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van der Valk ES, Mohseni M, Iyer AM, van den Hurk MJB, Lengton R, Kuckuck S, Wester VL, Leenen PJM, Dik WA, Visser JA, Kavousi M, Mirzaian M, van den Berg SAA, van Rossum EFC. Long-Term Glucocorticoid Exposure and Incident Cardiovascular Diseases-The Lifelines Cohort. J Clin Endocrinol Metab 2024; 109:2520-2529. [PMID: 38500477 PMCID: PMC11403319 DOI: 10.1210/clinem/dgae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 03/20/2024]
Abstract
CONTEXT Long-term glucocorticoid levels in scalp hair (HairGCs), including cortisol and the inactive form cortisone, represent the cumulative systemic exposure to glucocorticoids over months. HairGCs have repeatedly shown associations with cardiometabolic and immune parameters, but longitudinal data are lacking. DESIGN We investigated 6341 hair samples of participants from the Lifelines cohort study for cortisol and cortisone levels and associated these to incident cardiovascular diseases (CVD) during 5 to 7 years of follow-up. We computed the odds ratio (OR) of HairGC levels for incident CVD via logistic regression, adjusting for classical cardiovascular risk factors, and performed a sensitivity analysis in subcohorts of participants < 60 years and ≥ 60 years of age. We also associated HairGC levels to immune parameters (total leukocytes and subtypes). RESULTS Hair cortisone levels (available in n = 4701) were independently associated with incident CVD (P < .001), particularly in younger individuals (multivariate-adjusted OR 4.21, 95% CI 1.91-9.07 per point increase in 10-log cortisone concentration [pg/mg], P < .001). All immune parameters except eosinophils were associated with hair cortisone (all multivariate-adjusted P < .05). CONCLUSION In this large, prospective cohort study, we found that long-term cortisone levels, measured in scalp hair, represent a relevant and significant predictor for future CVD in younger individuals. These results highlight glucocorticoid action as possible treatment target for CVD prevention, where hair glucocorticoid measurements could help identify individuals that may benefit from such treatments.
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Affiliation(s)
- Eline S van der Valk
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Mostafa Mohseni
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Anand M Iyer
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Maartje J B van den Hurk
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Robin Lengton
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Susanne Kuckuck
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Vincent L Wester
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Pieter J M Leenen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Willem A Dik
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Laboratory of Medical Immunology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Jenny A Visser
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Mina Mirzaian
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Sjoerd A A van den Berg
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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2
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Lin L, Hu Y, Lei F, Huang X, Zhang X, Sun T, Liu W, Li R, Zhang XJ, Cai J, She ZG, Wang G, Li H. Cardiovascular health and cancer mortality: evidence from US NHANES and UK Biobank cohort studies. BMC Med 2024; 22:368. [PMID: 39237921 PMCID: PMC11378420 DOI: 10.1186/s12916-024-03553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND The American Heart Association recently introduced a novel cardiovascular health (CVH) metric, Life's Essential 8 (LE8), for health promotion. However, the relationship between LE8 and cancer mortality risk remains uncertain. METHODS We investigated 17,076 participants from US National Health and Nutrition Examination Survey (US NHANES) and 272,727 participants from UK Biobank, all free of cancer at baseline. The CVH score, based on LE8 metrics, incorporates four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (body mass index, lipid, blood glucose, and blood pressure). Self-reported questionnaires assessed health behaviors. Primary outcomes were mortality rates for total cancer and its subtypes. The association between CVH score (continuous and categorical variable) and outcomes was examined using Cox model with adjustments. Cancer subtypes-related polygenic risk score (PRS) was constructed to evaluate its interactions with CVH on cancer death risk. RESULTS Over 141,526 person-years in US NHANES, 424 cancer-related deaths occurred, and in UK Biobank, 8,872 cancer deaths were documented during 3,690,893 person-years. High CVH was associated with reduced overall cancer mortality compared to low CVH (HR 0.58, 95% CI 0.37-0.91 in US NHANES; 0.51, 0.46-0.57 in UK Biobank). Each one-standard deviation increase in CVH score was linked to a 19% decrease in cancer mortality (HR: 0.81; 95% CI: 0.73-0.91) in US NHANES and a 19% decrease (HR: 0.81; 95% CI: 0.79-0.83) in UK Biobank. Adhering to ideal CVH was linearly associated with decreased risks of death from lung, bladder, liver, kidney, esophageal, breast, colorectal, pancreatic, and gastric cancers in UK Biobank. Furthermore, integrating genetic data revealed individuals with low PRS and high CVH exhibited the lowest mortality from eight cancers (HRs ranged from 0.36 to 0.57) compared to those with high PRS and low CVH. No significant modification of the association between CVH and mortality risk for eight cancers by genetic predisposition was observed. Subgroup analyses showed a more pronounced protective association for overall cancer mortality among younger participants and those with lower socio-economic status. CONCLUSIONS Maintaining optimal CVH is associated with a substantial reduction in the risk of overall cancer mortality. Adherence to ideal CVH correlates linearly with decreased mortality risk across multiple cancer subtypes. Individuals with both ideal CVH and high genetic predisposition demonstrated significant health benefits. These findings support adopting ideal CVH as an intervention strategy to mitigate cancer mortality risk and promote healthy aging.
