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Wambua S, Singh M, Okoth K, Snell KIE, Riley RD, Yau C, Thangaratinam S, Nirantharakumar K, Crowe FL. Association between pregnancy-related complications and development of type 2 diabetes and hypertension in women: an umbrella review. BMC Med 2024; 22:66. [PMID: 38355631 PMCID: PMC10865714 DOI: 10.1186/s12916-024-03284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension. METHODS Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. RESULTS Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)). CONCLUSIONS GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension.
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Affiliation(s)
- Steven Wambua
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Megha Singh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kym I E Snell
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Christopher Yau
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3 Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- Health Data Research, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Pathirana MM, Lassi Z, Ali A, Arstall M, Roberts CT, Andraweera PH. Cardiovascular risk factors in women with previous gestational diabetes mellitus: A systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:729-761. [PMID: 33106997 DOI: 10.1007/s11154-020-09587-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
This systematic review and meta-analysis aimed to synthesize evidence on conventional cardiovascular disease (CVD) risk factors among women with previous Gestational Diabetes Mellitus (GDM). The review protocol is registered with PROSPERO (CRD42019118149). PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Studies reporting on CVD risk factors in women with previous GDM compared to women without previous GDM were selected. A total of 139 studies were eligible, of which 93 were included in the meta-analysis. Women with previous GDM have significantly higher systolic blood pressure (2.47 mmHg 95% CI 1.74 to 3.40, n = 48, 50,118 participants) diastolic blood pressure (1.89 mmHg 95% CI 1.32 to 2.46, n = 48, 49,495 participants), BMI (1.54 kg/m2 95% CI 1.32 to 2.46, n = 78, 255,308 participants), total cholesterol (0.26 SMD 95% CI 0.15 to 0.37, n = 48, 38,561 participants), LDL cholesterol (0.19 SMD 95% CI 0.08 to 0.30, n = 44, 16,980 participants), triglycerides (0.56 SMD 95% CI 0.42 to 0.70, n = 46, 13,175 participants), glucose (0.69 SMD 95% CI 0.56 to 0.81, n = 55, 127,900 participants), insulin (0.41 SMD 95% CI 0.23 to 0.59, n = 32, 8881 participants) and significantly lower HDL cholesterol (-0.28 SMD 95% CI -0.39 to -0.16, n = 56, 35,882 participants), compared to women without previous GDM. The increased blood pressure, total cholesterol, triglycerides and glucose are seen as early as <1 year post-partum.Women with previous GDM have a higher risk of CVD based on significant increases in conventional risk factors. Some risk factors are seen as early as <1 year post-partum. Women with GDM may benefit from early screening to identify modifiable CVD risk factors.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zohra Lassi
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Adelaide G-TRAC Centre & CRE Frailty & Healthy Ageing Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Margaret Arstall
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Prabha H Andraweera
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
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3
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Nilsen A, Hanssen TA, Lappegård KT, Eggen AE, Løchen ML, Selmer RM, Njølstad I, Wilsgaard T, Hopstock LA. Change in cardiovascular risk assessment tool and updated Norwegian guidelines for cardiovascular disease in primary prevention increase the population proportion at risk: the Tromsø Study 2015-2016. Open Heart 2021; 8:openhrt-2021-001777. [PMID: 34462328 PMCID: PMC8407203 DOI: 10.1136/openhrt-2021-001777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
Aims To compare the population proportion at high risk of cardiovascular disease (CVD) using the Norwegian NORRISK 1 that predicts 10-year risk of CVD mortality and the Norwegian national guidelines from 2009, with the updated NORRISK 2 that predicts 10-year risk of both fatal and non-fatal risk of CVD and the Norwegian national guidelines from 2017. Methods We included participants from the Norwegian population-based Tromsø Study (2015–2016) aged 40–69 years without a history of CVD (n=16 566). The total proportion eligible for intervention was identified by NORRISK 1 and the 2009 guidelines (serum total cholesterol ≥8 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg) and NORRISK 2 and the 2017 guidelines (serum total cholesterol ≥7 mmol/L, low density lipoprotein (LDL) cholesterol ≥5 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg). Results The total proportion at high risk as defined by a risk score was 12.0% using NORRISK 1 and 9.8% using NORRISK 2. When including single risk factors specified by the guidelines, the total proportion eligible for intervention was 15.5% using NORRISK 1 and the 2009 guidelines and 18.9% using NORRISK 2 and the 2017 guidelines. The lowered threshold for total cholesterol and specified cut-off for LDL cholesterol stand for a large proportion of the increase in population at risk. Conclusion The population proportion eligible for intervention increased by 3.4 percentage points from 2009 to 2017 using the revised NORRISK 2 score and guidelines.
