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Vila MDM, Igual L, Remeseiro B, Elosua R, Ramos R, Valdivielso JM, Martí-Lluch R, Marrugat J, Grau M. Polyvascular Subclinical Atherosclerosis: Correlation Between Ankle Brachial Index and Carotid Atherosclerosis in a Population-Based Sample. Angiology 2022; 74:443-451. [PMID: 35758047 DOI: 10.1177/00033197221110720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We assessed the correlation between the biomarkers of lower limb atherosclerosis (eg, ankle-brachial index [ABI]) and of carotid atherosclerosis (eg, common carotid intima-media thickness (IMT) and presence of atherosclerotic plaque) in a population-based cohort from Girona (Northwest Spain) recruited in 2010. Ankle-brachial index and carotid ultrasound were performed in all participants. Generalized additive multivariable models were used to adjust a regression model of common carotid IMT on ABI. Logistic regression multivariable models were adjusted to assess the probability of carotid plaque in individuals with peripheral artery disease. We included 3307 individuals (54.2% women), mean age 60 years (standard deviation 11). Two patterns of association were observed between subclinical biomarkers of atherosclerosis at the lower limb and carotid artery. Ankle-brachial index and common carotid IMT showed a linear trend in men [beta coefficient (95% confidence interval) =-.068 (-.123; -.012); P = .016]. Women with peripheral artery disease presented with high risk of atherosclerotic plaque at the carotid artery [Odds ratio (95% confidence interval) = 2.61, (1.46; 4.69); P = .001]. Men showed a significant linear association between ABI levels and common carotid IMT values. Women with peripheral artery disease presented with high risk of atherosclerotic plaque at the carotid artery.
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Affiliation(s)
- Maria Del Mar Vila
- Consortium for Biomedical Research - Cardiovascular Diseases (CIBERCV), Barcelona, Spain.,16551IMIM - Hospital del Mar Health Research Institute, Barcelona, Spain.,Department of Mathematics and Computer Science, 16724University of Barcelona, Spain
| | - Laura Igual
- Department of Mathematics and Computer Science, 16724University of Barcelona, Spain
| | - Beatriz Remeseiro
- Department of Computer Science, 16763University of Oviedo, Gijón, Spain
| | - Roberto Elosua
- Consortium for Biomedical Research - Cardiovascular Diseases (CIBERCV), Barcelona, Spain.,16551IMIM - Hospital del Mar Health Research Institute, Barcelona, Spain.,Faculty of Medicine, University of Vic - Central University of Catalunya, Vic, Spain
| | - Rafel Ramos
- 203271University Institute for Primary Health Care Research Jordi Gol (IDIAP Jordi Gol), Girona, Spain.,Vascular Health Research Group, Research Unit in Primary Care, Catalan Institute of Health, Girona, Spain.,Girona Biomedical Research Institute (IdIBGi), Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Jose M Valdivielso
- Vascular and Renal Translational Research Group and Unit for Detection and Treatment of Cardiovascular Diseases (UDETMA). Biomedical Research Institute (IRBLleida), Lleida, Spain
| | - Ruth Martí-Lluch
- 203271University Institute for Primary Health Care Research Jordi Gol (IDIAP Jordi Gol), Girona, Spain.,Vascular Health Research Group, Research Unit in Primary Care, Catalan Institute of Health, Girona, Spain
| | - Jaume Marrugat
- Consortium for Biomedical Research - Cardiovascular Diseases (CIBERCV), Barcelona, Spain.,16551IMIM - Hospital del Mar Health Research Institute, Barcelona, Spain
| | - Maria Grau
- 16551IMIM - Hospital del Mar Health Research Institute, Barcelona, Spain.,Serra-Hunter Fellow, Department of Medicine, School of Medicine and Health Sciences, 16724University of Barcelona, Barcelona, Spain.,Consortium for Biomedical Research - Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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2
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Yamasaki S, Tomihara T, Kimura G, Ueno Y, Ketema RM, Sato S, Mukai Y, Sikder T, Kurasaki M, Hosokawa T, Saito T. Long-term effects of maternal resveratrol intake during lactation on cholesterol metabolism in male rat offspring. Int J Food Sci Nutr 2019; 71:226-234. [PMID: 31290360 DOI: 10.1080/09637486.2019.1639638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Resveratrol (RSV) can protect against non-communicable diseases by improving cholesterol metabolism. However, it is unclear that effects of maternal RSV intake on health of adult offspring. In this study, we examined effects of maternal RSV intake during lactation on cholesterol metabolism in adult male rat offspring. Female Wistar rats were fed a control diet (CON) supplemented with or without RSV (20 mg/kg body weight/day) during their lactation period. Male offspring were weaned onto a standard diet and maintained on this diet for 36 weeks. As a result, plasma cholesterol level significantly decreased in RSV offspring compared to CON offspring. Furthermore, a decrease in hepatic 3-hydroxy-3-methylglutaryl-CoA reductase level and an increase in hepatic LDL-receptor level were observed in the RSV offspring. These results indicate that maternal RSV intake causes long-term decrease in plasma cholesterol level in the offspring through suppression of hepatic cholesterol biosynthesis and promotion of hepatic cholesterol uptake.
