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Niedermayer F, Schauberger G, Rathmann W, Klug SJ, Thorand B, Peters A, Rospleszcz S. Clusters of longitudinal risk profile trajectories are associated with cardiometabolic diseases: Results from the population-based KORA cohort. PLoS One 2024; 19:e0300966. [PMID: 38547172 PMCID: PMC10977748 DOI: 10.1371/journal.pone.0300966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Multiple risk factors contribute jointly to the development and progression of cardiometabolic diseases. Therefore, joint longitudinal trajectories of multiple risk factors might represent different degrees of cardiometabolic risk. METHODS We analyzed population-based data comprising three examinations (Exam 1: 1999-2001, Exam 2: 2006-2008, Exam 3: 2013-2014) of 976 male and 1004 female participants of the KORA cohort (Southern Germany). Participants were followed up for cardiometabolic diseases, including cardiovascular mortality, myocardial infarction and stroke, or a diagnosis of type 2 diabetes, until 2016. Longitudinal multivariate k-means clustering identified sex-specific trajectory clusters based on nine cardiometabolic risk factors (age, systolic and diastolic blood pressure, body-mass-index, waist circumference, Hemoglobin-A1c, total cholesterol, high- and low-density lipoprotein cholesterol). Associations between clusters and cardiometabolic events were assessed by logistic regression models. RESULTS We identified three trajectory clusters for men and women, respectively. Trajectory clusters reflected a distinct distribution of cardiometabolic risk burden and were associated with prevalent cardiometabolic disease at Exam 3 (men: odds ratio (OR)ClusterII = 2.0, 95% confidence interval: (0.9-4.5); ORClusterIII = 10.5 (4.8-22.9); women: ORClusterII = 1.7 (0.6-4.7); ORClusterIII = 5.8 (2.6-12.9)). Trajectory clusters were furthermore associated with incident cardiometabolic cases after Exam 3 (men: ORClusterII = 3.5 (1.1-15.6); ORClusterIII = 7.5 (2.4-32.7); women: ORClusterII = 5.0 (1.1-34.1); ORClusterIII = 8.0 (2.2-51.7)). Associations remained significant after adjusting for a single time point cardiovascular risk score (Framingham). CONCLUSIONS On a population-based level, distinct longitudinal risk profiles over a 14-year time period are differentially associated with cardiometabolic events. Our results suggest that longitudinal data may provide additional information beyond single time-point measures. Their inclusion in cardiometabolic risk assessment might improve early identification of individuals at risk.
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Affiliation(s)
- Fiona Niedermayer
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Neuherberg, Germany
- Department for Biometrics and Epidemiology, German Diabetes Research Institute, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Stefanie J. Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Neuherberg, Germany
| | - Annette Peters
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Susanne Rospleszcz
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK), Munich Heart Alliance, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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2
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Leiherer A, Brozek W, Muendlein A, Ulmer H, Saely CH, Fraunberger P, Nagel G, Zitt E, Drexel H, Concin H. The value of earlier-in-life systolic and diastolic blood pressure for cardiovascular risk prediction. iScience 2024; 27:109097. [PMID: 38384855 PMCID: PMC10879708 DOI: 10.1016/j.isci.2024.109097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/20/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
Blood pressure (BP) varies over a lifetime. This cardiovascular observation study (OS) compared the predictive value of earlier- and later-in-life blood pressure (BP) in 1,497 cardiovascular disease patients utilizing readings taken during a health survey (HS) and 15 years later from the same subjects at the baseline of this OS. Prediction of the cardiovascular risk during the OS follow-up (21 years) was significantly more effective if the earlier BP readings at HS were used instead of recent OS readings (NRI = 0.30, p < 0.001). For HS readings, each 10 mm Hg increase of systolic and diastolic BP was associated with a 17% and 20% higher risk, respectively. At OS, systolic BP lost significance and diastolic BP reversed its association. Noteworthy, different BP categorizations (European vs. US guidelines) yielded similar results. This study highlights the poor predictive power of BP readings in elderly cardiovascular disease patients but emphasizes the significant prognostic value of earlier-in-life BP.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
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3