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Affiliation(s)
- Amalie Nilsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway .,Department of Medicine, Nordlands Hospital, Bodo, Norway
| | - Tove Aminda Hanssen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.,Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Knut Tore Lappegård
- Department of Medicine, Nordlands Hospital, Bodo, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Randi Marie Selmer
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laila A Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Seematter-Bagnoud L, Santos-Eggimann B, Nanchen D, Blanco JM, Büla C, von Gunten A, Démonet JF, Henchoz Y. Older People's Health-Related Behaviors: Evidence from Three Cohorts of the Lc65+ Study. Behav Med 2021; 47:246-250. [PMID: 32078491 DOI: 10.1080/08964289.2019.1684234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Baby-boomers might be more health-conscious than earlier birth cohorts, but limited evidence has been produced so far. To investigate such changes, this study compared health-related behaviors at age 65 to 70 among three successive five-year birth cohorts (pre-war: born 1934-1938; war: born 1939-1943 and baby-boom: born 1944-1948) representative of the community-dwelling population. Information about alcohol use, smoking, physical activity, and nutrition was compared across the three cohorts (n = 4,270 participants) using Chi-squared test. Alcohol and the mean nutritional intake score did not vary across cohorts, whereas the consumption of nonalcoholic drinks increased significantly from pre-war to war and to baby-boom cohort (p<.001). Other differences across cohorts were observed only in women: the proportion of women who never or rarely engaged in sports decreased from 52.9% in the pre-war cohort to around 43% in subsequent cohorts (p<.001), while the proportion of women who had never smoked was higher in the pre-war cohort (56.1%) than in the war and the baby-boom cohorts (49.8% and 46.8%, respectively, p<.001). Overall, these results show some positive changes in older persons' health behaviors over time. Nevertheless, considerable room remains for improving lifestyles through public health interventions.
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Affiliation(s)
- Laurence Seematter-Bagnoud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne.,Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre
| | | | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Juan-Manuel Blanco
- Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre
| | - Armin von Gunten
- Service of Old-Age Psychiatry, University of Lausanne Hospital Centre
| | | | - Yves Henchoz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne
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Cham B, Scholes S, Groce NE, Badjie O, Mindell JS. High level of co-occurrence of risk factors for non-communicable diseases among Gambian adults: A national population-based health examination survey. Prev Med 2020; 141:106300. [PMID: 33121964 DOI: 10.1016/j.ypmed.2020.106300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality globally. Co-occurrence of risk factors predisposes an individual to NCDs; the burden increases cumulatively with the number of risk factors. Our study aimed to examine the co-occurrence of NCD risk factors among adults in The Gambia. This study is based on a random nationally representative sample of 4111 adults aged 25-64 years (78% response rate) with data collected between January and March 2010 in The Gambia using the WHO STEPwise survey methods. We restricted our analysis to non-pregnant participants with valid information on five NCD risk factors: high blood pressure, smoking, obesity, low fruit and vegetable consumption, and physical inactivity (n = 3000 adults with complete data on all risk factors). We conducted age-adjusted and fully-adjusted gender stratified multinomial logistic regression analysis to identify factors associated with the number of NCD risk factors. More than 90% of adults had at least one risk factor. Only 7% (95% CI: 5.2-9.8) had no risk factor; 22% (95% CI: 19.1-24.9) had at least three. Older age and ethnicity were significantly associated with having three or more risk factors (versus none) among men in the fully adjusted model. Lower education, older age, and urban residence were significantly associated with three or more risk factors (versus none) among women. The burden of NCDs is expected to increase in The Gambia if preventive and control measures are not taken. There should be an integrated approach targeting all risk factors, including wider treatment and control of hypertension.
