Body height, cardiovascular risk factors, and risk of stroke in middle-aged men and women. A 14-year follow-up of the Finnmark Study

Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic Review

BACKGROUND AND OBJECTIVES

Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), locating the research in the broader context of Indigenous health.

METHODS

We identified population-based stroke incidence studies published between 1990 and 2022 among Indigenous adult populations of developed countries using PubMed, Embase, and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with fewer than 10 Indigenous people, or not covering a 35- to 64-year minimum age range. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. We assessed quality using "gold standard" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting of Indigenous health research. An Indigenous Advisory Board provided oversight for the study.

RESULTS

From 13,041 publications screened, 24 studies (19 full-text articles, 5 abstracts) from 7 countries met the inclusion criteria. Age-standardized stroke incidence rate ratios were greater in Aboriginal and Torres Strait Islander Australians (1.7-3.2), American Indians (1.2), Sámi of Sweden/Norway (1.08-2.14), and Singaporean Malay (1.7-1.9), compared with respective non-Indigenous populations. Studies had substantial heterogeneity in design and risk of bias. Attack rates, male-female rate ratios, and time trends are reported where available. Few investigators reported Indigenous stakeholder involvement, with few studies meeting any of the CONSIDER criteria for research among Indigenous populations.

DISCUSSION

In countries with a very high HDI, there are notable, albeit varying, disparities in stroke incidence between Indigenous and non-Indigenous populations, although there are gaps in data availability and quality. A greater understanding of stroke incidence is imperative for informing effective societal responses to socioeconomic and health disparities in these populations. Future studies into stroke incidence in Indigenous populations should be designed and conducted with Indigenous oversight and governance to facilitate improved outcomes and capacity building.

REGISTRATION INFORMATION

PROSPERO registration: CRD42021242367.

Population health outcomes in South Korea 1990-2019, and projections up to 2040: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

South Korea has one of the longest operating universal health coverage (UHC) systems. A comprehensive analysis of long-term trajectories of morbidity and mortality in the South Korean population after the inception of UHC is needed to inform health-care policy and practice.

METHODS

We used data from the Global Burden of Disease Study (GBD) 2019 to present estimates of cause-specific mortality, incidence, prevalence, years of life lost (YLLs), years of life lived with disability, and disability-adjusted life-years (DALYs) in South Korea from 1990 to 2019. We also examined forecasted estimates of YLLs up to 2040 to investigate likely future changes in disease burden. Finally, we evaluated GBD estimates from seven comparator countries to place disease burden in South Korea within a broader context.

FINDINGS

Age-standardised DALYs related to non-communicable diseases (NCDs) decreased by 43·6% (95% uncertainty interval [UI] 39·4-47·9) and mortality by 58·8% (55·9-60·5) from 1990 to 2019. In 2019, the ratio of male to female age-standardised rates of YLLs in South Korea was higher than the global average for 75·9% (22 of 29 diseases) of leading causes, indicating a disproportional disease burden on males in South Korea. Among risk factors, tobacco use accounted for the highest number of 2019 deaths (44 470 [95% UI 37 432-53 989]) in males and high systolic blood pressure for the highest number (21 014 [15 553-26 723]) in females. Among the top ten leading causes of YLLs forecast in South Korea in 2040, nine were NCDs, for both males and females.

INTERPRETATION

Our report shows a positive landscape of population health outcomes in South Korea following the establishment of UHC. However, due in part to the effects of population ageing driving up medical expenditures for NCDs, financial pressures and sustainability challenges associated with UHC are pressing concerns. Policy makers should work to tackle population ageing and allocate resources efficiently by prioritising interventions that address the leading causes of death and disability identified in this study.

FUNDING

Bill & Melinda Gates Foundation.

Risk factors for stroke among anthropometric indices and lipid profiles in the Korean population: a large-scale cross-sectional study

Stroke is strongly associated with death and disability. However, the associations between stroke and lipid profiles such as total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and red blood cells (RBCs) and anthropometric indices such as waist circumference and waist-to-height ratio (WHtR) remain unclear. The objective of this study was to investigate these relationships in a Korean population. This large-scale cross-sectional study included data from 38,190 subjects collected from 2010 to 2018 by the Korea National Health and Nutrition Examination Survey (KNHANES). Simple logistic regression models and multiple logistic regression models were used to evaluate the association of stroke with lipid profiles and anthropometric indices in the crude model, adjusted Model 1, and fully adjusted Model 2. In men, stroke was negatively associated with height, weight, and hematocrit level. Total cholesterol and triglycerides were strongly negatively associated with stroke in Model 2. Creatinine level and stroke were weakly associated. Additionally, height, weight, total cholesterol, triglycerides, and hematocrit and creatinine levels were associated with stroke both before and after adjustment. In women, in Model 2, stroke was positively associated with height, weight, and creatinine level. A strong negative association was found between total cholesterol and stroke. Stroke was negatively associated with hemoglobin level, hematocrit level, and RBCs. Additionally, total cholesterol, hemoglobin level, hematocrit level, creatinine level, and RBCs were associated with stroke both before and after adjustment. Weight and height were more closely associated with stroke than waist circumference and WHtR in Korean men. Our results suggested that the association of stroke with triglycerides, height, and weight differed according to sex and that HDL-C was not associated with stroke in people of either sex.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association of body mass index with outcomes in patients with newly diagnosed atrial fibrillation: GARFIELD-AF

Objective

While greater body mass index (BMI) is associated with increased risk of developing atrial fibrillation (AF), the impact of BMI on outcomes in newly diagnosed AF is unclear. We examine the influence of BMI on outcomes and whether this is modified by sex and evaluate the effect of non-vitamin K oral anticoagulants (NOACs) in patients with high BMI.

Methods

GARFIELD-AF is a prospective registry of 52 057 newly diagnosed AF patients. The study population comprised 40 482 participants: 703 underweight (BMI <18.5 kg/m²), 13 095 normal (BMI=18.5–24.9 kg/m²), 15 043 overweight (BMI=25.0–29.9 kg/m²), 7560 obese (BMI=30.0–34.9 kg/m²) and 4081 extremely obese (BMI ≥35.0 kg/m²). Restricted cubic splines quantified the association of BMI with outcomes. Comparative effectiveness of NOACs and vitamin K antagonists (VKAs) by BMI was performed using propensity score overlap-weighted Cox models.

Results

The median age of participants was 71.0 years (Q1; Q3 62.0; 78.0), and 55.6% were male. Those with high BMI were younger, more often had vascular disease, hypertension and diabetes. Within 2-year follow-up, a U-shaped relationship between BMI and all-cause mortality was observed, with BMI of ~30 kg/m² associated with the lowest risk. The association with new/worsening heart failure was similar. Only low BMI was associated with major bleeding and no association emerged for non-haemorrhagic stroke. BMI was similarly associated with outcomes in men and women. BMI did not impact the lower rate of all-cause mortality of NOACs compared with VKAs.

Conclusions

In the GARFIELD-AF registry, underweight and extremely obese AF patients have increased risk of mortality and new/worsening heart failure compared with normal or obese patients.

Taller height and risk of coronary heart disease and cancer, a within-sibship Mendelian randomization study

Background:

Taller people have a lower risk of coronary heart disease but a higher risk of many cancers. Mendelian randomization (MR) studies in unrelated individuals (population MR) have suggested that these relationships are potentially causal. However, population MR studies are sensitive to demography (population stratification, assortative mating) and familial (indirect genetic) effects.