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Affiliation(s)
- Shojiro Yamasaki
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomomi Tomihara
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Goh Kimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yukako Ueno
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Shin Sato
- Department of Nutrition, Aomori University of Health and Welfare, Aomori, Japan
| | - Yuuka Mukai
- Faculty of Health and Social Work, Kanagawa University of Human Services, Yokosuka, Japan
| | - Tajuddin Sikder
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Masaaki Kurasaki
- Faculty of Environmental Earth Science, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Hosokawa
- Institute for the Advancement of Higher Education, Hokkaido University, Sapporo, Japan
| | - Takeshi Saito
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.,Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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3
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Mate Redondo C, Rodríguez-Pérez MC, Domínguez Coello S, Pedrero García AJ, Marcelino Rodríguez I, Cuevas Fernández FJ, Almeida González D, Brito Díaz B, Rodríguez Esteban M, Cabrera de León A. Mortalidad hospitalaria de 415.798 pacientes con IAM: 4 años antes en Canarias que en el conjunto de España. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Al Tunaiji H, Davis JC, Mansournia MA, Khan KM. Population attributable fraction of leading non-communicable cardiovascular diseases due to leisure-time physical inactivity: a systematic review. BMJ Open Sport Exerc Med 2019; 5:e000512. [PMID: 31191969 PMCID: PMC6539142 DOI: 10.1136/bmjsem-2019-000512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this systematic review was to investigate the methods used for estimating the population attributable fraction (PAF) to leisure-time physical inactivity (PI) of coronary artery diseases, hypertension and stroke in order to provide the best available estimate for PAF. Design Systematic review. Data sources Four electronic databases (MEDLINE/PubMed, EMBASE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2018. Eligibility criteria for selecting studies This review included prospective cohort studies, with men and women aged ≥18 years old, investigating the PAF attributable to leisure-time PI related to coronary artery diseases, hypertension and stroke. Results The PAF estimates of the three studies included were 13% (3%–22%) for ‘stage-1 hypertension’ subtype incidence due to ‘non-regular exercise’; 25% (10.4%–35.8%) for ‘stage-2 hypertension’ subtype incidence due to ‘activity of daily living’ and ‘vigorous-intensity sports’; and 8.5% (1.7%–16.7%) for ‘total: fatal and non-fatal’ cardiovascular events of ‘incidence and mortality’ endpoints due to non-accumulation of 550 kcal/week (subsets not specified). Conclusions The PAF estimate exhibited a protective dose–response relationship between hypertension and an increased amount of energy expenditure of leisure-time PI. In order to enhance accuracy of PAF estimates, the following steps are recommended: (1) to clearly define and state the working definition of leisure-time PI and dose using a reliable and valid objective measurement tool; (2) use a clear definition of outcome subtypes and endpoints using reliable and valid objective measures; and (3) estimate PAF using modelling techniques based on prospective data and ensuring to report 95% CI.
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Affiliation(s)
- Hashel Al Tunaiji
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada.,Sport Medicine & Sciences Unit, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Karim M Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada
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Félix-Redondo FJ, Lozano Mera L, Alvarez-Palacios Arrighi P, Grau Magana M, Ramírez-Romero JM, Fernández-Bergés D. [Impact of cardiovascular risk factors in the Extremadura population: HERMEX cohort contributions for a preventive strategy]. Aten Primaria 2019; 52:3-13. [PMID: 30638699 PMCID: PMC6938985 DOI: 10.1016/j.aprim.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. METHODS Design, Cohort study. LOCATION Representative population sample of a health area of Extremadura (Spain) PARTICIPANTS: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. MEASUREMENTS Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. OUTCOME VARIABLE First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. RESULTS 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). CONCLUSIONS Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy.