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Affiliation(s)
- Lijin Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Yulian Hu
- Department of Neonatology, Huanggang Central Hospital of Yangtze University, Huanggang, China
- Huanggang Institute of Translational Medicine, Huanggang, Hubei Province, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuewei Huang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xingyuan Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Weifang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Ru Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
- Institute of Model Animal, Wuhan University, Wuhan, China.
| | - Guoping Wang
- Huanggang Institute of Translational Medicine, Huanggang, Hubei Province, China.
- Department of Integrated TCM & Western Medicine, Huanggang Central Hospital of Yangtze University, Huanggang, 438000, China.
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
- Institute of Model Animal, Wuhan University, Wuhan, China.
- Huanggang Institute of Translational Medicine, Huanggang, Hubei Province, China.
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
- State Key Laboratory of New Targets Discovery and Drug Development for Major Diseases, Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China.
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3
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Sahu Y, Jamadade P, Ch Maharana K, Singh S. Role of mitochondrial homeostasis in D-galactose-induced cardiovascular ageing from bench to bedside. Mitochondrion 2024; 78:101923. [PMID: 38925493 DOI: 10.1016/j.mito.2024.101923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Ageing is an inevitable phenomenon which affects the cellular to the organism level in the progression of the time. Oxidative stress and inflammation are now widely regarded as the key processes involved in the aging process, which may then cause significant harm to mitochondrial DNA, leading to apoptosis. Normal circulatory function is a significant predictor of disease-free life expectancy. Indeed, disorders affecting the cardiovascular system, which are becoming more common, are the primary cause of worldwide morbidity, disability, and mortality. Cardiovascular aging may precede or possibly underpin overall, age-related health decline. Numerous studies have foundmitochondrial mechanistc approachplays a vital role in the in the onset and development of aging. The D-galactose (D-gal)-induced aging model is well recognized and commonly used in the aging study. In this review we redeposit the association of the previous and current studies on mitochondrial homeostasis and its underlying mechanisms in D-galactose cardiovascular ageing. Further we focus the novel and the treatment strategies to combat the major complication leading to the cardiovascular ageing.
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Affiliation(s)
- Yogita Sahu
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Vaishali, Bihar, India
| | - Pratiksha Jamadade
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Vaishali, Bihar, India
| | - Krushna Ch Maharana
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Vaishali, Bihar, India
| | - Sanjiv Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hajipur, Vaishali, Bihar, India.