Methods:

In this study, we performed within-sibship MR analyses using 78,988 siblings, a design robust against demography and indirect genetic effects of parents. For comparison, we also applied population MR and estimated associations with measured height.

Results:

Within-sibship MR estimated that 1 SD taller height lowers the odds of coronary heart disease by 14% (95% CI: 3–23%) but increases the odds of cancer by 18% (95% CI: 3–34%), highly consistent with population MR and height-disease association estimates. There was some evidence that taller height reduces systolic blood pressure and low-density lipoprotein cholesterol, which may mediate some of the protective effects of taller height on coronary heart disease risk.

Conclusions:

For the first time, we have demonstrated that the purported effects of height on adulthood disease risk are unlikely to be explained by demographic or familial factors, and so likely reflect an individual-level causal effect. Disentangling the mechanisms via which height affects disease risk may improve the understanding of the etiologies of atherosclerosis and carcinogenesis.

Funding:

This project was conducted by researchers at the MRC Integrative Epidemiology Unit (MC_UU_00011/1) and also supported by a Norwegian Research Council Grant number 295989.

Coronary heart disease and stroke in the Sami and non-Sami populations in rural Northern and Mid Norway-the SAMINOR Study

BACKGROUND

Previous studies have suggested that Sami have a similar risk of myocardial infarction and a higher risk of stroke compared with non-Sami living in the same geographical area.

DESIGN

Participants in the SAMINOR 1 Survey (2003-2004) aged 30 and 36-79 years were followed to the 31 December 2016 for observation of fatal or non-fatal events of acute myocardial infarction (AMI), coronary heart disease (CHD), ischaemic stroke (IS), stroke and a composite endpoint (fatal or non-fatal AMI or stroke).

AIM

Compare the risk of AMI, CHD, IS, stroke and the composite endpoint in Sami and non-Sami populations, and identify intermediate factors if ethnic differences in risks are observed.

METHODS

Cox regression models.

RESULTS

The sex-adjusted and age-adjusted risks of AMI (HR for Sami versus non-Sami 0.99, 95% CI: 0.83 to 1.17), CHD (HR 1.03, 95% CI: 0.93 to 1.15) and of the composite endpoint (HR 1.09, 95% CI: 0.95 to 1.24) were similar in Sami and non-Sami populations. Sami ethnicity was, however, associated with increased risk of IS (HR 1.36, 95% CI: 1.10 to 1.68) and stroke (HR 1.31, 95% CI: 1.08 to 1.58). Height explained more of the excess risk observed in Sami than conventional risk factors.

CONCLUSIONS

The risk of IS and stroke were higher in Sami and height was identified as an important intermediate factor as it explained a considerable proportion of the ethnic differences in IS and stroke. The risk of AMI, CHD and the composite endpoint was similar in Sami and non-Sami populations.

Short stature is associated with higher pulse wave velocity in subjects without overt cardiovascular disease

Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD.A total of 1019 subjects (48 ± 12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders.Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = -0.131, P = .003) and women (r = -0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (<50 years old) but not in older men, while group height was correlated with baPWV in older women (≥50 years old, P for trend = .014) but not in younger women.Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.

Relationships between metabolic markers and obesity measures in two populations that differ in stature-The SAMINOR Study

Background

The relationships between metabolic markers and obesity measures may differ by ethnicity, sex, and height. Questions have been posed whether these relationships differ by ethnicity in the population in Northern Norway, but this has not been explored yet.

Objectives

Investigate the relationships between metabolic markers and obesity measures in Sami and non‐Sami and explore the impact of stature.

Methods

In total, 13 921 men and women aged 30 and 36 to 79 years (22.0% Sami) from a population‐based cross‐sectional survey in Norway, the SAMINOR 1 Survey (2003‐2004, 57.2% attendance), were included. Relationships between triglycerides, high‐density lipoprotein cholesterol, glucose, systolic/diastolic blood pressure (BP), metabolic syndrome and diabetes mellitus as outcomes, and body mass index (BMI), waist circumference (WC), and waist‐to‐height ratio (WHtR), respectively, were modelled using fractional polynomial regression. Appropriate interaction analyses and adjustments were made.

Results

The non‐Sami were approximately 6 cm taller than the Sami. No interactions were found between ethnicity and obesity. At the same levels of WC, BMI, or WHtR, levels of lipids and BP differed marginally between Sami and non‐Sami, but these were eliminated by height adjustment, with one exception: At any given WC, BMI, or WHtR, Sami had approximately 1.4 mmHg (95% CI, −2.1 to −0.7) lower systolic BP than non‐Sami (P values < .001).

Conclusions

Height explained the marginal ethnic differences in metabolic markers at the same level of obesity, except for systolic BP, which was lower in Sami than in non‐Sami at any given BMI, WC, or WHtR.

Adult body height and age-related macular degeneration in healthy individuals: A nationwide population-based survey from Korea

We sought to evaluate the relationship between adult body height and risk of age-related macular degeneration (AMD) among healthy Koreans using nationwide population-based data. We analyzed data derived from the Korea National Health and Nutrition Examination Survey 2008–2011. Participants over 40 years of age were included in the sample after excluding individuals with systemic comorbidities or missing relevant data. The presence and severity of AMD were graded using fundus photographs. The relationship between body height and risk of AMD was determined using multiple logistic regression analyses. Among a total of 8,435 participants, 544 (6.45%) had AMD: 502 (5.95%) with early AMD and 42 (0.5%) with late AMD. In multivariate-adjusted analyses, taller body height was significantly associated with a lower prevalence of AMD (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.81–0.99), while body mass index (BMI) was not associated with AMD. An inverse association between body height and risk of AMD was observed most frequently in participants under 65 years of age (OR, 0.81; 95% CI, 0.70–0.94). Furthermore, body height showed an inverse association with risk of AMD among obese participants (BMI ≥25.0 kg/m²) (OR, 0.75; 95% CI, 0.60–0.93). Subgroup analysis by AMD type disclosed a significant inverse association between body height and early AMD (OR, 0.87; 95% CI, 0.79–0.97) but not late AMD. Our results suggest that shorter body height is independently associated with increased risk of AMD, especially early AMD, in a dose-response manner in people who are obese or under 65 years of age.

No additional long-term effect of group vs individual family intervention in the treatment of childhood obesity-A randomised trial

AIM

Long-term evaluations of childhood obesity treatments are needed. We examined changes in weight and cardiometabolic risk 1 year after children completed individual family or group-based weight management interventions.

METHODS

In 2009-2010, 6- to 12-year-old children with overweight or obesity from Finnmark and Troms (Norway) were recruited after media coverage and randomised to 24 months of individual family (n = 49) or group intervention (n = 48). Individual family intervention included counselling by a paediatric hospital team and a public health nurse in the local community. Group intervention included meetings with other families and a multidisciplinary hospital team, weekly physical activity sessions and a family camp. The primary outcome body mass index (BMI) and cardiometabolic risk factors were analysed 12 months after intervention.

RESULTS

From baseline to 36 months, children's BMI increased 3.0 kg/m² in individual family and 2.1 kg/m² in group intervention (between-group -0.9kg/m² , P = 0.096). Data were available from 62 children (64%). Between-group differences in C peptide (P = 0.01) were detected in favour of group intervention. Pooled data from both treatment groups showed continued decrease in BMI standard deviation score (P < 0.001).

CONCLUSION

No between-group difference in BMI was observed 12 months after intervention. Both groups combined showed sustained decrease in BMI standard deviation score.

