Composite End Points

Breitling, Lutz P.; Mons, Ute; Hahmann, Harry; Köenig, Wolfgang; Rothenbacher, Dietrich; Brenner, Hermann

doi:10.1161/circoutcomes.116.003458

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…In addition, the proportion of individuals with BD is consistent with prevalence rates in other studies (18,52). Finally, although the use of a composite end point is meaningful clinically and particularly relevant for this population, composite end points are more difficult to interpret than singular end points and may limit comparability between studies (53). In this study, we believed that the clinical relevance of the composite end point and the enhanced power it granted outweighed the negative aspects of its use.…”

Section: Discussionmentioning

confidence: 99%

Association of Bipolar Disorder With Major Adverse Cardiovascular Events: A Population-Based Historical Cohort Study

et al. 2021

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Objective: This study aimed to assess the association of bipolar disorder (BD) with risk of major adverse cardiac events (MACEs) after adjusting for established cardiovascular disease (CVD) risk factors. Methods: We conducted a population-based historical cohort study using the Rochester Epidemiology Project. Patients older than 30 years with a clinical encounter from 1998 to 2000 with no prior MACE, atrial fibrillation, or heart failure were followed up through March 1, 2016. BD diagnosis was validated by chart review. Cox proportional hazards regression models were adjusted for established CVD risk factors, alcohol use disorder, other substance use disorders (SUDs), and major depressive disorder (MDD). Results: The cohort included 288 individuals with BD (0.81%) and 35,326 individuals without BD as the reference group (Ref ). Median (interquartile range) follow-up was 16.5 (14.6-17.5) years. A total of 5636 MACE events occurred (BD, 59; Ref, 5577). Survival analysis showed an association between BD and MACE (median event-free-survival rates: BD, 0.80; Ref, 0.86; log-rank p = .018). Multivariate regression adjusting for age and sex also yielded an association between BD and MACE (hazard ratio [HR] = 1.93; 95% confidence interval [CI] = 1.43-2.52; p < .001). The association remained significant after further adjusting for smoking, diabetes mellitus, hypertension, high-density lipoprotein cholesterol, and body mass index (HR = 1.66; 95% CI = 1.17-2.28; p = .006), and for alcohol use disorder, SUD, and MDD (HR = 1.56; 95% CI = 1.09-2.14; p = .010). Conclusions: In this study, BD was associated with an increased risk of MACE, which persisted after adjusting for established CVD risk factors, SUDs, and MDD. These results suggest that BD is an independent risk factor for major clinical cardiac disease outcomes.

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Section: Discussionmentioning

confidence: 99%

Association of Bipolar Disorder With Major Adverse Cardiovascular Events: A Population-Based Historical Cohort Study

et al. 2021

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A Novel Tool for Visualizing Composite Endpoint Associations

Breitling

2018

Circ: Cardiovascular Quality and Outcomes

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Progression of Chronic Kidney Disease Risk Categories and Risk of Cardiovascular Disease and Total Mortality: Coronary Artery Risk Development in Young Adults Cohort

Choi

Jacobs

Shroff

et al. 2022

JAHA

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Background Previous studies of worsening chronic kidney disease (CKD) based on declining estimated glomerular filtration rate (eGFR) or increasing urine albumin‐creatinine ratio (UACR) are limited to later middle‐age and older adults. We examined associations of CKD progression and incident cardiovascular disease (CVD) and mortality in younger adults. Methods and Results We studied 4382 adults in CARDIA (Coronary Artery Risk Development in Young Adults) initially aged 27 to 41 years and prospectively over 20 years. Five‐year transition probabilities across CKD risk categories were based on eGFR and UACR measured at each exam. Proportional hazards models predicted incident CVD and all‐cause mortality by time‐varying CKD risk category, adjusting for demographics and CVD risk factors. Progression of CKD risk categories over 20 years occurred in 28.7% (1256/4382) of participants, driven by increases in UACR, but including 5.8% (n=255) with eGFR<60 mL/min per 1.73 m 2 or UACR ≥300 mg/g. Compared with eGFR ≥60 and UACR <10, demographic and smoking‐adjusted hazard ratios for CVD were 1.62 (95% CI, 1.21–2.18) for low CKD risk (eGFR ≥60 with UACR 10–29) and 13.65 (95% CI, 7.52–24.79) for very high CKD risk (eGFR <30 or eGFR 30–44 with UACR 30–299; or eGFR 30–59 with UACR ≥300). Corresponding hazard ratios for all‐cause mortality were 1.42 (95% CI, 1.08–1.88) and 14.75 (95% CI, 9.97–21.82). Although CVD associations were attenuated after adjustment for mediating CVD risk factors, all‐cause mortality associations remained statistically significant. Conclusions Among young to middle‐aged adults, progression to higher CKD risk category was common. Routine monitoring eGFR and UACR holds promise for prevention of CVD and total mortality.

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Composite End Points

Cited by 3 publications

References 18 publications

Association of Bipolar Disorder With Major Adverse Cardiovascular Events: A Population-Based Historical Cohort Study

Association of Bipolar Disorder With Major Adverse Cardiovascular Events: A Population-Based Historical Cohort Study

A Novel Tool for Visualizing Composite Endpoint Associations

Progression of Chronic Kidney Disease Risk Categories and Risk of Cardiovascular Disease and Total Mortality: Coronary Artery Risk Development in Young Adults Cohort

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