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Affiliation(s)
| | - Luis Lozano Mera
- Centro de Salud Urbano I, Servicio Extremeño de Salud, Mérida, Badajoz, España
| | - Paula Alvarez-Palacios Arrighi
- Unidad de Investigación Área de Salud Don Benito-Villanueva de la Serena. FUNDESALUD, Villanueva de la Serena, Badajoz, España
| | | | | | - Daniel Fernández-Bergés
- Unidad de Investigación Área de Salud Don Benito-Villanueva de la Serena. FUNDESALUD, Villanueva de la Serena, Badajoz, España
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6
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Mate Redondo C, Rodríguez-Pérez MC, Domínguez Coello S, Pedrero García AJ, Marcelino Rodríguez I, Cuevas Fernández FJ, Almeida González D, Brito Díaz B, Rodríguez Esteban M, Cabrera de León A. Hospital Mortality in 415 798 AMI Patients: 4 Years Earlier in the Canary Islands Than in the Rest of Spain. ACTA ACUST UNITED AC 2018; 72:466-472. [PMID: 30042007 DOI: 10.1016/j.rec.2018.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Canary Islands has the highest mortality from diabetes in Spain. The aim of this study was to determine possible differences in mortality due to acute myocardial infarction (AMI) during hospital admission between this autonomous community and the rest of Spain, as well as the factors associated with this mortality and the population fraction attributable to diabetes. METHODS Cross-sectional study of hospital admissions for AMI in Spain from 2007 to 2014, registered in the Minimum Basic Data Set. RESULTS A total of 415 798 AMI were identified. Canary Island patients (16 317) were younger than those living in the rest of Spain (63.93 ± 13.56 vs 68.25 ± 13.94; P < .001) and death occurred 4 years earlier in the archipelago (74.03 ± 11.85 vs 78.38 ± 11.10; P < .001). This autonomous community had the highest prevalence of smoking (44% in men and 23% in women); throughout Spain, AMI occurred 13 years earlier in smokers than in nonsmokers. Patients in the Canary Islands had the highest mortality rates whether they had diabetes (8.7%) or not (7.6%), and they also showed the highest fraction of AMI mortality attributable to diabetes (9.4; 95%CI, 4.8-13.6). After adjustment for type of AMI, diabetes, dyslipidemia, hypertension, smoking, cocaine use, renal failure, sex and age, the Canary Islands showed the highest risk of mortality vs the rest of Spain (OR = 1.25; 95%CI, 1.17-1.33; P < .001) and it was one of the autonomous communities showing no significant improvement in the risk of mortality due to AMI during the study period. CONCLUSIONS Mortality due to AMI during hospital admission is higher in the Canary Islands than in the rest of Spain.
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Affiliation(s)
- Carmen Mate Redondo
- Servicio de Medicina Preventiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - María Cristo Rodríguez-Pérez
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Santiago Domínguez Coello
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Arturo J Pedrero García
- Servicio de Medicina Preventiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Itahisa Marcelino Rodríguez
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Francisco J Cuevas Fernández
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Delia Almeida González
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Buenaventura Brito Díaz
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Marcos Rodríguez Esteban
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Antonio Cabrera de León
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
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7
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Ikeda K, Sawada M, Morioka H, Kyuzen M, Ebina J, Nagasawa J, Yanagihashi M, Miura K, Ishikawa Y, Hirayama T, Takazawa T, Kano O, Kawabe K, Iwasaki Y. Clinical Profile and Changes of Serum Lipid Levels in Epileptic Patients after Cerebral Infarction. J Stroke Cerebrovasc Dis 2016; 26:644-649. [PMID: 27939141 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/23/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Antiepileptic drugs (AEDs) may increase development of dyslipidemia and cerebrovascular disease (CVD). We examined the clinical profile and changes of serum lipid levels after AED monotherapy in patients with poststroke epilepsy (PSE) after cerebral infarction (CI). SUBJECTS AND METHODS Medical records were reviewed in consecutive 2144 CI patients. Monotherapy of valproate, carbamazepine (CBZ), phenytoin (PHT), zonisamide, levetiracetam, or lamotrigine was performed in PSE patients. Serum lipid levels were measured before and at 3 months after AED treatment. RESULTS The prevalence of PSE was 7.0% in CI patients. The TOAST etiology disclosed large-artery atherosclerosis in 68 patients (45%), cardioembolism in 63 patients (42%), and undetermined cause in 19 patients (13%). CVD risk profile showed obesity of 18 patients (12%), current smoker of 30 patients (20%), hypertension of 75 patients (50%), diabetes mellitus of 32 patients (21%), dyslipidemia of 15 patients (10%), and atrial fibrillation of 63 patients (42%). CBZ or PHT administration increased serum total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) levels significantly compared to baseline and AED-untreated controls. Those levels were not increased significantly in other AED and control groups. Serum high-density lipoprotein-cholesterol and triglyceride levels did not differ statistically in all groups. CONCLUSIONS The prevalence of post-CI epilepsy was 7.0%. The pathogenesis contributed to atherothrombosis and cardioembolism. CBZ or PHT administration increased serum TC and LDL-C significantly. Thus, we should pay more attention to serum lipid levels in patients receiving cytochrome P450 (CYP)-induced AEDs, and might considerer switching to non-CYP-induced AEDs in patients with unfavorable serum lipid changes.