Changes in conventional cardiovascular risk factors and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations in two population-based cross-sectional surveys: the SAMINOR Study

OBJECTIVE

To describe changes in cardiovascular risk factors and in the estimated 10-year risk of acute myocardial infarction (AMI) or cerebral stroke (CS) between SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014), and explore if these changes differed between Sami and non-Sami.

DESIGN

Two cross-sectional surveys.

SETTING

Inhabitants of rural Northern Norway.

PARTICIPANTS

Participants were aged 40-79 years and participated in SAMINOR 1 (n=6417) and/or SAMINOR 2 (n=5956).

PRIMARY OUTCOME MEASURES

Generalised estimating equation regressions with an interaction term were used to estimate and compare changes in cardiovascular risk factors and 10-year risk of AMI or CS between the two surveys and by ethnicity.

RESULTS

Mean cholesterol declined by 0.50, 0.43 and 0.60 mmol/L in women, Sami men and non-Sami men, respectively (all p<0.001). Sami men had a small decline in mean high-density lipoprotein (HDL) cholesterol and an increase in mean triglycerides (both p<0.001), whereas non-Sami showed no change in these variables. Non-Sami women had an increase in mean HDL cholesterol (p<0.001) whereas Sami women had no change. Triglycerides did not change in non-Sami and Sami women. Systolic and diastolic blood pressure declined by 3.6 and 1.0 mm Hg in women, and 3.1 and 0.7 in men, respectively (all p<0.01). Mean waist circumference increased by 6.7 and 5.9 cm in women and men, respectively (both p<0.001). The odds of being a smoker declined by 35% in women and 46% in men (both p<0.001). Estimated 10-year risk of AMI or CS decreased in all strata of sex and ethnicity (p<0.001), however, Sami women had a smaller decline than non-Sami did.

CONCLUSIONS

Independent of ethnicity, there was a decline in mean cholesterol, blood pressure, smoking, hypertension (women only) and 10-year risk of AMI or CS, but waist circumference increased. Relatively minor ethnic differences were found in changes of cardiovascular risk factors.

Greater Height Is Associated with a Larger Carotid Lumen Diameter

Background: Previous studies link tall stature with a reduced ischemic stroke risk. One theory posits that tall people have larger cerebral artery lumens and therefore have a lower plaque occlusion risk than those who are short. Previous studies have not critically evaluated the associations between height and cerebral artery structure independent of confounding factors. Methods: The hypothesis linking stature with cerebral artery lumen size was tested in 231 adults by measuring the associations between height and common carotid artery diameter (CCAD) and intima-media thickness (IMT) after controlling for recognized vascular influencing factors (e.g., adiposity, blood pressure, plasma lipids, etc.). Results: Height remained a significant CCAD predictor across all developed multiple regression models. These models predict a ~0.03 mm increase in CCAD for each 1-cm increase in height in this sample. This magnitude of CCAD increase with height represents over a 60% enlargement of the artery's lumen area across adults varying in stature from short (150 cm) to tall (200 cm). By contrast, IMT was non-significantly correlated with height across all developed regression models. Conclusions: People who are tall have a larger absolute CCAD than people who are short, while IMT is independent of stature. These observations potentially add to the growing cardiovascular literature aimed at explaining the lower risk of ischemic strokes in tall people.

Association between adult height, myocardial infarction, heart failure, stroke and death: a Korean nationwide population-based study

Background

The association between adult height and cardiovascular (CV) events and mortality has been suggested, albeit inconsistently. We sought to discover the comprehensive relationship between height, CV-related morbidity and all-cause death according to age.

Methods

We investigated the association between adult height and myocardial infarction (MI), heart failure (HF), stroke incidence and mortality in 16 528 128 Korean patients who underwent regular health check-ups (2005-08). Height was stratified by decile according to age (20-39 years, 40-59 years and ≥60 years) and gender.

Results

During a 9-year follow-up period, 590 346 participants died and 232 093 were admitted to hospital for MI, 201 411 for HF and 267 566 for stroke. An inverse relationship between height and MI, HF, stroke and all-cause death was observed in the overall cohort analysis. The association was unchanged after adjusting for CV risk and behavioural and adulthood socioeconomic factors. Both male and female sex showed an inverse relationship with height in adulthood, CV events and mortality. Adult height showed an inverse association in all CV events and mortality, especially in the older groups (≥40 years). In a subgroup analysis of body mass index, there was an inverse relationship between height, CV events and mortality in each group.

Conclusions

Shorter height in adulthood was strongly related to an increased risk of MI, HF, stroke and all-cause death. A suitable environment and appropriate nutrition early in life could influence adult height and eventually reduce the risk of CV events and mortality.

Does Body Mass Index and Height Influence the Incident Risk of Ischemic Stroke in Newly Diagnosed Type 2 Diabetes Subjects?

OBJECTIVE

To estimate the incident risk of ischemic stroke (IS) in newly diagnosed type 2 diabetes (T2D) subjects according to different body mass index (BMI) and height categories.

METHODS

A total of 25,130 newly diagnosed T2D subjects were included in this study. All T2D subjects were enrolled consecutively from the Chronic Disease Surveillance System (CDSS) of Ningbo. Standardized incidence ratio (SIR) and its 95% confidence interval (95% CI) stratified by BMI categories and height quartiles were used to estimate the incident risk of IS in T2D subjects.

RESULTS

In total, 22,795 subjects completed the follow-up. Among them, 1268 newly diagnosed IS cases were identified, with 149,675 person-years. The SIRs of normal BMI (18.5-24.0 kg/m²), overweight (24.0-28.0 kg/m²), and obese (≥28.0 kg/m²) in overall subjects were 2.56 (95% CI 1.90-3.13), 2.13 (95% CI 1.90-3.13), and 1.87 (95% CI 1.29-2.43), respectively (P _trend < 0.01), comparing to the general population of Ningbo. For each 1 kg/m² increment in BMI, the SIR was 0.948 (95% CI 0.903-0.999). For height quartiles, the SIRs of male subjects in quartile 1 (<160 cm), quartile 2 (161-165 cm), quartile 3 (165-170 cm), and quartile 4 (≥171 cm) were 2.27 (95% CI 1.99-2.56), 2.01 (95% CI 1.67-2.45), 1.37 (95% CI 1.05-1.68), and 0.91 (95% CI 0.40-1.32), respectively (P _trend < 0.01). While for female subjects, the SIRs in quartile 1 (<155 cm), quartile 2 (156-160 cm), quartile 3 (161-165 cm), and quartile 4 (≥166 cm) were 3.57 (95% CI 3.11-3.49), 2.96 (95% CI 2.61-3.31), 1.94 (95% CI 1.51-2.36), and 1.71 (95% CI 0.95-2.47), respectively (P _trend < 0.01).

CONCLUSION

Compared to the general population of Ningbo, T2D subjects had a higher incident risk of IS. Furthermore, the IS incident risk was not only higher in newly diagnosed T2D subjects with normal BMI but also lower in taller newly diagnosed T2D subjects.

