scholarly journals Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study

BMJ ◽  
2019 ◽  
pp. l4414 ◽  
Author(s):  
Séverine Sabia ◽  
Aurore Fayosse ◽  
Julien Dumurgier ◽  
Alexis Schnitzler ◽  
Jean-Philippe Empana ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Hazard Ratio ◽  
Blood Cholesterol ◽  
Health Score ◽  
Ideal Cardiovascular Health ◽  
Incidence Of Dementia

AbstractObjectivesTo examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia.DesignProspective cohort study.SettingCivil service departments in London (Whitehall II study; study inception 1985-88).Participants7899 participants with data on the cardiovascular health score at age 50.ExposuresThe cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health.Main outcome measureIncident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017.Results347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were −1.5 (95% confidence interval −2.3 to −0.7) for the group with intermediate cardiovascular health and −1.9 (−2.8 to −1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score).ConclusionAdherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.

scholarly journals Cardiovascular Disease and All-Cause Mortality in Male Twins With Discordant Cardiorespiratory Fitness: A Nationwide Cohort Study

2020 ◽  
Vol 189 (10) ◽  
pp. 1114-1123
Author(s):  
Marcel Ballin ◽  
Anna Nordström ◽  
Peter Nordström
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Confidence Interval ◽  
Cardiorespiratory Fitness ◽  
Military Service ◽  
Lower Risk ◽  
Hazard Ratio ◽  
Familial Factors ◽  
All Cause Mortality

Abstract Whether genetic and familial factors influence the association between cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) is unknown. Two cohorts were formed based on data from 1,212,295 men aged 18 years who were conscripted for military service in Sweden during 1972–1996. The first comprised 4,260 twin pairs in which the twins in each pair had different CRF (≥1 watt). The second comprised 90,331 nonsibling pairs with different CRF and matched on birth year and year of conscription. Incident CVD and all-cause mortality were identified using national registers. During follow-up (median 32 years), there was no difference in CVD and mortality between fitter twins and less fit twins (246 vs. 251 events; hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.83, 1.20). The risks were similar in twin pairs with ≥60-watt difference in CRF (HR = 0.96, 95% CI: 0.57, 1.64). In contrast, in the nonsibling cohort, fitter men had a lower risk of the outcomes than less fit men (4,444 vs. 5,298 events; HR = 0.83, 95% CI: 0.79, 0.86). The association was stronger in pairs with ≥60-watt difference in CRF (HR = 0.65, 95% CI: 0.59, 0.71). These findings indicate that genetic and familial factors influence the association of CRF with CVD and mortality.

Abstract 021: Higher Levels of Ideal Cardiovascular Health Are Associated With Lower Risk of Incident Type 2 Diabetes Mellitus Among Individuals With Normal Fasting Glucose but Not Impaired Fasting Glucose: The Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Joshua J Joseph ◽  
Aleena Bennett ◽  
Justin B Echouffo Tcheugui ◽  
Valery S Effoe ◽  
James Odei ◽  
...  
Keyword(s):  
Racial Differences ◽  
Impaired Fasting Glucose ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Fasting Glucose ◽  
Glycemic Status ◽  
Ideal Cardiovascular Health ◽  
Normal Fasting Glucose ◽  
Prevention Of Diabetes

