Trends in cardiovascular risk factors (1984-1993) in a Swiss region: results of three population surveys

The future backbone of nutritional science: integrating public health priorities with system-oriented precision nutrition

Adopting policies that promote health for the entire biosphere (One Health) requires human societies to transition towards a more sustainable food supply as well as to deepen the understanding of the metabolic and health effects of evolving food habits. At the same time, life sciences are experiencing rapid and groundbreaking technological developments, in particular in laboratory analytics and biocomputing, placing nutrition research in an unprecedented position to produce knowledge that can be translated into practice in line with One Health policies. In this dynamic context, nutrition research needs to be strategically organised to respond to these societal expectations. One key element of this strategy is to integrate precision nutrition into epidemiological research. This position article therefore reviews the recent developments in nutrition research and proposes how they could be integrated into cohort studies, with a focus on the Swiss research landscape specifically.

The relationships of shift work, hair cortisol concentration and dyslipidaemia: a cohort study in China

BACKGROUND

Currently, cardiovascular disease is the leading cause of death, and dyslipidaemia is an independent and modifiable major risk factor. Previous studies on shift work with dyslipidaemia and hair cortisol concentration (HCC) have yielded conflicting results. The aim of this study was to clarify the association between shift work, dyslipidaemia, and HCC. We further explored the mediating effect of HCC.

METHODS

In this cohort study, baseline data were collected from participants in May 2013. The cohort included 2170 participants- 1348 shift workers and 822 non-shift workers- who were followed up for 6 years with four questionnaire surveys from July 2014, October 2015, and May to December 2019. Hair samples were collected from 340 participants during the baseline period for HCC testing with an automated radioimmunoassay. Dyslipidaemia was defined using the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria.

RESULTS

Shift workers had a higher risk of dyslipidaemia than workers on the fixed day shift (two-shift RR = 1.408, 95% CI: 1.102-1.798; three-shift RR = 1.478, 95% CI: 1.134-1.926; four-shift RR = 1.589, 95% CI: 1.253-2.015). Additionally, shift workers had higher HCC levels than fixed day shift workers, with geometric mean concentration (GMC) ± geometric standard difference (GSD) = 2.625 ± 2.012 ng/g, two-shift GMC ± GSD = 3.487 ± 1.930 ng/g, three-shift GMC ± GSD = 2.994 ± 1.813 ng/g, and four-shift GMC ± GSD = 3.143 ± 1.720 ng/g. High HCC was associated with a high incidence of dyslipidaemia. After controlling for confounding factors, this study showed that HCC played a role in mediating dyslipidaemia in shift workers and accounted for 16.24% of the effect.

CONCLUSIONS

Shift work was linked to increased risk of dyslipidaemia compared with fixed day shift work. Higher HCC was associated with a higher prevalence of dyslipidaemia. HCC had a significant mediating effect on dyslipidaemia in shift workers.

Exome Sequencing Data Analysis and a Case-Control Study in Mexican Population Reveals Lipid Trait Associations of New and Known Genetic Variants in Dyslipidemia-Associated Loci

Background: Plasma lipid levels are a major risk factor for cardiovascular diseases. Although international efforts have identified a group of loci associated with the risk of dyslipidemia, Latin American populations have been underrepresented in these studies.

Objective: To know the genetic variation occurring in lipid-related loci in the Mexican population and its association with dyslipidemia.

Methods: We searched for single-nucleotide variants in 177 lipid candidate genes using previously published exome sequencing data from 2838 Mexican individuals belonging to three different cohorts. With the extracted variants, we performed a case-control study. Logistic regression and quantitative trait analyses were implemented in PLINK software. We used an LD pruning using a 50-kb sliding window size, a 5-kb window step size and a r2 threshold of 0.1.

Results: Among the 34251 biallelic variants identified in our sample population, 33% showed low frequency. For case-control study, we selected 2521 variants based on a minor allele frequency ≥1% in all datasets. We found 19 variants in 9 genes significantly associated with at least one lipid trait, with the most significant associations found in the APOA1/C3/A4/A5-ZPR1-BUD13 gene cluster on chromosome 11. Notably, all 11 variants associated with hypertriglyceridemia were within this cluster; whereas variants associated with hypercholesterolemia were located at chromosome 2 and 19, and for low high density lipoprotein cholesterol were in chromosomes 9, 11, and 19. No significant associated variants were found for low density lipoprotein. We found several novel variants associated with different lipemic traits: rs3825041 in BUD13 with hypertriglyceridemia, rs7252453 in CILP2 with decreased risk to hypercholesterolemia and rs11076176 in CETP with increased risk to low high density lipoprotein cholesterol.

Conclusions: We identified novel variants in lipid-regulation candidate genes in the Mexican population, an underrepresented population in genomic studies, demonstrating the necessity of more genomic studies on multi-ethnic populations to gain a deeper understanding of the genetic structure of the lipemic traits.

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: a pooled analysis of 458 population-based studies in Asian and Western countries

BACKGROUND

Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries.

METHODS

We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group.

RESULTS

Since ∼1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at ∼0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as ∼0.7 per decade in Swiss men (equivalent to ∼26% decline in coronary heart disease risk per decade). The ratio increased in China.

CONCLUSIONS

HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.

Risk prediction model of dyslipidaemia over a 5-year period based on the Taiwan MJ health check-up longitudinal database

OBJECTIVE

This study aimed to provide an epidemiological model to evaluate the risk of developing dyslipidaemia within 5 years in the Taiwanese population.

METHODS

A cohort of 11,345 subjects aged 35-74 years and was non-dyslipidaemia in the initial year 1996 and followed in 1997-2006 to derive a risk score that could predict the occurrence of dyslipidaemia. Multivariate logistic regression was used to derive the risk functions using the check-up centre of the overall cohort. Rules based on these risk functions were evaluated in the remaining three centres as the testing cohort. We evaluated the predictability of the model using the area under the receiver operating characteristic (ROC) curve (AUC) to confirm its diagnostic property on the testing sample. We also established the degrees of risk based on the cut-off points of these probabilities after transforming them into a normal distribution by log transformation.

RESULTS

The incidence of dyslipidaemia over the 5-year period was 19.1%. The final multivariable logistic regression model includes the following six risk factors: gender, history of diabetes, triglyceride level, HDL-C (high-density lipoprotein cholesterol), LDL-C (low-density lipoprotein cholesterol) and BMI (body mass index). The ROC AUC was 0.709 (95% CI: 0.693-0.725), which could predict the development of dyslipidaemia within 5 years.

CONCLUSION

This model can help individuals assess the risk of dyslipidaemia and guide group surveillance in the community.

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

BACKGROUND

Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher.

METHODS

For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure.

FINDINGS

We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7-128·3) in men and 122·3 mm Hg (121·0-123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9-79·5) for men and 76·7 mm Hg (75·9-77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4-27·1) in men and 20·1% (17·8-22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence.

INTERPRETATION

During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

FUNDING

Wellcome Trust.

Ameliorative effects of Nigella sativa on dyslipidemia

INTRODUCTION

Dyslipidemia is an established risk factor for ischemic heart disease. Nigella sativa (NS) is a medicinal plant that has been used for the treatment and prevention of a variety of diseases, in particular hyperlipidemia.

METHODS

We reviewed the existing literature published until 2014 by using the following keywords: ''Nigella sativa'', ''black cumin'', ''black seeds'', ''thymoquinone'', and ''lipid''.

RESULTS

In the conducted studies, different preparations of NS including seed powder (100 mg-20 g daily), seed oil (20-800 mg daily), thymoquinone (3.5-20 mg daily), and seed extract (methanolic extract especially), were shown to reduce plasma levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides, but the effect on high-density lipoprotein cholesterol (HDL-C) was not significant. NS and thymoquinone have been reported to be safe and well tolerated with no severe adverse effect. In clinical trials, NS was found to be effective when added as adjunct to standard antihyperlipidemic and antidiabetic medications. Lipid-modifying effects of NS could be attributed to the inhibition of intestinal cholesterol absorption, decreased hepatic cholesterol synthesis, and up-regulation of LDL receptors.