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von Falkenhausen AS, Freudling R, Waldenberger M, Gieger C, Peters A, Müller-Nurasyid M, Kääb S, Sinner MF. Common electrocardiogram measures are not associated with telomere length. Aging (Albany NY) 2022; 14:5620-5627. [PMID: 35787517 PMCID: PMC9365565 DOI: 10.18632/aging.204149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
AIMS Aging is accompanied by telomere shortening. Increased telomere shortening is considered a marker of premature aging. Cardiac aging results in the development of cardiac pathologies. Electrocardiogram (ECG) measures reflect cardiac excitation, conduction, and repolarization. ECG measures also prolong with aging and are associated with cardiac pathologies including atrial fibrillation. As premature prolongation of ECG measures is observed, we hypothesized that such prolongation may be associated with telomere length. METHODS AND RESULTS We studied the large, community-based KORA F4 Study. Of 3,080 participants enrolled between 2006 and 2007 with detailed information on demographic, anthropometric, clinical, and ECG characteristics, 2,575 presented with available data on leukocyte telomere length. Telomere length was determined by real-time quantitative PCR and expressed relative to a single copy gene. We fitted multivariable adjusted linear regression models to associate the ECG measures RR-interval, PR-interval, QRS-duration, and heart rate corrected QTc with telomere length. In our cohort, the mean age was 54.9±12.9 years and 46.6% were men. Increased age was associated with shorter telomere length (p<0.01), and men had shorter telomere length than women (p<0.05). In unadjusted models, heart rate (p=0.023), PR-interval (p<0.01), and QTc-interval (p<0.01) were significantly associated with shorter telomere length. However, no significant associations remained after accounting for age, sex, and covariates. CONCLUSIONS ECG measures are age-dependent, but not associated with shortened telomere length as a marker of biological aging. Further research is warranted to clarify if shortened telomeres are associated with clinical cardiac pathologies including atrial fibrillation.
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Affiliation(s)
- Aenne S von Falkenhausen
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Rebecca Freudling
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Waldenberger
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christian Gieger
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany.,Pettenkofer School of Public Health Munich, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany
| | - Stefan Kääb
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz F Sinner
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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4
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Guardino CE, Pan S, Vasan RS, Xanthakis V. Multi-system trajectories and the incidence of heart failure in the Framingham Offspring Study. PLoS One 2022; 17:e0268576. [PMID: 35617332 PMCID: PMC9135195 DOI: 10.1371/journal.pone.0268576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart failure is a multi-system disease, with non-cardiac systems playing a key role in disease pathogenesis. OBJECTIVE Investigate whether longitudinal multi-system trajectories incrementally predict heart failure risk compared to single-occasion traits. METHODS We evaluated 3,412 participants from the Framingham Heart Study Offspring cohort, free of heart failure, who attended examination cycle 5 and at least one examination between 1995-2008 (mean age 67 years, 54% women). We related trajectories for the following organ systems and metabolic functions to heart failure risk using Cox regression: kidney (estimated glomerular filtration rate), lung (forced vital capacity and the ratio of forced expiratory volume in one second/forced vital capacity), neuromotor (gait time), muscular (grip strength), cardiac (left ventricular mass index and heart rate), vascular function (pulse pressure), cholesterol (ratio of total/high-density lipoprotein), adiposity (body mass index), inflammation (C-reactive protein) and glucose homeostasis (hemoglobin A1c). Using traits selected via forward selection, we derived a trajectory risk score and related it to heart failure risk. RESULTS We observed 276 heart failure events during a median follow up of 10 years. Participants with the 'worst' multi-system trajectory profile had the highest heart failure risk. A one-unit increase in the trajectory risk score was associated with a 2.72-fold increase in heart failure risk (95% CI 2.21-3.34; p<0.001). The mean c-statistics for models including the trajectory risk score and single-occasion traits were 0.87 (95% CI 0.83-0.91) and 0.83 (95% CI 0.80-0.86), respectively. CONCLUSION Incorporating multi-system trajectories reflective of the aging process may add incremental information to heart failure risk assessment when compared to using single-occasion traits.
