@article{DenglerMaldanerGlaeskeretal.2016, author = {Dengler, Julius and Maldaner, Nicolai and Gl{\"a}sker, Sven and Endres, Matthias and Wagner, Martin and Malzahn, Uwe and Heuschmann, Peter U. and Vajkoczy, Peter}, title = {Outcome of Surgical or Endovascular Treatment of Giant Intracranial Aneurysms, with Emphasis on Age, Aneurysm Location, and Unruptured Aneuryms - A Systematic Review and Meta-Analysis}, series = {Cerebrovascular Diseases}, volume = {41}, journal = {Cerebrovascular Diseases}, number = {3-4}, organization = {Giant Intracranial Aneurysm Study Group}, issn = {1015-9770}, doi = {10.1159/000443485}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-196792}, pages = {187-198}, year = {2016}, abstract = {Background: Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA. Methods: Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model. Results: We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95\% CI 10.8-42.0). PGO was 80.9\% (77.4-84.4) in the analysis of all GIA compared to 81.2\% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8\%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3\% (95\% CI 76.0-84.6) compared to 84.2\% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7\% (95\% CI 71.5-87.8) after surgical treatment and 84.9\% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95\% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO. Conclusions: We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.}, language = {en} } @article{RueckerKeilFitzgeraldetal.2016, author = {R{\"u}cker, Viktoria and Keil, Ulrich and Fitzgerald, Anthony P and Malzahn, Uwe and Prugger, Christof and Ertl, Georg and Heuschmann, Peter U and Neuhauser, Hannelore}, title = {Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts}, series = {PLoS ONE}, volume = {11}, journal = {PLoS ONE}, number = {9}, doi = {10.1371/journal.pone.0162188}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-166804}, pages = {e0162188}, year = {2016}, abstract = {Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008-11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40-65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29\% and the estimated proportion of high risk people (10-year risk > = 5\%) by 50\% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk.}, language = {en} }