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4
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Vergallo R, Patrono C. Weekly Journal Scan: incremental utility of circulating biomarkers for cardiovascular risk prediction. Eur Heart J 2024:ehae481. [PMID: 39106856 DOI: 10.1093/eurheartj/ehae481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Affiliation(s)
- Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genova, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Carlo Patrono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Rome, Italy
- Center of Excellence on Ageing, CAST, 'G. d'Annunzio' University School of Medicine, Chieti, Italy
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5
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Rivera CF, Farra YM, Silvestro M, Medvedovsky S, Matz J, Pratama MY, Vlahos J, Ramkhelawon B, Bellini C. Mapping the unicellular transcriptome of the ascending thoracic aorta to changes in mechanosensing and mechanoadaptation during aging. Aging Cell 2024; 23:e14197. [PMID: 38825882 PMCID: PMC11320362 DOI: 10.1111/acel.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/04/2024] Open
Abstract
Aortic stiffening is an inevitable manifestation of chronological aging, yet the mechano-molecular programs that orchestrate region- and layer-specific adaptations along the length and through the wall of the aorta are incompletely defined. Here, we show that the decline in passive cyclic distensibility is more pronounced in the ascending thoracic aorta (ATA) compared to distal segments of the aorta and that collagen content increases in both the medial and adventitial compartments of the ATA during aging. The single-cell RNA sequencing of aged ATA tissues reveals altered cellular senescence, remodeling, and inflammatory responses accompanied by enrichment of T-lymphocytes and rarefaction of vascular smooth muscle cells, compared to young samples. T lymphocyte clusters accumulate in the adventitia, while the activation of mechanosensitive Piezo-1 enhances vasoconstriction and contributes to the overall functional decline of ATA tissues. These results portray the immuno-mechanical aging of the ATA as a process that culminates in a stiffer conduit permissive to the accrual of multi-gerogenic signals priming to disease development.
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Affiliation(s)
- Cristobal F. Rivera
- Department of Surgery, Division of Vascular and Endovascular SurgeryNew York University Langone Medical CenterNew YorkNew YorkUSA
- Department of Cell BiologyNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - Yasmeen M. Farra
- Department of BioengineeringNortheastern UniversityBostonMassachusettsUSA
| | - Michele Silvestro
- Department of Surgery, Division of Vascular and Endovascular SurgeryNew York University Langone Medical CenterNew YorkNew YorkUSA
- Department of Cell BiologyNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - Steven Medvedovsky
- Department of Surgery, Division of Vascular and Endovascular SurgeryNew York University Langone Medical CenterNew YorkNew YorkUSA
- Department of Cell BiologyNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - Jacqueline Matz
- Department of BioengineeringNortheastern UniversityBostonMassachusettsUSA
| | - Muhammad Yogi Pratama
- Department of Surgery, Division of Vascular and Endovascular SurgeryNew York University Langone Medical CenterNew YorkNew YorkUSA
- Department of Cell BiologyNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - John Vlahos
- Department of Surgery, Division of Vascular and Endovascular SurgeryNew York University Langone Medical CenterNew YorkNew YorkUSA
- Department of Cell BiologyNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - Bhama Ramkhelawon
- Department of Surgery, Division of Vascular and Endovascular SurgeryNew York University Langone Medical CenterNew YorkNew YorkUSA
- Department of Cell BiologyNew York University Langone Medical CenterNew YorkNew YorkUSA
| | - Chiara Bellini
- Department of BioengineeringNortheastern UniversityBostonMassachusettsUSA
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6