Aims/hypothesis: Ideal cardiovascular health (ICH) is associated with lower risk of incident diabetes, but whether this association varies by baseline glycemia (normal [<100 mg/dL] vs. impaired fasting glucose [100-125 mg/dL]) remains to be clarified. We assessed the incidence of diabetes based on American Heart Association (AHA) ICH components stratified by glycemic status to determine whether ICH is more effective for primordial or primary prevention of diabetes among middle-aged and older adults. Methods: This study included 7,662 non-Hispanic whites and African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study without prevalent diabetes at baseline (2003-2006), who completed the follow-up exam (2013-2016). Participants were categorized as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 Impact Goals, based on baseline ICH components (total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index (BMI)). We categorized participants based on their total number of components that were ideal (0-1 “poor”, 2-3 “intermediate”, and 4+ “ideal”). Incident rate ratios (IRR) were calculated using modified poisson regression adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin:creatinine ratio and high-sensitivity C-reactive protein. After confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test, we stratified by glycemic status (normal vs. impaired fasting glucose). Results: Among REGARDS participants (mean age 63.0 [SD 8.4] years, 56% female, 26% African American), there were 560 incident diabetes cases (median follow-up 9.5 years). Overall, those with 2-3 and 4+ ICH components vs. 0-1 components had 31% (IRR 0.69; 95% CI 0.61, 0.79) and 71% lower (IRR 0.29; 95% CI 0.20, 0.42) risk of diabetes, respectively. Among 5,930 participants with normal fasting glucose, these risks were 36% (IRR 0.64; 95% CI 0.52, 0.79) and 80% lower (IRR 0.20; 95% CI 0.10, 0.37), while among 1,732 participants with baseline impaired fasting glucose these risks were 8% (IRR 0.92; 95% CI 0.80,1.07) and 13% lower (IRR 0.87; 95% CI 0.58,1.30) (p for interaction by baseline glucose status <0.0001). Conclusions/interpretation: Meeting an increasing number of ideal levels of dietary intake, physical activity, smoking, blood pressure, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes for individuals with normal fasting glucose but not impaired fasting glucose. This suggests the AHA 2020 guidelines may be more effective for primordial versus primary prevention of diabetes among middle-aged and older adults.

Abstract 2118: A Population-based Comparison of the Cardiovascular Protective Effects of Hydrochlorothiazide and Chlorthalidone

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jeff Nagge ◽  
David N Juurlink
Keyword(s):  
Confidence Interval ◽  
Lower Risk ◽  
Primary Outcome ◽  
Population Based ◽  
Hazard Ratio ◽  
Protective Effects ◽  
Composite Outcome ◽  
Index Event ◽  
Significant Difference

Background Clinical practice guidelines for the treatment of hypertension recommend a thiazide diuretic as initial therapy for the majority of patients. Most clinicians consider chlorthalidone (CHL) and hydrochlorothiazide (HCTZ), the two most commonly prescribed thiazides, to be interchangeable, despite evidence suggesting these drugs are not equivalent. Methods We constructed a population-based retrospective cohort study by linking the health records of 1.4 million residents of Ontario, Canada aged 66 or older between July 1, 1993 and March 1, 2002. The index event for entry into the cohort was a new prescription for either HCTZ or CHL. The primary outcome was the time from the index event to a composite outcome of acute myocardial infarction (AMI), stroke, or all-cause mortality. Secondary analyses explored each outcome individually. Analysis was done using Cox proportional hazards regression with the HCTZ group as the reference. Results During 218,360 person-years of follow-up in the HCTZ group, there were 10 025 events (death, AMI or stroke), compared to 113 events during 4,214 person-years of follow-up in the CHL group. The unadjusted hazard ratio for the primary outcome was 0.73 (95% confidence interval 0.61 to 0.88), suggesting a substantially lower risk of events during CHL therapy. After adjustment for differences in baseline demographic and clinical characteristics, there was no statistically significant difference between the groups for the primary outcome (adjusted hazard ratio 0.85; 95% confidence interval 0.71 to 1.03). The hazard ratios for each component of the primary composite outcome all trended in the direction of a lower risk of events in users of CHL. Conclusion In a large cohort of older patients treated with thiazide diuretics, the use of CHL was not associated with a statistically significant reduction in the risk of AMI, stroke, or death. However, treatment effects favored CHL for every outcome, raising the hypothesis that CHL is superior to HCTZ. Further research is needed to confirm or refute this hypothesis.

