RESUMEN
OBJECTIVE: The goal of this study was to evaluate the prevalence of chronic kidney disease (CKD) in young patients with acute myocardial infarction (AMI) and to report their characteristics and clinical outcomes. BACKGROUND: Underlying renal dysfunction is a risk factor for poor cardiovascular outcomes in older patients. The implication of CKD in young patients with AMI is not well studied. METHODS: This is a retrospective population-based cohort study of patients aged 18-50 who presented with AMI between 2006 and 2016. Medical records were reviewed to confirm diagnosis and to identify treatment and long-term outcomes. Cox regression models were used to evaluate the association of CKD with mortality. RESULTS: Among 1753 young patients with type 1 AMI (median age 45 years, 85.3% male), CKD was present in 112 (6.8%) patients. A higher proportion of CKD patients had concomitant hypertension, hyperlipidemia, diabetes, and obesity. Use of statin and P2Y12 inhibitors post-AMI was lower in CKD patients. Over a median follow-up of 7.2 years, CKD was associated with higher all-cause mortality [hazard ratio (HR), 9.3; 95% CI, 6.3-13.8]. This association persisted after adjusting for demographics, comorbidities, and treatment (adjusted HR, 3.6; 95% CI, 2.2-6.0). CONCLUSION: Presence of CKD was associated with 3.6-fold higher mortality over a median follow-up of 7.2 years. A lower proportion of CKD patients were treated with statin therapy and P2Y12 inhibitors. These findings highlight the need for intensive risk factor modification and optimal use of guideline-directed medical therapies in this high-risk population.
Asunto(s)
Inhibidores de Hidroximetilglutaril-CoA Reductasas , Infarto del Miocardio , Insuficiencia Renal Crónica , Anciano , Estudios de Cohortes , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: To limit transmission of COVID-19, state governments issued shelter-in-place orders. These orders coincided with a decrease in daily step count and an increase in overeating. We evaluated factors associated with weight gain of ≥ 15 pounds during the pandemic within an integrated health care system. METHODS: We included adults ages 18 and above with at least one weight measurement before the pandemic (March 19, 2019-March 19, 2020) and another measurement after COVID-19 vaccines became available, more than 9 months into the pandemic (December 14, 2020-December 14, 2021). Logistic regression was used to identify factors associated with weight gain of 15 pounds or more. RESULTS: Of 524,451 adults included in the study, median age was 61 years, 43.2% were men, 36.2% self identified as White, 8.6% Black, 35.7% Hispanic, and 16.2% Asian. During the pandemic, 38,213 (7.3%) adults gained ≥ 15 pounds. A higher proportion of young adults gained weight (16.2% age 18-39, 7.6% age 40-64, 4.7% age 65-79%, and 3.1% age ≥ 80). No significant difference was observed between men and women (7.2% men and 7.4% women). Weight gain was more prevalent among adults from low-income neighborhoods (8.9% low-income neighborhoods, 8.0% intermediate-income neighborhoods, and 6.5% high-income neighborhoods). Multivariable logistic regression demonstrated that compared to adults ages 65-79 years, young adults ages 18-39 years had the highest risk of gaining ≥ 15 pounds (adjusted OR 5.19, 95% CI 5.01-5.38). Black race was associated with weight gain in an unadjusted analysis (OR 1.25, 95% CI 1.21-1.30). However, this association was significantly attenuated after adjusting for other risk factors including neighborhood income levels (adjusted OR 1.06, 95% CI 1.02-1.10). Having a diagnosis of depression pre-pandemic was also associated with weight gain during the pandemic (adjusted OR 1.54, 95% CI 1.50-1.58). CONCLUSION: In this racially and ethnically diverse population in southern California, significant weight gain of 15 pounds or more was observed in 7.3% of the adult population during the COVID-19 pandemic. Young adults, individuals who resided in low-income neighborhoods, and patients with depression were disproportionally affected.
Asunto(s)
COVID-19 , Adolescente , Adulto , Anciano , COVID-19/epidemiología , Vacunas contra la COVID-19 , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Pandemias , Aumento de Peso , Adulto JovenRESUMEN
Chronological age alone does not fully reflect a patient's prognosis. We sought to assess the association of cardiorespiratory fitness (quantified by METs) with all-cause mortality among patients aged 60 to 90 years. This retrospective study included patients who underwent exercise treadmill testing at an integrated healthcare system from 2011 to 2019. Patients were categorized into age groups: 60 to <70 years, 70 to <80 years, and 80 to 90 years; and cardiorespiratory fitness level: low (<5 METs), moderate (5 to 10 METs), and high fitness (>10 METs). Mean follow-up was 3.5 years. A total of 40,520 patients were included (mean age 67.7 ± 4.7 years, 48.6% women). Of whom, 27,021 were 60 to <70 years old (66.7%); 12,638 70 to <80 years old (31.2%); and 1,861 80 to 90 years old (4.6%). There were 3,494 patients categorized as low (8.6%), 21,863 as moderate (54%), and 15,163 as high fitness (37.4%). Low fitness level was independently associated with lower survival (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.15 to 2.24). Using age 60 to 70 group with high fitness level as reference, the age 80 to 90 group with high fitness level had better survival than their younger counterparts with low fitness level (age 80 to 90 years high fitness level: HR 2.9, 95% CI 1.2 to 7.2; age 60 to 70 years low fitness level: HR 4.3, 95% CI 3.1 to 5.9; age 70 to 80 years low fitness level: HR 6.8, 95% CI 5.2 to 8.9) on adjusted analysis. In conclusion, higher cardiorespiratory fitness is associated with better survival. Patients >80 years old with high fitness level have comparable or even better survival than their younger counterparts with submoderate fitness levels. Chronological age alone should not be the only factor when considering prognosis.