CONCLUSIONS

Overall, the evidence from experimental and a clinical studies suggests that NS seeds are a promising natural therapy for dyslipidemic patients.

Cardiovascular Risk Assessment and Effects on Behavior in Switzerland The Swiss Heart Foundation HerzCheck(®)/Cardio-Test(®)

Background:

“CardioTest^®” is a tool for cardiovascular risk assessment. The aim of this study was to evaluate if this test used in Swiss pharmacies provides risk stratification and if it had impact on individual behaviour.

Methods:

Individuals were evaluated (blood pressure, body waist circumference, random blood samples and coronary artery disease risk factors). The cardiovascular risk was calculated (AGLA Risk Score (ARS) a modified PROCAM Score) and participants were informed about their result. One year after the initial testing individuals were followed up by questionnaire with respect to the action they had taken based upon the ARS results. The relation between ARS results and events during follow-up were assessed. Events were defined as cardiovascular events due to chest pain, myocardial infarction or stroke.

Result:

A total of 1415 individuals were contacted for follow-up, 746 (53%) with a mean age of 62.7 (±12.8) years (60% were male) returned their questionnaire. The cardiovascular risk throughout the study-population turned out to be low: 73.9% had a low ARS <10%, 21.7% an intermediate ARS 10-20% and 4.4% had a high ARS >20%. Significantly more participants with ARS >20% consulted their family doctor (46.2%) than those with ARS 10-20% (25.2%) and ARS <10% (10.4%), respectively (p<0,01 for both comparisons). Sixty-four individuals (9%) suffered a cardiovascular event. The event rates increased as a function of ARS.

Conclusion:

The overall cardiovascular risk of individuals participating in a pharmacy based risk assessment program seems to be low. CardioTest ^® provided risk stratification with respect to future cardio-vascular events. CardioTest ^® seems to have impact on individual behavior and lifestyle modification. Other settings and locations for screening might be considered to reach higher risk individuals at an earlier stage.

Association of foods enriched in conjugated linoleic acid (CLA) and CLA supplements with lipid profile in human studies: a systematic review and meta-analysis

Objective

The present study aimed to review the association of conjugated linoleic acid (CLA) consumption in two forms, foods enriched in CLA and CLA supplements, with serum lipid profile in human studies.

Design

Systematic review and meta-analysis.

Setting

Search process was conducted in PubMed, Cochrane Library, Google Scholar, Scopus and Science Direct. Clinical trials that investigated the association of CLA intakes either in the form of supplements or enriched foods with lipid profile in healthy adults were included. All outcomes were recorded as continuous variables, and the effect size was measured by analysis of the mean and standard deviation before and after the intervention for case and control groups.

Subjects

Healthy adult population.

Results

CLA supplementation was associated with a significant decrease in LDL cholesterol (mean difference=−0·218; 95 % CI −0·358, −0·077;P=0·002), a non-significant decrease in HDL cholesterol (mean difference=−0·051; 95 % CI −0·188, 0·086;P=0·468), a non-significant increase in total cholesterol (mean difference=0·009; 95 % CI −0·128, 0·146;P=0·896) and a non-significant decrease in TAG (mean difference=−0·065; 95 % CI −0·20, 0·07;P=0·344). Foods enriched with CLA were associated with significantly decreased LDL cholesterol (mean difference=−0·231; 95 % CI −0·438, −0·024;P=0·028), non-significantly increased HDL-C (mean difference=0·075; 95 % CI −0·121, 0·270;P=0·455), non-significantly decreased total cholesterol (mean difference=−0·158; 95 % CI −0·349, 0·042;P=0·124) and non-significantly decreased TAG (mean difference=−0·078; 95 % CI −0·274, 0·117;P=0·433).

Conclusions

According to our analysis, consumption of foods enriched with CLA or CLA supplements has favourable effects on LDL cholesterol levels.

The combined effect on survival of four main behavioural risk factors for non-communicable diseases

OBJECTIVE

To quantify and illustrate the combined effects of WHO's four behavioural risk factors for non-communicable diseases (NCDs) on mortality.

METHODS

Participants (n=16,721) were part of two Swiss population studies conducted between 1977 and 1993. Smoking status, alcohol consumption, physical activity and diet were assessed at baseline. With record linkage in 2008, up to 31years of follow-up with 3,533 deaths could be recorded. Mortality was assessed with Cox proportional hazard models for each risk factor and their combinations. Ten-year survival probabilities for 65- and 75-year-olds were estimated with Weibull regression models.

RESULTS

Hazard ratios for the combination of all four risk factors compared to none were 2.41 (1.99-2.93) in men and 2.46 (1.88-3.22) in women. For 65-year-olds, the probability of surviving the next 10years was 86% for men with no risk factors and 67% for men with four. In women, the respective numbers were 90% and 77%. In 75-year-olds, probabilities were 67% and 35% in men, and 74% and 47% in women.

CONCLUSIONS

The combined impact of four behavioural NCD risk factors on survival probability was comparable in size to a 10-year age difference and bigger than the gender effect.

Impact of different domains of physical activity on cause-specific mortality: a longitudinal study

OBJECTIVE

The aim of this paper is to examine the associations between different domains of physical activity and all-cause, cardiovascular disease (CVD) and cancer mortality.

METHODS

Participants (n=17,663, aged 16-92 years) of two general population health studies conducted between 1977 and 1993 in Switzerland were included. Physical activity was assessed at baseline in the domains of commuting to work, work-related physical activity, and leisure-time physical activity (including leisure-time activity level and sport activity). A median follow-up time of 20.2 years was obtained with anonymous record linkage providing 3878 deaths (CVD: 1357; cancer: 1351). Adjusted Cox proportional hazard models were calculated.

RESULTS

There were no significant associations between commuting and work-related physical activities, respectively, and mortality. Leisure-time activity level was associated with all-cause mortality in men [adjusted hazard ratio (HR) 0.75, 95% confidence intervals (CI) 0.63-0.89] and women [HR 0.82 (0.74-0.91)], with CVD mortality in women only [HR 0.79 (0.67-0.94)] and with cancer mortality in men only [HR 0.63 (0.47-0.86)]. Sport activity was associated with all-cause, CVD and cancer mortality in men [HR ranged between 0.76 (0.63-0.92) and 0.85 (0.76-0.95)], but not in women.

CONCLUSIONS

These results underline the public health relevance of physical activity for the prevention of CVD and cancer, especially regarding leisure-time physical activity.

Mortality risk associated with underweight: a census-linked cohort of 31,578 individuals with up to 32 years of follow-up

Background

In contrast to obesity, information on the health risks of underweight is sparse. We examined the long-term association between underweight and mortality by considering factors possibly influencing this relationship.

Methods

We included 31,578 individuals aged 25–74 years, who participated in population based health studies between 1977 and 1993 and were followed-up for survival until 2008 by record linkage with the Swiss National Cohort (SNC). Body Mass Index (BMI) was calculated from measured (53% of study population) or self-reported height and weight. Underweight was defined as BMI < 18.5 kg/m². Cox regression models were used to determine mortality Hazard Ratios (HR) of underweight vs. normal weight (BMI 18.5- < 25.0 kg/m²). Covariates were study, sex, smoking, healthy eating proxy, sports frequency, and educational level.

Results

Underweight individuals represented 3.0% of the total study population (n = 945), and were mostly women (89.9%). Compared to normal weight, underweight was associated with increased all-cause mortality (HR: 1.37; 95% CI: 1.14-1.65). Increased risk was apparent in both sexes, regardless of smoking status, and mainly driven by excess death from external causes (HR: 3.18; 1.96-5.17), but not cancer, cardiovascular or respiratory diseases. The HR were 1.16 (0.88-1.53) in studies with measured BMI and 1.59 (1.24-2.05) with self-reported BMI.