scholarly journals Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study

BMJ ◽  
2019 ◽  
pp. l4897 ◽  
Author(s):  
Tammy Y N Tong ◽  
Paul N Appleby ◽  
Kathryn E Bradbury ◽  
Aurora Perez-Cornago ◽  
Ruth C Travis ◽  
...  
Keyword(s):  
Heart Disease ◽  
Confidence Interval ◽  
Ischaemic Heart Disease ◽  
Prospective Cohort ◽  
Disease Risk ◽  
Haemorrhagic Stroke ◽  
Hazard Ratio ◽  
Blood Cholesterol ◽  
Incident Cases

Abstract Objective To examine the associations of vegetarianism with risks of ischaemic heart disease and stroke. Design Prospective cohort study. Setting The EPIC-Oxford study, a cohort in the United Kingdom with a large proportion of non-meat eaters, recruited across the country between 1993 and 2001. Participants 48 188 participants with no history of ischaemic heart disease, stroke, or angina (or cardiovascular disease) were classified into three distinct diet groups: meat eaters (participants who consumed meat, regardless of whether they consumed fish, dairy, or eggs; n=24 428), fish eaters (consumed fish but no meat; n=7506), and vegetarians including vegans (n=16 254), based on dietary information collected at baseline, and subsequently around 2010 (n=28 364). Main outcome measures Incident cases of ischaemic heart disease and stroke (including ischaemic and haemorrhagic types) identified through record linkage until 2016. Results Over 18.1 years of follow-up, 2820 cases of ischaemic heart disease and 1072 cases of total stroke (519 ischaemic stroke and 300 haemorrhagic stroke) were recorded. After adjusting for sociodemographic and lifestyle confounders, fish eaters and vegetarians had 13% (hazard ratio 0.87, 95% confidence interval 0.77 to 0.99) and 22% (0.78, 0.70 to 0.87) lower rates of ischaemic heart disease than meat eaters, respectively (P<0.001 for heterogeneity). This difference was equivalent to 10 fewer cases of ischaemic heart disease (95% confidence interval 6.7 to 13.1 fewer) in vegetarians than in meat eaters per 1000 population over 10 years. The associations for ischaemic heart disease were partly attenuated after adjustment for self reported high blood cholesterol, high blood pressure, diabetes, and body mass index (hazard ratio 0.90, 95% confidence interval 0.81 to 1.00 in vegetarians with all adjustments). By contrast, vegetarians had 20% higher rates of total stroke (hazard ratio 1.20, 95% confidence interval 1.02 to 1.40) than meat eaters, equivalent to three more cases of total stroke (95% confidence interval 0.8 to 5.4 more) per 1000 population over 10 years, mostly due to a higher rate of haemorrhagic stroke. The associations for stroke did not attenuate after further adjustment of disease risk factors. Conclusions In this prospective cohort in the UK, fish eaters and vegetarians had lower rates of ischaemic heart disease than meat eaters, although vegetarians had higher rates of haemorrhagic and total stroke.

Abstract 381: Ideal Cardiovascular Health and Cardiovascular Disease: Heterogeneity Across Event Phenotype and Contribution of Multiple Biomarkers

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Bamba Gaye ◽  
Muriel Tafflet ◽  
Dominique Arveil ◽  
Frank Kee ◽  
Alun Evans ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Mediating Effect ◽  
Blood Biomarkers ◽  
Disease Heterogeneity ◽  
Ideal Cardiovascular Health

Aims: To investigate whether or not the association between baseline cardiovascular health (CVH) and incident cardiovascular disease (CVD) differs by event phenotypes and to address the mediating effect of inflammatory and haemostatic blood biomarkers. Methods: The association of ideal CVH with outcomes was computed in 9312 middle-aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline blood biomarkers was evaluated in a case control study nested within the cohort after 10 years of follow-up. Results: After a median follow-up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared to those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (HR=0.28; 95% CI: 0.17; 0.46) and a 76% lower risk of stroke (HR=0.24; 95% CI: 0.06; 0.98). No heterogeneity was detected across main CHD and main stroke phenotypes. While significantly lower mean concentrations of hs-CRP, IL-6 (inflammatory markers), and fibrinogen, von Willbrandt factor (haemostatic factors) were noted in the controls with higher CVH status, the association of CVH with incident CHD was not attenuated upon adjustment for these biomarkers. Conclusion: these results support the universal promotion of ideal CVH for CVD in general and suggest that the lower risk of CHD associated with ideal CVH is independent from inflammatory and haemostatic biomarkers.