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Affiliation(s)
- Bai Cham
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom; Department of Public Health, University of The Gambia, Brikama Campus, P.O.Box, 3530, Serrekunda, The Gambia; Disease Control and Elimination theme, Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, P.O.Box 273, Banjul, The Gambia.
| | - Shaun Scholes
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
| | - Nora E Groce
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
| | - Omar Badjie
- Non-Communicable Diseases Unit, Ministry of Health, Banjul, The Gambia
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
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6
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The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information? Nutrients 2020; 12:nu12040912. [PMID: 32230720 PMCID: PMC7230699 DOI: 10.3390/nu12040912] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022] Open
Abstract
The effects of alcohol on cardiovascular health are heterogeneous and vary according to consumption dose and pattern. These effects have classically been described as having a J-shaped curve, in which low-to-moderate consumption is associated with less risk than lifetime abstention, and heavy drinkers show the highest risk. Nonetheless, the beneficial effects of alcohol have been questioned due to the difficulties in establishing a safe drinking threshold. This review focuses on the association between alcohol consumption and cardiovascular risk factors and the underlying mechanisms of damage, with review of the literature from the last 10 years.
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Hazra NC, Rudisill C, Gulliford MC. Developing the role of electronic health records in economic evaluation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1117-1121. [PMID: 30877401 DOI: 10.1007/s10198-019-01042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Nisha C Hazra
- School of Population Health and Environmental Sciences, King's College London, London, UK.
| | - Caroline Rudisill
- Department of Health Promotion, Education and Behaviour, Arnold School of Public Health, University of South Carolina, Greenville, SC, USA
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK
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Gondek D, Bann D, Ning K, Grundy E, Ploubidis GB. Post-war (1946-2017) population health change in the United Kingdom: A systematic review. PLoS One 2019; 14:e0218991. [PMID: 31269039 PMCID: PMC6608959 DOI: 10.1371/journal.pone.0218991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 06/10/2019] [Indexed: 11/18/2022] Open
Abstract
We systematically reviewed the evidence on secular trends in main chronic conditions, disability and self-assessed general health among adults in the United Kingdom, as reported in primary/secondary care databases and population-based surveys. Searches were conducted separately for: (1) trends in age-standardised or age-specific prevalence of major non-communicable diseases, disability, and self-reported general health; (2) trends in health expectancy. The databases searched were MEDLINE, EMBASE/EMBASE Classic and Web of Science (all from 1946/7). The evidence was synthesised narratively. There were 39 studies reporting trends in prevalence of health conditions and 15 studies in health expectancy. We did not find evidence for improvement in the age-standardised or age-specific prevalence of any of the studied major chronic conditions over the last few decades, apart from Alzheimer's disease and other dementias. Both increasing or stable prevalence rates with simultaneous rising life expectancy support the expansion of morbidity theory, meaning that people are expected to spend a greater number of years with chronic condition(s). The evidence on disability-expressed as prevalence or health expectancy-was mixed, but also appeared to support the expansion of morbidity among those aged 65 or over. The evidence on trends in disability for younger age is lacking. Across the studied period (1946-2017), the UK population endured more years with chronic morbidity and disability, which may place a serious strain on the health care system, the economy and the society.