Conclusions

The increased risk of dying of underweight people was mainly due to an increased mortality risk from external causes. Using self-reported BMI may lead to an overestimation of mortality risk associated with underweight.

Mediterranean diet and mortality in Switzerland: an alpine paradox?

PURPOSE

Reports on the protective effect of a Mediterranean diet on mortality usually refer to populations from Mediterranean countries, leaving uncertain whether really diet is the fundamental cause. Our aim was to examine the effect of a Mediterranean diet on mortality in Switzerland, a country combining cultural influences from Mediterranean and Central European countries within a common national health and statistical registry.

METHODS

In this prospective investigation, we included 17,861 men and women aged ≥16 years who participated 1977-1993 in health studies and were followed up for survival until 2008 by anonymous record linkage with the Swiss National Cohort. A 9-point score Mediterranean Diet Score (MDS) was used to assess adherence to a Mediterranean diet. Mortality hazard ratios (HR) and 95% confidence intervals (CIs) were calculated by using Cox regression models adjusted for age, sex, survey wave, marital status, smoking, body mass index, language region and nationality.

RESULTS

In all language regions, MDS was inversely associated with mortality. Consumption of dairy products was also consistently associated with lower mortality. When categorizing dairy food consumption as beneficial instead of harmful, this association between MDS and mortality increased in strength and was partly statistically significant. For all causes of death combined (HR for a one-point increase in MDS 0.96, 95% CI 0.94-0.98), in men (0.94, 0.92-0.97), in women (0.98, 0.95-1.02) for cardiovascular diseases (CVD, 0.96, 0.92-0.99; 0.95, 0.90-1.00; 0.98, 0.92-1.04) and for cancer (0.95, 0.92-0.99; 0.92, 0.88-0.97; 0.98, 0.93-1.04).

CONCLUSIONS

Stronger adherence to a Mediterranean diet was associated with lower all-cause, CVD and cancer mortality, largely independently of cultural background. These associations were primary due to the effect in men. Our finding of a beneficial rather than a deleterious impact of dairy products consumption prompts at considering culturally adapted Mediterranean diet recommendations. However, results should be interpreted with caution since only a crude 1-day dietary estimate was available to assess individuals' habitual dietary intake.

Prevalence of dyslipidemia and associated risk factors in Turkish adults

BACKGROUND AND OBJECTIVES

Dyslipidemia is a modifiable major risk factor for coronary heart disease. The objective of this study was to determine the prevalence of dyslipidemia among Turkish adults and its associations with other cardiovascular risk factors.

METHODS

This study included 4309 people ages 20 to 83 years old from 7 provinces of Turkey. People from the city centers, districts, and villages were selected by a stratified sampling method. Weight, height, and waist and hip circumferences were measured. Blood samples were obtained to determine glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG); these parameters were measured with an autoanalyzer. Dyslipidemia was defined according to National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria.

RESULTS

Of 4309 subjects, 43% had high TC, 41.5% had low HDL-C, 36.2% had high LDL-C, and 35.7% had high TG. Of these measures, at least 1 lipid abnormality was diagnosed in 78.7% of men and 80.4% of women. The prevalence of high TC, LDL-C, and TG increased with age, with the highest prevalence in the 46-to-65-year-old age group. The mean values (mg/dL) of TC, LDL-C, HDL-C, and TG were 194.2 ± 47.7, 117.7 ± 41.1, 50.3 ± 16.3, and 145.4 ± 96.3, respectively. Dyslipidemia was positively associated with age, body mass index, waist circumference, fasting blood glucose, and blood pressure, and negatively associated with altitude.

CONCLUSIONS

The high prevalence of dyslipidemia in Turkey is an important public health problem. Enhanced public health preventive measures should be implemented to better diagnose and comprehensively treat dyslipidemia in Turkey.

Physical activity in daily life is associated with lower adiposity values than doing weekly sports in Lc65+ cohort at baseline

Background

Overweight and obesity prevalence is the highest at age 65–75 years in Lausanne (compared with younger classes). We aimed to describe 1) eating habits, daily physical activity (PA), and sports frequency in community-dwelling adults aged 65–70, 2) the links of these behaviors with socio-economic factors, and 3) with adiposity.

Methods

Cross-sectional analysis of Lc65+ cohort at baseline, including 1260 adults from the general population of Lausanne aged 65–70 years. Eating habits (8 items from MNA) and PA (sports frequency and daily PA: walking and using stairs) were assessed by questionnaires. Body mass index (BMI), supra-iliac (SISF), triceps skin-folds (TSF), waist circumference (WC), and WHR were measured.

Results

Prevalence of overweight (BMI 25.0-29.9 kg/m²), obesity (BMI ≥30.0 kg/m²), and abdominal obesity was 53%, 24%, and 45% in men; 35%, 23%, and 45% in women.

Intake of fruits or vegetables (FV) ≥ twice/day was negatively associated with male sex (prevalence 81% versus 90%, chi-square P < 0.001). The proportion avoiding stairs in daily life was higher among women (25%) than among men (20%, chi-square P = 0.003).

In multivariate analyses among both sexes, eating FV, using stairs in daily life (“stairs”), and doing sports ≥ once/week were significantly negatively associated with financial difficulties (stairs: OR = 0.54, 95% CI = 0.40-0.72) and positively with educational level (stairs: OR = 1.68, 95% CI = 1.17-2.43 for high school).

For all five log-transformed adiposity indicators in women, and for all indicators except SISF and TSF in men, a gradual decrease in adiposity was observed from category “no stairs, sports < once/week” (reference), to “no stairs, sports ≥ once/week”, to “stairs, sports < once/week”, and “stairs, sports ≥ once/week” (for example: WC in men, respectively: ß = −0.03, 95% CI = −0.07-0.02; ß = −0.06, 95% CI = −0.09- -0.03; ß = −0.10, 95% CI = −0.12- -0.07).

Conclusions

In this population with high overweight and obesity prevalence, eating FV and PA were strongly negatively associated with financial difficulties and positively with education. Using stairs in daily life was more strongly negatively associated with adiposity than doing sports ≥ once/week.

Direct estimation of death attributable to smoking in Switzerland based on record linkage of routine and observational data

INTRODUCTION

In Switzerland, estimations of smoking-attributable deaths were based on age- and sex-adjusted hazard ratios (HRs) from foreign cohorts, precluding consideration of country-specific properties and adjustment for confounding. In order to overcome this, we analyzed recently available individual data from Switzerland.

METHODS

We included 17,861 individuals aged ≥16 years who participated between 1977-1993 in health studies and were anonymously linked with the Swiss National Cohort. Adjusted Cox regression was used to calculate mortality HRs. Smoking status at baseline was categorized into never-smokers, former smokers, and current light or heavy smokers (<20 or ≥20 cigarettes/day). As covariates, we selected education, marital status, lifestyle, alcohol consumption, and body mass index. We differentiated between cardiovascular disease (CVD), cancer, and noncancer-non-CVD deaths. Smoking-attributable deaths were estimated with a HR-based approach and with age-specific prevalence rates and mortality estimates from 2007.

RESULTS

Smoking men and women not only had an increased risk for all-cause (HR and 95% confidence interval vs. never-smokers: 1.71 [1.53-1.90]; 1.54 [1.36-1.75]), CVD (1.72 [1.43-2.06]; 1.50 [1.19-1.90]) and cancer (1.87 [1.56-2.25]; 1.58 [1.30-1.93]), but also for noncancer-non-CVD death (1.57 [1.29-1.89]; 1.58 [1.30-1.93]). Former smoking men had an increased risk for all-cause (1.16 [1.03-1.31]) and cancer death (1.35 [1.10-1.65]). Multivariate adjustment only slightly modified the association between smoking and mortality. Overall, 7,153 deaths per year could be attributed to smoking.