Distribution of risk factors for cardiovascular disease and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations: The SAMINOR 2 Clinical Survey

Objective: This study aimed to assess and compare the distribution of cardiovascular risk factors and the estimated 10-year risk of fatal or non-fatal acute myocardial infarction (AMI) or cerebral stroke (CS) among the Sami and non-Sami populations of Northern Norway. Methods: The SAMINOR 2 Clinical Survey is a cross-sectional survey conducted in 10 municipalities in the counties of Finnmark, Troms and Nordland in rural Northern Norway in 2012–2014. All inhabitants aged 40–79 years were invited to participate, and 6004 (48.2%) accepted. The NORRISK 2 model was used to estimate the 10-year risk of fatal or non-fatal AMI or CS. Sex and age were included in the model, as well as the following risk factors for cardiovascular disease (CVD): serum total cholesterol, serum high-density lipoprotein cholesterol, systolic blood pressure, smoking habits and anti-hypertensive treatment. Results: Only minor ethnic differences were observed between Sami and non-Sami populations in a number of individual risk factors for CVDs. Overall, the NORRISK 2 model revealed no ethnic differences in the 10-year risk of AMI or CS. Conclusions:There were no differences in 10-year risk of AMI or CS between the Sami and non-Sami populations in 10 selected municipalities in Northern Norway.

Distributional change of women's adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data

BACKGROUND

Adult height reflects childhood circumstances and is associated with health, longevity, and maternal-fetal outcomes. Mean height is an important population metric, and declines in height have occurred in several low- and middle-income countries, especially in Africa, over the last several decades. This study examines changes at the population level in the distribution of height over time across a broad range of low- and middle-income countries during the past half century.

METHODS AND FINDINGS

The study population comprised 1,122,845 women aged 25-49 years from 59 countries with women's height measures available from four 10-year birth cohorts from 1950 to 1989 using data from the Demographic and Health Surveys (DHS) collected between 1993 and 2013. Multilevel regression models were used to examine the association between (1) mean height and standard deviation (SD) of height (a population-level measure of inequality) and (2) median height and the 5th and 95th percentiles of height. Mean-difference plots were used to conduct a graphical analysis of shifts in the distribution within countries over time. Overall, 26 countries experienced a significant increase, 26 experienced no significant change, and 7 experienced a significant decline in mean height between the first and last birth cohorts. Rwanda experienced the greatest loss in height (-1.4 cm, 95% CI: -1.84 cm, -0.96 cm) while Colombia experienced the greatest gain in height (2.6 cm, 95% CI: 2.36 cm, 2.84 cm). Between 1950 and 1989, 24 out of 59 countries experienced a significant change in the SD of women's height, with increased SD in 7 countries-all of which are located in sub-Saharan Africa. The distribution of women's height has not stayed constant across successive birth cohorts, and regression models suggest there is no evidence of a significant relationship between mean height and the SD of height (β = 0.015 cm, 95% CI: -0.032 cm, 0.061 cm), while there is evidence for a positive association between median height and the 5th percentile (β = 0.915 cm, 95% CI: 0.820 cm, 1.002 cm) and 95th percentile (β = 0.995 cm, 95% CI: 0.925 cm, 1.066 cm) of height. Benin experienced the largest relative expansion in the distribution of height. In Benin, the ratio of variance between the latest and earliest cohort is estimated as 1.5 (95% CI: 1.4, 1.6), while Lesotho and Uganda experienced the greatest relative contraction of the distribution, with the ratio of variance between the latest and earliest cohort estimated as 0.8 (95% CI: 0.7, 0.9) in both countries. Limitations of the study include the representativeness of DHS surveys over time, age-related height loss, and consistency in the measurement of height between surveys.

CONCLUSIONS

The findings of this study indicate that the population-level distribution of women's height does not stay constant in relation to mean changes. Because using mean height as a summary population measure does not capture broader distributional changes, overreliance on the mean may lead investigators to underestimate disparities in the distribution of environmental and nutritional determinants of health.

Body size and risk of atrial fibrillation: a cohort study of 1.1 million young men

BACKGROUND

Whilst tall stature has been related to lower risk of vascular disease, it has been proposed as a risk factor for atrial fibrillation. Little is known about other anthropometric measures and their joint effects on risk of atrial fibrillation.

OBJECTIVES

We aim to investigate associations and potential joint effects of height, weight, body surface area (BSA) and body mass index (BMI) with risk of atrial fibrillation.

METHODS

In a cohort covering 1 153 151 18-year-old men participating in the Swedish military conscription (1972-1995), Cox regression was used to investigate associations of height, weight, BSA and BMI with risk of atrial fibrillation.

RESULTS

During a median of 26.3 years of follow-up, higher height was associated with higher risk of atrial fibrillation (hazard ratio [HR] 2.80; 95% CI 2.63-2.98; for 5th vs. 1st quintile) and so was larger BSA (HR 3.05; 95% CI 2.82-3.28; for 5th vs. 1st quintile). Higher weight and BMI were to a lesser extent associated with risk of atrial fibrillation (BMI: 1.42; 95% CI 1.33-1.52, for 5th vs. 1st quintile). We found a multiplicative joint effect of height and weight. Adjusting for muscle strength, exercise capacity and diseases related to atrial fibrillation attenuated these measures.

CONCLUSIONS

Higher height and weight are strongly associated with higher risk of atrial fibrillation. These associations are multiplicative and independent of each other and are summarized in a strong association of body surface area with risk of atrial fibrillation. The mechanisms remain unknown but may involve increased atrial volume load with larger body size.

Associations between body mass index and mortality or cardiovascular events in a general Korean population

Background/Objectives

The relationship between body mass index (BMI) and mortality remains controversial. Furthermore, the association between BMI and cardiovascular events (CVE) is not conclusive and may differ by ethnicity. We aimed to estimate the associations between the BMI and mortality or cardiovascular disease in a general Korean population.

Subjects/Methods

This study was based on a sample cohort database released by the Korean National Health Insurance Service. We analyzed a total of 415,796 adults older than 30 years of age who had undergone a national health examination at least once from 2002 to 2012. Hazard ratios for death and cardiovascular events were calculated using Cox proportional hazards models.

Results

For both men and women, BMI and overall mortality showed a U-shaped association, with the lowest mortality rate among those with a BMI of 25–27.4 kg/m². Compared with them, subjects with a BMI ≥ 30kg/m², men with a BMI < 25 kg/m², and women with a BMI < 22.5 kg/m² showed significantly higher overall mortality. Additionally, men with a BMI < 22.5 kg/m² and women with a BMI < 20 kg/m² displayed an increased risk of cardiovascular mortality. Unlike the mortality trend, the CVD events trend showed a linearly positive association. The risk of a CVE was the lowest in men with a BMI ranging from 20 to 22.4 kg/m² and in women with a BMI < 20 kg/m².

Conclusions

The BMI showed a U-shaped association with overall mortality, where slightly obese subjects showed the lowest rate of mortality. The CVE exhibited a linear association with the BMI, where the lowest risk was observed for normal weight subjects in a general Korean population.

Association of fasting glucose levels with incident atherosclerotic cardiovascular disease: An 8-year follow-up study in a Chinese population

BACKGROUND

Identification of the population at high risk of developing atherosclerotic cardiovascular disease (ASCVD) is critical for its prevention. The aim of the present study was to evaluate the use of fasting blood glucose (FBG) to predict ASCVD.

METHODS

In all, 18 610 participants, aged 35-74 years at enrollment, were included in this prospective study. Baseline information was collected using a standardized questionnaire, physical examinations, and laboratory tests. During follow-up, disease status and vital information were updated. Cox proportional hazards regression analysis was used to estimate associations, with normal FBG (70-99 mg/dL) as the reference group. Anthropometric measurements, socioeconomic status, and conventional cardiovascular risk factors were included in the multivariate-adjusted model.

