Alcohol Consumption is Associated With An Increased Risk of Microscopic Colitis: Results From 2 Prospective US Cohort Studies

2021 ◽  
Author(s):  
Blake Niccum ◽  
Kevin Casey ◽  
Kristin Burke ◽  
Emily W Lopes ◽  
Paul Lochhead ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Intake ◽  
Cox Proportional Hazards ◽  
Dietary Factors ◽  
Microscopic Colitis ◽  
Health Study ◽  
Higher Alcohol ◽  
Increased Risk ◽  
Incident Cases ◽  
The Impact

Abstract Background No dietary factors have yet been shown to conclusively impact the incidence of microscopic colitis (MC). Here, we sought to examine the relationship between alcohol intake and the risk of MC. Methods We conducted a prospective cohort study of 209,902 participants (age range, 28.5–66.7 years) enrolled in the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII). Validated data on alcohol consumption were collected at baseline in 1986 in the NHS and 1991 in the NHSII and updated every 4 years. Diagnoses of MC were confirmed via review of histopathology data. We used Cox proportional hazards modeling to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results Through 2016 in the NHS and 2017 in the NHSII, we confirmed 352 incident cases of MC over 4,994,324 person-years. Higher alcohol consumption was associated with an increased risk of MC (Ptrend < .001). Compared to non-users, the aHRs of MC were 1.20 (95% CI, 0.86–1.67) for consumers of 0.1–4.9 g/day of alcohol, 1.90 (95% CI, 1.34–2.71) for consumers of 5–14.9 g/day, and 2.31 (95% CI, 1.54–3.46) for consumers of ≥15 g/day. The associations were consistent across the histologic subtypes of collagenous and lymphocytic colitis (Pheterogeneity = .523). When stratified by alcohol type, the risk according to every 2 servings/week appeared to be strongest with consumption of wine (aHR, 1.08; 95% CI, 1.04–1.12) as compared to beer (aHR, 1.01; 95% CI, 0.91–1.12) or liquor (aHR, 1.00; 95% CI, 0.92–1.09). Conclusions Alcohol consumption was associated with an increased risk of MC. Further studies are needed to determine the mechanism underlying these associations, as well as the impact of reducing alcohol intake in patients with MC.

Abstract P196: Bidirectional Association Between Hypertension and Gout: The Singapore Chinese Health Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
An Pan ◽  
Gim Gee Teng ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh
Keyword(s):  
Smoking Status ◽  
Final Analysis ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Increased Risk ◽  
Bidirectional Association ◽  
Singapore Chinese ◽  
Incident Cases

Introduction: Although it has been hypothesized that the hypertension-gout relation is bidirectional, few studies have addressed this hypothesis in a prospective setting, particularly in the Asian populations. Methods: We analyzed data from the Singapore Chinese Health Study (SCHS), a cohort of 63,257 Chinese aged 45-74 years at recruitment from 1993-98. The information about self reports of physician-diagnosed hypertension and gout was enquired at follow-ups I (1999-2004) and II (2006-2010). We included participants with complete data for both follow-ups and who were free of heart disease, stroke and cancer at follow-up I. For the analysis of hypertension and risk of incident gout, participants with prevalent gout were further excluded and the final analysis included 31,694 participants. For the analysis of gout and risk of incident hypertension, participants with prevalent hypertension were further excluded and the final analysis included 20,490 participants. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) with adjustment for age, sex, years of interview, dialect group, education, smoking status, alcohol intake, physical activity, body mass index (BMI) and history of diabetes. Results: The mean age of the participants at baseline was 60.1 (SD 7.3) years, and the average follow-up year was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 836 incident cases were identified. Compared to normotensive participants, hypertensive patients had a 93% increased risk of developing gout (RR 1.93; 95% CI 1.66-2.24). The association was slightly stronger in women (RR 2.09; 95% CI 1.69-2.58) compared to men (RR 1.72; 95% CI 1.39-2.14; P for interaction=0.056). The association was also stronger in normal weight adults (BMI <24 kg/m2; RR 2.25; 95% CI 1.82-2.77) compared to overweight/obese individuals (BMI ≥24 kg/m2; RR 1.66; 95% CI 1.34-2.04; P for interaction=0.03). In the parallel analysis of gout and risk of hypertension, 5491 participants reported to have newly diagnosed hypertension during the follow-up. Compared to participants without gout, those with gout had a 17% increased risk of developing hypertension (RR 1.17; 95% CI 1.01-1.35). The association was evident in men (RR 1.29; 95% CI 1.07-1.55) but not in women (RR 0.94; 95% CI 0.73-1.20; P for interaction=0.03). The association was present in normal weight adults (RR 1.34; 95% CI 1.09-1.64) but not among overweight/obese individuals (RR 0.99; 95% CI 0.80-1.23; P for interaction=0.03). Conclusions: Our results provide compelling evidence that the hypertension-gout association is bidirectional in Chinese population. The potential interactions of the bidirectional association with sex and obesity deserve further investigations.

