Yamei Cai

Development and external validation of risk scores for cardiovascular hospitalisation and rehospitalisation in diabetes patients

Context Cardiovascular disease (CVD) is a common and costly reason for hospitalization and rehospitalization among patients with type 2 diabetes. Objective This study aimed to develop and externally validate two risk-prediction models for cardiovascular hospitalization and cardiovascular rehospitalization. Design Two independent prospective cohorts. Setting The derivation cohort includes 4704 patients with type 2 diabetes from 18 general practices in Cambridgeshire. The validation cohort comprises 1121 patients with type 2 diabetes from post-trial follow-up data. Main Outcome Measure Cardiovascular hospitalization over 2 years and cardiovascular rehospitalization after 90 days of the prior CVD hospitalization. Results The absolute rate of cardiovascular hospitalization and rehospitalization was 12.5% and 6.7% in the derivation cohort and 16.3% and 7.0% in the validation cohort. Discrimination of the models was similar in both cohorts, with C statistics above 0.70 and excellent calibration of observed and predicted risks. Conclusion Two prediction models that quantify risks of cardiovascular hospitalization and rehospitalization have been developed and externally validated. They are based on a small number of clinical measurements that are available for patients with type 2 diabetes in many developed countries in primary care settings and could serve as the tools to screen the population at high risk of cardiovascular hospitalization and rehospitalization.

Potential health impact and cost-effectiveness of drug therapy for prehypertension

BACKGROUND Studies have reported that pharmacologic interventions with candesartan or ramipril could reduce the risk of hypertension among prehypertensive subjects free of clinical cardiovascular disease (CVD), however, the cost-effectiveness and long-term cardiovascular risk of drug treatment among these population is unclear. METHOD A Markov state-transition model was developed to simulate a hypothetical cohort of Chinese adults with high-range prehypertension (130-139/85-89mmHg) but without CVD. Data on the incidence of CVD and hypertension was obtained from corresponding risk equations. Utility and disease-related costs were obtained from published literatures. Robustness and uncertainty was evaluated using deterministic and probabilistic sensitivity analyses. RESULTS Compared with placebo, drug treatment resulted in delaying the development of hypertension by nearly 12years and reducing the absolute incidence of hypertension by 32.01% over lifetime. The cumulative incidence of coronary heart disease, stroke and heart failure were reduced and survival was improved from 28.46 to 28.80years. The average incremental cost effectiveness ratio for drug treatment was

Association between lung capacity and abnormal glucose metabolism : findings from China and Australia

12,994 per quality-adjusted life-year and the value was mostly sensitive to the effect size of treatment and age starting treatment. At a willingness-to-pay threshold of >3×China gross domestic product per capita in 2014, there was a 30.48% chance that drug treatment would remain cost-effective and a low chance of being cost-effective if relative risk of treatment on hypertension was larger than 0.64. CONCLUSION Drug treatment for prehypertension may help stem the current epidemic of hypertension among Chinese adults free of CVD, which may in turn reduce CVD complications and potentially be cost effective.

Dose-Response Between Cardiovascular Risk Factors and Cardiovascular Mortality Among Incident Peritoneal Dialysis Patients.

Restricted pulmonary function is found among people with diabetes. This study aimed to investigate the dose–response relationship between pulmonary function measurements [forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)] and risk of metabolic syndrome (MS)/type 2 diabetes.

Impact of peer support on inpatient and outpatient payments among people with Type 2 diabetes: a prospective cohort study

Background/Aims: Traditional cardiovascular (CV) risk factors (RFs) and their management targets may not be applicable to specific medical subpopulations, particularly dialysis patients. This study aimed to evaluate the dose-response association between measurements of RFs, cardiovascular mortality, and potential metabolic targets among Chinese patients initializing peritoneal dialysis (PD). Methods: Risk-set sampling was applied to two population based 1: 10 case-control studies of incident PD patients, matched by age, sex and the year of initialisation of PD: a main sample (204 cases and 2,040 controls) and a replication sample (81 cases and 810 controls). The dose-response association between continuous measurements of CV RFs (blood pressure, fasting glucose, body mass index, total cholesterol, phosphate and ejection fraction) at baseline and the 2-year CV mortality were analyzed using conditional Logistic regression. The final threshold was chosen based upon a significant break in the regression coefficients and achievement of the minimum Bayesian information criterion (BIC). Results: A linear relationship was identified between fasting glucose and CV mortality. Non-linear associations between other measurements and CV mortality suggested potential metabolic treatment intensification thresholds as < 145/92mmHg for blood pressure, < 1.70mmol/L for phosphate, 24 kg/m2 for body mass index, 4.6mmol/L for total cholesterol, and > 60% for ejection fraction respectively. Conclusion: Our findings highlight the potential importance of more intensive glucose management, anti-hypertensive treatment and dietary management among PD patients. We recommend that the clinical relevance of these epidemiological associations be tested using randomized controlled trials of multifaceted interventions.