CONCLUSIONS

Smoking is an important avoidable health burden in Switzerland, and its consequences may persist for decades after quitting. This stresses the need for putting more efforts in strategies aimed at preventing the onset of smoking.

Population specific and up to date cardiovascular risk charts can be efficiently obtained with record linkage of routine and observational data

Background

Only few countries have cohorts enabling specific and up-to-date cardiovascular disease (CVD) risk estimation. Individual risk assessment based on study samples that differ too much from the target population could jeopardize the benefit of risk charts in general practice. Our aim was to provide up-to-date and valid CVD risk estimation for a Swiss population using a novel record linkage approach.

Methods

Anonymous record linkage was used to follow-up (for mortality, until 2008) 9,853 men and women aged 25–74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CVD) study of 1983–92. The linkage success was 97.8%, loss to follow-up 1990–2000 was 4.7%. Based on the ESC SCORE methodology (Weibull regression), we used age, sex, blood pressure, smoking, and cholesterol to generate three models. We compared the 1) original SCORE model with a 2) recalibrated and a 3) new model using the Brier score (BS) and cross-validation.

Results

Based on the cross-validated BS, the new model (BS = 14107×10⁻⁶) was somewhat more appropriate for risk estimation than the original (BS = 14190×10⁻⁶) and the recalibrated (BS = 14172×10⁻⁶) model. Particularly at younger age, derived absolute risks were consistently lower than those from the original and the recalibrated model which was mainly due to a smaller impact of total cholesterol.

Conclusion

Using record linkage of observational and routine data is an efficient procedure to obtain valid and up-to-date CVD risk estimates for a specific population.

Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne cohort Lc65+

OBJECTIVES

To estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria.

DESIGN

Population-based cohort study of noninstitutionalized elderly adults at baseline; cross-sectional analysis.

SETTING

Lausanne, Switzerland.

PARTICIPANTS

One thousand two hundred eighty-three individuals with complete data on frailty, aged 65 to 70 (58.5% women).

MEASUREMENTS

Frailty was assessed according to an adaptation of Fried's criteria (shrinking, weakness, exhaustion, slowness, and low activity, three criteria needed for the diagnosis of frailty, 1 to 2 for prefrailty). Other outcomes were diseases diagnosed by a doctor (≥ 2 chronic diseases: comorbidity) and limitations in activities of daily living (ADLs, basic and instrumental).

RESULTS

At baseline, of 1,283 participants 71.1% were classified as nonfrail, 26.4% as prefrail, and 2.5% as frail. The proportion of women increased across these three groups (56.5%, 62.8%, and 71.9%, respectively; P = .01), as did the proportion of individuals with one or more chronic diseases (68.0%, 82.8%, and 90.6%, respectively; P < .001) and the proportion with basic or instrumental ADL disability (1.6%, 10.3%, and 59.4%, respectively; P < .001). Weakness (low grip strength) was the most frequent criterion (14.3%). Prefrail participants had significantly more comorbidity and ADL disability than nonfrail participants (P < .001). When present in isolation, weakness was associated with two to three times greater prevalence of coronary heart disease, other heart diseases, diabetes mellitus, and arthritis. Similarly, a significant association was identified between exhaustion and depression.

CONCLUSION

Prefrailty is common in the youngest old. The most prevalent frailty criterion is weakness, which is associated with cardiovascular diseases. Longitudinal studies of the evolution of prefrailty should explore the role of potential interactions between individual frailty criteria and specific chronic diseases.

Public health significance of four cardiovascular risk factors assessed 25 years ago in a low prevalence country

BACKGROUND

The individual and combined effect of cardiovascular disease (CVD) risk factors (RFs) on CVD mortality varies between populations. Our aim was to examine this association and its public health impact in Switzerland, a country with comparably low CVD mortality.

METHODS

We included 9853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovascular disease) study (1983-1992) and were followed up for survival until 2008. Adjusted Cox regression was used to calculate CVD mortality hazard ratios (HR). CVD-RFs were obesity (body mass index ≥ 30 kg/m(2)), smoking (≥ 1 cig/d), high blood pressure (≥ 140 or ≥ 90 mmHg), and total: high-density lipoprotein cholesterol ratio (≥ 5.0). Besides age and sex, models were adjusted for diet, physical activity, educational class, marital status, and the respective other CVD-RFs.

RESULTS

After adjustment for age and sex, the HR of CVD death was for obesity 1.86 (95% CI 1.50-2.31), for smoking 1.63 (95% CI 1.32-2.01), for high blood pressure 1.42 (95% CI 1.16-1.73), and for high cholesterol ratio 1.30 (95% CI 1.06-1.60). Adjustment for other covariates moderately attenuated estimates. CVD-RFs had an independent and synergistic effect and accounted for 43.0% of population attributable risk. The presence of all four compared to zero CVD-RFs was associated with a 9.6 years shorter expected survival for a man aged 50.

CONCLUSIONS

Most CVD deaths could be avoided by prevention of four traditional CVD-RFs. Reduction of smoking prevalence and avoidance of weight gain in the population are the most effective measures. Particular attention should be dedicated to persons with multiple CVD-RFs.

Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care

Mortality rates from coronary heart disease (CHD), which had risen during the twentieth century in many countries, started declining in some countries during the 1960s. Once initial skepticism about the validity of the observed trends dissipated, researchers attempted to generate explanations about the events that had transpired using a variety of techniques, including ecological examinations of the trends in risk factors for CHD and changes in management of CHD, multivariate risk equations, and increasingly sophisticated modeling techniques. Improvements in risk factors as well as changes in cardiac treatments have both contributed to the reductions in CHD mortality, although estimates of their contributions have varied among countries. Models suggest that additional large reductions in CHD mortality are feasible by either improving the distribution of risk factors in the population or raising the percentage of patients receiving evidence-based treatments.

Obesity but not overweight is associated with increased mortality risk

The association between body mass index (BMI) and survival has been described in various populations. However, the results remain controversial and information from low-prevalence Western countries is sparse. Our aim was to examine this association and its public health impact in Switzerland, a country with internationally low mortality rate and obesity prevalence. We included 9,853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983-1992) and could be followed up for survival until 2008 by using anonymous record linkage. Cox regression models were used to calculate mortality hazard ratios (HRs) and to estimate excess deaths. Independent variables were age, sex, survey wave, diet, physical activity, smoking, educational class. After adjustment for age and sex the association between BMI and all-cause mortality was J shaped (non-smokers) or U shaped (smokers). Compared to BMI 18.5-24.9, among those with BMI ≥ 30 (obesity) HR for all-cause mortality was 1.41 (95% confidence interval: 1.23-1.62), for cardiovascular disease (CVD) 2.05 (1.60-2.62), for cancer 1.29 (1.04-1.60). Further adjustment attenuated the obesity-mortality relationship but the associations remained statistically significant. No significant increase was found for overweight (BMI 25-29.9). Between 4 and 6.5% of all deaths, 8.8-13.7% of CVD deaths and 2.4-3.9% of cancer deaths could be attributed to obesity. Obesity, but not overweight was associated with excess mortality, mainly because of an increased risk of death from CVD and cancer. Public health interventions should focus on preventing normal- and overweight persons from becoming obese.

Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007

BACKGROUND

Switzerland has a low mortality rate from cardiovascular diseases, but little is known regarding prevalence and management of cardiovascular risk factors (CV RFs: hypertension, hypercholesterolemia and diabetes) in the general population. In this study, we assessed 10-year trends in self-reported prevalence and management of cardiovascular risk factors in Switzerland.

METHODS

data from three national health interview surveys conducted between 1997 and 2007 in representative samples of the Swiss adult population (49,261 subjects overall). Self-reported CV RFs prevalence, treatment and control levels were computed. The sample was weighted to match the sex - and age distribution, geographical location and nationality of the entire adult population of Switzerland.

