS levels and long-term mortality among first myocardial infarction (MI) survivors, (2) compare the effect of PSS measured shortly after the first MI to PSS measured 10-13 years after MI, and (3) compare the prognostic role of different PSS components: family, friends, and significant others.Methods: Patients were drawn from the longitudinal prospective Israel Study of First Acute Myocardial Infarction (ISFAMI). PSS, sociodemographic and health variables were assessed in two subcohorts during initial hospitalization from 1992 to 1993 (T1, n = 660) and in 2002-2005 (T2, n = 969). Vital status was determined through 2011. Cox regression models assessed mortality risk associated with PSS.Results: By the end of follow-up, 212 (32%) of the T1 and 229 (24%) of T2 subcohorts had died. Higher PSS levels were associated with lower mortality risk at both T1 and T2 (per one standard deviation [1SD] increase hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.75-0.96; HR = 0.74, 95% CI = 0.66-0.83, respectively). These associations were attenuated on adjustment for sociodemographic and clinical variables (HR = 0.93, 95% CI = 0.80-1.07; HR = 0.88, 95% CI = 0.77-1.00, respectively). PSS from friends was significantly associated with lower mortality risk at both T1 and T2 and remained significant only at T2 after adjustment (HR = 0.85, 95% CI = 0.73-0.98).Conclusions: Higher PSS levels were significantly associated with reduced mortality risk post-MI. This should encourage clinicians to assess post-MI psychosocial status to identify high-risk patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare the characteristics and prognosis of acute myocardial infarctions (AMIs) that were not the primary reason for hospitalization, and thus not primary discharge diagnosis, to AMIs that were the primary reason for hospitalization. Methods: Primary discharge diagnoses for Reasons for Geographic and Racial Differences in Stroke study participants (black and white men and women age >45 years) with adjudicated AMIs were categorized as "AMI" or "other". Cox models were used to compare mortality up to 5 years post-AMI between primary discharge diagnoses of AMI and other. Results: Of 871 AMIs, primary discharge diagnosis was not AMI in 550 (63%). When primary discharge diagnosis was not AMI, average troponin elevations were smaller and heart failure was more common. Adjusted for participant and hospitalization characteristics, all-cause, coronary heart disease, and cardiovascular disease mortality after AMI were similar between groups (hazard ratios (95% confidence intervals): 1.08 [0.80-1.47]; 1.29 [0.76-2.18); and 0.86 [0.58-1.27), respectively). Conclusions: Studies limited to individuals with primary discharge diagnosis of AMI may underestimate the burden of AMI and exclude a group with elevated risk of all-cause, coronary heart disease, and cardiovascular disease mortality. [ABSTRACT FROM AUTHOR]

Purpose To examine the association of depressive symptoms with coronary heart disease (CHD) end points by race and income. Methods Study participants were blacks and whites ( n = 24,443) without CHD at baseline from the national Reasons for Geographical and Racial Differences in Stroke cohort. Outcomes included acute CHD and CHD or revascularization. We estimated race-stratified multivariate Cox proportional hazards models of incident CHD and incident CHD or revascularization with the 4-item Center for Epidemiological Studies Depression Scale, adjusting for risk factors. Results Mean follow-up was 4.2 ± 1.5 years; CHD incidence was 8.3 events per 1000 person-years ( n = 366) among blacks and 8.8 events per 1000 person-years ( n = 613) among whites. After adjustment for age, sex, marital status, region, and socioeconomic status, depressive symptoms were significantly associated with incident CHD among blacks (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.00–1.91) but not among whites (HR, 1.10; 95% CI, 0.74–1.64). In the fully adjusted model, compared with blacks who reported no depressive symptoms, those reporting depressive symptoms had greater risk for the composite end point of CHD or revascularization (HR, 1.36; 95% CI, 1.01–1.81). Depressive symptoms were not associated with incident CHD end points among whites. Conclusions High depressive symptoms were associated with higher risk of CHD or revascularization for blacks but not whites. [ABSTRACT FROM AUTHOR]

Purpose: To understand if baseline levels of the anti-inflammatory cytokine interleukin-10 (IL-10) are associated with either subclinical atherosclerosis or risk for adverse cardiovascular (CV) events.Methods: The study included 930 adults from the Multi-Ethnic Study of Atherosclerosis (MESA) ancillary Stress Study. Participants, age 48-90 years at enrollment, were followed for an average of 10.2 years. IL-10 level was measured at the initial Stress Study visit. Cardiovascular outcomes were defined as composite CV death, myocardial infarction, stroke, stroke death, and resuscitated cardiac arrest. Coronary calcification was determined by Agatston coronary artery calcium (CAC) score. The association between IL-10 level and CV event risk was evaluated by Cox proportional hazard modeling, while that of IL-10 level and CAC presence and amount was determined with prevalence risk ratio (PRR) and linear regression modeling, respectively. Models were adjusted for CV risk factors and proinflammatory biomarkers.Results: After full adjustment, IL-10 level did not predict CV events (HR 1.19, 95%CI 0.89, 1.60) and was not associated with CAC prevalence (PRR 1.00, 95%CI 0.94, 1.07), nor amount of CAC in those with nonzero CAC (β -0.01, 95%CI -0.23, 0.21).Conclusion: In individuals without clinical heart disease, baseline IL-10 level appears unrelated to risk of CV events and is a poor marker of subclinical coronary atherosclerosis. [ABSTRACT FROM AUTHOR]

Purpose: Progressive physical frailty in older adults is associated with increased risk of falls, disability, institutionalization, and mortality. Although associations between diabetes and frailty have been observed, the impact of diabetes on frailty in older Hispanics is largely unexplored. We examine the association of diabetes on the odds of frailty among older Mexican Americans.Methods: Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly from 1995 until 2012, frailty was assessed by slow gait, weak hand grip strength, exhaustion, and unexplained weight loss (n = 1327).Results: Logistic regression showed a large magnitude of effect of diabetes on the odds of frailty (odds ratio 1.47, 95% confidence interval 1.14-1.90). Other contributors to frailty included arthritis, heart attack, and hip fracture. Positive and negative effects had significant and opposing associations. Ordinal logit models assessed the odds of frail compared to nonfrail and prefrail. In these models, diabetes was associated with a 32% increase in the odds of a higher level of frailty.Conclusions: Diabetes is a significant contributor to increased frailty in older Mexican Americans. Interventions to reduce frailty rates should focus on mitigating the effects of diabetes and shifting away from negative and toward positive effect. [ABSTRACT FROM AUTHOR]