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Yu Y, Sun Y, Yu Y, Wang Y, Chen C, Tan X, Lu Y, Wang N. Life's Essential 8 and risk of non-communicable chronic diseases: Outcome-wide analyses. Chin Med J (Engl) 2024; 137:1553-1562. [PMID: 37821910 PMCID: PMC11230768 DOI: 10.1097/cm9.0000000000002830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Life's Simple 7, the former construct of cardiovascular health (CVH) has been used to evaluate adverse non-communicable chronic diseases (NCDs). However, some flaws have been recognized in recent years and Life's Essential 8 has been established. In this study, we aimed to analyze the association between CVH defined by Life's Essential 8 and risk of 44 common NCDs and further estimate the population attributable fractions (PAFs) of low-moderate CVH scores in the 44 NCDs. METHODS In the UK Biobank, 170,726 participants free of 44 common NCDs at baseline were included. The Life's Essential 8 composite measure consists of four health behaviours (diet, physical activity, nicotine exposure, and sleep) and four health factors (body mass index, non-high density lipoprotein cholesterol, blood glucose, and blood pressure), and the maximum CVH score was 100 points. CVH score was categorized into low, moderate, and high groups. Participants were followed up for 44 NCDs diagnosis across 10 human system disorders according to the International Classification of Diseases 10th edition (ICD-10) code using linkage to national health records until 2022. Cox proportional hazard models were used in this study. The hazard ratios (HRs) and PAFs of 44 NCDs associated with CVH score were examined. RESULTS During the median follow-up of 10.85 years, 58,889 incident NCD cases were documented. Significant linear dose-response associations were found between higher CVH score and lower risk of 25 (56.8%) of 44 NCDs. Low-moderate CVH (<80 points) score accounted for the largest proportion of incident cases in diabetes (PAF: 80.3%), followed by gout (59.6%), sleep disorder (55.6%), chronic liver disease (45.9%), chronic kidney disease (40.9%), ischemic heart disease (40.8%), chronic obstructive pulmonary disease (40.0%), endometrium cancer (35.8%), lung cancer (34.0%), and heart failure (34.0%) as the top 10. Among the eight modifiable factors, overweight/obesity explained the largest number of cases of incident NCDs in endocrine, nutritional, and metabolic diseases (35.4%), digestive system disorders (21.4%), mental and behavioral disorders (12.6%), and cancer (10.3%); however, the PAF of ideal sleep duration ranked first in nervous system (27.5%) and neuropsychiatric disorders (9.9%). CONCLUSIONS Improving CVH score based on Life's Essential 8 may lower risk of 25 common NCDs. Among CVH metrics, avoiding overweight/obesity may be especially important to prevent new cases of metabolic diseases, NCDs in digestive system, mental and behavioral disorders, and cancer.
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Affiliation(s)
- Yuetian Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Yuefeng Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Xiao Tan
- School of Public Health, Zhejiang University, Hangzhou 310058, Zhejiang, China
- Department of Medical Sciences, Uppsala University, Uppsala 75185, Sweden
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
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7
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Neumann JT, Twerenbold R, Weimann J, Ballantyne CM, Benjamin EJ, Costanzo S, de Lemos JA, deFilippi CR, Di Castelnuovo A, Donfrancesco C, Dörr M, Eggers KM, Engström G, Felix SB, Ferrario MM, Gansevoort RT, Giampaoli S, Giedraitis V, Hedberg P, Iacoviello L, Jørgensen T, Kee F, Koenig W, Kuulasmaa K, Lewis JR, Lorenz T, Lyngbakken MN, Magnussen C, Melander O, Nauck M, Niiranen TJ, Nilsson PM, Olsen MH, Omland T, Oskarsson V, Palmieri L, Peters A, Prince RL, Qaderi V, Vasan RS, Salomaa V, Sans S, Smith JG, Söderberg S, Thorand B, Tonkin AM, Tunstall-Pedoe H, Veronesi G, Watanabe T, Watanabe M, Zeiher AM, Zeller T, Blankenberg S, Ojeda F. Prognostic Value of Cardiovascular Biomarkers in the Population. JAMA 2024; 331:1898-1909. [PMID: 38739396 PMCID: PMC11091824 DOI: 10.1001/jama.2024.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/16/2024] [Indexed: 05/14/2024]
Abstract
Importance Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants Individual-level analysis including data on cardiovascular biomarkers from 28 general population-based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years. Exposure Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein. Main Outcomes and Measures The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses. Results The analyses included 164 054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17 211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people. Conclusions and Relevance Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality.