RESULTS

After 7.8 years follow-up (145 223 person-years), there were 519 cases of ASCVD. The multivariate-adjusted hazard ratios (HR), with 95% confidence intervals (CI), for ASCVD in patients with low FBG (<70 mg/dL), impaired fasting glucose (IFG; 100-125 mg/dL), and diabetes (≥126 mg/dL, use of antidiabetic medication and/or self-report) were 1.35 (0.84, 2.15), 1.02 (0.81, 1.27), and 1.68 (1.26, 2.23), respectively. Although IFG was associated with the development of diabetes (multivariate-adjusted HR 3.67; 95% CI 3.20, 4.21), it was only associated with incident ASCVD in the univariate model (HR 1.52; 95% CI 1.23, 1.88). The association of diabetes with coronary heart disease was more pronounced than that with stroke. Gender and residential differences were also identified.

CONCLUSIONS

In the present study, IFG was associated with the development of diabetes but not incident ASCVD. Prevention strategies to reduce the development of diabetes in people with IFG are critical to improve cardiovascular health.

Weight Gain and Height Growth during Infancy, Childhood, and Adolescence as Predictors of Adult Cardiovascular Risk

OBJECTIVES

To investigate independent relationships of childhood linear growth (height gain) and relative weight gain to adult cardiovascular disease (CVD) risk traits in Asian Indians.

STUDY DESIGN

Data from 2218 adults from the Vellore Birth Cohort were examined for associations of cross-sectional height and body mass index (BMI) and longitudinal growth (independent conditional measures of height and weight gain) in infancy, childhood, adolescence, and adulthood with adult waist circumference (WC), blood pressure (BP), insulin resistance (homeostatic model assessment-insulin resistance [HOMA-IR]), and plasma glucose and lipid concentrations.

RESULTS

Higher BMI/greater conditional relative weight gain at all ages was associated with higher adult WC, after 3 months with higher adult BP, HOMA-IR, and lipids, and after 15 years with higher glucose concentrations. Taller adult height was associated with higher WC (men β = 2.32 cm per SD, women β = 1.63, both P < .001), BP (men β = 2.10 mm Hg per SD, women β = 1.21, both P ≤ .001), and HOMA-IR (men β = 0.08 log units per SD, women β = 0.12, both P ≤ .05) but lower glucose concentrations (women β = -0.03 log mmol/L per SD P = .003). Greater height or height gain at all earlier ages were associated with higher adult CVD risk traits. These positive associations were attenuated when adjusted for adult BMI and height. Shorter length and lower BMI at birth were associated with higher glucose concentration in women.

CONCLUSIONS

Greater height or weight gain relative to height during childhood or adolescence was associated with a more adverse adult CVD risk marker profile, and this was mostly attributable to larger adult size.

Risk-factor profile for the incidence of subarachnoid and intracerebral haemorrhage, cerebral infarction, and unspecified stroke during 21 years' follow-up in men

Aims: To study the risk-factor profile for the incidence of non-fatal and fatal stroke among middle-aged men according to the stroke subtypes subarachnoid or intracerebral haemorrhage, cerebral infarction, and unspecified stroke. Methods: The study design is a prospective cohort study. A total of 16,209 men aged 40—49 years resident in Oslo were screened for cardiovascular disease risk factors in 1972—73. Of these, 14,403 men had no cardiovascular symptoms or diseases or diabetes. The incidence of stroke after 21 years of follow-up of all men was extracted from hospital records and linkage to Statistics Norway. Results: A total of 429 non-fatal and 107 fatal stroke events were registered. Case fatality within 28 days (number and percentage of cases) was 51% (41, 7.7%) for subarachnoid haemorrhage, 39% (67, 12.6%) for cerebral haemorrhage, 10% (246, 46.3%) for cerebral infarct, and 19% (177, 33.4%) for unspecified stroke. Risk of stroke (not subarachnoid haemorrhage) increased with the presence of symptoms or a history of cardiovascular disease or diabetes. In multivariate analysis of men without CVD or diabetes, high blood pressure was a risk factor for all subtypes of stroke; furthermore, daily smoking was a risk factor for all subtypes except subarachnoid haemorrhage. Serum cholesterol and glucose concentrations and height (inverse association) were independently associated with cerebral infarction. Smoking was a significantly stronger predictor of fatal than non-fatal events. Conclusions: The risk-factor profile differed according to the underlying subtype of stroke. Cerebral infarction clearly shared with myocardial infarction the classical risk factors, including non-fasting glucose concentration.

Relation of Stature to Outcomes in Korean Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction (from the INTERSTELLAR Registry)

Although epidemiologic studies have shown the impact of height on occurrence and/or prognosis of cardiovascular diseases, the underlying mechanism is unclear. In addition, the relation in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains unknown. We sought to assess the influence of height on outcomes of patients with acute STEMI undergoing primary PCI and to provide a pathophysiological explanation. All 1,490 patients with STEMI undergoing primary PCI were analyzed. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned hospitalization for heart failure (HF). Patients were divided into (1) MACCE (+) versus MACCE (-) and (2) first- to third-tertile groups according to height. MACCE (+) group was shorter than MACCE (-) group (164 ± 8 vs 166 ± 8 cm, p = 0.012). Prognostic impact of short stature was significant in older (≥70 years) male patients even after adjusting for co-morbidities (hazard ratio 0.951, 95% confidence interval 0.912 to 0.991, p = 0.017). The first-tertile group showed the worst MACCE-free survival (p = 0.035), and most cases of MACCE were HF (n, 17 [3%] vs 6 [1%] vs 2 [0%], p = 0.004). On post-PCI echocardiography, left atrial volume and early diastolic mitral velocity to early diastolic mitral annulus velocity ratio showed an inverse relation with height (p <0.001 for all) despite similar left ventricular ejection fraction. In conclusion, short stature is associated with occurrence of HF after primary PCI for STEMI, and its influence is prominent in aged male patients presumably for its correlation with diastolic dysfunction.

Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis

BACKGROUND

Raised total cholesterol is a strong risk factor for cardiovascular disease (CVD). It remains unknown whether sex differences exist in the relationship between total cholesterol and CVD outcomes.

METHODS

PubMed was searched in December 2014 for cohort studies reporting on the relationship between total cholesterol and coronary heart disease (CHD) and total stroke, separately in men and women. Random effects meta-analyses with inverse variance weighting were used to obtain adjusted pooled sex-specific relative risks (RR) and women-to-men ratio of RRs (RRRs).

RESULTS

Data from 97 cohorts, 1,022,276 individuals, and 20,176 CHD and 13,067 stroke cases were included. The pooled RR (95% confidence interval) for CHD associated with a 1-mmol/L increase in total cholesterol was 1.20 (1.16; 1.24) in women and 1.24 (1.20; 1.28) in men, resulting in a RRR of 0.96 (0.93; 0.99). Corresponding RRs for the risk of total stroke were 1.01 (0.98; 1.05) in women, and 1.03 (1.00; 1.05) in men, with a pooled RRR of 0.99 (0.93; 1.04). Pooled RRRs (95% CI) comparing individuals in the highest TC category to those in the lowest, such as the highest versus lowest third, were 0.87 (0.79; 0.96) for CHD and 0.86 (0.76; 0.97) for total stroke.

CONCLUSION

Raised total cholesterol is a strong risk factor for CHD, with evidence of a small, but significantly stronger, effect in men compared to women. Raised total cholesterol had little effect on the risk of total stroke in both sexes.