Development and validation of risk prediction models for cardiovascular mortality in Chinese people initialising peritoneal dialysis: a cohort study

To investigate the impact of a low‐cost diabetes peer‐support intervention, aimed at reducing inpatient and outpatient care utilization and healthcare payments, by conducting a cohort study that followed up a randomized controlled trial.

Author Correction: Development and validation of risk prediction models for cardiovascular mortality in Chinese people initialising peritoneal dialysis: a cohort study

Cardiovascular disease is the leading cause of death among patients receiving peritoneal dialysis. We aimed to develop and validate a risk prediction model for cardiovascular death within 2 years after the initiation of peritoneal dialysis (PD). A cohort including all patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2014. Multivariate logistic regression analysis was used to develop the risk prediction model. The HPDR data was randomly divided into two cohorts with 60% (1,835 patients) for model derivation, and 40% (1,219 patients) for model validation. The absolute rate of cardiovascular mortality was 14.2% and 14.4 in the derivation and validation cohort, respectively. Age, body mass index, blood pressure, serum lipids, fasting glucose, sodium, albumin, total protein, and phosphorus were the strongest predictors of cardiovascular mortality in the final model. Discrimination of the model was similar in both cohorts, with a C statistic above 0.70, with good calibration of observed and predicted risks. The new prediction model that has been developed and validated with clinical measurements that are available at the point of initiation of PD and could serve as a tool to screen for patients at high risk of cardiovascular death and tailor more intensive cardio-protective care.

Hypertriglyceridemic-waist is more predictive of abnormal liver and renal function in an Australian population than a Chinese population

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Dialysate Creatinine Response Patterns During Peritoneal Equilibration Test and the Association Between Cardiovascular Mortality: Findings from a Prospective Cohort Study

OBJECTIVE We aimed to compare the association of hypertriglyceridemic-waist (HTGW), with glycaemia, liver and renal function between a Chinese and an Australian population using 3 HTGW definitions. METHODS 1454 Australian and 5824 Chinese adults, from randomly selected households provided clinical history, glucose, lipids, anthropometric, and blood pressure measurements. Liver and renal functions were assessed using alanine aminotransferase and estimated Glomerular Filtration Rate respectively. The impact of interaction between HTGW and glucose on the liver and renal functions were measured by General Linear Model. Logistic regression was used to estimate the association between this interaction and abnormal liver and renal function. RESULTS HTGW was associated with abnormal liver and renal function in both Chinese and Australian populations using all 3 HTGW definitions. The highest sensitivity (93 (95% confidence interval: 87, 97) %) and specificity (81 (80, 84) %) were observed for abnormal renal function in the Australian population. The probability of having abnormal liver or renal function increased with glucose in the presence of HTGW phenotype only in the Australian population. Similar findings were revealed in people without type 2 diabetes. CONCLUSIONS In both Chinese and Australian populations, HTGW is associated with abnormal liver and renal function using any of the 3 definitions. HTGW is a potential tool to identify high-risk individuals with impaired renal function especially in the Australian population. HTGW interacted with the fasting glucose in its association with impaired liver and renal function only in the Australian population, suggesting different underlying interactions between environmental and genetic backgrounds.

Derivation and Validation of Risk Scores to Predict Cerebrovascular Mortality Among Incident Peritoneal Dialysis Patients

Background/Aims: During peritoneal equilibrium test (PET), intermediate measures of Dt/P (dialysate/plasma creatinine ratio), D0/P, D2/P and D4/P ratios might provide additional information regarding a patient’s cardiovascular mortality. We aimed to characterise heterogeneity of dialysate creatinine response patterns based on three ratios and compare cardiovascular mortality risks by response patterns. Methods: 3,477 patients initialising peritoneal dialysis (PD) between 2007-2015 were measured D0/P, D2/P and D4/P at baseline and 2-year cardiovascular mortality was defined as the primary outcome. Latent class mixed-effect models were fitted to identify distinct patterns of dialysate creatinine response. Multivariable Logistic regression model with adjustment of cardiometabolic factors were used to compare cardiovascular mortality by latent classes. Results: The 1st latent class including 36% of participants was characterised by consistently increasing and high Dt/P ratios both at 2-hour and 4-hour. The 2nd class including 61% of participants characterised by sharply increased ratio at 2-hour and slightly increased ratio at 4-hour. The 3rd class included 3% of participants with decreased ratio at 2-hour and increased ratio at 4-hour. Comparing the 1st class, the lower cardiovascular mortality risk was identified in the 2nd and 3rd class with adjusted odds ratio 0.65 (95% confidence interval: 0.62-0.69) and 0.48 (0.41-0.57), respectively. Conclusion: Patients with decreased Dt/P ratio between 0-hour and 2-hour and low ratios at 2-hour and 4-hour tend to have low cardiovascular mortality. Latent class analysis seems to be a promising method to reveal unidentified subgroups that do not fit into the risk category defined by Dt/P ratio at 4-hour.