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Affiliation(s)
- Johannes Tobias Neumann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christie M. Ballantyne
- Center for Cardiometabolic Disease Prevention, Department of Medicine, College of Medicine, Baylor University, Houston, Texas
| | - Emelia J. Benjamin
- Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - James A. de Lemos
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | | | | | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
| | - Marcus Dörr
- Department of Internal Medicine B, University Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Kai M. Eggers
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Stephan B. Felix
- Department of Internal Medicine B, University Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Marco M. Ferrario
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ron T. Gansevoort
- Department of Nephrology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Pär Hedberg
- Department of Clinical Physiology and Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, Libera Università Mediterranea, Casamassima, Italy
| | - Torben Jørgensen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research and Prevention, BFH Hospital, Copenhagen, Denmark
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, Northern Ireland
| | - Wolfgang Koenig
- German Heart Center, Technical University of Munich, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joshua R. Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Medical School, University of Western Australia, Perth
- Centre for Kidney Research, Children’s Hospital at Westmead, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thiess Lorenz
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Magnus N. Lyngbakken
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Olle Melander
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Matthias Nauck
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Teemu J. Niiranen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Internal Medicine, University of Turku, Turku, Finland
| | - Peter M. Nilsson
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Michael H. Olsen
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health, University of Southern Denmark, Odense
| | - Torbjorn Omland
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
| | - Anette Peters
- German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Richard L. Prince
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Medical School, University of Western Australia, Perth
| | - Vazhma Qaderi
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ramachandran S. Vasan
- Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- University of Texas School of Public Health and the University of Texas Health Science Center, San Antonio
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Susana Sans
- Catalan Department of Health, Barcelona, Spain
| | - J. Gustav Smith
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Andrew M. Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, Scotland
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
| | - Andreas M. Zeiher
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
- German Center for Cardiovascular Disease Research, Partner Site Rhine-Main, Mainz, Germany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Abou Deb G, Hamdallah H. Cardiovascular risk and physical activity in Syrians living in England compared with the population of North West England: a cross-sectional study. BMJ Open 2024; 14:e084899. [PMID: 38830737 PMCID: PMC11149141 DOI: 10.1136/bmjopen-2024-084899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE This study aims to assess the 10-year cardiovascular risk and physical activity among Syrians residing in England and compare them with the North West England population. DESIGN Cross-sectional study. SETTING Bilingual online questionnaire distributed through social media platforms from 21 June to 23 July 2023. PARTICIPANTS Syrian individuals in England (aged 25-69, migrated post-2010) and residents of North West England within the same age bracket. All participants had no history of cardiovascular disease (CVD). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures included differences in QRISK3 score, 10-year relative risk (RR), metabolic equivalent of task (MET) and self-reported physical activity between the two groups. Secondary outcome measures included subgroup analyses based on sex and age. RESULTS Of the 273 eligible participants (137 in the Syrian group and 136 in the Northwest England group), the QRISK3 score was twofold higher in the Syrian group (2.20, 5.50) than in the North West England group (1.20, 3.15) (p=0.042). The 10-year RR was approximately three times higher in the Syrian group (p<0.001), while MET was about twice as high in the Northwest England group (p<0.001). CONCLUSIONS Despite relocating to England, Syrians face substantially elevated cardiovascular risks attributed to an unhealthy lifestyle, including smoking, reduced physical activity, increased body mass index and diabetes, coupled with a strong family history of CVD in first-degree relatives under the age of 60. The study underscores the need for early assessment, risk factor identification and tailored interventions for this population. Raising awareness, particularly in the context of smoking, and promoting physical activity are crucial for mitigating cardiovascular risks. The findings emphasise the importance of culturally sensitive interventions to address the unique health challenges of Syrians in the UK.