Ischemic Stroke and Its Risk Factors in a Registry-Based Large Cross-Sectional Diabetic Cohort in a Country Facing a Diabetes Epidemic

The main aim of this study is to determine the prevalence and risk factors of ischemic stroke among diabetic patients registered in the Saudi National Diabetes Registry (SNDR) database. A cross-sectional sample of 62,681 diabetic patients aged ≥25 years was used to calculate ischemic stroke prevalence and its risk factors. Univariate and multivariate logistic regression analyses were used to assess the roles of different risk factors. The prevalence of ischemic stroke was 4.42% and was higher in the older age group with longer diabetes duration. Poor glycemic control and the presence of chronic diabetes complications were associated with a high risk of ischemic stroke. History of smoking and type 2 diabetes were more frequent among stroke patients. Obesity significantly decreased the risk for ischemic stroke. Regression analysis for ischemic stroke risk factors proved that age ≥45 years, male gender, hypertension, coronary artery disease (CAD), diabetes duration ≥10 years, insulin use, and hyperlipidemia were significant independent risk factors for ischemic stroke. We conclude that ischemic stroke is prevalent among diabetic individuals, particularly among those with type 2 diabetes. Good glycemic, hypertension, and hyperlipidemia control, in addition to smoking cessation, are the cornerstones to achieve a significant reduction in ischemic stroke risk.

The DBP Phenotype Gc-1f/Gc-1f Is Associated with Reduced Risk of Cancer. The Tromsø Study

BACKGROUND AND OBJECTIVE

In addition to its role as a transport protein, the vitamin D binding protein (DBP) may also affect lipid metabolism, inflammation and carcinogenesis. There are three common variants of the DBP, Gc1s (1s), Gc1f (1f), Gc2 (2) that result in six common phenotypes (1s/1s, 1s/1f, 1s/2, 1f/1f, 1f/2, and 2/2). These phenotypes can be identified by genotyping for the two single nucleotide polymorphisms rs7041 and rs4588 in the GC gene. The DBP variants have different binding coefficients for the vitamin D metabolites, and accordingly there may be important relations between DBP phenotypes and health.

METHODS

DNA was prepared from subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints myocardial infarction (MI), type 2 diabetes (T2DM), cancer or death as well as a randomly selected control group. The endpoint registers were complete up to 2010- 2013. Genotyping was performed for rs7041 and rs4588 and serum 25-hydroxyvitamin D (25(OH)D) was measured.

RESULTS

Genotyping for rs7041 and rs4588 was performed successfully in 11 704 subjects. Among these, 1660 were registered with incident MI, 958 with T2DM, 2410 with cancer and 4318 had died. Subjects with the DBP phenotype 1f/1f had 23 - 26 % reduced risk of incident cancer compared to the 1s/1s and 2/2 phenotypes (P < 0.02, Cox regression with gender as covariate). Differences in serum 25(OH)D levels could not explain the apparent cancer protective effect of the DBP variant 1f. In addition to cancer and 25(OH)D, there were significant associations between DBP phenotype and body height, hip circumference and serum calcium.

CONCLUSION

There are important biological differences between the common DBP phenotypes. If the relation between the DBP variant 1f and cancer is confirmed in other studies, determination of DBP phenotype may have clinical importance.

Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults

BACKGROUND AND AIMS

Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk.

METHODS AND RESULTS

Black South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m(2), men 20.9 ± 4.3 kg/m(2)); median WC women 81.9 cm (interquartile range 61-103), men 74.7 cm (63-87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men.

CONCLUSIONS

The WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa.

Height, its components, and coagulability among older Chinese: the Guangzhou biobank cohort study

OBJECTIVES

The causal role of some cardiovascular risk factors, such as HDL cholesterol, has been increasingly challenged and attention is returning to all elements of Virchow's triad, i.e., hypercoagulability (including viscosity) as well as endothelial function and blood flow. We examined the life course origins of coagulability.

METHODS

We used multivariable linear regression to assess whether childhood influences, proxied by height and its components, were associated with hematocrit (Hct), hemoglobin (HGB), and other hematological parameters in 28,595 older Chinese adults (mean age = 61.8 years) from the Guangzhou Biobank Cohort Study.

RESULTS

Adjusted for age, sex, and recruitment phase, leg length was negatively associated with platelets (PLT) (-0.83 × 10(9) /l per centimeter (cm), 95% confidence interval (CI) -1.01 to -0.65). Sitting height and height were positively associated with Hct (0.05% per cm, 95% CI 0.04-0.07 for sitting height; 0.02% per cm, 95% CI 0.01-0.02 for height), HGB (0.21 g/l per cm, 95% CI 0.17-0.25; 0.07 g/l per cm, 95% CI 0.04-0.09) and negatively associated with PLT (-1.2 × 10(9) /l per cm, 95% CI -1.4 to -1.0; -0.83 × 10(9) /l per cm, 95% CI -0.95 to -0.70). Further adjustment for potential confounders did little to change the estimates.

CONCLUSIONS

For the first time we provide anthropometric evidence for the different roles of prepubertal and pubertal influences in relation to Hct and HGB. Whether factors that promote leg growth but reduce growth of sitting height may help to prevent cardiovascular events, via effects on hypercoagulability or viscosity, overall or in specific subgroups, remains to be determined.

The phosphodiesterase 8B gene rs4704397 is associated with thyroid function, risk of myocardial infarction, and body height: the Tromsø study

OBJECTIVE

High serum thyrotropin (TSH) levels predict cardiovascular disease (CVD). Recently several single nucleotide polymorphisms (SNPs) associated with TSH levels have been identified, one of them being the rs4704397 SNP in the phosphodiesterase 8B (PDE8B) gene. If the relation between thyroid function and CVD is causal, one could also expect rs4704397 genotypes to predict CVD and possibly health in general.

METHODS

DNA was prepared and genotyping performed for rs4704397 in subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints myocardial infarction (MI), type 2 diabetes (T2DM), cancer, or death, as well as a randomly selected control group. Similarly, genotyping was performed in subjects who had participated in clinical trials where serum TSH, free T4 (fT4), and free T3 (fT3) were measured.

RESULTS

From the Tromsø Study, 8938 subjects without thyroid disease or thyroid medication were successfully genotyped for rs4704397. Among these, 2098 were registered with MI, 1025 with T2DM, 2748 with cancer, and 3592 had died. The minor homozygote genotype (A:A) had a median serum TSH level that was 0.29 mIU/L higher than in the major homozygote genotype (G:G). The A:A genotype had a significantly increased risk of MI as compared to the G:G genotype (1.14 [1.00-1.29], hazard ratio [confidence interval], Cox regression with adjustment for age, sex, and body mass index). No significant associations were seen with the other endpoints or CVD risk factors. Furthermore, subjects with the G:G genotype were significantly taller than subjects with the A:A genotype (mean difference 1.5 cm). In 584 subjects with serum TSH, fT4, and fT3 measurements, the subjects with the A:A genotype had significantly higher serum TSH and nonsignificantly lower serum fT3 (mean difference 0.15 pmol/L) levels than subjects with the G:G genotype.

CONCLUSION

rs4704397 is associated with thyroid function, risk of MI, and body height. However, confirmation in other cohorts is needed before firm conclusions can be drawn.

Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium

OBJECTIVE

To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians.

DESIGN

Pooled analyses of 20 prospective cohorts in Asia, including data from 835,082 east Asians and 289,815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability.

SETTING

General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh).

PARTICIPANTS

1,124,897 men and women (mean age 53.4 years at baseline).

MAIN OUTCOME MEASURES

Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes.

