In a large cohort of 1034 patients with the diagnosis of definite or probable amyotrophic lateral sclerosis (ALS), the association of forced vital capacity (FVC) at baseline with (a) time to progression of 20 points i...
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In a large cohort of 1034 patients with the diagnosis of definite or probable amyotrophic lateral sclerosis (ALS), the association of forced vital capacity (FVC) at baseline with (a) time to progression of 20 points in Appel ALS (AALS) score or (b) tracheostomy free survival was investigated. The median survival of ALS patients with baseline FVC < 75%was 2.91 years, compared with 4.08 years for patients with baselineFVC >75%(p < 0.001). Patients with baseline FVC < 75%progressed more rapidly (taking 8.0 months to progress 20 AALS points) compared with patients with baseline FVC >75%(10.0 months, p < 0.001). Moreover, FVC at first examination was identified as a significant predictor of survival and disease progression in both univariate and multivariate cox regression models, after adjustment for age, sex, site of onset, diagnostic delay, riluzole therapy, and use of bilateral positive airway pressure and percutaneous endoscopic gastrostomy (p < 0.001). We conclude that a single FVC value obtained at an initial visit may serve as a clinically meaningful predictor of survival and disease progression in ALS.
OBJECTIVES: We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease(PAD). BACKGROUND: Peripheral arterial disease is associated with increased card...
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OBJECTIVES: We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease(PAD). BACKGROUND: Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factors and lifestyle modifications. However, the potential benefit of cardiac medication in patients with PAD remains ill defined. METHODS: In this prospective observational cohort study, 2,420 consecutive patients(age, 64± 11 years, 72% men) with PAD(ankle-brachial index ≤ 0.90) were screened for clinical risk factors and cardiac medication. Follow-up end point was death from any cause. Propensity scores for statins, beta-blockers, aspirin, angiotensin- converting enzyme(ACE) inhibitors, calcium channel blockers, diuretics, nitrates, coumarins, and digoxin were calculated. cox regression models were used to analyze the relation between cardiac medication and long-term mortality. RESULTS: Medical history included diabetes mellitus in 436 patients(18% ), hypercholesterolemia in 581(24% ), smoking in 837(35% ), hypertension in 1,162(48% ), coronary artery disease in 1,065(44% ), and a history of heart failure in 214(9% ). Mean ankle-brachial index was 0.58(± 0.18). During a median follow-up of eight years, 1,067 patients(44% ) died. After adjustment for risk factors and propensity scores, statins(hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.36 to 0.58), beta-blockers(HR 0.68, 95% CI 0.58 to 0.80), aspirins(HR 0.72, 95% CI 0.61 to 0.84), and ACE inhibitors(HR 0.80, 95% CI 0.69 to 0.94)were significantly associated with a reduced risk of long-term mortality. CONCLUSIONS: On the basis of this observational longitudinal study, statins, beta-blockers, aspirins, and ACE inhibitors are associated with a reduction in long-term mortality in patients with PAD.
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