Elizabeth Mostofsky

Background It remains unknown whether estimated glomerular filtration rate (eGFR) using the refit Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation without a term for race is associated with mortality and the need for kidney replacement therapy (KRT) differentially between Black and White heart transplant recipients. Methods We studied 25,900 adults included in the Scientific Registry of Transplant Recipients. We classified recipients into six categories of eGFR (< 30, 30 to < 45, 45 to < 60, 60 to < 90, 90 to < 120, ≥ 120 ml/min/1.73 m²) using the race-neutral CKD-EPI refit equation, and assessed survival with multivariable adjusted Cox proportional hazards regression. Results The association between pre-transplant race-neutral eGFR and mortality varied by race (P_interaction = 0.006). Compared to White patients with an eGFR of 90–120 ml/min/1.73 m², the mortality rates were 57% (95% CI 1.25, 1.98), 29% (95% CI 1.11, 1.51), 34% (95% CI 1.19, 1.52), and 19% (95% CI 1.06, 1.33) higher in Black patients with an eGFR less than 30, 30–45, 45–60, and 60–90 ml/min/1.73m², respectively; and 53% (95% CI 1.28, 1.82), 49% (95% CI 1.33, 1.66), and 23% (95% CI 1.11, 1.35) higher among White patients with an eGFR less than 30, 30–45, and 45–60 ml/min/1.73 m², respectively. The association between pre-transplant eGFR and the need for KRT during follow-up was similar between Black and White patients (P_interaction = 0.57). Conclusions Worsening pre-transplant eGFR using the new race-neutral CKD-EPI refit equation was associated with a higher rate of post-heart transplant mortality and KRT in Black and White recipients. The racial disparity in post-heart transplant mortality was narrower in the setting of severe kidney dysfunction. Graphical abstract

Background: Alcohol intake is associated with breast cancer (BC) risk, but estimates of greatest public health relevance have not been quantified in large studies with long duration. Materials and Methods: In this prospective cohort study of 39,811 women (median 25 years follow-up), we examined the association between alcohol consumption and BC incidence and mortality with adjusted hazard ratios (HRs), cubic splines, absolute risks, number needed to harm (NNH), and population-attributable fractions. Results: We documented 2,830 cases of BC, including 237 BC deaths. Each additional alcoholic drink/day was associated with a 10% higher rate (HR = 1.10, 95% confidence intervals [CIs]: 1.04–1.16) of total BC in a linear manner ( p = 0.0004). The higher rate was apparent for estrogen receptor (ER) ⁺ (HR = 1.12, 95% CI: 1.06–1.18) but not ER ⁻ tumors (HR = 0.95, 95% CI: 0.82–1.10), with a statistically significant difference between these associations ( p = 0.03). We constructed models comparing BC incidence among 100,000 women followed for 10 years. Compared to a scenario where all women rarely or never consumed alcohol, we expect 63.79 (95% CI: 58.35–69.24) more cases (NNH = 1,567) had all women consumed alcohol at least monthly and 278.66 (95% CI: 268.70–288.62) more cases (NNH = 358) had all women consumed >1 drink/day. Approximately 4.1% of BC cases were attributable to consumption exceeding one drink/month. Conclusion: Alcohol consumption is associated with a linear dose–response increase in BC incidence even within recommended limits of up to one alcoholic drink/day, at least for ER ⁺ tumors. Our estimates of risk differences, attributable fraction, and NNH quantify the burden that alcohol consumption imposes on women in the general population. ClinicalTrials.gov Identifier: NCT00000479.

Purpose: To determine whether alcohol intake is associated with occurrence of headaches on the following day. Methods: In this prospective cohort study, adults with episodic migraine completed electronic diaries every morning and evening for at least six weeks in March 2016-October 2017. Every day, participants reported alcohol intake, lifestyle factors, and details about each headache. We constructed within-person fixed-effect models adjusted for time-varying factors to calculate odds ratios for the association between 1,2,3,4, or 5+ servings of alcohol and headache the following day. We also calculated the adjusted risk of headache the following day for each level of intake. Results: Among 98 participants who reported 825 headaches over 4,467 days, there was a statistically significant linear association (p-trend =0.03) between alcohol and headache the following day. Compared to no alcohol, 1-2 servings were not associated with headaches, but 5+ servings were associated with a 2.08-fold (95% confidence interval [CI] 1.16-3.73) odds of headache. The adjusted absolute risk of headaches was 20% (95%CI 19%-22%) on days following no alcohol compared with 33% (95%CI 22%-44%) on days following 5+ servings. Conclusion: 1-2 servings of alcoholic beverages were not associated with higher risk of headaches the following day, but 5+ servings were associated with higher risk.

Background and Objectives: Although absolute risks provide useful information on the number of excess cases attributable to a harmful exposure or the number of fewer cases attributable to an effective treatment, most research findings are reported in terms of multiplicative effects of exposure on the outcome. We aimed to examine patient and physician preferences for communicating research findings in terms of additive and multiplicative measures of effect and measures of heterogeneity of treatment effects. Methods: We conducted a cross-sectional study of 76 patients and 26 physicians at an academic medical center in Boston, Massachusetts. Trained study staff conducted interviews about interpretations of study findings. Results: Physicians were equally likely to prefer the number needed to harm or the risk ratio as the most useful measure for making informed health decisions, and patients strongly preferred risk ratios. Participants perceived changes in risk as larger when they were presented using multiplicative measures such as risk ratios than when presented as additive measures such as the risk differences or number needed to treat or harm. Conclusions: Despite the importance of considering absolute risks and benefits of treatment options, patients and physicians who rely on study findings for making informed decisions often prefer relative measures.

Background—: Although considerable research describes the cardiovascular effects of habitual moderate and heavy alcohol consumption, the immediate risks following alcohol intake have not been well characterized. Based on its physiological effects, alcohol may have markedly different effects on immediate and long-term risk. Methods and Results—: We searched CINAHL, Embase, and PubMed from inception to March 12, 2015, supplemented with manual screening for observational studies assessing the association between alcohol intake and cardiovascular events in the following hours and days. We calculated pooled relative risks and 95% confidence intervals for the association between alcohol intake and myocardial infarction, ischemic stroke, and hemorrhagic stroke using DerSimonian and Laird random-effects models to model any alcohol intake or dose–response relationships of alcohol intake and cardiovascular events. Among 1056 citations and 37 full-text articles reviewed, 23 studies (29 457 participants) were included. Moderate alcohol consumption was associated with an immediately higher cardiovascular risk that was attenuated after 24 hours, and even protective for myocardial infarction and hemorrhagic stroke (≈2–4 drinks: relative risk=30% lower risk) and protective against ischemic stroke within 1 week (≈6 drinks: 19% lower risk). In contrast, heavy alcohol drinking was associated with higher cardiovascular risk in the following day (≈6–9 drinks: relative risk=1.3–2.3) and week (≈19–30 drinks: relative risk=2.25–6.2). Conclusions—: There appears to be a consistent finding of an immediately higher cardiovascular risk following any alcohol consumption, but, by 24 hours, only heavy alcohol intake conferred continued risk.