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Affiliation(s)
- Ken Ikeda
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
| | - Masahiro Sawada
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Harumi Morioka
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Maya Kyuzen
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junya Ebina
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junpei Nagasawa
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Masaru Yanagihashi
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Ken Miura
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takehisa Hirayama
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takanori Takazawa
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kiyokazu Kawabe
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yasuo Iwasaki
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
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Vyas MV, Davidson BA, Escalaya L, Costella J, Saposnik G, Burneo JG. Antiepileptic drug use for treatment of epilepsy and dyslipidemia: Systematic review. Epilepsy Res 2015; 113:44-67. [DOI: 10.1016/j.eplepsyres.2015.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/16/2015] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
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Sugiyama D, Okamura T, Watanabe M, Higashiyama A, Okuda N, Nakamura Y, Hozawa A, Kita Y, Kadota A, Murakami Y, Miyamatsu N, Ohkubo T, Hayakawa T, Miyamoto Y, Miura K, Okayama A, Ueshima H. Risk of hypercholesterolemia for cardiovascular disease and the population attributable fraction in a 24-year Japanese cohort study. J Atheroscler Thromb 2014; 22:95-107. [PMID: 25185893 DOI: 10.5551/jat.25908] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS The population-attributable fraction (PAF) is an indicator of the disease burden. In Western countries, the PAF of hypercholesterolemia in cardiovascular disease (CVD) is the highest among that for traditional risk factors; however, data for Asian populations are limited. METHODS A 24-year cohort study was conducted among 9,209 randomly selected participants who were not taking statins. We estimated the hazard ratio (HR) after adjusting for covariates and PAF associated with the serum total cholesterol (TC) levels in relation to CVD mortality. RESULTS The TC level was found to be positively associated with an increased risk of CVD, coronary heart disease (CHD) and cardiac death (CHD plus heart failure), with an HR of 1.08 (95% confidence interval [CI]: 1.00-1.16), 1.33 (95% CI: 1.14-1.55) and 1.21 (95% CI: 1.08-1.35) for a 1-SD increment in the serum TC level, respectively. Similar positive associations between the TC level and both CHD and cardiac death were observed after classifying the patients by age and sex. Furthermore, the highest serum TC level (≥ 6.72 mmol/L) was positively associated with CVD death, with an HR of 1.76 (95% CI: 1.25-2.47), as well as both CHD death and cardiac death. In contrast, no significant relationships were observed between the serum TC level and stroke. Meanwhile, the PAF for CVD, CHD, and cardiac deaths due to hypercholesterolemia (serum TC level ≥ 5.69 mmol/L, defined by the Japan Atherosclerosis Society) was 1.7%, 10.6% and 5.6%, respectively. CONCLUSIONS The estimated PAF of CVD death due to hypercholesterolemia is moderately high, but lower than that for other risk factors, such as hypertension.
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Affiliation(s)
- Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
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Wu TW, Chan HL, Hung CL, Lu IJ, Wang SD, Wang SW, Wu YJ, Wang LY, Yeh HI, Wei YH. Differential patterns of effects of age and sex on metabolic syndrome in Taiwan: implication for the inadequate internal consistency of the current criteria. Diabetes Res Clin Pract 2014; 105:239-44. [PMID: 24933651 DOI: 10.1016/j.diabres.2014.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 04/02/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
AIMS Current criteria of metabolic syndrome (MetS) give equal weight to each component and apply mostly the same cut-off values to all ages. The contribution of each component to MetS and the effects of age and sex on each component and MetS were explored. METHODS We carried out a survey on residents aged 40-74 years of the northern coastal area of Taiwan. The prevalent rates of MetS in 646 males and 961 females were 32.4% and 27.8%, respectively. Logistic regression analyses were used to assess the main and interactive effects of age and sex. The Cronbach's α coefficient was calculated as the indicator of internal consistency of MetS components. RESULTS There were significant age trends for MetS components, except for low HDL-C in both sexes and high fasting triglyceride in males. Logistic regression analyses showed that the effects of age and sex on MetS and its component were all different. The age-sex-specific Cronbach's α coefficients for MetS ranged from 0.43 to 0.61. The age trends of the coefficients in males and females were opposite. The exclusion of some components from the MetS resulted in an increase of the coefficients. CONCLUSIONS Our results indicate that the internal consistency of MetS was questionable. It seems that the currently defined MetS components of MetS did not formulate a single pathophysiological entity. Given equal weight to each component and used the same cut-off values for the subjects of all age groups in both sexes need to be reconsidered.
