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Noncardiovascular deaths are more common than cardiovascular deaths in patients with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: Insights from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial

The American heart journal, 2017-04, Vol.186, p.73-82 [Peer Reviewed Journal]

2016 Elsevier Inc. ;Copyright © 2016 Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Apr 1, 2017 ;ISSN: 0002-8703 ;EISSN: 1097-6744 ;DOI: 10.1016/j.ahj.2016.12.011 ;PMID: 28454835

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Title:
Noncardiovascular deaths are more common than cardiovascular deaths in patients with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: Insights from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial
Author: Sharma, Abhinav ; de Souza Brito, Flávio ; Sun, Jie-Lena ; Thomas, Laine ; Haffner, Steven ; Holman, Rury R. ; Lopes, Renato D.
Subjects: Aged ; Blood cells ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - mortality ; Cause of Death ; Clinical trials ; Death ; Diabetes ; Drug overdose ; Family medical history ; Fasting ; Fatalities ; Female ; Follow-Up Studies ; Glucose ; Glucose Intolerance - complications ; Glucose tolerance ; Health risk assessment ; Health risks ; Humans ; Infections ; Laboratories ; Male ; Malignancy ; Melanoma ; Middle Aged ; Mortality ; Myocardial infarction ; Patients ; Population ; Potassium ; Risk analysis ; Risk Factors ; Skin cancer ; Statistical analysis
Is Part Of: The American heart journal, 2017-04, Vol.186, p.73-82
Description: Patients with impaired glucose tolerance have an elevated risk of cardiovascular (CV) death; however, the causes and risk factors associated with non-CV deaths are poorly understood. The NAVIGATOR trial enrolled 9,306 participants with impaired glucose tolerance and CV disease or at high CV risk, with a median follow-up of 6.4years. Using this population, we identified (1) the proportion of deaths attributed to CV, non-CV, and unknown causes, and (2) the risk factors associated with non-CV death. During the NAVIGATOR trial follow-up, 622 patients died. Investigators reported 244 (39.2%) CV deaths, 313 (50.3%) non-CV deaths, and 65 (10.5%) deaths of unknown cause. Myocardial infarction was the leading cause of investigator-reported death (57/622 [9.2%]). Among non-CV deaths, the most commonly identified cause related to malignancy (177/313 [56.5%]). Using adjudicated causes of death, Cox proportional hazard models identified 3 independent prognostic markers that increased the risk of non-CV death: history of non–melanoma skin cancer (hazard ratio 2.67 [95% CI 1.65-4.33]; P<.0001), white blood cell count (1 unit >5000/mm3; 1.10 [1.02-1.18]; P=.011), and serum potassium levels (per 1mmol/L above any value; 1.67 [1.302.15]; P<.0001). Despite the high baseline CV risk among patients in the NAVIGATOR trial, the most common cause of death was non-CV. The high burden of non-CV death in this population has potential implications for future CV event–driven trials.
Publisher: United States: Elsevier Inc
Language: English
Identifier: ISSN: 0002-8703
EISSN: 1097-6744
DOI: 10.1016/j.ahj.2016.12.011
PMID: 28454835
Source: MEDLINE
ProQuest Central

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Noncardiovascular deaths are more common than cardiovascular deaths in patients with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: Insights from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial

2016 Elsevier Inc. ;Copyright © 2016 Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Apr 1, 2017 ;ISSN: 0002-8703 ;EISSN: 1097-6744 ;DOI: 10.1016/j.ahj.2016.12.011 ;PMID: 28454835

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