RESUMO
OBJECTIVES: To determine the prevalence of type 1 diabetes mellitus (T1D) in patients with juvenile idiopathic arthritis (JIA) and to characterize patients having both. STUDY DESIGN: Diabetes comorbidity was recorded in the National Pediatric Rheumatologic Database since 2012. Data from the North Rhine-Westphalian diabetes registry served as the reference population for the prevalence of diabetes in the general population. The National Pediatric Rheumatologic Database data were indirectly standardized for age and sex for comparison with the general population. The diabetes prevalence ratio was calculated using the Poisson regression model. RESULTS: The analysis included 12 269 patients with JIA. A total of 58 patients had comorbid T1D, and the diabetes prevalence was 0.5%. The mean age was 11.6 years at the time of documentation, and the mean disease duration was 4.2 years. Compared with the general population, the prevalence of diabetes in patients with JIA was significantly increased (prevalence ratio 1.76 [95% CI 1.34; 2.28], P < .001). The onset of diabetes in patients with JIA was earlier than that reported in the reference data. Sixty-three percent of patients developed T1D before JIA. On average, diabetes onset was 56 months before the onset of JIA. Patients who first developed JIA developed T1D on average 40 months later. The majority of patients had not received disease-modifying antirheumatic drugs before diabetes onset. CONCLUSIONS: T1D occurs more frequently in patients with JIA than in the general population. The likelihood of T1D occurrence appears to be slightly higher before JIA manifestation and without disease-modifying antirheumatic drug therapy after JIA onset.
Assuntos
Artrite Juvenil/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Idade de Início , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Distribuição de Poisson , Prevalência , Sistema de Registros , Análise de RegressãoRESUMO
Background: Measuring circulating cardiac troponin using novel sensitive assays has revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. Less well defined, however, is the incremental value of measuring circulating cardiac troponin I (cTnI) by a sensitive assay for risk assessment in primary prevention. Methods: We measured circulating concentrations of cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) in 5388 individuals free of known cardiovascular disease recruited into the DETECT study, a prospective longitudinal population-based cohort study. We determined the prognostic implications for incident major adverse cardiovascular events (MACE) during 5 years of follow-up. Results: Circulating cTnI was detectable in 19% of the subjects. Increased cTnI concentrations were associated with established risk factors for atherosclerosis and demonstrated a graded relationship with all-cause mortality and incident MACE during 5-year follow-up. A single measurement of cTnI significantly improved risk prediction over established risk factors, and also added prognostic information, when adjusted for serum concentrations of NT-proBNP and hsCRP. Conclusions: Minute increases in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment.
Antecedentes: La medición de troponina cardíaca en circulación mediante nuevos ensayos sensibles ha revelado que incluso mínimas elevaciones se asocian con mayor mortalidad en pacientes con enfermedad arterial coronaria, o incluso en la población general. Sin embargo, menos conocido es el valor incremental o agregado de la medición de la troponina I cardiaca (cTnI) circulante mediante un ensayo sensible para la evaluación del riesgo en prevención primaria. Métodos: Se midieron las concentraciones circulantes de cTnI, de pro- péptido natriurético tipo B N-terminal (NT-proBNP), y de proteína C reactiva de alta sensibilidad (PCRus), en 5388 personas sin enfermedad cardiovascular conocida reclutadas en el estudio DETECT, un estudio prospectivo longitudinal de cohorte de base poblacional. Se determinaron las implicancias pronósticas en la incidencia de eventos adversos cardiovasculares mayores (MACE) durante 5 años de seguimiento. Resultados: La cTnI se detectó en el 19% de los sujetos. El aumento de las concentraciones de cTnI se asoció con factores de riesgo establecidos para la aterosclerosis y demostró una relación gradual con la mortalidad por todas las causas y la incidencia de MACE durante los 5 años de seguimiento. Una sola medición de cTnI mejoró significativamente la predicción del riesgo por encima de los factores de riesgo establecidos, y también agregó información pronóstica cuando se ajustó por la concentración sérica de NT-proBNP y PCRus. Conclusiones: Mínimos incrementos de cTnI se asociaron con mayor mortalidad e incidencia de MACE en una gran cohorte de prevención primaria y, por tanto, la identificación de sujetos con riesgo cardiovascular no siempre son detectados completamente por la evaluación de factores de riesgo tradicionales.
Assuntos
Humanos , Doenças Cardiovasculares/prevenção & controle , Troponina I/sangue , Biomarcadores , Doenças Cardiovasculares/diagnóstico , Prevenção Primária , Fatores de RiscoRESUMO
Background: Measuring circulating cardiac troponin using novel sensitive assays has revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. Less well defined, however, is the incremental value of measuring circulating cardiac troponin I (cTnI) by a sensitive assay for risk assessment in primary prevention. Methods: We measured circulating concentrations of cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) in 5388 individuals free of known cardiovascular disease recruited into the DETECT study, a prospective longitudinal population-based cohort study. We determined the prognostic implications for incident major adverse cardio¡vascular events (MACE) during 5 years of follow-up. Results: Circulating cTnI was detectable in 19% of the subjects. Increased cTnI concentrations were associated with established risk factors for atherosclerosis and demonstrated a graded relationship with all-cause mortality and incident MACE during 5-year follow-up. A single measurement of cTnI significantly improved risk prediction over established risk factors, and also added prognostic information, when adjusted for serum concentrations of NT-proBNP and hsCRP. Conclusions: Minute increases in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment.(AU)
Antecedentes: La medición de troponina cardíaca en circulación mediante nuevos ensayos sensibles ha revelado que incluso mínimas elevaciones se asocian con mayor mortalidad en pacientes con enfermedad arterial coronaria, o incluso en la población general. Sin embargo, menos conocido es el valor incremental o agregado de la medición de la troponina I cardiaca (cTnI) circulante mediante un ensayo sensible para la evaluación del riesgo en prevención primaria. Métodos: Se midieron las concentraciones circulantes de cTnI, de pro- péptido natriurético tipo B N-terminal (NT-proBNP), y de proteína C reactiva de alta sensibilidad (PCRus), en 5388 personas sin enfermedad cardiovascular conocida reclutadas en el estudio DETECT, un estudio prospectivo longitudinal de cohorte de base poblacional. Se determinaron las implicancias pronósticas en la incidencia de eventos adversos cardiovasculares mayores (MACE) durante 5 años de seguimiento. Resultados: La cTnI se detectó en el 19% de los sujetos. El aumento de las concentraciones de cTnI se asoció con factores de riesgo establecidos para la aterosclerosis y demostró una relación gradual con la mortalidad por todas las causas y la incidencia de MACE durante los 5 años de seguimiento. Una sola medición de cTnI mejoró significativamente la predicción del riesgo por encima de los factores de riesgo establecidos, y también agregó información pronóstica cuando se ajustó por la concentración sérica de NT-proBNP y PCRus. Conclusiones: Mínimos incrementos de cTnI se asociaron con mayor mortalidad e incidencia de MACE en una gran cohorte de prevención primaria y, por tanto, la identificación de sujetos con riesgo cardiovascular no siempre son detectados completamente por la evaluación de factores de riesgo tradicionales.(AU)