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Affiliation(s)
- Tzu-Wei Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Hsin-Lung Chan
- Department of Healthcare Center, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Chung-Lieh Hung
- Department of Cardiology, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - I-Jung Lu
- Department of Leisure and Recreation Management, Chihlee Institute of Technology, New Taipei City, Taiwan
| | - Shwun-De Wang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Shih-Wei Wang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yih-Jer Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Cardiology, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Li-Yu Wang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan.
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Cardiology, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Yau-Huei Wei
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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11
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Grau M, Subirana I, Vila J, Elosua R, Ramos R, Sala J, Dégano IR, Tresserras R, Bielsa O, Marrugat J. Validation of a population coronary disease predictive system: the CASSANDRA model. J Epidemiol Community Health 2014; 68:1012-9. [PMID: 24619990 DOI: 10.1136/jech-2013-203516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The use of validated multivariate cardiovascular predictive models in a population setting is of interest for public health policy makers. We aimed to validate the estimations of the CASSANDRA model (coronary heart disease (CHD) incidence and CHD risk distribution), considering the population changes in age, sex and CHD risk factors prevalence in a 10-year period. METHODS We compared the projected CHD incidence estimated with CASSANDRA with that observed in the Girona Heart Registry (REGICOR) for 1995-2004 and 2000-2009 in the population of Girona (Spain) aged 35-74 years. We used official age and sex distributions for this population. Baseline cardiovascular risk factors prevalence and the distribution of cardiovascular risk were obtained from three cross-sectional studies performed in 1995, 2000 and 2005. To validate the future distribution of cardiovascular risk, we tested the yearly CHD risk variance over the study period. RESULTS No significant differences between the estimated and observed annual CHD incidence per 100 000 men were found in 1995-2004 (CASSANDRA=457.8 and REGICOR=420.3, incidence rate ratio (IRR) (95% CI)=0.92 (0.89 to 0.96)) and in 2000-2009 (441.4 and 409.6, respectively, IRR=0.93 (0.90 to 0.96)). However, overpredictions of 18% and 22%, respectively, were observed in women (198.8 and 160.4, IRR=0.82 (0.77 to 0.86), and 197.1 and 152.8, IRR=0.78 (0.74 to 0.83), respectively). No significant differences were found in the CHD risk variance in the three different cross-sectional studies. CONCLUSIONS The CASSANDRA model produces valid estimates, particularly in men, of the future burden of disease and in the distribution of cardiovascular risk in individuals aged 35-74 years.
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Affiliation(s)
- Maria Grau
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Isaac Subirana
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Joan Vila
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Rafel Ramos
- Docent and Research Unit of Family Medicine, IDIAP Jordi Gol (University Institute in Primary Care Research Jordi Gol), Girona, Spain Departament of Medicine, University of Girona, Girona, Spain
| | - Joan Sala
- Cardiology Unit, University Hospital Josep Trueta, Girona, Spain
| | - Irene R Dégano
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Oscar Bielsa
- Department of Urology, Hospital del Mar, Barcelona, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Félix-Redondo FJ, Grau M, Baena-Díez JM, Dégano IR, de León AC, Guembe MJ, Alzamora MT, Vega-Alonso T, Robles NR, Ortiz H, Rigo F, Mayoral-Sanchez E, Tormo MJ, Segura-Fragoso A, Fernández-Bergés D. Prevalence of obesity and associated cardiovascular risk: the DARIOS study. BMC Public Health 2013; 13:542. [PMID: 23738609 PMCID: PMC3695785 DOI: 10.1186/1471-2458-13-542] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 05/29/2013] [Indexed: 12/28/2022] Open
Abstract
