Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims data

Article

作者: Hu, Xinyue ; Schulz, Paul Ernest ; Feng, Jingna ; Lundin, Karl Kristian ; Li, Lu ; Chen, Yong ; Tao, Cui ; Lundin, Sori Kim

BACKGROUNDFindings regarding the protective effect of Angiotensin II receptor blockers (ARBs) against Alzheimer's disease and related dementias (AD/ADRD) and cognitive decline have been inconclusive.METHODSIndividuals with hypertension who do not have any prior ADRD diagnosis were included in this retrospective cohort study from Optum's de-identified Clinformatics® Data Mart. We identified antihypertensive medication (AHM) drug classes and subclassified ARBs by blood-brain barrier (BBB) permeability. We compared baseline characteristics and used the Kaplan-Meier (KM) survival curve and adjusted Cox proportional hazards (PH) model for survival analyses.FINDINGSFrom 6,390,826 individuals with hypertension, there were 1,839,176 ARB users, 3,366,841 non-ARB AHM users, and 1,184,809 AHM non-users. The unadjusted KM curve showed that ARB users had lower cumulative hazard than other AHM users or AHM non-users (P < 0.0001). In Cox PH analysis, ARB users showed a 20% lower adjusted hazard of developing ADRD compared to angiotensin-converting enzyme inhibitor (ACEI) users and a 29% and 18% reduced hazard when compared to non-ARB/ACEI AHM users and AHM non-users (all P < 0.0001). Consumption of BBB-crossing ARBs was linked to a lower hazard of ADRD development than non-BBB-crossing ARBs, undetermined ARBs, and non-consumption of AHMs by 11%, 25%, and 31% (all P < 0.0001).INTERPRETATIONThis study suggests that ARBs are superior to ACEIs, non-ARB/ACEI AHMs, or non-use of AHMs in reducing the hazard of ADRD among patients with hypertension. Also, BBB-permeability in ARBs was associated with lower ADRD incidence. There is no cure for AD, ADRD, or vascular dementia; hence, these findings are significant in preventing those disorders in an inexpensive, convenient, and safe way. Limitations in claims data should be considered when interpreting our findings.FUNDINGThis research was supported by the National Institute on Aging grants (R01AG084236, R01AG083039, RF1AG072799, R56AG074604).

2024-09-01·Journal of Dairy Science

Effect of automated health monitoring based on rumination, activity, and milk yield alerts versus visual observation on herd health monitoring and performance outcomes

Article

作者: Thomas, M.J. ; Giordano, J O ; Rial, C. ; Thomas, M J ; Rial, C ; Stangaferro, M.L. ; Stangaferro, M L ; Giordano, J.O.

A primary objective of this randomized trial was to compare the percentage of cows that underwent clinical examination and were diagnosed with clinical health disorders (CHD) with a health monitoring program that relied only on automated monitoring system alerts vs a program that relied only on visual observation of clinical signs of disease to select cows for clinical examination. Another objective was to compare the effects of these health monitoring programs on milk yield, the herd exit dynamics (i.e., cows sold and dead), and first service reproductive outcomes. Lactating Holstein cows (n = 1,204) enrolled in the experiment were fitted with a neck-attached sensor of an automated monitoring system (HR Tags; Merck & Co., Inc.) that generated health alerts based on rumination time and activity. Milk yield was monitored 3 times per day by automated milk meters (MM27BC, DeLaval). Cows were blocked by parity, close-up period diet, and stratified by previous lactation milk yield, and then were randomly assigned within block to different programs for monitoring health from 3 to 21 d in milk (DIM). Cows in the visual observation group (VO; n = 597) were selected for clinical examination exclusively based on visual observation of clinical signs of disease, whereas cows in the automated health monitoring group (AHM; n = 607) were selected for clinical examination based on health alerts consisting of the following: a Health Index Score < 86 arbitrary units, daily rumination < 250 min, or a reduction of > 20% in daily milk yield. Once selected for examination, the clinical exam was the same for both treatment groups. Binary data such as the occurrence of CHD, herd exit, and pregnancies per AI were analyzed with logistic regression. Daily and weekly milk yield were analyzed using ANOVA with repeated measurements. More cows underwent a clinical examination, more cows were diagnosed with at least one CHD, and more cows received treatment in the AHM than the VO treatment group. Cows in the AHM treatment had more accumulated milk than cows in the VO treatment from 2 to 21 DIM. Cows in the AHM treatment diagnosed with at least one CHD produced more milk from 3 to 18 and 20 to 21 DIM than cows diagnosed with a CHD in the VO treatment. Fewer cows left the herd up to 21 DIM for the AHM than the VO treatment. Pregnancies per AI at first service were greater for the VO than the AHM treatment at 30 d but not at 50 d after AI and no difference in pregnancy loss was detected. In conclusion, a health monitoring strategy that used automated health alerts increased the risk of undergoing clinical examination and having CHD diagnosed compared with a program that selected cows for clinical examination based exclusively on visual observation. Cows monitored with the program that relied on automated alerts also had greater milk yield in the first 21 DIM. Thus, monitoring cow health based on automated behavior and milk yield alerts might be a more effective alternative for health monitoring than exclusive use of visual observation of clinical signs of disease.

2024-08-01·Hypertension

Antihypertensive Medication Use Trajectories After Bariatric Surgery: A Matched Cohort Study

Article

作者: Passman, Jesse E ; Liu, Yuki ; Cohen, Jordana B ; Zheng, Feibi ; Wall-Wieler, Elizabeth

BACKGROUND:Metabolic and bariatric surgery (MBS) is the most effective and durable treatment for obesity. We aimed to compare the trajectories of antihypertensive medication (AHM) use among obese individuals treated and not treated with MBS.METHODS: Adults with a body mass index of ≥35 kg/m 2 were identified in the Merative Database (US employer-based claims database). Individuals treated with versus without MBS were matched 1:1 using baseline demographic and clinical characteristics as well as AHM utilization. Monthly AHM use was examined in the 3 years after the index date using generalized estimating equations. Subanalyses investigated rates of AHM discontinuation, AHM initiation, and apparent treatment-resistant hypertension. RESULTS: The primary cohort included 43 206 adults who underwent MBS matched with 43 206 who did not. Compared with no MBS, those treated with MBS had sustained, markedly lower rates of AHM use (31% versus 15% at 12 months; 32% versus 17% at 36 months). Among patients on AHM at baseline, 42% of patients treated with MBS versus 7% treated medically discontinued AHM use ( P <0.01). The risk of apparent treatment-resistant hypertension was 3.41× higher (95% CI, 2.91–4.01; P <0.01) 2 years after the index date in patients who did not undergo MBS. Among those without hypertension treated with MBS versus no MBS, 7% versus 21% required AHM at 2 years. CONCLUSIONS:MBS is associated with lower rates of AHM use, higher rates of AHM discontinuation, and lower rates of AHM initiation among patients not taking AHM. These findings suggest that MBS is both an effective treatment and a preventative measure for hypertension.

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适应症	最高研发状态	国家/地区	公司	日期
多发性骨髓瘤	临床1期	-	The University of Tokushima	-
多发性骨髓瘤	临床1期	英国	Chugai Pharma France SAS	-
多发性骨髓瘤	临床1期	-	Chugai Pharmaceutical Co., Ltd.	-