scholarly journals Understanding Educational and Psychosocial Factors Associated with Alcohol Use among Adolescents in Denmark; Implications for Health Literacy Interventions

2018 ◽  
Vol 15 (8) ◽  
pp. 1671 ◽  
Author(s):  
Claudia König ◽  
Mette V. Skriver ◽  
Kim M. Iburg ◽  
Gillian Rowlands
Keyword(s):  
Health Literacy ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Social Factors ◽  
Alcohol Intake ◽  
Alcohol Misuse ◽  
Educational Performance ◽  
Higher Alcohol ◽  
Factors Associated ◽  
The Impact

Background. Alcohol misuse is a global public health priority, with a variation in prevalence and impact between countries. Alcohol misuse in adolescence is associated with adverse psychological, social and physical health. Adolescents in Denmark have higher alcohol consumption and problematic alcohol use than adolescents in other European countries. Associations between social determinants of health (SDH), psycho-social factors and alcohol consumption are complex and influenced by national context and cultures. This study explored these associations in Danish adolescents. Method. The European School Survey Project on Alcohol and Other Drugs (ESPAD) survey collects data on alcohol and substance use among 15–16-year-old European students. Data contributed by Danish students to the 2011 survey were analyzed. The outcomes of interest were alcohol consumption (any, intoxication and problematic). Health literacy was not directly measured, so self-described educational performance and knowledge about alcohol were used as proxies for health literacy. Exploratory factors thus included socio-demographic, health literacy-related (knowledge about alcohol, educational performance) and psycho-social factors, as well as expectancies of the effect of alcohol (both positive and negative) and self-reported health. Univariate and multivariate logistic regression analyses were undertaken. Results. Of the 2768 adolescents who participated in the survey, 2026 (80%) consumed alcohol during the last 30 days, 978 (38%) were intoxicated at least once during the last 30 days, and 1050 (41%) experienced at least one problem because of alcohol use during the last 12 months. Multivariable analysis showed that the factors associated with higher alcohol intake were gender, poor relationships with parents, expectancies of the impact of alcohol (both positive and negative), and the influence of peers and their alcohol use. Higher school performance was related to lower alcohol consumption. Low socio-demographic status was not associated with higher alcohol consumption. Conclusions. This study confirmed the high levels of alcohol intake, intoxication, and problem drinking amongst the Danish students in the survey and the complexity of the socio-demographic, psychosocial, health literacy-related, and environmental factors associated with alcohol behaviours. Approaches to addressing the issue of alcohol use in Danish adolescents will need to be multi-factorial, including supporting students to develop alcohol-related health literacy skills to enable them to make informed choices.

Abstract 018: Egg Consumption and Risk of Cardiovascular Disease: Findings from Three Large Prospective US Cohort Studies of Men and Women

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Amanda L Sands ◽  
Deirdre K Tobias ◽  
Meir J Stampfer ◽  
Walter C Willett ◽  
Frank B Hu
Keyword(s):  
Cardiovascular Disease ◽  
Dietary Cholesterol ◽  
Dietary Factors ◽  
Self Report ◽  
Health Study ◽  
Processed Meat ◽  
Cvd Risk ◽  
Men And Women ◽  
Increased Risk ◽  
Incident Cases