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Affiliation(s)
- Cara E. Guardino
- Division of Cardiology, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island, United States of America
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Section of Cardiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vanessa Xanthakis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
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5
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Marín-Jiménez N, Cruz-León C, Perez-Bey A, Conde-Caveda J, Grao-Cruces A, Aparicio VA, Castro-Piñero J, Cuenca-García M. Predictive Validity of Motor Fitness and Flexibility Tests in Adults and Older Adults: A Systematic Review. J Clin Med 2022; 11:jcm11020328. [PMID: 35054020 PMCID: PMC8779466 DOI: 10.3390/jcm11020328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Motor fitness and flexibility have been linked to several health issues. We aimed to investigate the predictive validity of motor fitness and flexibility tests in relation to health outcomes in adults and older adults. Web of Science and PubMed databases were screened for studies published from inception to November 2020. Two authors systematically searched, evaluated, and extracted data from identified original studies and systematic reviews/meta-analysis. Three levels of evidence were constructed: strong, moderate, and limited/inconclusive evidence. In total, 1182 studies were identified, and 70 studies and 6 systematic reviews/meta-analysis were summarized. Strong evidence indicated that (i) slower gait speed predicts falls and institutionalization/hospitalization in adults over 60 years old, cognitive decline/impairment over 55 years old, mobility disability over 50 years old, disability in instrumental activities of daily living (IADL) over 54 years old, cardiovascular disease risk over 45 years old, and all-cause mortality over 35 years old; (ii) impaired balance predicts falls and disability in IADL/mobility disability in adults over 40 years old and all-cause mortality over 53 years old; (iii) worse timed up&go test (TUG) predicts falls and fear of falling over 40 years old. Evidence supports that slower gait speed, impaired balance, and worse TUG performance are significantly associated with an increased risk of adverse health outcomes in adults.
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Affiliation(s)
- Nuria Marín-Jiménez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Carolina Cruz-León
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Alejandro Perez-Bey
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
- Correspondence: ; Tel.: +34-65-7588624
| | - Julio Conde-Caveda
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Alberto Grao-Cruces
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Virginia A. Aparicio
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix Verdú”, University of Granada, 18071 Granada, Spain;
- Sport and Health University Research Centre, University of Granada, 18007 Granada, Spain
| | - José Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Magdalena Cuenca-García
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
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Stevens D, Lane DA, Harrison SL, Lip GYH, Kolamunnage-Dona R. Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review. BMC Med Res Methodol 2021; 21:283. [PMID: 34922465 PMCID: PMC8684210 DOI: 10.1186/s12874-021-01472-x] [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] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The identification of methodology for modelling cardiovascular disease (CVD) risk using longitudinal data and risk factor trajectories. METHODS We screened MEDLINE-Ovid from inception until 3 June 2020. MeSH and text search terms covered three areas: data type, modelling type and disease area including search terms such as "longitudinal", "trajector*" and "cardiovasc*" respectively. Studies were filtered to meet the following inclusion criteria: longitudinal individual patient data in adult patients with ≥3 time-points and a CVD or mortality outcome. Studies were screened and analyzed by one author. Any queries were discussed with the other authors. Comparisons were made between the methods identified looking at assumptions, flexibility and software availability. RESULTS From the initial 2601 studies returned by the searches 80 studies were included. Four statistical approaches were identified for modelling the longitudinal data: 3 (4%) studies compared time points with simple statistical tests, 40 (50%) used single-stage approaches, such as including single time points or summary measures in survival models, 29 (36%) used two-stage approaches including an estimated longitudinal parameter in survival models, and 8 (10%) used joint models which modelled the longitudinal and survival data together. The proportion of CVD risk prediction models created using longitudinal data using two-stage and joint models increased over time. CONCLUSIONS Single stage models are still heavily utilized by many CVD risk prediction studies for modelling longitudinal data. Future studies should fully utilize available longitudinal data when analyzing CVD risk by employing two-stage and joint approaches which can often better utilize the available data.
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Affiliation(s)
- David Stevens
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK. .,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ruwanthi Kolamunnage-Dona
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
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7
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Lin CC, Li CI, Liu CS, Lin CH, Lin WY, Wang MC, Yang SY, Li TC. Three-year trajectories of metabolic risk factors predict subsequent long-term mortality in patients with type 2 diabetes. Diabetes Res Clin Pract 2021; 179:108995. [PMID: 34363863 DOI: 10.1016/j.diabres.2021.108995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
AIM This study aims to evaluate the associations between 3-year trajectories of metabolic risk factors and subsequent mortality in patients with type 2 diabetes. METHODS A total of 6400 persons aged ≥ 30 years with type 2 diabetes and ≥ 3 years of follow-up period were included. The cluster analysis determined the patterns of 3-year trajectories, and Cox proportional hazards models evaluated the associations between patterns and mortality. RESULTS Three trajectory subgroups of metabolic risk factors, namely, cluster 1, normal; cluster 2, high-stable or reducing with high level at baseline; and cluster 3, fluctuation: elevated and decreasing, were generated. The clusters 2 and 3 of body mass index (BMI), fasting plasma glucose (FPG), HbA1c, and triglyceride (TG) trajectories were associated with increased risks of all-cause mortality compared with cluster 1 (hazard ratio = 1.27, 95% confidence interval = 1.06-1.51 and 1.45, 1.19-1.78 for BMI; 1.41, 1.22-1.62 and 1.81, 1.38-2.38 for FPG; 1.42, 1.23-1.64 and 1.47, 1.23-1.75 for HbA1c; 1.34, 1.10-1.63 and 2.40, 1.30-4.37 for TG, respectively). For the systolic blood pressure trajectory, only cluster 3 was associated with an increased mortality risk relative to cluster 1 (1.76, 1.13-2.77). CONCLUSIONS Long-term metabolic risk factor trajectories may be associated with subsequent mortality.