Background To estimate the prevalence of overweight and obesity in the Spanish population as measured with body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) and to determine the associated cardiovascular risk factors. Methods Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. Participants aged 35–74 years were asked about the history of cardiovascular diseases, hypertension, diabetes and hypercholesterolemia. Height, weight, WC, blood pressure, glycaemia, total cholesterol, low-density and high-density lipoprotein cholesterol and coronary risk were measured. The prevalence of overweight (BMI 25–29.9 kg/m2), general obesity (BMI ≥30 kg/m2), suboptimal WC (≥ 80 cm and < 88 in women, ≥ 94 and < 102 in men), abdominal obesity (WC ≥88 cm ≥102 cm in women and men, respectively) and WHtR ≥0.5 was estimated, standardized for the European population. Results We included 28,743 individuals. The prevalence of overweight and suboptimal WC was 51% and 30% in men and 36% and 22% in women, respectively; general obesity was 28% in both sexes and abdominal obesity 36% in men and 55% in women. The prevalence of WHtR ≥0.5 was 89% and 77% in men and women, respectively. All cardiovascular risk factors were significantly associated with abnormal increased values of BMI, WC and WHtR. Hypertension showed the strongest association with overweight [OR = 1.99 (95% confidence interval 1.81-2.21) and OR = 2.10 (1.91-2.31)]; suboptimal WC [OR = 1.78 (1.60-1.97) and OR = 1.45 (1.26-1.66)], with general obesity [OR = 4.50 (4.02-5.04), and OR = 5.20 (4.70-5.75)] and with WHtR ≥0.5 [OR = 2.94 (2.52-3.43), and OR = 3.02 (2.66-3.42)] in men and women respectively, besides abdominal obesity in men only [OR = 3.51 (3.18-3.88)]. Diabetes showed the strongest association with abdominal obesity in women [OR = 3,86 (3,09-4,89). Conclusions The prevalence of obesity in Spain was high. Overweight, suboptimal WC, general, abdominal obesity and WHtR ≥0.5 was significantly associated with diabetes, hypertension, hypercholesterolemia and coronary risk. The use of lower cut-off points for both BMI and particularly WC and could help to better identify the population at risk and therefore achieve more effective preventive measures.
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Affiliation(s)
| | - María Grau
- Grupo de Epidemiología y Genética Cardiovascular, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
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Davin C, Vollenweider P, Waeber G, Paccaud F, Marques-Vidal P. Cardiovascular risk factors attributable to obesity and overweight in Switzerland. Nutr Metab Cardiovasc Dis 2012; 22:952-958. [PMID: 21478001 DOI: 10.1016/j.numecd.2011.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 12/07/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Obesity increases the risk for cardiovascular risk factors (CVRFs), including hypertension, dyslipidaemia and type 2 diabetes. In this study, we assessed the burden of overweight and obesity on CVRFs in Switzerland, using Swiss-specific population attributable fractions (PAFs). METHODS AND RESULTS The number of cases of CVRFs that could have been prevented if the increase in overweight and obesity in Switzerland had been contained was estimated using gender-specific, age- and smoking-adjusted PAFs for overweight and obesity. PAFs were estimated from the Swiss Health Survey 2007 (self-reported) and the CoLaus study (measured) data. PAFs from self-reported were lower than from measured data. Using measured data, overweight and obesity contributed to 38% of hypertension cases in men (32% in women). In men, overweight had a larger impact than obesity (22.2% and 15.6%, respectively), while the opposite was observed for women (13.6% and 18.1%, respectively). In men, 37% of dyslipidaemia (30% in women) could be attributed to overweight and obesity; overweight had a higher contribution than obesity in both sexes. In men, 57% of type 2 diabetes (62% in women) was attributable to overweight and obesity; obesity had a larger impact than overweight in both sexes. Overall, approximately 27,000 cases of type 2 diabetes, 63,000 cases of high blood pressure and 37,000 cases of dyslipidaemia could have been avoided if overweight and obesity levels were maintained at 1992 levels. CONCLUSION A large proportion of CVRFs is attributable to overweight and/or obesity and could have been prevented by containing the overweight/obesity epidemic.
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Affiliation(s)
- C Davin
- Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and Faculty of Biology and Medicine, 17 rue du Bugnon, 1005 Lausanne, Switzerland.