RESULTS

self-reported prevalence of hypertension, hypercholesterolemia and diabetes increased from 22.1%, 11.9% and 3.3% in 1997 to 24.1%, 17.4% and 4.8% in 2007, respectively. Prevalence of self-reported treatment among subjects with CV RFs also increased from 52.1%, 18.5% and 50.0% in 1997 to 60.4%, 38.8% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Self-reported control levels increased from 56.4%, 52.9% and 50.0% in 1997 to 80.6%, 75.1% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Finally, screening during the last 12 months increased from 84.5%, 86.5% and 87.4% in 1997 to 94.0%, 94.6% and 94.1% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively.

CONCLUSION

in Switzerland, the prevalences of self-reported hypertension, hypercholesterolemia and diabetes have increased between 1997 and 2007. Management and screening have improved, but further improvements can still be achieved as over one third of subjects with reported CV RFs are not treated.

Prospective Swiss cohort study of living-kidney donors: study protocol

Background Offering living kidney donation raised the concern that donors are exposed to unknown risks. All Swiss transplant centres therefore decided to start a prospective cohort study of living kidney donors in Switzerland. This paper describes the rationale for and implementation of this cohort study. Methods/design All kidney donors in Switzerland are registered and examined before donation and biennially after donation starting in the first year after nephrectomy. Before each follow-up visit, the study centre sends a package to the kidney donor containing the health questionnaire, blood and urine tubes and a prepaid envelope for sending the samples to the central laboratory. The donor makes an appointment with their family physician, who examines the donor and reports findings such as pain and other complaints, blood pressure, creatinine, albumin, all major health events and the state of mental and social well-being to the study centre. The family doctor draws the blood sample and mails it with the urine sample in the prepaid envelope. All data are centrally managed. All abnormal findings in the follow-up of individual donors are regularly discussed with the principal investigator, and necessary clinical changes made and recorded in the database. The health insurance of the recipient covers all costs of the donor follow-up. The main outcomes are the occurrence of albuminuria, hypertension and renal insufficiency. The secondary outcomes are major somatic and social events such as death, cardiovascular disease, stroke and depression. Discussion This prospective cohort offers unique opportunities to assess the risks of living kidney donation and will allow us to examine the risks associated with the methods used for nephrectomy in Switzerland (various forms of open surgery and laparoscopic nephrectomy). The prospective collection of all clinically relevant data and the regular monitoring of donors will allow timely interventions at early stages before serious kidney and general health problems occur.

Establishing a follow-up of the Swiss MONICA participants (1984-1993): record linkage with census and mortality data

Background

To assess the feasibility and quality of an anonymous linkage of 1) MONICA (MONItoring of trends and determinants in CArdiovscular disease, three waves between 1984 and 1993) data with 2) census and mortality records of the Swiss National Cohort in order to establish a mortality follow-up until 2008. Many countries feature the defect of lacking general population cohorts because they have missed to provide for follow-up information of health surveys.

Methods

Record linkage procedures were used in a multi-step approach. Kaplan-Meier curves from our data were contrasted with the survival probabilities expected from life tables for the general population, age-standardized mortality rates from our data with those derived from official cross-sectional mortality data. Cox regression models were fit to investigate the influence of covariates on survival.

Results

97.8% of the eligible 10,160 participants (25-74y at baseline) could be linked to a census (1990: 9,737; 2000: 8,749), mortality (1,526, 1984-2008) and/or emigration record (320, 1990-2008). Linkage success did not differ by any key study characteristic. Results of survival analyses were robust to linkage step or certainty of a correct link. Loss to follow-up between 1990 and 2000 amounted to 4.7%. MONICA participants had lower mortality than the general population, but similar mortality patterns, (e.g. variation by educational level, marital status or region).

Conclusions

Using anonymized census and death records allowed an almost complete mortality follow-up of MONICA study participants of up to 25 years. Lower mortality compared to the general population was in line with a presumable ‚healthy participant' selection in the original MONICA study. Apart from that, the derived data set reproduced known mortality patterns and showed only negligible potential for selection bias introduced by the linkage process. Anonymous record linkage was feasible and provided robust results. It can thus provide valuable information, when no cohort study is available.

BMI distribution/social stratification in Swiss conscripts from 1875 to present

BACKGROUND/OBJECTIVES

We aimed to extend the actual overweight discussion with new unbiased Swiss conscript data from 2005 to 2006, and to present for the first time Swiss data on body mass index (BMI) before 1950 and for the late-nineteenth century.

SUBJECTS/METHODS

For this study, 19-year-old Swiss male conscripts (draft army; Cantons Bern, Zurich, Basel-Stadt and Basel-Land) from the census of 1875-1879, 1933-1939 and 2005-2006 (N=28 033; 2005-2006 census) were included. BMI distribution (World Health Organization (WHO) classification) and social stratification (International Labour Organization classification) were main outcome measures.

RESULTS

Mean BMI of 19-year-old men in Switzerland increased in the 50 years between the 1870s and the 1930s by 0.80 kg/m(2) and between the 1930s and 2005 by 1.45 kg/m(2). The modern BMI sample is much more right skewed and s.d. is higher. Obesity prevalence (according to modern WHO classification) has increased by a factor of 105 from 1870s until present. Over 23% of our representative sample of Swiss men in 2005-2006 had a BMI of over 25 kg/m(2). In 2005-2006, contrary to the nineteenth century, unskilled workers had articulately higher BMI values at the 75th, 90th and 95th percentile than students; 12% of unskilled workers were obese against 2% of students.

CONCLUSIONS

It thus seems that BMI relations between the upper and the lower end of the socio-economic strata changed inversely from the late-nineteenth century to 2005-2006. We further propose that the phenomenon of massive right-skewing BMI distribution between the 1930s and 2005-2006 affected the lower socio-economic strata to a far greater extent than the higher socio-economic group.

Prevalence of dyslipidemia and its associated factors among Jordanian adults

BACKGROUND

Dyslipidemia, which has been closely linked to pathophysiology of cardiovascular diseases, is a key independent modifiable risk factor for cardiovascular diseases. Estimation of the prevalence of dyslipidemia ensures proper planning of health actions for both primary and secondary prevention of cardiovascular diseases.

OBJECTIVES

To estimate the prevalence of various types of dyslipidemia and determine their associated factors among adults in north of Jordan.

METHOD

Data were analyzed from a cross-sectional study that included a random sample of 1121 Jordanians aged 25 years and older. High total cholesterol (TC) was defined as TC ≥200 mg/dL and hypertriglyceridemia as serum triglycerides level ≥150 mg/dL. Low high-density lipoprotein cholesterol (HDL-C) was defined as serum HDL-C <40 mg/dL. High low-density lipoprotein cholesterol (LDL-C) was defined as serum LDL-C ≥130 mg/dL.

RESULTS

Of a total of 1121 subjects, 48.8% had high TC level, 40.7% had high LDL-C, 40.1% had low HDL-C, 43.6% had high triglyceride levels, and 75.7% had at least one abnormal lipid level. Age was associated with high triglycerides, high LDL-C, and high TC. Men were more likely than women to have a high triglycerides level and low HDL-C. Compared with people with a body mass index <25, overweight and obese subjects had greater odds of having high triglycerides, high TC, and low HDL-C. Diabetes was associated with increased odds of high triglycerides only.

CONCLUSION

The prevalence dyslipidemia is high in Jordan, which necessitates appropriate the institution of community-based intervention strategies to prevent and manage cardiovascular risk factors.

Low prevalence of atrial fibrillation in asymptomatic adults in Geneva, Switzerland

AIMS

To determine the prevalence of atrial fibrillation (AF) in a population-based sample of adults.