Background: Limiting dietary cholesterol intake is widely recommended for prevention of cardiovascular disease (CVD). Eggs are a major source of dietary cholesterol, but they also contain a variety of other nutrients. Several recent studies have examined egg intake and CVD with conflicting findings. Objective: To prospectively evaluate the association between egg intake and CVD risk in three large cohorts. Methods: Women and men from the Nurses’ Health Study (1980-2010; N=84,537), Nurses’ Health Study II (1991-2010; N=92,588), and Health Professionals Follow-up Study (1986-2010; N=42,815) were included if they were free of CVD and cancer at baseline. Egg intake was assessed every 4 years via validated food frequency questionnaire and evaluated in the following categories for frequency of consuming 1 egg: <1/month (reference), 1-3/month, 1/week, 2-4/week, 5-6/week, 1+/day. Incident coronary heart disease (CHD) (nonfatal myocardial infarction (MI) and fatal coronary disease) and stroke cases were ascertained via self-report and confirmed with review of medical records. Relative risks (HR) and 95% confidence intervals (CI) for CVD risk across categories of egg intake were estimated using multivariate Cox proportional hazards models, adjusted for age, race, smoking, physical activity, BMI, family history of CVD, alcohol, red and processed meat, whole milk, and other dietary covariates. Individual cohort estimates were combined using fixed effects meta-analysis. Results: We identified 5,838 incident cases of CHD (nonfatal MI and fatal CHD) and 6,030 stroke cases. Consumption of up to 1+eggs/day was not significantly associated with risk of incident total CVD (CHD and stroke) after adjustment for several diet and lifestyle factors (HR (CI) by category: <1/month: 1(reference); 1-3/month: 0.95(0.88, 1.02); 1/week: 0.85(0.79, 0.91); 2-4/week: 0.88(0.81, 0.96); 5-6/week: 0.96(0.84, 1.09); 1+/day: 0.99 (0.87, 1.13) (p-trend=0.77). When incident stroke and CHD were evaluated individually, egg intake was not associated with either endpoint (p-trend=0.09 for CHD and 0.52 for stroke). Conclusions: After controlling for lifestyle and dietary factors, egg intake (up to 1+/day) was not associated with increased risk of CVD in three prospective cohorts of men and women.

scholarly journals Red Meat Consumption and Risk of Frailty in Older Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 52-52
Author(s):  
Ellen Struijk ◽  
Teresa Fung ◽  
Frank Hu ◽  
Walter Willett ◽  
Fernando Rodriguez-Artalejo ◽  
...  
Keyword(s):  
Red Meat ◽  
Dietary Factors ◽  
Health Study ◽  
The European Union ◽  
Protein Sources ◽  
Funding Sources ◽  
Increased Risk ◽  
Prospective Association ◽  
Incident Cases ◽  
Processed Red Meat

Abstract Objectives The aim of this study was to examine the prospective association between the consumption of total, unprocessed, and processed red meat and the risk of frailty in older adults. Methods We analyzed data from 85,870 women aged ≥60 participating in the Nurses’ Health Study. Consumption of red meat was obtained from repeated food frequency questionnaires administered between 1980 and 2010. Frailty was defined as having at least three of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 chronic illnesses, and weight loss ≥5%. The occurrence of frailty was assessed every four years from 1992 to 2014. Results During follow-up we identified 13,279 incident cases of frailty. Women with a higher intake of red meat showed an increased risk of frailty after adjustment for lifestyle factors, medication use, and dietary factors. The relative risk (95% confidence interval) for one serving/day increment in consumption was 1.13 (1.08, 1.18) for total red meat, 1.08 (1.02, 1.15) for unprocessed red meat, and 1.26 (1.15, 1.39) for processed red meat. Replacing one serving/day of unprocessed red meat with other protein sources was associated with significantly lower risk of frailty; the risk reduction estimates were 21% for fish and 14% for nuts, while for replacement of processed red meat the percentages were 32% for fish, 26% for nuts, 13% for legumes, and 16% for dairy. Conclusions Habitual consumption of red meat was associated with a higher risk of frailty. Replacement of red meat by other protein sources might reduce the risk of frailty. Funding Sources This work was supported by grants from the Instituto de Salud Carlos III, State Secretary of R+D+I of Spain and FEDER/FSE (FIS 16/609, 16/1512, 19/319); the European Union (JPI A Healthy Diet for a Healthy Life, SALAMANDER project); and the Nurses´ health study is supported by grant UM1 CA186107 from National Institutes of Health.