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Affiliation(s)
- George Abou Deb
- Chester Medical School, The Faculty of Medicine and Life Sciences, University of Chester, Chester, Cheshire, UK
| | - Hanady Hamdallah
- Chester Medical School, The Faculty of Medicine and Life Sciences, University of Chester, Chester, Cheshire, UK
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9
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Lee HS, Lim HI, Moon TJ, Lee SY, Lee JH. Trajectories of atherosclerotic cardiovascular disease risk scores as a predictor for incident chronic kidney disease. BMC Nephrol 2024; 25:141. [PMID: 38649847 PMCID: PMC11036697 DOI: 10.1186/s12882-024-03583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The relationship between atherosclerosis and renal function is well established. Atherosclerotic cardiovascular disease (ASCVD) risk scores reflect atherosclerotic burden, which changes over time. We investigated the association between ASCVD risk trajectories and incident chronic kidney disease (CKD) using data from a large community-based Korean cohort with up to 16 years of follow-up. METHODS We analyzed data from 5032 participants without CKD from the baseline survey of the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Participants were categorized into stable or increasing ASCVD risk groups based on the revised ASCVD risk pooled cohort equation over a median period of exposure of 5.8 years. Incident CKD was defined as two consecutive events of an estimated glomerular filtration rate < 60 mL/min/1.73 m2. RESULTS During a median 9.9 years of event accrual period, 449 (8.92%) new-onset CKD cases were identified. Multiple Cox proportional regression analyses showed that the hazard ratio (95% confidence interval) for incident CKD in the increasing group, compared to the stable group, was 2.13 (1.74-2.62) in the unadjusted model and 1.35 (1.02-1.78) in the fully-adjusted model. Significant relationships were maintained in subgroups of individuals in their 50s, without diabetes mellitus or hypertension. The prevalence of proteinuria was consistently higher in the increasing group than that in the stable group. CONCLUSIONS An increasing trend in ASCVD risk scores independently predicted adverse renal outcomes in patients without diabetes mellitus or hypertension. Continuous monitoring of ASCVD risk is not only important for predicting cardiovascular disease but also for predicting CKD.
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Affiliation(s)
- Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, 03277, Republic of Korea
| | - Hong Il Lim
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea
| | - Tae Ju Moon
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea
| | - So Young Lee
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea
| | - Jun-Hyuk Lee
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea.
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10
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Yoo TK, Han KD, Rhee EJ, Lee WY. Risk of Cardiovascular Disease according to Baseline Low-Density Lipoprotein Cholesterol Level in Different Age Groups in Korean Diabetes Population: A Cohort Study. Diabetes Metab J 2024; 48:265-278. [PMID: 38403889 PMCID: PMC10995493 DOI: 10.4093/dmj.2022.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/16/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGRUOUND The association between low-density lipoprotein (LDL-C) levels and cardiovascular disease (CVD) risk in different age groups within the diabetes mellitus (DM) population remains unclear. The cohort study was conducted to investigate this relationship. METHODS We assessed the 2009 to 2012 Korean National Health Screening and National Health Insurance Service records, with follow-up to the primary outcome (myocardial infarction [MI] or stroke) or December 2018. After excluding the participants with a history of MI or stroke, 2,227,394 participants with DM were included and categorized according to baseline LDL-C levels and age. Cox proportional hazards modeling was conducted. The CVD risk of age <40 years and LDL-C <70 mg/dL was set as the reference. In each age group, LDL-C <70 mg/dL was used as a reference for the subgroup analysis. RESULTS The cut-off LDL-C value for increased MI risk in each age group varied (<40 years old, LDL-C ≥160 mg/dL: hazard ratios [HR], 2.03; 95% confidence interval [CI], 1.644 to 2.506) (40-49-year-old, LDL-C <115 mg/dL: HR, 1.245; 95% CI, 1.04 to 1.489) (50-59-year-old, LDL-C <115 mg/dL: HR, 1.21; 95% CI, 1.014 to 1.445) (60-69-year-old, LDL-C <145 mg/dL: HR, 1.229; 95% CI, 1.022 to 1.479) (≥70 years old group, LDL-C <100 mg/dL: HR, 1.238; 95% CI, 1.018 to 1.504). The cut-off LDL-C values for increased stroke risk varied in each age subgroup (<40 years old, LDL-C ≥160 mg/dL: HR, 1.395; 95% CI, 1.094 to 1.779) (40-49-year-old, LDL-C <145 mg/dL: HR, 1.13; 95% CI, 1.019 to 1.253) (50-59-year-old, LDL-C <160 mg/dL: HR, 1.079; 95% CI, 1.008 to 1.154) (60-69-year-old, LDL-C <130 mg/dL: HR, 1.07; 95% CI, 1.022 to 1.119) (≥70 years old, LDL-C <115 mg/dL: HR, 1.064; 95% CI, 1.019 to 1.112). CONCLUSION The effect of LDL-C on the risk of CVD differs depending on the age of the population with DM.
