Height and risk of incident intraparenchymal hemorrhage: Atherosclerosis Risk in Communities and Cardiovascular Health study cohorts

Additive association of blood pressure and short stature with stroke incidence in 450,000 Japanese adults: the Shizuoka study

Short stature was suggested to be a risk factor for cardiovascular events. Because short stature increases central blood pressure, this study aimed to investigate a longitudinal association between short stature, blood pressure, and incidence of cardiovascular disease by the analysis of insurance-based real-world dataset. We analyzed data from 463,844 adults aged 40 or older with a mean age of 66.7 enrolled in National Health Insurance, excluding individuals who experienced a stroke or myocardial infarction, or required long-term care. Data from annual health checkups were used to obtain baseline clinical information. Comorbidities and incidences of stroke and myocardial infarction were obtained from the insurance data. During a 5.5-year follow-up period, we observed 11,027 cases of stroke. Adults of a short stature exhibited a higher incidence rate in both men (≤155 cm: 99.7, >175 cm: 24.4) and women (≤140 cm: 85.9, >160 cm: 13.7). Although those in the short stature group had higher blood pressure, and often took antihypertensive drugs, the inverse association between height and stroke incidence was independent of these factors (hazard ratio for 5 cm shorter in height; men: 1.06 [1.03-1.09], women: 1.11 [1.06-1.13]). Short stature and blood pressure showed additive association with stoke incidence (log-rank p < 0.001). No significant association was observed with myocardial infarction (men: 1.01 [0.95-1.06], women: 1.06 [0.98-1.14]). In a longitudinal analysis of a large general Japanese population, short stature was linked to an increased risk of stroke in both genders in any blood pressure range.

The Association Between Adult Height and Stroke Incidence in Japanese Men and Women: A Population-based Case-Control Study

BACKGROUND

No studies have examined the associations between adult height and ischemic stroke subtypes.

METHODS

We conducted a population-based case-control study that included 2,451 thrombotic and 687 embolic stroke cases, as well as 1,623 intracerebral and 768 subarachnoid hemorrhage cases without history of stroke aged 40-79 years, and the same number of sex- and age-matched controls. Cases and controls were grouped according to the quintile cut-off values of height in controls, and the third quintile, which was approximately the average height group, was used as the reference group. Height divided by one standard deviation of height in controls was also examined as a continuous variable. The analyses were carried out separately for participants aged 40-59 years and 60-79 years.

RESULTS

In both younger and older men, height was linearly inversely associated with total and thrombotic strokes, and the shortest quintile compared to the reference group was associated with increased risks of these strokes. Although height was linearly inversely associated with embolic stroke and intracerebral hemorrhage in younger men, the shortest quintile did not show increased risks of these strokes. Height did not seem to be associated with total stroke and any stroke subtypes in younger women. In contrast, the tallest quintile was significantly associated with increased risks of total stroke and intracerebral hemorrhage, and height tended to be positively associated with these strokes in older women.

CONCLUSION

We reported the associations between adult height and ischemic stroke subtypes for the first time, which differed according to sex and age group.

Evaluation of non-invasive arterial stiffness parameters and their relationship with physical activity, anthropometric indices and lipid profiles in healthy middle-aged adults: Results of the PERSIAN cohort study

BACKGROUND

Arterial stiffness (AS) indicates the initial stage of cardiovascular disease (CVD), which is associated with modifiable and lifestyle risk factors. We aimed to examine the association of AS with anthropometric indices, lipid profiles and physical activity (PA).

METHODS

Six hundred and fifty-eight healthy middle-aged adults were selected and anthropometric indices [body mass index, waist circumferences (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), neck circumferences, a body shape index (ABSI), body roundness index (BRI), body fat mass (BFM), visceral fat area, fat-free mass (FFM), lipid profiles and PA] were measured. AS is measured by carotid-femoral pulse wave velocity (cf-PWV) and central augmentation index (cAIx).

RESULTS

Our results show that cf-PWV was positively associated with TGs (β = 0.10, P = .01) and anthropometric indices correlated with WC (β = 0.11, P = .02), WHR (β = 0.09, P = .03), WHtR (β = 0.1, P = .02) and BRI (β = 0.09, P = .04). cAIx was independently positively associated with cholesterol (β = 0.08, P = .03), WC (β = 0.1, P = .03), WHR (β = 0.09, P = .02), ABSI (β = 0.09, P = .01), BRI (β = 0.08, P = .05), visceral fat area (β = 0.09, P = .03) and BFM (β = 0.08, P = .04) and negatively associated with PA (β = -0.08, P = .03).

CONCLUSIONS

WC, WHR and BRI were associated with both cf-PWV and cAIx. TGs and WHtR were associated with cf-PWV, while cAIx was associated with ABSI, improving these indices may be helpful to prevent CVD.

Association Between Intracerebral Hemorrhage and Subsequent Arterial Ischemic Events in Participants From 4 Population-Based Cohort Studies

Importance

Intracerebral hemorrhage and arterial ischemic disease share risk factors, to our knowledge, but the association between the 2 conditions remains unknown.