METHODS AND RESULTS

Between January 2005 and December 2007 individuals aged > or =50 years, residents of the city of Geneva, who had participated in a previous random survey were invited for follow-up examination. AF was assessed on a single resting 6-lead ECG. Reported prevalences were standardized for the age distribution of Canton Geneva. Overall participation was 72.8%. Twenty-nine cases of AF (22 men) were diagnosed among 3285 subjects (1696 men). The crude prevalence of AF (95% CI) was 0.88% (0.86, 0.90) overall, but higher in men [1.30% (1.26, 1.34)] than in women [0.44% (0.41, 0.47)]. The age-standardized AF prevalence was slightly higher [overall: 0.94% (0.91, 0.97), men: 1.23% (1.19, 1.27), women: 0.54% (0.47, 0.61)]. AF prevalence increased with age in both sexes. A 'history of suspected arterial embolism' (brain or legs) was higher in the AF cases (10.3 vs. 3.3%; P = 0.03).

CONCLUSION

This population-based survey of a general Swiss population indicates that the prevalence of AF remains below 1%. These results are less alarming than those from previous studies based on patients seeking medical care.

Wine in moderation: how could and should recentin vitroandin vivodata be interpreted?

In Australia, death from cardiovascular diseases accounts for approximately 25% of all deaths. Epidemiological data suggest that the moderate consumption of alcoholic beverages may significantly reduce the risk of death from cardiovascular disease and indeed from all causes. Data also suggest that the ethanol component common to all alcoholic beverages confers primarily this protection and other data suggests that the wine-specific polyphenolic compounds confer additional protective effects. Is the amount and pattern of consumption really relevant? In vitro and in vivo studies have been undertaken recently, the results of which have both weakened and strengthened the traditional arguments cited on the type, amount and pattern of the consumption of alcoholic beverages. For example, the components of wine may act in concert rather than individually for cancer and cardioprotection, and more rather than less may be required for activity. This paper reviews relevant studies and evaluates critically their results, putting them in context with actual dietary practices rather than guidelines and policies.

End-digits preference for self-reported height depends on language

Background

When individuals report figures, they often prefer to round to specific end-digits (e.g. zero). Such preference has been found in reports of body weight, cigarette consumption or blood pressure measurements. Very little is known about self-reported body height. End-digit preference can distort estimates of prevalence and other statistical parameters. This study examines end-digit preference for self-reported height and how it relates with sex, age, educational level or cultural affiliation.

Methods

We analysed reports of height of 47,192 individuals (aged 15 years or older) living in Switzerland and participating in one of the three population-based Swiss Health Surveys carried out in 1992/93, 1997 and 2002 respectively. Digit preferences were analysed by sex, age group, educational level, survey, smoking status, interview language (only for Swiss nationals) and nationality. Adjusted odds ratios (OR) with 95% confidence interval were calculated by using multivariate logistic regression.

Results

Italian and French nationals (44.1% and 40.6%) and Italian and French Swiss (39.6% and 35.3%) more strongly preferred zero and five than Germans and German Swiss (29.2% and 30.3%). Two, four, six and eight were more popular in Germans and German Swiss (both 44.4%). Compared to German Swiss (OR = 1), for the end-digits zero and five, the OR were 1.50 (1.38–1.63) for Italian Swiss and 1.24 (1.18–1.30) for French Swiss; 1.73 (1.58–1.89) for Italian nationals and 1.61 (1.33–1.95) for French nationals. The end-digits two, four, six and eight showed an opposite pattern.

Conclusion

Different preferences for end-digits depending on language and nationality could be observed consistently in all three national health surveys. The patterns were strikingly similar in Swiss and foreign nationals speaking the same language, suggesting that preferences were specific to language rather than to nationality. Taking into account rounding preferences could allow more valid comparisons in analyses of self-reported data originating from different cultures.

The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty

Background

Frailty is a relatively new geriatric concept referring to an increased vulnerability to stressors. Various definitions have been proposed, as well as a range of multidimensional instruments for its measurement. More recently, a frailty phenotype that predicts a range of adverse outcomes has been described. Understanding frailty is a particular challenge both from a clinical and a public health perspective because it may be a reversible precursor of functional dependence. The Lausanne cohort Lc65+ is a longitudinal study specifically designed to investigate the manifestations of frailty from its first signs in the youngest old, identify medical and psychosocial determinants, and describe its evolution and related outcomes.

Methods/Design

The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934–1938) in the non-institutionalized population of Lausanne (Switzerland). The baseline data collection was completed among 1422 participants in 2004–2005 through questionnaires, examination and performance tests. It comprised a wide range of medical and psychosocial dimensions, including a life course history of adverse events. Outcomes measures comprise subjective health, limitations in activities of daily living, mobility impairments, development of medical conditions or chronic health problems, falls, institutionalization, health services utilization, and death. Two additional random samples of 65–70 years old subjects will be surveyed in 2009 (birth year 1939–1943) and in 2014 (birth year 1944–1948).

Discussion

The Lc65+ study focuses on the sequence "Determinants → Components → Consequences" of frailty. It currently provides information on health in the youngest old and will allow comparisons to be made between the profiles of aging individuals born before, during and at the end of the Second World War.

The CoLaus study: a population-based study to investigate the epidemiology and genetic determinants of cardiovascular risk factors and metabolic syndrome

Background

Cardiovascular diseases and their associated risk factors remain the main cause of mortality in western societies. In order to assess the prevalence of cardiovascular risk factors (CVRFs) in the Caucasian population of Lausanne, Switzerland, we conducted a population-based study (Colaus Study). A secondary aim of the CoLaus study will be to determine new genetic determinants associated with CVRFs.

Methods

Single-center, cross-sectional study including a random sample of 6,188 extensively phenotyped Caucasian subjects (3,251 women and 2,937 men) aged 35 to 75 years living in Lausanne, and genotyped using the 500 K Affymetrix chip technology.

Results

Obesity (body mass index ≥ 30 kg/m²), smoking, hypertension (blood pressure ≥ 140/90 mmHg and/or treatment), dyslipidemia (high LDL-cholesterol and/or low HDL-cholesterol and/or high triglyceride levels) and diabetes (fasting plasma glucose ≥ 7 mmol/l and/or treatment) were present in 947 (15.7%), 1673 (27.0%), 2268 (36.7%), 2113 (34.2%) and 407 (6.6%) of the participants, respectively, and the prevalence was higher in men than in women. In both genders, the prevalence of obesity, hypertension and diabetes increased with age.

Conclusion

The prevalence of major CVRFs is high in the Lausanne population in particular in men. We anticipate that given its size, the depth of the phenotypic analysis and the availability of dense genome-wide genetic data, the CoLaus Study will be a unique resource to investigate not only the epidemiology of isolated, or aggregated CVRFs like the metabolic syndrome, but can also serve as a discovery set, as well as replication set, to identify novel genes associated with these conditions.

High prevalence of major cardiovascular risk factors in first-degree relatives of individuals with familial premature coronary artery disease--the GENECARD project

BACKGROUND

Hypertension, hypercholesterolemia, obesity and smoking are highly prevalent among patients with familial premature coronary artery disease (FP-CAD). Whether these risk factors equally affect other family members remains unknown.

METHODS

We examined 222 FP-CAD patients, 158 unaffected sibs, 197 offspring and 94 spouses in 108 FP-CAD families (> or = 2 sibs having survived CAD diagnosed before age 51 (M)/56 (F)), and compared them to population controls.

RESULTS

Unaffected sibs had a higher prevalence of hypertension (49% versus 24%, p<0.001), hypercholesterolemia (47% versus 34%, p=0.002), abdominal obesity (35% versus 24%, p=0.006) and smoking (39% versus 24%, p=0.001) than population controls. Offspring had a higher prevalence of hypertension (females), hypercholesterolemia and abdominal obesity than population controls. No difference was observed between spouses and controls. Compared to unaffected sibs, FP-CAD affected sibs had a similar risk factor profile, except for smoking, which was more prevalent (76% versus 39%, p=0.008).

