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High-risk multimorbidity patterns on the road to cardiovascular mortality.

ABSTRACT: BACKGROUND:Multimorbidity, the co-occurrence of two or more diseases in one patient, is a frequent phenomenon. Understanding how different diseases condition each other over the lifetime of a patient could significantly contribute to personalised prevention efforts. However, most of our current knowledge on the long-term development of the health of patients (their disease trajectories) is either confined to narrow time spans or specific (sets of) diseases. Here, we aim to identify decisive events that potentially determine the future disease progression of patients. METHODS:Health states of patients are described by algorithmically identified multimorbidity patterns (groups of included or excluded diseases) in a population-wide analysis of 9,000,000 patient histories of hospital diagnoses observed over 17 years. Over time, patients might acquire new diagnoses that change their health state; they describe a disease trajectory. We measure the age- and sex-specific risks for patients that they will acquire certain sets of diseases in the future depending on their current health state. RESULTS:In the present analysis, the population is described by a set of 132 different multimorbidity patterns. For elderly patients, we find 3 groups of multimorbidity patterns associated with low (yearly in-hospital mortality of 0.2-0.3%), medium (0.3-1%) and high in-hospital mortality (2-11%). We identify combinations of diseases that significantly increase the risk to reach the high-mortality health states in later life. For instance, in men (women) aged 50-59 diagnosed with diabetes and hypertension, the risk for moving into the high-mortality region within 1 year is increased by the factor of 1.96 ± 0.11 (2.60 ± 0.18) compared with all patients of the same age and sex, respectively, and by the factor of 2.09 ± 0.12 (3.04 ± 0.18) if additionally diagnosed with metabolic disorders. CONCLUSIONS:Our approach can be used both to forecast future disease burdens, as well as to identify the critical events in the careers of patients which strongly determine their disease progression, therefore constituting targets for efficient prevention measures. We show that the risk for cardiovascular diseases increases significantly more in females than in males when diagnosed with diabetes, hypertension and metabolic disorders.

SUBMITTER: Haug N

PROVIDER: S-EPMC7063814 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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High-risk multimorbidity patterns on the road to cardiovascular mortality.

Haug Nina N Deischinger Carola C Gyimesi Michael M Kautzky-Willer Alexandra A Thurner Stefan S Klimek Peter P

BMC medicine 20200310 1

<h4>Background</h4>Multimorbidity, the co-occurrence of two or more diseases in one patient, is a frequent phenomenon. Understanding how different diseases condition each other over the lifetime of a patient could significantly contribute to personalised prevention efforts. However, most of our current knowledge on the long-term development of the health of patients (their disease trajectories) is either confined to narrow time spans or specific (sets of) diseases. Here, we aim to identify decis ...[more]

PMID: 32151252

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Project description:BackgroundThe Healthy Eating Index-2015 (HEI-2015) score measures adherence to recommendations from the 2015-2020 Dietary Guidelines for Americans. The HEI-2015 was altered from the HEI-2010 by reclassifying sources of dietary protein and replacing the empty calories component with 2 new components: saturated fats and added sugars.ObjectivesOur aim was to assess whether the HEI-2015 score, along with 3 other previously defined indices, were associated with incident cardiovascular disease (CVD), CVD mortality, and all-cause mortality.MethodsWe conducted a prospective analysis of 12,413 participants aged 45-64 y (56% women) from the Atherosclerosis Risk in Communities (ARIC) Study. The HEI-2015, Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean (aMed) diet, and Dietary Approaches to Stop Hypertension Trial (DASH) scores were computed using the average dietary intakes of Visits 1 (1987-1989) and 3 (1993-1995). Incident CVD, CVD mortality, and all-cause mortality data were ascertained from baseline through 31 December, 2017. We used Cox proportional hazards models to estimate HRs and 95% CIs.ResultsThere were 4509 cases of incident CVD, 1722 cases of CVD mortality, and 5747 cases of all-cause mortality over a median of 24-25 y of follow-up. Compared with participants in the lowest quintile of HEI-2015, participants in the highest quintile had a 16% lower risk of incident CVD (HR: 0.84; 95% CI: 0.76-0.93; P-trend < 0.001), 32% lower risk of CVD mortality (HR: 0.68; 95% CI: 0.58-0.80; P-trend < 0.001), and 18% lower risk of all-cause mortality (HR: 0.82; 95% CI: 0.75-0.89; P-trend < 0.001) after adjusting for demographic and lifestyle covariates. There were similar protective associations for AHEI-2010, aMed, and DASH scores, and no significant interactions by race.ConclusionsHigher adherence to the 2015-2020 Dietary Guidelines for Americans was associated with lower risks of incident CVD, CVD mortality, and all-cause mortality among US adults.

Project description:AbstractAnimals often disperse from one habitat to another to access mates or suitable breeding sites. The costs and benefits of such movements depend, in part, on the dispersing individuals' phenotypes, including their sex and age. Here we investigated dispersal and road-related mortality in larvae of a bioluminescent beetle, the European common glow-worm, Lampyris noctiluca, in relation to habitat, sex and proximity of pupation. We expected these variables to be relevant to larval dispersal because adult females are wingless, whereas adult males fly when searching for glowing females. We found that dispersing glow-worm larvae were almost exclusively females and close to pupation. The larvae were often found on a road, where they were able to move at relatively high speeds, with a tendency to uphill orientation. However, each passing vehicle caused a high mortality risk, and we found large numbers of larvae run over by cars, especially close to covered, forest-like habitat patches. In contrast, adult females in the same area were most often found glowing in more open rocky and grassy habitats. These findings demonstrate an underappreciated ecological strategy, sex-biased dispersal at larval phase, motivated by different habitat needs of larvae and wingless adult females. The results are also consistent with roads being an ecological trap, facilitating dispersal and presumably females' signal visibility but causing severe larval mortality just before the reproductive stage. Hence, in addition to the previously recognised threats of urbanisation, even low traffic volumes have a high potential to negatively affect especially females of this iconic beetle.Significance statementAnimals sometimes need to move from one habitat to another to find mating partners or breeding sites. We found this need to result in strongly female-biased larval dispersal in the European common glow-worm, a beetle known for the glow of wingless females that attract flying males to mate. Female larvae moving between habitats often used a road or trail but perished in high numbers when run over by cars. Hence, roads are likely to be ecological traps for the female glow-worm larvae, attracting them during dispersal, but causing grave mortality. The sex-biased larval dispersal, demonstrated in this study, is a poorly known ecological strategy that was found to be very risky in a human-modified landscape.Supplementary informationThe online version contains supplementary material available at 10.1007/s00265-020-02962-6.

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High-risk multimorbidity patterns on the road to cardiovascular mortality.

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High-risk multimorbidity patterns on the road to cardiovascular mortality.

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