Objective

To evaluate whether intracerebral hemorrhage was associated with an increased risk of incident ischemic stroke and myocardial infarction.

Design, Setting, and Participants

An analysis was conducted of pooled longitudinal participant-level data from 4 population-based cohort studies in the United States: the Atherosclerosis Risk in Communities (ARIC) study, the Cardiovascular Health Study (CHS), the Northern Manhattan Study (NOMAS), and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Patients were enrolled from 1987 to 2007, and the last available follow-up was December 31, 2018. Data were analyzed from September 1, 2019, to March 31, 2020.

Exposure

Intracerebral hemorrhage, as assessed by an adjudication committee based on predefined clinical and radiologic criteria.

Main Outcomes and Measures

The primary outcome was an arterial ischemic event, defined as a composite of ischemic stroke or myocardial infarction, centrally adjudicated within each study. Secondary outcomes were ischemic stroke and myocardial infarction. Participants with prevalent intracerebral hemorrhage, ischemic stroke, or myocardial infarction at their baseline study visit were excluded. Cox proportional hazards regression was used to examine the association between intracerebral hemorrhage and subsequent arterial ischemic events after adjustment for baseline age, sex, race/ethnicity, vascular comorbidities, and antithrombotic medications.

Results

Of 55 131 participants, 47 866 (27 639 women [57.7%]; mean [SD] age, 62.2 [10.2] years) were eligible for analysis. During a median follow-up of 12.7 years (interquartile range, 7.7-19.5 years), there were 318 intracerebral hemorrhages and 7648 arterial ischemic events. The incidence of an arterial ischemic event was 3.6 events per 100 person-years (95% CI, 2.7-5.0 events per 100 person-years) after intracerebral hemorrhage vs 1.1 events per 100 person-years (95% CI, 1.1-1.2 events per 100 person-years) among those without intracerebral hemorrhage. In adjusted models, intracerebral hemorrhage was associated with arterial ischemic events (hazard ratio [HR], 2.3; 95% CI, 1.7-3.1), ischemic stroke (HR, 3.1; 95% CI, 2.1-4.5), and myocardial infarction (HR, 1.9; 95% CI, 1.2-2.9). In sensitivity analyses, intracerebral hemorrhage was associated with arterial ischemic events when updating covariates in a time-varying manner (HR, 2.2; 95% CI, 1.6-3.0); when using incidence density matching (odds ratio, 2.3; 95% CI, 1.3-4.2); when including participants with prevalent intracerebral hemorrhage, ischemic stroke, or myocardial infarction (HR, 2.2; 95% CI, 1.6-2.9); and when using death as a competing risk (subdistribution HR, 1.6; 95% CI, 1.1-2.1).

Conclusions and Relevance

This study found that intracerebral hemorrhage was associated with an increased risk of ischemic stroke and myocardial infarction. These findings suggest that intracerebral hemorrhage may be a novel risk marker for arterial ischemic events.

Novel and traditional anthropometric indices for identifying metabolic syndrome in non-overweight/obese adults

Background

Metabolic syndrome (MetS) in non-overweight/obese people is insidiously associated with cardiovascular disease. Novel anthropometric indices can reflect central obesity better than the traditional anthropometric indices. Therefore, we hypothesize that these newly developed anthropometric indices can better identify MetS in non-overweight/obese people than conventional indices.

Methods

Cross-sectional data of sociodemographic, biochemical and anthropometric indices were collected from 2916 non-overweight/obese Chinese people. A body shape index (ABSI), body roundness index (BRI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI) and abdominal volume index (AVI) were calculated. Partial correlation analysis was used to clarify the correlation between anthropometric indices and MetS variables. Binary logistic regression analysis was applied to assess the association between anthropometric indices and MetS and its components. Receiver-operating characteristic curve was used to identify the diagnostic ability of anthropometric indices for MetS and its components. The area under curve (AUC) difference between WHtR and each new anthropometric index was compared in pairs.

Results

After adjusting for covariates, AVI had the optimal ability of identifying MetS (AUC: 0.743 for male, 0.819 for female) and the strongest correlation with high-density lipoprotein cholesterol (HDL-C) (coe: − 0.227 for male, − 0.207 for female) and the highest odds rations (OR) with low HDL-C group (male: OR = 1.37, female: OR = 1.55). The WHtR was comparable to BRI in assessing MetS (AUC: 0.739 for male, 0.817 for female). WHtR or BRI could also well identify hypertension (AUC: 0.602 for male, 0.688 for female) and dysglycemia (AUC: 0.669 for male, 0.713 for female) and female’s high triglyceride level (AUC 0.712). The recognition ability of the two was equivalent. The ability of ABSI and WWI to identify MetS was weak.

Conclusions

AVI is the optimal anthropometric indices to identify MetS in non-overweight/obese Chinese adults. BRI and WHtR can also be considered as discriminators, while ABSI and WWI are weak discriminators. WHtR is easy to measure. So, it is recommended as an early preliminary screening method for the MetS in non-overweight/obese people.