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Affiliation(s)
- Tae Kyung Yoo
- Department of Medicine, MetroWest Medical Center, Framingham, MA, USA
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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Luu N, Bajpai A, Li R, Park S, Noor M, Ma X, Chen W. Aging-associated decline in vascular smooth muscle cell mechanosensation is mediated by Piezo1 channel. Aging Cell 2024; 23:e14036. [PMID: 37941511 PMCID: PMC10861209 DOI: 10.1111/acel.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Aging of the vasculature is associated with detrimental changes in vascular smooth muscle cell (VSMC) mechanosensitivity to extrinsic forces in their surrounding microenvironment. However, how chronological aging alters VSMCs' ability to sense and adapt to mechanical perturbations remains unexplored. Here, we show defective VSMC mechanosensation in aging measured with ultrasound tweezers-based micromechanical system, force instantaneous frequency spectrum, and transcriptome analyses. The study reveals that aged VSMCs adapt to a relatively inert mechanobiological state with altered actin cytoskeletal integrity, resulting in an impairment in their mechanosensitivity and dynamic mechanoresponse to mechanical perturbations. The aging-associated decline in mechanosensation behaviors is mediated by hyperactivity of Piezo1-dependent calcium signaling. Inhibition of Piezo1 alleviates vascular aging and partially restores the loss in dynamic contractile properties in aged cells. Altogether, our study reveals the signaling pathway underlying aging-associated aberrant mechanosensation in VSMC and identifies Piezo1 as a potential therapeutic mechanobiological target to alleviate vascular aging.
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Affiliation(s)
- Ngoc Luu
- Department of Biomedical EngineeringNew York UniversityBrooklynNew YorkUSA
| | - Apratim Bajpai
- Department of Mechanical and Aerospace EngineeringNew York UniversityBrooklynNew YorkUSA
| | - Rui Li
- Department of Mechanical and Aerospace EngineeringNew York UniversityBrooklynNew YorkUSA
| | - Seojin Park
- Department of Biomedical EngineeringNew York UniversityBrooklynNew YorkUSA
| | - Mahad Noor
- Department of Mechanical and Aerospace EngineeringNew York UniversityBrooklynNew YorkUSA
| | - Xiao Ma
- Department of Biomedical EngineeringNew York UniversityBrooklynNew YorkUSA
| | - Weiqiang Chen
- Department of Biomedical EngineeringNew York UniversityBrooklynNew YorkUSA
- Department of Mechanical and Aerospace EngineeringNew York UniversityBrooklynNew YorkUSA
- Laura and Isaac Perlmutter Cancer CenterNYU Langone HealthNew YorkUSA
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Hisamatsu T, Kadota A, Hayakawa T, Kita Y, Harada A, Okami Y, Kondo K, Ohkubo T, Okamura T, Okayama A, Ueshima H, Miura K. High blood pressure and colorectal cancer mortality in a 29-year follow-up of the Japanese general population: NIPPON DATA80. Hypertens Res 2024; 47:206-214. [PMID: 37993591 DOI: 10.1038/s41440-023-01497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023]
Abstract
Onco-hypertension has been proposed, although associations of high blood pressure (BP) with cancer risk remain inconsistent. We examined associations of high BP with risk of mortality from stomach, lung, colorectal, liver, and pancreatic cancers independent of possible confounders in an analysis that excluded deaths within the first 5 years of follow-up to consider the reverse causality. In a prospective cohort representative of the general Japanese population (1980-2009), we studied 8088 participants (mean age, 48.2 years; 56.0% women) without clinical cardiovascular disease or antihypertensive medication at baseline. Fine-Gray competing risks regression was used to estimate hazard ratios for 10 mmHg higher BP adjusted for confounders including smoking, alcohol-drinking, obesity, and diabetes mellitus. During 29-year follow-up, 159 (2.0%), 159 (2.0%), 89 (1.1%), 86 (1.1%), and 68 (0.8%) participants died from stomach, lung, colorectal, liver, and pancreatic cancers, respectively. We observed a positive association of high BP with risk of colorectal cancer mortality but not with mortality risks from any other cancers. The association with colorectal cancer mortality for systolic and diastolic BP was evident in those aged 30-49 years (hazard ratios 1.43 [95% confidence interval, 1.22-1.67] and 1.86 [1.32-2.62], respectively) but not in those aged 50-59 years and ≥60 years (P for age interaction <0.01 for systolic and diastolic BP). The associations with colorectal cancer mortality were similar in the analyses stratified by smoking, alcohol-drinking, obesity, and diabetic status. In conclusion, high BP among young to middle-aged adults was independently associated with risk of colorectal cancer mortality later in life.