CONCLUSIONS

Hypertension, obesity and hypercholesterolemia are highly prevalent among first-degree relatives, but not spouses, of patients with FP-CAD. These persons deserve special medical attention due to their familial/genetic susceptibility to atherogenic metabolic abnormalities. In these families, smoking may be the trigger for FP-CAD.

Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: results of the Swiss SAPALDIA study

BACKGROUND

Impaired renal function is evolving as an independent marker of the risk of cardiovascular morbidity and mortality. Little is known about the prevalence of impaired renal function and its relationship to cardiovascular risk factors in the Swiss general population.

METHODS

SAPALDIA comprises a random sample of the Swiss population established in 1991, originally to investigate the health effects of long-term exposure to air pollution. Participants were reassessed in 2002/3 and blood measurements were obtained (n = 6317). Renal function was estimated using the Cockcroft-Gault equation and the modified MDRD (four-component) equation incorporating age, race, gender and serum creatinine level.

RESULTS

The estimated prevalence of impaired renal function [estimated glomerular filtration rate <60 ml/min/1.73 m(2)] differed substantially between men and women, particularly at higher ages, and amounted to 13% [95% confidence interval (CI) 10-16%] and 36% (95% CI 32-40%) in men and women, respectively, of 65 years or older. Smoking, obesity, blood lipid levels, high systolic blood pressure and hyperuricaemia were all more common in men when compared with women. These cardiovascular risk factors were also associated independently with creatinine in both women and men. Women were less likely to receive cardiovascular drugs, in particular angiotensin-converting enzyme inhibitors and beta-blockers, when compared with men of the same age.

CONCLUSION

Moderate renal impairment seems to be prevalent in the general population, with an apparent excess in females which is not explained by conventional cardiovascular risk factors. The unexpected finding questions the validity of the prediction equations, in particular in females.

Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project

OBJECTIVE

To explore the relationship between hypercholesterolaemia, age and BMI among females and males.

DESIGN

Population-based cross-sectional survey.

SUBJECTS

The data came from the initial surveys of the WHO MONICA Project. In all, 27 populations with 48 283 subjects (24 017 males and 24 266 females) aged 25-64 y were used for the analysis.

MEASUREMENTS

Total cholesterol, weight, height, BMI, prevalence of hypercholesterolaemia (PHC) defined as cholesterol >/=6.5 mmol/l, and the prevalence of obesity (POB) defined as BMI >/=30 kg/m(2).

RESULTS

PHC increased with age, with PHC in males being significantly higher than in females at age range 25-49 y and significantly lower than in females at age range 50-64 y. Age-related increase in hypercholesterolaemia was steeper in females than in males. There was a statistically significant positive association between hypercholesterolaemia and BMI. Multiple logistic regression analysis revealed a negative statistically significant (P<0.001) effect modification involving age and BMI on the risk of having hypercholesterolaemia both in females and males. The relation between PHC and BMI became weaker in higher age groups, with no statistically significant association in females aged 50-64 y.

CONCLUSION

Public health measures should be directed at the prevention of obesity in young adults since the strongest effect of obesity on the risk of hypercholesterolaemia has been found in subjects aged 25-39 y.

Binary classification of dyslipidemia from the waist-to-hip ratio and body mass index: a comparison of linear, logistic, and CART models

Background

We sought to improve upon previously published statistical modeling strategies for binary classification of dyslipidemia for general population screening purposes based on the waist-to-hip circumference ratio and body mass index anthropometric measurements.

Methods

Study subjects were participants in WHO-MONICA population-based surveys conducted in two Swiss regions. Outcome variables were based on the total serum cholesterol to high density lipoprotein cholesterol ratio. The other potential predictor variables were gender, age, current cigarette smoking, and hypertension. The models investigated were: (i) linear regression; (ii) logistic classification; (iii) regression trees; (iv) classification trees (iii and iv are collectively known as "CART"). Binary classification performance of the region-specific models was externally validated by classifying the subjects from the other region.

Results

Waist-to-hip circumference ratio and body mass index remained modest predictors of dyslipidemia. Correct classification rates for all models were 60–80%, with marked gender differences. Gender-specific models provided only small gains in classification. The external validations provided assurance about the stability of the models.

Conclusions

There were no striking differences between either the algebraic (i, ii) vs. non-algebraic (iii, iv), or the regression (i, iii) vs. classification (ii, iv) modeling approaches. Anticipated advantages of the CART vs. simple additive linear and logistic models were less than expected in this particular application with a relatively small set of predictor variables. CART models may be more useful when considering main effects and interactions between larger sets of predictor variables.

The associations between blood lipids and the Food Guide Pyramid: findings from the Third National Health and Nutrition Examination Survey

BACKGROUND

Dietary recommendations are based on nutrients, foods, and food groups, but the relationship between the Food Guide Pyramid (FGP) food groups and serum lipids has not been studied.

METHODS

NHANES III data were obtained for US adults who met the following criteria: aged 20-59 years, reliable participant, and typical 24-h recall. We examined whether serum lipids (serum total cholesterol (STC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triacylglycerol) were related to FGP food group intake (dairy, fruit, grain, meat, and vegetable).

RESULTS

A sample of 9111 participants qualified for this analysis. Fruit intakes were inversely related to STC, HDL-C, and LDL-C (P = 0.012, P = 0.001, and P = 0.014, respectively) and directly related to triacylglycerol levels (P = 0.003). Grain intake was inversely associated with both STC and HDL-C (P = 0.020 and P = 0.000). Dairy and meat intakes were directly related to LDL-C (P = 0.026 and P = 0.020).

CONCLUSIONS

Food groups are related to serum lipids. Universal definitions for food groups are needed in research and nutrition education. Studying the relationships between food groups and serum lipids is important for future dietary recommendations related to serum lipids.

Seroepidemiology of Herpes Simplex virus type 1 and 2 in Western and Southern Switzerland in adults aged 25-74 in 1992-93: a population-based study

Background

Genital herpes is one of the most prevalent sexually-transmitted diseases, and accounts for a substantial morbidity. Genital herpes puts newborns at risk for very severe disease and also increases the risk of horizontal HIV transmission. It thus stands as an important public health problem. The recent availability of type-specific gG-based assays detecting IgG against HSV-1 and HSV-2 allows to establish the prevalence of each subtype. Worldwide, few data have been published regarding the seroprevalence in general populations of HSV-2, the major causative agent for genital herpes, while no data exist regarding the Swiss population.

Methods

To evaluate the prevalence of IgG antibodies against HSV-1 and HSV-2 in Switzerland, we used a population-based serum repository from a health examination survey conducted in the Western and Southern area of Switzerland in 1992–93. A total of 3,120 sera were analysed by type-specific gG-based ELISA and seroprevalence was correlated with available volunteers characteristics by logistic regression.

Results

Overall, seroprevalence rates were 80.0 ± 0.9% (SE, 95% CI: 78.1–81.8) for HSV-1 and 19.3 ± 0.9% (SE, 95% CI: 17.6–21.1) for HSV-2 in adults 35–64 year old. HSV-1 and HSV-2 seroprevalence increased with age, with a peak HSV-2 seroprevalence in elderly gentlemen, possibly a seroarcheological evidence of sexually transmitted disease epidemics during World War II. Risk factors for HSV-2 infection included female sex, marital status other than married, and size of town of residence larger than 1500 inhabitants. Unexpectedly and conversely to HSV-1, HSV-2 seroprevalence increased with educational level. HSV-2 infection was less prevalent among HSV-1 infected individuals when compared to HSV-1 uninfected individuals. This effect was most apparent among women at high risk for HSV-2 infection.

Conclusions

Our data demonstrate that by the early nineties, HSV-2 had spread quite largely in the Swiss population. However, the epidemiology of HSV-2 in Switzerland presents paradoxical characteristics, e.g. positive correlation with education level, that have not been observed elsewhere.