scholarly journals Poor oral hygiene and dental caries predict high mortality rate in hemodialysis: a 3-year cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Koji Mizutani ◽  
Risako Mikami ◽  
Tomohito Gohda ◽  
Hiromichi Gotoh ◽  
Norio Aoyama ◽  
...  
Keyword(s):  
Cohort Study ◽  
Dental Caries ◽  
Confidence Interval ◽  
Oral Hygiene ◽  
Dental Plaque ◽  
Hazard Ratio ◽  
Periodontal Pocket ◽  
All Cause Mortality ◽  
The Impact

AbstractThe aim of this study was to investigate the impact of oral hygiene, periodontal diseases, and dental caries on all-cause mortality in hemodialysis. This prospective cohort study included 266 patients with end-stage renal disease who were undergoing hemodialysis. Medical interviews, blood biochemical tests, and comprehensive dental examinations including periodontal pocket examination on all teeth and dental plaque accumulation by debris index-simplified (DI-S), were performed. Survival rates were assessed at a 3-year follow-up. Overall, 207 patients were included in the longitudinal analysis, and 38 subjects died during the follow-up period. Cox proportional hazards analysis of the multivariate model demonstrated that the highest tertile of DI-S had a significantly higher risk of all-cause mortality than the lowest two tertiles after adjustment for age, sex, smoking habit, body mass index, diabetes, prior cardiovascular disease, hemodialysis vintage, high sensitivity C-reactive protein, albumin, and number of remaining teeth (hazard ratio, 3.04; 95% confidence interval, 1.50–6.17; p = 0.002). Moreover, the number of decayed teeth significantly increased the hazard ratio to 1.21 (95% confidence interval, 1.06.1.37; p = 0.003). This study suggests that accumulated dental plaque and untreated decay, but not periodontal disease, may be independently associated with all-cause mortality in patients undergoing hemodialysis.

Abstract P509: Olive Oil Consumption and Risk of Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Marta Guasch ◽  
Gang Liu ◽  
Yanping Li ◽  
Laura Sampson ◽  
Joann E Manson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Heart Disease ◽  
Confidence Interval ◽  
Olive Oil ◽  
Lower Risk ◽  
Hazard Ratio ◽  
Mediterranean Populations ◽  
Dairy Fat ◽  
Incident Cases

Background: Olive oil intake has been associated with lower risk of cardiometabolic risk factors in Mediterranean populations, but little is known about these associations in the U.S. population, where olive oil intake is relatively low. Objectives: To examine whether olive oil intake is associated with total Cardiovascular Disease (CVD), coronary heart disease (CHD) and stroke risk. Methods: We included 63,867 women from the Nurses’ Health Study (1990 to 2014) and 35,512 men from the Health Professionals Follow-up Study (1990 to 2014) who were free of cancer, heart disease, and stroke at baseline. Diet was assessed using food frequency questionnaires at baseline and then every 4 years. Cumulative average of intake was used in the primary analysis. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals. Results: During 24 years of follow-up, we documented 10,240 incident cases of CVD, including 6,270 CHD cases and 3,970 stroke cases. After adjusting for major diet and lifestyle factors, compared with non-consumers, those with higher olive oil intake (>1/2 tablespoon/d or > 7g/d) had 15% lower risk of total CVD [pooled hazard ratio (95% confidence interval): 0.85 (0.77, 0.93)] and 21% lower risk of CHD [pooled hazard ratio (95% confidence interval): 0.79 (0.70, 0.89)]. No significant associations were observed for total stroke or ischemic stroke. We estimated that replacing 5g of margarine, butter, mayonnaise, or dairy fat with the equivalent amount of olive oil was associated with 5-7% lower risk of total CVD and CHD. No significant associations were observed when olive oil was compared with other plant oils combined (corn, safflower, soybean and canola oil). Conclusions: Higher olive oil intake was associated with a lower risk of CHD and total CVD in two large prospective cohorts of U.S. men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil might lead to a lower risk for CHD and CVD.