Adolescent intakes of alcohol and folate and risk of proliferative benign breast disease.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 169-169 ◽  
Author(s):  
Y. Liu ◽  
R. M. Tamimi ◽  
C. S. Berkey ◽  
W. C. Willett ◽  
L. C. Collins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Alcohol Consumption ◽  
Alcohol Intake ◽  
Benign Breast Disease ◽  
Breast Disease ◽  
Folate Intake ◽  
Health Study ◽  
Adolescent Alcohol ◽  
Increased Risk ◽  
Proliferative Bbd

169 Background: Given the importance of exposure between menarche and first childbirth in breast cancer risk, adolescent alcohol consumption may influence the risk of proliferative benign breast disease (BBD). Folate may modify the adverse effect of alcohol on breast cancer. Methods: We used data from 29,329 women in the Nurses’ Health Study II who completed both adolescent alcohol consumption questions in 1989 and an adolescent diet questionnaire in 1998. A total of 666 women with proliferative BBD between 1991 and 2001 were confirmed by centralized pathology review. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for established risk factors of breast cancer. Results: Adolescent alcohol consumption was dose-dependently associated with an increased risk of proliferative BBD (HR = 1.12 per 10g/day consumption; 95% CI, 1.03-1.22). There was no significant association with adolescent folate intake. While the interaction between adolescent alcohol and folate intake was not statistically significant, among women with low folate intake (<279 mg/day) the BBD risk was significantly increased with moderate alcohol intake (HR = 1.62; 95% CI, 1.14-2.28) and with high alcohol intake (HR = 1.90; 95% CI, 0.98-3.70; Ptrend <0.01). Adolescent alcohol consumption was not associated with increased risk among women with higher adolescent folate intake. Conclusions: Adolescent alcohol consumption is associated with higher risk of proliferative BBD, especially in women with low adolescent folate intake.

scholarly journals Alcohol and the risk of pneumonia: a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e022344 ◽  
Author(s):  
Evangelia Simou ◽  
John Britton ◽  
Jo Leonardi-Bee
Keyword(s):  
Systematic Review ◽  
Alcohol Consumption ◽  
Dose Response ◽  
Alcohol Intake ◽  
Meta Analysis ◽  
Community Acquired Pneumonia ◽  
Response Analysis ◽  
Higher Alcohol ◽  
Increased Risk ◽  
Study Heterogeneity

ObjectiveA systematic review and meta-analysis to estimate the magnitude of the association between alcohol consumption and the risk of community-acquired pneumonia (CAP) in adults was undertaken.DesignSystematic review and meta-analysis.MethodsComprehensive searches of Medline, Embase and Web of Science were carried out to identify comparative studies of the association between alcohol intake and CAP between 1985 and 2017. Reference lists were also screened. A random-effects meta-analysis was used to estimate pooled effect sizes. A dose–response meta-analysis was also performed.ResultsWe found 17 papers eligible for inclusion in the review, of which 14 provided results which could be pooled. Meta-analysis of these 14 studies identified an 83% increased risk of CAP among people who consumed alcohol or in higher amounts, relative to those who consumed no or lower amounts of alcohol, respectively (relative risk=1.83, 95% CI 1.30 to 2.57). There was substantial between-study heterogeneity, which was attributable in part to differences in study continent, adjustment for confounders and pneumonia diagnosis (clinical vs death). Dose–response analysis found that for every 10–20 g higher alcohol intake per day, there was an 8% increase in the risk of CAP.ConclusionsThe findings suggest that alcohol consumption increases the risk of CAP. Therefore, strengthening policies to reduce alcohol intake would be likely to reduce the incidence of CAP.

Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

VASA ◽  
2015 ◽  
Vol 44 (4) ◽  
pp. 313-323 ◽  
Author(s):  
Lea Weingarz ◽  
Marc Schindewolf ◽  
Jan Schwonberg ◽  
Carola Hecking ◽  
Zsuzsanna Wolf ◽  
...  
Keyword(s):  
Factor V Leiden ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Younger Patients ◽  
Risk Of Recurrence ◽  
G20210a Mutation ◽  
Increased Risk ◽  
The Impact

Abstract. Background: Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient’s age at the time of the first VTE. Patients and methods: Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy. Results: Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years. Conclusions: Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

scholarly journals Association of oral contraceptives and tubal ligation with risk of early natural menopause