RESULTS

49,184 cardiovascular deaths (40,791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12).

CONCLUSIONS

Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.

Body Mass Index and Risk of Total and Type-Specific Stroke in Chinese Adults: Results from a Longitudinal Study in China

Background

The prevalence rate of overweight and obese has been escalating over the past two decades in China. Even so, the association between obesity and stroke still remains unclear to some extent.

Aims

The aim of this study was to elucidate the association between body mass index and stroke in a large Chinese population cohort.

Methods

A cohort of 26 607 Chinese people, aged over 35 years, was investigated in 1987. Baseline information of body weight and height was used to calculate BMI (weight in kilograms divided by height in meters squared, kg/m2). Cox proportional hazards model was fitted to estimate hazard ratios of stroke adjusted for age, educational level, smoking and alcohol consumption.

Results

The 11-year follow-up revealed (241 149 person-years) a total of 1108 stroke events (614 ischemic, 451 hemorrhagic, and 44 undefined stroke). Body mass index ≥ 30·0 was an independent risk factor for stroke both in men and women. Compared with normal weight, hazard ratios for total stroke were 0·74 in men underweight (95% confidence interval: 0·53∼1·03), 1·63 overweight (95% confidence interval: 1·35∼1·96), and 2·20 with obesity (95% confidence interval: 1·47∼3·30); and with ischemic stroke, hazard ratios were 0·52 in those underweight (95% confidence interval: 0·30∼0·89), 208 overweight (95% confidence interval: 1·65∼2·62), and 3·80 with obesity (95% confidence interval: 2·47∼5·86). In women, the corresponding hazard ratios for total stroke were 0·79 underweight (95% confidence interval: 0·58∼1·07), 1·42 overweight (95% confidence interval: 1·16∼1·73), and 1·57 with obesity (95% confidence interval: 1·06∼2·31); and for those with ischemic stroke, 0·92 underweight (95% confidence interval: 0·59∼1·43), 1·90 overweight (95% confidence interval: 1·44∼2·50), and 2·42 with obesity (95% confidence interval: 1·50∼3·93). There appeared an evident dose-response relationship between body mass index and the risk of developing stroke, which still appeared, however, adjusted low for hypertension, diabetes, and heart disease. Decreased risk for stroke in the leanest group was confined to men only. No association was found between body mass index and hemorrhagic stroke in both genders.

Conclusions

Our data suggest that body mass index was an independent risk factor for total and ischemic stroke but not for hemorrhagic stroke in both genders. Association between body mass index and stroke was extremely mediated by hypertension, diabetes, and heart disease. Decreased risk for the leanest group was confined to men.

High prevalence of overweight and obesity among 6-year-old children in Finnmark County, North Norway

AIM

The aim was to determine the prevalence of overweight and obesity among 6-year-old children in Finnmark, the northernmost county of Norway.

METHODS

This is a survey of 1774 children born during 1999 and 2000 from 18 of 19 child healthcare centres in Finnmark. Body mass index data extracted retrospectively in 2007 from health records at the age of 6 years were compared with international definitions of over- and underweight. The prevalence figures were further compared with socio-demographic figures on municipality level.

RESULTS

Overall, 19% of the children were classified as overweight or obese; 5% were classified as obese. The prevalence of overweight and obesity was higher among girls (22%) than among boys (16%) (p < 0.01). The prevalence of underweight was 8% among both girls and boys. Despite large variations in the prevalence of overweight and obesity between municipalities (9-35%), no association was found with municipality figures on socio-demographic factors.

CONCLUSION

In the northernmost county Finnmark, the prevalence of overweight including obesity among 6-year-old children was somewhat higher than in previous surveys from Norway, especially among girls.

Risk factors for aneurysmal subarachnoid hemorrhage - BMI and serum lipids: 11-year follow-up of the HUNT and the Tromsø Study in Norway

OBJECTIVES

Life-style factors have been associated with the risk for aneurysmal subarachnoid hemorrhage (aSAH), but it is not clear whether body mass index (BMI) and serum lipids are associated with risk. We prospectively assessed these associations in two large population studies.

METHODS

A total of 65,526 participants in the Nord-Trøndelag Health Study (1995-1997) and 26,882 participants in the Tromsø Study (1994-1995) were included. Studies included measurements of body weight and height, serum lipids, and self-administered questionnaires. Participants who experienced aSAH were identified, and hazard ratios (HRs) were estimated using Cox regression analysis.

RESULTS

During 11 years of follow-up, aSAH was diagnosed in 122 participants. Overweight (BMI 25-29.9) was negatively associated with the risk of aSAH (HR 0.7, 95% CI 0.4-1.0). There was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH, but in participants younger than 50 years, HDL cholesterol was inversely associated with the risk (HR per standard deviation increase 0.6, 95% CI 0.4-0.9).

CONCLUSIONS

Overweight may be associated with reduced risk of aSAH, but there was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH in this prospective study.

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

BACKGROUND

Height is inversely associated with incident coronary disease and total stroke, but few studies have examined the association between height and intraparenchymal hemorrhage (IPH). We hypothesized that height would be inversely associated with incident IPH in the combined cohorts of the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study.

METHODS

Data on Caucasian and African American participants were used to estimate the association of height at baseline with incident IPH verified by clinician review of medical records and imaging reports. Sex-specific Cox proportional hazards regression models were used to calculate hazard ratios.

RESULTS

A total of 20,983 participants initially free of stroke (11,788 women and 9195 men) were followed for an average of 15.9 years (standard deviation [SD] 5.1 years). Incident IPH occurred in 115 women and 73 men. Sex, but not age, race, study, or blood pressure, modified the association (P = .03). After adjustment for risk factors (age, systolic blood pressure, triglycerides, low-density lipoprotein cholesterol, fibrinogen, and race), among women, height was significantly inversely associated with incident IPH (hazard ratio [HR] per SD [6.3 cm] was 0.81; 95% confidence interval [CI] 0.66-0.99; P = .04). The HR for tertile 3 vs 1 in women was 0.63 (95% CI 0.37-1.08). Among men, height was not linearly associated with incident IPH (HR per SD [6.7 cm] was 1.09; 95% CI 0.84-1.40; P = .52).

CONCLUSIONS

This large prospective study provides evidence that shorter height may be a risk factor for incident IPH in women.

Incidence of aneurysmal subarachnoid hemorrhage in Norway, 1999-2007

OBJECTIVE

To investigate changes and regional variations in annual incidence rates of aneurysmal subarachnoid hemorrhage (SAH) in Norway between 1999 and 2007.

METHODS

The authors retrospectively reviewed data from the Norwegian Patient Register for the period 1999-2007.

RESULTS

Crude incidence of aneurysmal SAH was 10.0/100,000 person years [95% CI (confidence interval): 9.7-10.3] and was higher in women (12.0/100,000 person years; 95% CI: 11.5-12.5) than men (8.1/100,000 person years; 95% CI: 7.7-8.4). Decreasing annual incidence rates were observed from 11.1/100,000 person years (95% CI: 10.5-11.6) in the period 1999-2001 to 8.9/100,000 person years (95% CI: 8.4-9.4) in the period 2005-2007 (P for trend <0.001). Regional variations were observed, from 8.4/100,000 person years (95% CI: 7.7-9.00) in the southern region, 10.4/100,000 person years (95% CI: 9.5-11.2) in the central region and 11.9/100,000 person years (95% CI: 10.8-12.9) in the northern region.

CONCLUSIONS

Incidence of aneurysmal SAH in Norway decreased from 1999 to 2007, with significant regional variations indicating an increasing gradient from south to north.

Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women

We assessed the relationship of the dietary glycemic index (GI), glycemic load (GL), and intake of carbohydrate and rice, and risk of mortality from stroke and its subtypes. The cohort consisted of 12,561 men and 15,301 women residing in Takayama, Japan, in 1992. At the baseline, a food frequency questionnaire was administered; and the dietary GI, GL, and intake of carbohydrates and rice were estimated. Deaths from stroke occurring in the cohort were prospectively noted until 1999 with data from the office of the National Vital Statistics. The risk of mortality from stroke was assessed with a Cox proportional hazard model after adjusting for age; body mass index; smoking status; physical activity; history of hypertension; education; and intake of total energy, alcohol, dietary fiber, salt, and total fat. The risk of stroke subtypes was assessed in the age-adjusted model. The hazard ratios of total stroke comparing the highest vs the lowest quartiles of the dietary GI were 0.78 (95% confidence interval [CI], 0.41-1.47) with P(trend) = .50 in men and 2.09 (95% CI, 1.01-4.31) with P(trend) = .10 in women. Among women, the association was also significant with the risk of ischemic stroke (hazard ratio = 2.45; 95% CI, 1.01-5.92; P(trend) = .03); and a significant positive trend was also observed between dietary GL and mortality from hemorrhagic stroke (P(trend) = .05). The current study implies that diets with a high dietary GI increase the risk of mortality from stroke among Japanese women.

Adult height and the risk of cardiovascular disease among middle aged men and women in Japan

An inverse association between height and risk of cardiovascular disease has been reported, but the evidence is limited for stroke subtypes, in particular in Asian populations. Further, few studies have examined how socioeconomic status in adulthood influence the relationship between height and risk of cardiovascular disease. This study examined the association between height and risks of stroke and coronary heart disease, and whether education level, an indicator of adult socioeconomic status, modify the effect of height on those risks, within a cohort of the Japan Public Health Center-based Prospective Study (JPHC Study). The hazard ratios for the incidence of cardiovascular disease associated with height were calculated by a 16-year follow-up of 15,564 Japanese men and women, aged 40-59. The hazard ratios were adjusted for age, gender, area, education, occupation and cardiovascular risk factors. Height was inversely associated with risks of total stroke, either hemorrhagic or ischemic stroke but not with coronary heart disease. The adjusted hazard ratios (95% confidence interval (CI)) of total stroke, hemorrhagic stroke, and ischemic stroke for a 1 SD height increments were 0.82 (95% CI: 0.74, 0.90), 0.80 (95% CI: 0.70, 0.92), and 0.83 (95% CI: 0.73, 0.95), respectively. No multiplicative interaction was observed between height and education level on stroke risk. Short stature was associated with increased risk of total stroke, either hemorrhagic or ischemic stroke, independent of adult socioeconomic status and cardiovascular risk factors, but not with risk of coronary heart disease in Japanese men and women.

Triglyceride level modifying functional variants of GALTN2 and MLXIPL in patients with ischaemic stroke

BACKGROUND

Recent genome-wide studies identified several genetic variants associated with blood lipid level alterations. Because affected lipid metabolism can confer risk to the development of ischaemic stroke, we studied three polymorphisms reportedly associated with triglyceride-level changes, rs17145738 and rs3812316 of the MLXIPL locus, and rs4846914 variant of GALNT2 gene in biobanked samples of patients with stroke. This pool of samples was previously investigated for haplotype tagging minor alleles of apolipoprotein A5 gene (T-1131C, T1259C, IVS3+G476A and C56G), and an association was found between the minor allele carriage and the triglyceride levels, and also these variants were found to confer risk to the development of stroke.

METHODS

Here, a total of 467 patients with stroke, stratified as large vessel, small vessel and mixed stroke groups, and 156 control subjects were genotyped using PCR-RFLP methods.

RESULTS

In the current study, we could not verify association of the variants analyzed either with triglyceride and total cholesterol levels or with the risk of ischaemic stroke susceptibility.

CONCLUSIONS

The data presented here revealed differentiated risk nature of the triglyceride level modifying natural gene variants.

Height, wealth, and health: an overview with new data from three longitudinal studies

This overview, based on a literature review and new data from the three cohorts (Whitehall Studies I and II, and the Vietnam Experience Study), has four objectives: (a) to outline the major determinants of height, so providing an indication as to what exposures this characteristic may capture; (b) to summarise, by reviewing reports from large scale studies, the relation between adult height and a range of disease outcomes--both somatic and psychiatric--with particular emphasis on coronary heart disease (CHD) and stroke; (c) to discuss why these relationships may exist, in particular, the role, if any, of socioeconomic position in explaining the apparent associations; and, finally (d) to outline future research directions in this field. The large majority of evidence for predictors of height, and its health consequences, comes from observational studies. While genetic predisposition is a major determinant of height, secular rises in childhood and adult stature across successive birth cohorts suggest that early life environment also has an important impact. Plausible non-genetic determinants of height include nutrition, illness, socioeconomic status, and psychosocial stress. Evidence for an association between height and a series of health endpoints is accumulating. Thus, shorter people appear to experience increased risk of CHD, and these associations appear to be independent of socioeconomic position and other potentially confounding variables. For stroke, and its sub-types, findings are less clear. In contrast to CHD, some cancers, such as carcinoma of the colorectum, prostate, breast (in women), central nervous system, skin, endometrium, thyroid and blood (haematopoietic) are more common in taller people. While height may be negatively related to the risk of completed suicide, conclusions about the links between stature and other health endpoints is problematic given the paucity of evidence, which should be addressed. Ultimately, for want of better data, investigators in this area have used height as a proxy for a range of pre-adult exposures. In future, research should aim to explore the predictive capacity of direct measures of diet, psychosocial stress, childhood chronic illness and so on, rather than focus on height or its components. The problem is that extended follow-up of child cohorts with such data are required, and studies which hold these data are not currently available, although several are either maturing to the point where they offer sufficient clinical outcomes to facilitate analyses or are in the advanced planning stage.

Risk factors for first-ever stroke in the EPIC-Norfolk prospective population-based study

BACKGROUND

Many studies examining stroke risk factors have focused on men and younger age groups. We examined stroke risk factors over a wide age range including elderly and women in a British population.

METHODS

We examined the prospective relationship between known risk factors for stroke and stroke incidence in 22 516 men and women aged 40-79 years without stroke at baseline in the years 1993-1997 participating in the European Prospective Investigation into Cancer-Norfolk.

RESULTS

During a total of 214 542 person-years of follow-up, 507 incident strokes occurred (fatal=162). Stroke risk increased with increasing age [relative risk (RR) 1.65, 95% confidence interval: 1.54, 1.75 per increase in 5 years]. Our results confirm the importance of modifiable risk factors for stroke in men and women, in particular, blood pressure and smoking. Higher systolic blood pressure of 10 mmHg was associated with RR of 1.19 (1.13, 1.24) and current smokers had RR of 1.70 (1.29, 2.23) compared with never smokers independent of age, sex, body mass index, cholesterol, triglycerides and diabetes. Having a systolic blood pressure greater than 140 mmHg compared with less than 140 mmHg was equivalent to being 6 years older and current smoking compared with nonsmoking equivalent to being 5 years older and diabetes 5 years older in terms of stroke risk.

CONCLUSION

Classical modifiable stroke risk factors, blood pressure and smoking, may have a substantial impact on the age-related increase in stroke risk in men and women.