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Calvo-Sánchez M, Perelló R, Pérez I, Mateo MG, Junyent M, Laguno M, Blanco JL, Martínez-Rebollar M, Sánchez M, Mallolas J, Gatell JM, Domingo P, Martínez E. Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case-control studies. HIV Med 2012; 14:40-8. [PMID: 23088307 DOI: 10.1111/j.1468-1293.2012.01057.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of the study was to assess the separate contributions of smoking, diabetes and hypertension to acute coronary syndrome (ACS) in HIV-infected adults relative to uninfected adults. METHODS Two parallel case-control studies were carried out. In the first study, HIV-positive adults diagnosed with ACS between 1997 and 2009 (HIV+/ACS) were matched for age, gender and known duration of HIV infection with HIV-positive adults without ACS (HIV+/noACS), each individual in the HIV+/ACS group being matched with three individuals in the HIV+/noACS group. In the second study, each individual in the HIV+/ACS group in the first study was matched for age, gender and calendar date of ACS diagnosis with three HIV-negative individuals diagnosed with ACS between 1997 and 2009 (HIV-/ACS). Each individual in the HIV-/ACS group was then matched for age and gender with an HIV-negative adult without ACS (HIV-/noACS). After matching, the ratio of numbers of individuals in the HIV+/ACS, HIV+/noACS, HIV-/ACS and HIV-/noACS groups was therefore 1 : 3 : 3 : 3, respectively. We performed logistic regression analyses to identify risk factors for ACS in each case-control study and calculated population attributable risks (PARs) for smoking, diabetes and hypertension in HIV-positive and HIV-negative individuals. RESULTS There were 57 subjects in the HIV+/ACS group, 173 in the HIV+/noACS group, 168 in the HIV-/ACS group, and 171 in the HIV-/noACS group. Independent risk factors for ACS were smoking [odds ratio (OR) 4.091; 95% confidence interval (CI) 2.086-8.438; P < 0.0001] and a family history of cardiovascular disease (OR 7.676; 95% CI 1.976-32.168; P = 0.0003) in HIV-positive subjects, and smoking (OR 4.310; 95% CI 2.425-7.853; P < 0.0001), diabetes (OR 5.778; 95% CI 2.393-15.422; P = 0.0002) and hypertension (OR 6.589; 95% CI 3.554-12.700; P < 0.0001) in HIV-negative subjects. PARs for smoking, diabetes and hypertension were 54.35 and 30.58, 6.57 and 17.24, and 9.07 and 38.81% in HIV-positive and HIV-negative individuals, respectively. CONCLUSIONS The contribution of smoking to ACS in HIV-positive adults was generally greater than the contributions of diabetes and hypertension, and was almost twice as high as that in HIV-negative adults. Development of effective smoking cessation strategies should be prioritized to prevent cardiovascular disease in HIV-positive adults.
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Affiliation(s)
- M Calvo-Sánchez
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Bozorgmanesh M, Hadaegh F, Sheikholeslami F, Ghanbarian A, Azizi F. Shadow of diabetes over cardiovascular disease: comparative quantification of population-attributable all-cause and cardiovascular mortality. Cardiovasc Diabetol 2012; 11:69. [PMID: 22704235 PMCID: PMC3461411 DOI: 10.1186/1475-2840-11-69] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/15/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We contrasted impacts on all-cause and cardiovascular disease (CVD) mortality of diabetes vs. CVD. METHODS Among participants the Tehran lipid and glucose study aged ≥ 30 years (n = 9752), we selected those who participated in the follow-up study until 20 March 2009 (n = 8795). Complete data on covariate were available for 8, 469 participants, contributing to a 67935 person-year follow up. In the analysis of outcomes (all-cause and CVD mortality), diabetes and CVD were assessed using Cox proportional hazard regression model adjusting for established CVD risk factors. We used population attributable hazard fraction (PAHF) and rate advancement period (RAP) that expresses how much sooner a given mortality rate is reached among exposed than among unexposed individuals. RESULTS Ten percent of the participants self-reported to have pervious CVD, and diabetes was ascertained in 17% of participants at baseline examination. During a median follow-up of 9 years 386 participants died of which 184 were due to CVD. All-cause and CVD mortality rate (95% CIs) were 5.5 (5.0-6.1) and 2.6 (2.3-3.0) per 1000 person-year, respectively. The PAHF of all-cause mortality for diabetes 9.2 (7.3-11.1) was greater than the one for CVD 3.5 (1.1-5.5). RAP estimates for all-cause mortality associated with diabetes ranged from 7.4 to 8.6 years whereas the RAP estimates for all-cause mortality associated with CVD ranged from 3.1 to 4.3 years. The PAHF of CVD mortality for diabetes 9.4 (6.8-12.0) was greater than the one for CVD 4.5 (1.8-7.0). RAP estimates for CVD mortality associated with diabetes ranged from 8.2 to 9.8 years whereas the RAP estimates for CVD mortality associated with CVD ranged from 4.7 to 6.7 years. CONCLUSIONS We demonstrated that diabetes, which was shown to be keeping pace with prevalent CVD in terms of conferring excess risk of incident CVD, is currently causing more deaths in the population than does CVD.