Cardiovascular risk factor profiles and their social gradient from adolescence to age 74 in a Swiss region

BACKGROUND

Few European studies have investigated how cardiovascular risk factors (CRF) in adults relate to those observed in younger generations.

OBJECTIVE

To explore this issue in a Swiss region using two population health surveys of 3636 adolescents ages 9-19 years and 3299 adults ages 25-74 years.

METHODS

Age patterns of continuous CRF were estimated by robust locally weighted regression and those of high-risk groups were calculated using adult criteria with appropriate adjustment for children.

RESULTS

Gender differences in height, weight, blood pressure, and HDL cholesterol observed in adults were found to emerge in adolescents. Overweight, affecting 10-12% of adolescents, was increasing steeply in young adults (three times among males and twice among females) in parallel with inactivity. Median age at smoking initiation was decreasing rapidly from 18 to 20 years in young adults to 15 in adolescents. A statistically significant social gradient in disfavor of the lower education level was observed for overweight in all age groups of women above 16 (odds ratios (ORs) 2.4 to 3.3, P < 0.01), for inactivity in adult males (ORs 1.6 to 2.0, P < 0.05), and for regular smoking in older adolescents (OR 1.9 for males, 2.7 for females, P < 0.005), but not for elevated blood pressure.

CONCLUSION

Discontinuities in the cross-sectional age patterns of CRF indicated the emergence of a social gradient and the need for preventive actions against the early adoption of persistent unhealthy behaviors, to which low-educated girls and women are particularly exposed.

Contribution of major cardiovascular risk factors to familial premature coronary artery disease: the GENECARD project

OBJECTIVES

This study was designed to assess the prevalence of major cardiovascular risk factors in familial premature coronary artery disease (P-CAD), affecting two or more siblings within one sibship.

BACKGROUND

Premature CAD has a genetic component. It remains to be established whether familial P-CAD is due to genes acting independently from major cardiovascular risk factors.

METHODS

We recruited 213 P-CAD survivors from 103 sibships diagnosed before age <or=50 (men) or <or=55 (women) years old. Hypertension, hypercholesterolemia, obesity, and smoking were documented at the time of the event in 163 patients (145 men and 18 women). Each patient was compared with two individuals of the same age and gender, diagnosed with sporadic (nonfamilial) P-CAD, and three individuals randomly sampled from the general population.

RESULTS

Compared with the general population, patients with sporadic P-CAD had a higher prevalence of hypertension (29% vs. 14%, p < 0.001), hypercholesterolemia (54% vs. 33%, p < 0.001), obesity (20% vs. 13%, p < 0.01), and smoking (76% vs. 39%, p < 0.001). These risk factors were equally or even more prevalent in patients with familial P-CAD (43% [p < 0.05 vs. sporadic P-CAD], 58% [p = 0.07], 21% and 72%, respectively). Overall, only 7 (4%) of 163 of patients with familial P-CAD and 22 (7%) of 326 of patients with sporadic P-CAD had none of these conditions, as compared with 167 (34%) of 489 patients in the general population.

CONCLUSIONS

Classic, remediable risk factors are highly prevalent in patients with familial P-CAD. Accordingly, a major contribution of genes acting in the absence of these risk factors is unlikely.

Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries

BACKGROUND

Obesity is increasing worldwide because developing countries are adopting Western high-fat foods and sedentary lifestyles. In parallel, in many of them, hypertension is rising more rapidly, particularly with age, than in Western countries.

OBJECTIVE

To assess the relationship between adiposity and blood pressure (BP) in a developing country with high average BP (The Seychelles, Indian Ocean, population mainly of African origin) in comparison to a developed country with low average BP (Switzerland, population mainly of Caucasian origin).

DESIGN

Cross-sectional health examination surveys based on population random samples.

SETTING

The main Seychelles island (Mahé) and two Swiss regions (Vaud-Fribourg and Ticino).

SUBJECTS

Three thousand one hundred and sixteen adults (age range 35-64) untreated for hypertension.

MEASUREMENTS

Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), systolic and diastolic blood pressure (SBP and DBP, mean of two measures).

METHODS

Scatterplot smoothing techniques and gender-specific linear regression models.

RESULTS

On average, SBP and DBP were found to increase linearly over the whole variation range of BMI, WHR and WC. A modest, but statistically significant linear association was found between each indicator of adiposity and BP levels in separate regression models controlling for age. The regression coefficients were not significantly different between the Seychelles and the two Swiss regions, but were generally higher in women than in men. For the latter, a gain of 1.7 kg/m(2) in BMI, of 4.5 cm in WC or of 3.4% in WHR corresponded to an elevation of 1 mmHg in SBP. For women, corresponding figures were 1.25 kg/m(2), 2.5 cm and 1.8% respectively. Regression coefficients for age reflected a higher effect of this variable on both SBP and DBP in the Seychelles than in Switzerland.

CONCLUSION

These findings suggest a stable linear relation of adiposity with BP, independent of age and body fat distribution, across developed and developing countries. The more rapid increase of BP with age observed in the latter countries are likely to reflect higher genetic susceptibility and/or higher cumulative exposure to another risk factor than adiposity.

Leanness and squamous cell oesophageal cancer

BACKGROUND

Squamous cell oesophageal cancer is one of the few neoplasms inversely related to body mass index (BMI). However, it is not clear whether this is due to cancer-related weight loss or to other correlates of leanness.

PATIENTS AND METHODS

395 incident, histologically confirmed cases of squamous cell oesophageal cancer and 1,066 controls, admitted for acute, non-neoplastic diseases, in Italy and Switzerland. Odds ratios (ORs) were derived from multiple logistic regression, including terms for education, tobacco. alcohol, non-alcohol energy, fruit and vegetable intake.

RESULTS

The ORs for the lowest vs. the highest quartile of BMI in the year before diagnosis were 2.0 in men, 1.6 in women, and 1.9 (95% confidence interval: 1.3-2.9) in both sexes combined. The association with leanness was stronger in heavy smokers, but was not accounted for by smoking and drinking, nor by differences in diet. Weight change in the decade prior to diagnosis showed no linear association with risk. However, cases were not leaner than controls at age 30 (OR = 0.6 for the lowest BMI quartile) and 50 (OR = 1.1).

CONCLUSIONS

Leanness appears to be an indicator of squamous cell oesophageal carcinogenesis. However, low BMI in the distant past was unrelated to oesophageal cancer risk.

Non-Linear trends in the blood pressure of Japanese adults

Hypertension is one of the risk factors for the development of coronary artery disease as well as stroke. The National Nutrition Survey shows that the systolic and diastolic blood pressures of Japanese adults have decreased over time. These trends have plateaued during the last decade. We investigated national trends in blood pressure (BP) levels during these 10 years by plotting the relation between the mean BP levels during year t, BP(t), and those of the following year, BP(t+1). When we plotted the systolic BP levels of Japanese men and women aged 15 to 80 years, the trace revolved clockwise, with cycles of 4 to 5 years. The approximate center of the circular trace corresponding to data for 1985 through 1990 was at 134 mmHg in men and 129 mmHg in women, and the approximate center of a smaller circle was at 135 mmHg in men and 130 mmHg in women, respectively. In addition, with respect to the data for Japanese men in their 60s, the mean systolic BP level decreased linearly from 1982 to 1986, whereas it seemed to generate 4 circles after 1986. The approximate center of the first circle was 146 mmHg in the men. The center of the second circle was 145 mmHg and that of the third circle was 144 mmHg. Plotting of the data for Japanese women of the same age group yielded the same number of circles as the data for men. Our method of documenting changes in the mean BP levels in Japanese adults provided information about a chaotic oscillation that occurred in the populations we studied. The centers of Lorenz-plotted circles may thus provide essential information about trends in the BP levels in these populations.