Bundle branch blocks and the risk of mortality in the Atherosclerosis Risk in Communities study

Aims The main objective of our study was to evaluate the associations between different categories of bundle branch blocks (BBBs) and mortality and to consider possible impact of QRS prolongation in these associations. Methods This analysis included 15 408 participants (mean age 54 years, 55.2% women, and 26.9% blacks) from the Atherosclerosis Risk in Communities study. We used Cox regression to examine associations between left BBB (LBBB), right BBB (RBBB) and indetermined type of ventricular conduction defect [intraventricular conduction defect (IVCD)] with coronary heart disease (CHD) death and all-cause mortality. Results During a mean 21 years of follow-up, 4767 deaths occurred; of these, 728 were CHD deaths. Compared to No-BBB, LBBB and IVCD were strongly associated with increased CHD death (hazard ratios 4.11 and 3.18, respectively; P < 0.001 for both). Furthermore, compared to No-BBB with QRS duration less than 100 ms, CHD mortality risk was increased 1.33-fold for the No-BBB group with QRS duration 100-109 ms, and 1.48-fold with QRS duration 110-119 ms, 3.52-fold for pooled LBBB-IVCD group with QRS duration less than 140 ms and 4.96-fold for pooled LBBB-IVCD group with QRS duration at least 140 ms (P < 0.001). However, mortality risk was not significantly increased for lone RBBB. For all-cause mortality, trends similar to those for CHD death were observed within the BBB groups, although at lower levels of risk. Conclusion Prevalent LBBB and IVCD, but not RBBB, are associated with increased risk of CHD death and all-cause mortality. Mortality risk is further increased as the QRS duration is prolonged above 140 ms

The metabolic syndrome and risk of sudden cardiac death: The atherosclerosis risk in communities study

Background--Prior studies have demonstrated a link between the metabolic syndrome and increased risk of cardiovascular mortality. Whether the metabolic syndrome is associated with sudden cardiac death is uncertain. Methods and Results--We characterized the relationship between sudden cardiac death and metabolic syndrome status among participants of the ARIC (Atherosclerosis Risk in Communities) Study (1987-2012) free of prevalent coronary heart disease or heart failure. Among 13 168 participants, 357 (2.7%) sudden cardiac deaths occurred during a median follow-up of 23.6 years. Participants with the metabolic syndrome (n=4444) had a higher cumulative incidence of sudden cardiac death than those without it (n=8724) (4.1% versus 2.3%, P < 0.001). After adjustment for participant demographics and clinical factors other than components of the metabolic syndrome, the metabolic syndrome was independently associated with sudden cardiac death (hazard ratio, 1.70, 95% confidence interval, 1.37-2.12, P < 0.001). This relationship was not modified by sex (interaction P=0.10) or race (interaction P=0.62) and was mediated by the metabolic syndrome criteria components. The risk of sudden cardiac death varied according to the number of metabolic syndrome components (hazard ratio 1.31 per additional component of the metabolic syndrome, 95% confidence interval, 1.19-1.44, P < 0.001). Of the 5 components, elevated blood pressure, impaired fasting glucose, and low high-density lipoprotein were independently associated with sudden cardiac death. Conclusions--We observed that the metabolic syndrome was associated with a significantly increased risk of sudden cardiac death irrespective of sex or race. The risk of sudden cardiac death was proportional to the number of metabolic syndrome components

Effect of age, sex and gender on pain sensitivity: A narrative review

© 2017 Eltumi And Tashani. Introduction: An increasing body of literature on sex and gender differences in pain sensitivity has been accumulated in recent years. There is also evidence from epidemiological research that painful conditions are more prevalent in older people. The aim of this narrative review is to critically appraise the relevant literature investigating the presence of age and sex differences in clinical and experimental pain conditions. Methods: A scoping search of the literature identifying relevant peer reviewed articles was conducted on May 2016. Information and evidence from the key articles were narratively described and data was quantitatively synthesised to identify gaps of knowledge in the research literature concerning age and sex differences in pain responses. Results: This critical appraisal of the literature suggests that the results of the experimental and clinical studies regarding age and sex differences in pain contain some contradictions as far as age differences in pain are concerned. While data from the clinical studies are more consistent and seem to point towards the fact that chronic pain prevalence increases in the elderly findings from the experimental studies on the other hand were inconsistent, with pain threshold increasing with age in some studies and decreasing with age in others. Conclusion: There is a need for further research using the latest advanced quantitative sensory testing protocols to measure the function of small nerve fibres that are involved in nociception and pain sensitivity across the human life span. Implications: Findings from these studies should feed into and inform evidence emerging from other types of studies (e.g. brain imaging technique and psychometrics) suggesting that pain in the older humans may have unique characteristics that affect how old patients respond to intervention

Prevalence of increased arterial pulse pressure among children and adolescents

Arterial pulse pressure (APP) is used as a noninvasive measurement of arterial stiffness (AS). Most AS studies were conducted in adult populations as it is often considered a phenomenon of aging. The objective of this study is to assess the longitudinal change in prevalence of AS among children and adolescents. The Minneapolis Children's Blood Pressure Study (MCBPS) is a prospective cohort study and the initial (1978) and multiple timed measurements of systolic blood pressure (SBP) and fourth phase diastolic blood pressure (DBP4) were made semiannually or annually. Visit 16 was completed in 1987. Black and white subjects who participated in all 16 visits were included in the analysis (n=487). APP, a surrogate measure of AS, is derived mathematically as the difference between SBP and DBP4. The level of 60 mmHg or higher of APP was defined as presence of AS. There were 218 females, 269 males, 114 blacks and 373 whites. The mean ages of children in visits 1 and 16 were 7.7 (SD=0.7) and 16.6 (SD=0.7) years, respectively. Similarly, the mean APP levels at these two visits were 36.3 (SD=12.0), and 43.6 (SD=11.5) mmHg, respectively. Prevalence of increased APP varied at each timed point. At the beginning of the study (1978), prevalence was 3.9%. In 1987, prevalence increased to 10.1%. Proportions of those with increased APP ranged from 3.3% to 21.4% during 8 years of follow-up. Our results indicate that AS, as defined by APP, exists even during childhood and adolescence. These results should be confirmed by using a more accurate measure of AS that can be used in population studies