In this large observational cohort with extended follow-up, normalization of TT levels after TRT was associated with a significant reduction in all-cause mortality, MI, and stroke.

Objective To examine the relationship between maternal stress exposure, stress coping styles, and pregnancy complications. Design Quantitative, cross-sectional, and prospective study. Setting Tulane-Lakeside Hospital, New Orleans, LA and Women's Hospital, Baton Rouge, LA. Participants The study included 146 women (122 from New Orleans and 24 from Baton Rouge), who were pregnant during or immediately after Hurricane Katrina. Methods Participants were interviewed regarding their hurricane experiences and perceived stress, and coping styles were assessed using the Brief COPE. Medical charts were also reviewed to obtain information about pregnancy outcomes. Logistic regression was performed to determine possible associations. Results Hurricane exposure was significantly associated with induction of labor (adjusted odds ratio (aOR) =1.39; 95% confidence interval (CI) =1.03, 1.86; P=0.03) and current perceived stress (aOR=1.50; CI=1.34, 1.99; P<0.01). Stress perception significantly predisposed to pregnancy-induced hypertension (aOR=1.16; CI=1.05, 1.30; P<0.01) and gestational diabetes (aOR=1.13; CI=1.02, 1.25; P=0.03). Use of planning, acceptance, humor, instrumental support, and venting coping styles were associated with a significantly reduced occurrence of pregnancy complications (P<0.05). Higher rates for gestational diabetes was found among women using the denial coping style (aOR=2.25; CI=1.14, 4.45; P=0.02). Conclusion Exposure to disaster-related stress may complicate pregnancy, while some coping styles may mitigate its effects. Further research should explore how coping styles may mitigate or exacerbate the effect of major stressors and how positive coping styles can be encouraged or augmented.

Objective Aim of the study was to examine the effects of the vitamin D (Vit-D) treatment and non-treatment on Vit-D-deficient patients without a prior history of myocardial infarction (MI). Materials and Methods This is an retrospective, observational, nested case-control study of patients (N=20,025) with low 25-hydroxyvitamin D [(25-OH)D] levels (&lt;20 ng/ml) who received care at the Veterans Health Administration from 1999-2018. Patients were divided into three groups: Group A (untreated, levels ≤20 ng/ml), Group B (treated, levels 21-29 ng/ml), and Group C (treated, levels ≥30 ng/ml). The risk of MI and all-cause-mortality were compared utilizing propensity score-weighted cox-proportional hazard models. Results Among the cohort of 20,025 patients, the risk of MI was significantly lower in Group C, compared to Group B [hazard ratio (HR) 0.65, 95% CI; 0.49-0.85, P=.002] and Group A (HR 0.73, 95% CI; 0.55-0.96), P=.02). There was no difference in the risk of MI between Group B and Group A (HR 1.14, 95% CI; 0.91-1.42, P=.24]. Compared to Group A, both Group B (HR 0.59, 95% CI; 0.54-0.63, P&lt;.001] and Group C (HR 0.61, 95% CI; 0.56-0.67, P&lt;.001] had significantly lower all-cause-mortality. There was no difference in all-cause-mortality between Group B and Group C (HR 0.99, 95% CI; 0.89-1.09, P=.78). Conclusions In patients with Vit-D-deficiency and no prior history of MI, treatment to the (25-OH)D level of &gt;20 ng/ml and &gt;30 ng/ml was associated with a significantly lower risk of all-cause-mortality. The lower risk of MI was observed only in individuals maintaining the (25-OH)D levels ≥30 ng/ml.

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BackgroundAtrial fibrillation (AF) is the most common cardiac dysrhythmia associated with significant morbidity and mortality. Several small studies have reported that low serum total testosterone (TT) levels were associated with a higher incidence of AF. In contrast, it is also reported that anabolic steroid use is associated with an increase in the risk of AF. To date, no study has explored the effect of testosterone normalization on new incidence of AF after testosterone replacement therapy (TRT) in patients with low testosterone.Methods and ResultsUsing data from the Veterans Administrations Corporate Data Warehouse, we identified a national cohort of 76 639 veterans with low TT levels and divided them into 3 groups. Group 1 had TRT resulting in normalization of TT levels (normalized TRT), group 2 had TRT without normalization of TT levels (nonnormalized TRT), and group 3 did not receive TRT (no TRT). Propensity score–weighted stabilized inverse probability of treatment weighting Cox proportional hazard methods were used for analysis of the data from these groups to determine the association between post‐TRT levels of TT and the incidence of AF. Group 1 (40 856 patients, median age 66 years) had significantly lower risk of AF than group 2 (23 939 patients, median age 65 years; hazard ratio 0.90, 95% CI 0.81–0.99, P=0.0255) and group 3 (11 853 patients, median age 67 years; hazard ratio 0.79, 95% CI 0.70–0.89, P=0.0001). There was no statistical difference between groups 2 and 3 (hazard ratio 0.89, 95% CI 0.78– 1.0009, P=0.0675) in incidence of AF.ConclusionsThese novel results suggest that normalization of TT levels after TRT is associated with a significant decrease in the incidence of AF.