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Affiliation(s)
- Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mu-Cyun Wang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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8
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Castro-Piñero J, Marin-Jimenez N, Fernandez-Santos JR, Martin-Acosta F, Segura-Jimenez V, Izquierdo-Gomez R, Ruiz JR, Cuenca-Garcia M. Criterion-Related Validity of Field-Based Fitness Tests in Adults: A Systematic Review. J Clin Med 2021; 10:jcm10163743. [PMID: 34442050 PMCID: PMC8397016 DOI: 10.3390/jcm10163743] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022] Open
Abstract
We comprehensively assessed the criterion-related validity of existing field-based fitness tests used to indicate adult health (19–64 years, with no known pathologies). The medical electronic databases MEDLINE (via PubMed) and Web of Science (all databases) were screened for studies published up to July 2020. Each original study’s methodological quality was classified as high, low and very low, according to the number of participants, the description of the study population, statistical analysis and systematic reviews which were appraised via the AMSTAR rating scale. Three evidence levels were constructed (strong, moderate and limited evidence) according to the number of studies and the consistency of the findings. We identified 101 original studies (50 of high quality) and five systematic reviews examining the criterion-related validity of field-based fitness tests in adults. Strong evidence indicated that the 20 m shuttle run, 1.5-mile, 12 min run/walk, YMCA step, 2 km walk and 6 min walk test are valid for estimating cardiorespiratory fitness; the handgrip strength test is valid for assessing hand maximal isometric strength; and the Biering–Sørensen test to evaluate the endurance strength of hip and back muscles; however, the sit-and reach test, and its different versions, and the toe-to-touch test are not valid for assessing hamstring and lower back flexibility. We found moderate evidence supporting that the 20 m square shuttle run test is a valid test for estimating cardiorespiratory fitness. Other field-based fitness tests presented limited evidence, mainly due to few studies. We developed an evidence-based proposal of the most valid field-based fitness tests in healthy adults aged 19–64 years old.
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Affiliation(s)
- Jose Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Nuria Marin-Jimenez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
- Correspondence: ; Tel.: +34-956-016-253
| | - Jorge R. Fernandez-Santos
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Fatima Martin-Acosta
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Victor Segura-Jimenez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Rocio Izquierdo-Gomez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Jonatan R. Ruiz
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, School of Sports Science, University of Granada, 18007 Granada, Spain;
| | - Magdalena Cuenca-Garcia
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Avenida República Saharaui s/n, Puerto Real, 11519 Cádiz, Spain; (J.C.-P.); (J.R.F.-S.); (F.M.-A.); (V.S.-J.); (R.I.-G.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), 11009 Cádiz, Spain
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Talegawkar SA, Jin Y, Kandula NR, Kanaya AM. Associations between Cumulative Biological Risk and Subclinical Atherosclerosis in Middle- and Older-Aged South Asian Immigrants in the United States. JOURNAL OF ASIAN HEALTH 2021; 1:e202104. [PMID: 35510154 PMCID: PMC9062994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The aim of this study was to investigate associations between cumulative biological risk and subclinical atherosclerosis in South Asian immigrants. METHODS Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, including 858 participants at baseline (mean age = 56 [standard deviation = 9] years, 46% women). A cumulative biological risk score was derived using nine biomarkers across cardiovascular, immune, and metabolic systems with a possible score range of 0-9. Common and internal carotid artery intima media thickness (CIMT) and coronary artery calcium (CAC) were used as indicators of subclinical atherosclerosis. RESULTS Higher cumulative biological risk score was significantly associated with higher common and internal CIMT and higher odds of CAC at baseline. The odds of new CAC after 5 years of follow-up were 31% higher per 1-point increase in cumulative biological risk score, and the higher cumulative biological risk score was also associated with CAC progression. CONCLUSIONS Among South Asian immigrants, cumulative biological risk was directly associated with subclinical atherosclerosis and its progression.
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Affiliation(s)
- Sameera A. Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Yichen Jin
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Namratha R. Kandula
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alka M. Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA
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