Comparison of the ability to identify arterial stiffness between two new anthropometric indices and classical obesity indices in Chinese adults

BACKGROUND AND AIMS

The association between anthropometric indices of body composition and arterial stiffness is inconclusive. The objective of this study was to examine the predictive ability of two new obesity indices: a body shape index (ABSI), and a body roundness index (BRI), for the identification of arterial stiffness among Chinese adults, as well as to compare the relative strength of association between the anthropometric indices and arterial stiffness.

METHODS

A total of 10,197 subjects were recruited in this cross-sectional study. We tested the association between anthropometric indices (body mass index [BMI], waist circumference [WC], waist-height-ratio [WHtR], ABSI and BRI) and brachial-ankle pulse wave velocity (PWV). Receiver operating characteristic curve and area under curve (AUC) were employed to evaluate the predictive value of the anthropometric indices for identification of arterial stiffness.

RESULTS

After adjusting for confounding variables, BRI (linear regression: 0.112; AUC: 0.726; OR: 1.228 for female and linear regression: 0.047; AUC: 0.631; OR: 1.173 for male) exhibited a more powerful predictive ability of arterial stiffness than ABSI (linear regression: 0.110; AUC: 0.674; OR: 1.315 for female and linear regression: 0.058; AUC: 0.610; OR: 1.150 for male) and WC (linear regression: 0.078; AUC: 0.699; logistic regression: negative for female and linear regression: negative; AUC: 0.593; logistic regression: negative for male) while having a similar predictive value to that of WHtR (linear regression: 0.113; AUC: 0.726; OR: 1.228 for female and linear regression: 0.047; AUC: 0.631; OR: 1.185 for male) among both sexes. BMI (linear and logistic regression: negative; AUC: 0.660 for female and 0.568 for male) had the lowest predictive power in both sex categories. The optimal cut-off of WHtR for detecting arterial stiffness was 0.49 in females and 0.53 in males, that of BRI was 3.19 in females and 3.89 in males.

CONCLUSIONS

WHtR, ABSI and BRI were significantly associated with arterial stiffness. BRI and WHtR, rather than ABSI, showed superior predictive abilities for arterial stiffness in both sexes.

Should Blood Pressure Targets After Lacunar Stroke Vary by Body Size? The SPS3 Trial

BACKGROUND

It is unknown whether the physiological impact of a given blood pressure (BP) varies by body size. We explored interactions between higher vs. lower systolic BP (SBP) targets and anthropometric measures (body mass index (BMI), body surface area (BSA), height, weight) and recurrent stroke and death in the Secondary Prevention of Small Subcortical Strokes (SPS3) Trial.

METHODS

Patients with recent magnetic resonance imaging-proven lacunar infarcts were randomized to 2 BP targets (130-149 mm Hg vs. <130) in a prospective, open-label, blinded end-point design. Time to outcome was evaluated with Cox proportional hazard models and compared between targets. We examined multiplicative interactions between each anthropometric measure and target and mean difference in achieved BP 1 year after randomization between BP groups by quartile. We also computed rates of recurrent stroke and death by quartiles of anthropometrics.

RESULTS

Three thousand and twenty patients were followed over a mean of 3.7 (SD 2.0) years. Mean age was 63; 63% were male. Mean height was 167 (SD 11) cm, weight 81 (18) kg, BMI 29 (5.9) kg/m(2), and BSA 1.9 (0.25) m(2). Achieved BP at 1 year was comparable between quartiles for each anthropometric measurement. We found no consistent interactions between BP target and anthropometrics for either outcome, nor were there any significant associations between hazard of stroke or death when assessed by BMI, BSA, height, or weight.

CONCLUSIONS

We found no interactions between BP target groups and quartiles of anthropometrics for rates of stroke and death in SPS3. There is no evidence at this time supporting body size-based modifications to current BP targets for secondary prevention after lacunar stroke.

CLINICAL TRIALS REGISTRATION

Trial Number NCT00059306.

Relationships between age of puberty onset and height at age 18 years in girls and boys

BACKGROUND

Changes during puberty may influence final adult height. Height is related to multiple health conditions, including lung function. We investigated the association between the age of onset of five puberty events and height at age 18 years, analyzing boys and girls separately.

METHODS

Of 1456 children recruited into the Isle of Wight birth cohort (1989-1990), 1313 were followed up at age 18 years. Height was measured, and age of pubertal onset was collected at age 18 years. Cluster analysis was performed on the five puberty events in boys and girls and linear regression was applied with the clusters predicting height at age 18 years. Individual linear regression analyses assessed the age of onset of each pubertal event as a potential predictor for height at age 18 years.

RESULTS

Of the 1313 children followed up at age 18 years, 653 were males and 660 were females. All puberty variables had high internal consistency. In girls, earlier age of menarche, breast development, and growth spurt were related to shorter height. In boys, earlier age of growth spurt and slower progression through puberty were related to taller height at age 18 years.

CONCLUSIONS

Given that boys and girls may have opposing associations between pubertal timing and adult height and that height is an important predictor of lung function, the effect of pubertal timing on respiratory health should be explored.