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Affiliation(s)
- Dawid Gondek
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
| | - David Bann
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
| | - Ke Ning
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
| | - Emily Grundy
- Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom
| | - George B. Ploubidis
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
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Nilsen A, Hanssen TA, Lappegård KT, Eggen AE, Løchen ML, Njølstad I, Wilsgaard T, Hopstock L. Secular and longitudinal trends in cardiovascular risk in a general population using a national risk model: The Tromsø Study. Eur J Prev Cardiol 2019; 26:1852-1861. [DOI: 10.1177/2047487319830806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Primary prevention guidelines promote the use of risk assessment tools to estimate total cardiovascular risk. We aimed to study trends in cardiovascular risk and contribution of single risk factors, using the newly developed NORRISK 2 risk score, which estimates 10-year risk of fatal and non-fatal cardiovascular events. Design Prospective population-based study. Methods We included women and men aged 45–74 years attending the sixth and seventh survey of the Tromsø Study (Tromsø 6, 2007–2008, n = 7284 and Tromsø 7, 2015–2016, n = 14,858) to study secular trends in NORRISK 2 score. To study longitudinal trends, we followed participants born 1941–1962 attending both surveys ( n = 4534). We calculated NORRISK 2 score and used linear regression models to study the relative contribution (% R2) of each single risk factor to the total score. Results Mean NORRISK 2 score decreased and distribution in risk categories moved from higher to lower risk in both sexes and all age-groups between the first and second surveys ( p < 0.001). In birth cohorts, when age was set to baseline in NORRISK 2 calculations, risk score decreased during follow-up. Main contributors to NORRISK 2 were systolic blood pressure, smoking and total cholesterol, with some sex, age and birth cohort differences. Conclusion We found significant favourable secular and longitudinal trends in total cardiovascular risk and single risk factors during the last decade. Change in systolic blood pressure, smoking and cholesterol were the main contributors to risk score change; however, the impact of single risk factors on the total score differed by sex, age and birth cohort.
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Affiliation(s)
- Amalie Nilsen
- Department of Medicine, Nordland Hospital, Bodø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tove A Hanssen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Knut T Lappegård
- Department of Medicine, Nordland Hospital, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne E Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laila Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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10
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Berkelmans GF, van der Graaf Y, Dorresteijn JA, de Borst GJ, Cramer MJ, Kappelle LJ, Westerink J, Visseren FL. Decline in risk of recurrent cardiovascular events in the period 1996 to 2014 partly explained by better treatment of risk factors and less subclinical atherosclerosis. Int J Cardiol 2018; 251:96-102. [DOI: 10.1016/j.ijcard.2017.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/01/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022]
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11
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Hazra NC, Gulliford M. Evolution of the "fourth stage" of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records. Popul Health Metr 2017; 15:18. [PMID: 28499387 PMCID: PMC5429583 DOI: 10.1186/s12963-017-0136-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/04/2017] [Indexed: 01/15/2023] Open
Abstract
Background In the “fourth stage” of epidemiological transition, the distribution of non-communicable diseases is expected to shift to more advanced ages, but age-specific changes beyond 80 years of age have not been reported. Methods This study aimed to evaluate demographic and health transitions in a population aged 80 years and over in the United Kingdom from 1990 to 2014, using primary care electronic health records. Epidemiological analysis of chronic morbidities and age-related impairments included a cohort of 299,495 participants, with stratified sampling by five-year age group up to 100 years and over. Cause-specific proportional hazards models were used to estimate hazard ratios for incidence rates over time. Results Between 1990 and 2014, nonagenarians and centenarians increased as a proportion of the over-80 population, as did the male-to-female ratio among individuals aged 80 to 95 years. A lower risk of coronary heart disease (HR 0.54, 95% confidence interval [CI]: 0.50–0.58), stroke (0.83, 0.76–0.90) and chronic obstructive pulmonary disease (0.59, 0.54–0.64) was observed among 80–84 year-olds in 2010–2014 compared to 1995–1999. By contrast, the risk of type II diabetes (2.18, 1.96–2.42), cancer (1.52, 1.43–1.61), dementia (2.94, 2.70–3.21), cognitive impairment (5.57, 5.01–6.20), and musculoskeletal pain (1.26, 1.21–1.32) was greater in 2010–2014 compared to 1995–1999. Conclusions Redistribution of the over-80 population to older ages, and declining age-specific incidence of cardiovascular and respiratory diseases in over-80s, are consistent with the “fourth stage” of epidemiologic transition, but increases in diabetes, cancer, and age-related impairment show new emerging epidemiological patterns in the senior elderly. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0136-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nisha C Hazra
- Department of Primary Care and Public Health Sciences, King's College London, 3rd Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Martin Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, 3rd Floor Addison House, Guy's Campus, London, SE1 1UL, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
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