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Affiliation(s)
- Mohammadreza Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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Lluis-Ganella C, Subirana I, Lucas G, Tomás M, Muñoz D, Sentí M, Salas E, Sala J, Ramos R, Ordovas JM, Marrugat J, Elosua R. Assessment of the value of a genetic risk score in improving the estimation of coronary risk. Atherosclerosis 2012; 222:456-63. [PMID: 22521901 DOI: 10.1016/j.atherosclerosis.2012.03.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/09/2012] [Accepted: 03/17/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association has established criteria for the evaluation of novel markers of cardiovascular risk. In accordance with these criteria, we assessed the association between a multi-locus genetic risk score (GRS) and incident coronary heart disease (CHD), and evaluated whether this GRS improves the predictive capacity of the Framingham risk function. METHODS AND RESULTS Using eight genetic variants associated with CHD but not with classical cardiovascular risk factors (CVRFs), we generated a multi-locus GRS, and found it to be linearly associated with CHD in two population based cohorts: The REGICOR Study (n=2351) and The Framingham Heart Study (n=3537) (meta-analyzed HR [95%CI]: ~1.13 [1.01-1.27], per unit). Inclusion of the GRS in the Framingham risk function improved its discriminative capacity in the Framingham sample (c-statistic: 72.81 vs.72.37, p=0.042) but not in the REGICOR sample. According to both the net reclassification improvement (NRI) index and the integrated discrimination index (IDI), the GRS improved re-classification among individuals with intermediate coronary risk (meta-analysis NRI [95%CI]: 17.44 [8.04; 26.83]), but not overall. CONCLUSIONS A multi-locus GRS based on genetic variants unrelated to CVRFs was associated with a linear increase in risk of CHD events in two distinct populations. This GRS improves risk reclassification particularly in the population at intermediate coronary risk. These results indicate the potential value of the inclusion of genetic information in classical functions for risk assessment in the intermediate risk population group.
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Prevalencia de obesidad y riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Estudio Hermex. ACTA ACUST UNITED AC 2012; 59:160-8. [DOI: 10.1016/j.endonu.2012.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/12/2012] [Accepted: 01/16/2012] [Indexed: 12/11/2022]
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Wang WS, Wahlqvist ML, Hsu CC, Chang HY, Chang WC, Chen CC. Age- and gender-specific population attributable risks of metabolic disorders on all-cause and cardiovascular mortality in Taiwan. BMC Public Health 2012; 12:111. [PMID: 22321049 PMCID: PMC3305485 DOI: 10.1186/1471-2458-12-111] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 02/10/2012] [Indexed: 11/16/2022] Open
Abstract
Background The extent of attributable risks of metabolic syndrome (MetS) and its components on mortality remains unclear, especially with respect to age and gender. We aimed to assess the age- and gender-specific population attributable risks (PARs) for cardiovascular disease (CVD)-related mortality and all-cause mortality for public health planning. Methods A total of 2,092 men and 2,197 women 30 years of age and older, who were included in the 2002 Taiwan Survey of Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH), were linked to national death certificates acquired through December 31, 2009. Cox proportional hazard models were used to calculate adjusted hazard ratios and PARs for mortality, with a median follow-up of 7.7 years. Results The respective PAR percentages of MetS for all-cause and CVD-related mortality were 11.6 and 39.2 in men, respectively, and 18.6 and 44.4 in women, respectively. Central obesity had the highest PAR for CVD mortality in women (57.5%), whereas arterial hypertension had the highest PAR in men (57.5%). For all-cause mortality, younger men and post-menopausal women had higher PARs related to Mets and its components; for CVD mortality, post-menopausal women had higher overall PARs than their pre-menopausal counterparts. Conclusions MetS has a limited application to the PAR for all-cause mortality, especially in men; its PAR for CVD mortality is more evident. For CVD mortality, MetS components have higher PARs than MetS itself, especially hypertension in men and waist circumference in post-menopausal women. In addition, PARs for diabetes mellitus and low HDL-cholesterol may exceed 20%. We suggest differential control of risk factors in different subpopulation as a strategy to prevent CVD-related mortality.
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Affiliation(s)
- Wuan-Szu Wang
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, No, 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
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Validez relativa de la estimación del riesgo cardiovascular a 10 años en una cohorte poblacional del estudio REGICOR. Rev Esp Cardiol 2011; 64:385-94. [DOI: 10.1016/j.recesp.2010.12.011] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 12/13/2010] [Indexed: 11/23/2022]
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