2021 ◽  
Author(s):  
C R Langton ◽  
B W Whitcomb ◽  
A C Purdue-Smithe ◽  
L L Sievert ◽  
S E Hankinson ◽  
...  
Keyword(s):  
Oral Contraceptives ◽  
Proportional Hazards ◽  
Reproductive Factors ◽  
Cox Proportional Hazards ◽  
Tubal Ligation ◽  
Health Study ◽  
Early Menopause ◽  
Natural Menopause ◽  
Increased Risk

Abstract STUDY QUESTION What is the association of oral contraceptives (OCs) and tubal ligation (TL) with early natural menopause? SUMMARY ANSWER We did not observe an association of OC use with risk of early natural menopause; however, TL was associated with a modestly higher risk. WHAT IS KNOWN ALREADY OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of early menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. STUDY DESIGN, SIZE, DURATION We examined the association of OC use and TL with natural menopause before the age of 45 years in a population-based study within the prospective Nurses’ Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until early menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. MAIN RESULTS AND THE ROLE OF CHANCE Over 1.6 million person-years, 2579 members of the analytic cohort experienced early natural menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of early menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for early menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of early menopause (HR = 1.17, 95% CI, 1.06-1.28). LIMITATIONS, REASONS FOR CAUTION Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the largest study examining the association of OC use and TL with early natural menopause to date. While TL was associated with a modest higher risk of early menopause, our findings do not support any material hazard or benefit for the use of OCs. STUDY FUNDING/COMPETING INTEREST(S) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. TRIAL REGISTRATION NUMBER N/A

A narrative review of chronic alcohol-induced atrial fibrillation

2021 ◽  
Author(s):  
Rea Mittal ◽  
Lilly Su ◽  
Devyani Ramgobin ◽  
Ashwani Garg ◽  
Rahul Jain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Alcohol Use ◽  
Alcohol Intake ◽  
Cardiovascular Complications ◽  
Chronic Alcohol ◽  
Higher Alcohol ◽  
Dependent Relationship ◽  
Increased Risk ◽  
Low Levels ◽  
Dose Dependent

Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.

Abstract 3073: Metabolic Syndrome, Inflammation and Risk of Symptomatic Peripheral Artery Disease in Women: A Prospective Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
David Conen ◽  
Kathryn M Rexrode ◽  
Paul M Ridker ◽  
Aruna D Pradhan
Keyword(s):  
Metabolic Syndrome ◽  
Peripheral Artery Disease ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Intercellular Adhesion Molecule ◽  
Peripheral Artery ◽  
Risk Increase ◽  
Increased Risk ◽  
Multivariable Models ◽  
Artery Disease

Background Metabolic syndrome (MetS) includes a number of cardiovascular risk factors known to predict vascular disease. Little is known, however, about the interrelationships between MetS, inflammation and the risk of incident peripheral artery disease (PAD). Methods We conducted a prospective cohort study among 27111 women participating in the Women’s Health Study. Subjects were free of cardiovascular disease at baseline and followed for the incidence of symptomatic PAD (n=114) over a follow-up period of 13.3 years. We used Cox proportional-hazards models to compare the risk of PAD among women with and without the MetS. We also evaluated relationships between MetS and markers of subclinical inflammation including high sensitivity C-reactive protein (hsCRP) and soluble intercellular adhesion molecule-1 (sICAM-1) and adjusted for these biomarker levels in multivariable models. Results At study entry, 25.5% of participants had the MetS. Women with the MetS had a 62% increased risk of incident PAD (HR 1.62; 95% CI 1.10 –2.38). After multivariable adjustment, MetS remained significantly associated with incident PAD (Table ). Similar results were obtained when we assessed the risk of PAD according to the number of MetS defining traits (21% risk increase per additional trait) (Table ). Median plasma levels of hsCRP and sICAM-1 were 4.0 mg/L versus 1.53 mg/L (p<0.0001) and 374 ng/mL versus 333 ng/mL (p<0.0001) in women with and without MetS, respectively. From 0 to 5 MetS defining traits, median hsCRP levels gradually increased from 1.0 to 5.9 mg/L (p<0.0001) and median sICAM-1 levels increased from 321 to 413 ng/mL (p<0.0001). When hsCRP and sICAM-1 were added to multivariable models for incident PAD, risk estimates for the MetS were substantially attenuated and became non-significant (Table ). Conclusion Women with the MetS have an increased risk of incident PAD. This increased risk may be largely mediated by the effects of inflammation and/or endothelial activation. Metabolic Syndrome and Risk of PAD

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