scholarly journals SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study

BMJ ◽  
2021 ◽  
pp. e068665
Author(s):  
Anders Husby ◽  
Jørgen Vinsløv Hansen ◽  
Emil Fosbøl ◽  
Emilia Myrup Thiesson ◽  
Morten Madsen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Population Based ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Absolute Rate ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Absolute

AbstractObjectiveTo investigate the association between SARS-CoV-2 vaccination and myocarditis or myopericarditis.DesignPopulation based cohort study.SettingDenmark.Participants4 931 775 individuals aged 12 years or older, followed from 1 October 2020 to 5 October 2021.Main outcome measuresThe primary outcome, myocarditis or myopericarditis, was defined as a combination of a hospital diagnosis of myocarditis or pericarditis, increased troponin levels, and a hospital stay lasting more than 24 hours. Follow-up time before vaccination was compared with follow-up time 0-28 days from the day of vaccination for both first and second doses, using Cox proportional hazards regression with age as an underlying timescale to estimate hazard ratios adjusted for sex, comorbidities, and other potential confounders.ResultsDuring follow-up, 269 participants developed myocarditis or myopericarditis, of whom 108 (40%) were 12-39 years old and 196 (73%) were male. Of 3 482 295 individuals vaccinated with BNT162b2 (Pfizer-BioNTech), 48 developed myocarditis or myopericarditis within 28 days from the vaccination date compared with unvaccinated individuals (adjusted hazard ratio 1.34 (95% confidence interval 0.90 to 2.00); absolute rate 1.4 per 100 000 vaccinated individuals within 28 days of vaccination (95% confidence interval 1.0 to 1.8)). Adjusted hazard ratios among female participants only and male participants only were 3.73 (1.82 to 7.65) and 0.82 (0.50 to 1.34), respectively, with corresponding absolute rates of 1.3 (0.8 to 1.9) and 1.5 (1.0 to 2.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 1.48 (0.74 to 2.98) and the absolute rate was 1.6 (1.0 to 2.6) per 100 000 vaccinated individuals within 28 days of vaccination. Among 498 814 individuals vaccinated with mRNA-1273 (Moderna), 21 developed myocarditis or myopericarditis within 28 days from vaccination date (adjusted hazard ratio 3.92 (2.30 to 6.68); absolute rate 4.2 per 100 000 vaccinated individuals within 28 days of vaccination (2.6 to 6.4)). Adjusted hazard ratios among women only and men only were 6.33 (2.11 to 18.96) and 3.22 (1.75 to 5.93), respectively, with corresponding absolute rates of 2.0 (0.7 to 4.8) and 6.3 (3.6 to 10.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 5.24 (2.47 to 11.12) and the absolute rate was 5.7 (3.3 to 9.3) per 100 000 vaccinated individuals within 28 days of vaccination.ConclusionsVaccination with mRNA-1273 was associated with a significantly increased risk of myocarditis or myopericarditis in the Danish population, primarily driven by an increased risk among individuals aged 12-39 years, while BNT162b2 vaccination was only associated with a significantly increased risk among women. However, the absolute rate of myocarditis or myopericarditis after SARS-CoV-2 mRNA vaccination was low, even in younger age groups. The benefits of SARS-CoV-2 mRNA vaccination should be taken into account when interpreting these findings. Larger multinational studies are needed to further investigate the risks of myocarditis or myopericarditis after vaccination within smaller subgroups.

Sign in / Sign up

Export Citation Format

Share Document