ABSTRACT
INTRODUCTION: Comorbid diabetes, hypertension, and hyperlipidemia is associated with an adverse effect on cardiovascular (CV) outcomes. Adherence to concurrent anti-diabetics, anti-hypertensives, and lipid-lowering therapies is essential to achieve therapeutic benefits. AIM: The objective was to evaluate the association between adherence to concomitant oral antidiabetics, statins, and RAS antagonists (triple therapy) and CV outcomes, among elderly patients using marginal structural modeling (MSM). METHODS: A retrospective study was conducted among patients on concurrent triple therapy from January 2016 until December 2019. Adherence to concurrent triple therapy was measured every 6 months using proportion of days covered (PDC) to determine the different adherence groups. CV outcomes were also measured every 6 months. A MSM controlling for baseline covariates and time-varying confounders affected by prior adherence was conducted to evaluate the association between adherence and CV outcomes. A sub-analysis was conducted among patients with prior CV events to evaluate the association between adherence to triple therapy and CV outcomes using MSMs. RESULTS: The final cohort comprised of 7433 patients. The MSM model revealed no significant associations between adherence to triple/double therapies and cardiovascular outcomes. For sub-analysis, 471 patients with a prior CV event were identified. Results of the sub-analysis revealed no significant associations between adherence to triple/double therapies and CV outcomes among patients with prior CV events. CONCLUSION: Future studies should evaluate the association with longer follow-up periods.
Subject(s)
Cardiovascular Diseases , Diabetes Mellitus , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hyperlipidemias , Hypertension , Humans , Aged , Hyperlipidemias/diagnosis , Hyperlipidemias/drug therapy , Hyperlipidemias/epidemiology , Retrospective Studies , Medication Adherence , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiologyABSTRACT
SETTING: The tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are used as supportive evidence to diagnose active tuberculosis (TB). Novel IGRAs could improve diagnosis, but data are lacking in young children. DESIGN: Children (age îº5 years) with suspected TB were prospectively screened at a tertiary hospital in Pune, India; the children underwent TST, and standard (early secretory antigenic target 6 and culture filtrate protein 10) and enhanced (five additional novel antigens) enzyme-linked immunospot (ELISpot) assays. RESULTS: Of 313 children (median age 30 months) enrolled, 92% had received bacille Calmette-Guérin vaccination, 53% were malnourished and 9% were coinfected with the human immunodeficiency virus (HIV); 48 (15%) had TB, 128 (41%) did not, and TB could not be ruled out in 137 (44%). The sensitivity of enhanced (45%) and standard (42%) ELISpot assays for diagnosing TB was better than that of TST (20%) (P îº 0.03); however, enhanced ELISpot was not more sensitive than the standard ELISpot assay (P = 0.50). The specificity of enhanced ELISpot, standard ELISpot and TST was respectively 82% (95%CI 74-89), 88% (95%CI 81-94) and 98% (95%CI 93-100). Rv3879c and Rv3615c, previously reported to be promising antigens, failed to improve the diagnostic performance of the ELISpot assay. CONCLUSION: The TST and the standard and novel ELISpot assays performed poorly in diagnosing active TB among young children in India.