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Affiliation(s)
- Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan.
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Takehito Hayakawa
- Research Center for Social Studies of Health and Community, Ritsumeikan University, Kyoto, Japan
| | - Yoshikuni Kita
- Science of Nursing, Tsuruga Nursing University, Tsuruga, Japan
| | - Akiko Harada
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Yukiko Okami
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Keiko Kondo
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
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Takahashi N, Tsubota-Utsugi M, Takahashi S, Yonekura Y, Ohsawa M, Kuribayashi T, Onoda T, Takanashi N, Sakata K, Yamada T, Ogasawara K, Omama S, Tanaka F, Asahi K, Ishigaki Y, Itabashi R, Itamochi H, Takahashi F, Okayama A, Tanno K. Sex- and Age-Specific Associations Between Metabolic Syndrome and Future Functional Disability in the Japanese Older Population. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241273103. [PMID: 39183635 PMCID: PMC11348345 DOI: 10.1177/00469580241273103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 08/27/2024]
Abstract
Whether the association between metabolic syndrome (MetS) and functional disability differs depending on sex or age remains unknown. To determine the association between MetS and functional disability in older people separately by sex and age groups. A total of 11 083 participants (4407 men and 6676 women) aged 65 years or over without functional disability were enrolled. MetS was defined according to the revised NCEP ATP III guidelines. Functional disability was defined by a new certification in the long-term care insurance in Japan. Cox proportional hazards models were used to assess the risk of functional disability with adjustment for possible confounding factors. Over the mean observation period of 10.5 years, 1282 men and 2162 women experienced functional disability. For those aged 65 to 74 years, HRs (95% CIs) for functional disability in the MetS group were 1.33 (1.07-1.66) in men and 1.15 (1.000-1.32) in women. For those aged 75 years or older, there was no significant association in men or women. In subjects with a severe care need level, there was a marginal significant association in men aged 65 to 74 years. Among the MetS components that independently increased the risk of functional disability were glucose intolerance and elevated blood pressure (men and women aged 65-74 years), obesity (women aged 65-74 years), and glucose intolerance (women aged 75 years or older). MetS contributed to an increase in a high risk of future functional disability among individuals aged 65 to 74 years. In this age group, improvement of lifestyle, health promotion and interventions for MetS from middle age may prevent future functional disability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akira Okayama
- The Research Institute of Strategy for Prevention, Tokyo, Japan
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14
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Kuckuck S, Lengton R, Boon MR, Boersma E, Penninx BWJH, Kavousi M, van Rossum EFC. Long-term glucocorticoids in relation to the metabolic syndrome and cardiovascular disease: A systematic review and meta-analysis. J Intern Med 2024; 295:2-19. [PMID: 37926862 DOI: 10.1111/joim.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The striking link of Cushing's syndrome with the metabolic syndrome (MetS) and cardiovascular disease (CVD) suggests that long-term exposure to extremely high cortisol levels catalyzes cardiometabolic deterioration. However, it remained unclear whether the findings from the extreme glucocorticoid overabundance observed in Cushing's syndrome could be translated into more subtle variations in long-term glucocorticoid levels among the general population, for example, due to chronic stress. Here, we performed a systematic review (PROSPERO: CRD42023425541) of evidence regarding the role of subtle variations in long-term biological stress, measured as levels of scalp hair cortisol (HairF) and cortisone (HairE), in the context of MetS and CVD in adults. We also performed a meta-analysis on the cross-sectional difference in HairF levels between individuals with versus without CVD. Seven studies were included regarding MetS, sixteen regarding CVD, and one regarding both. Most articles indicated a strong, consistent cross-sectional association of higher HairF and HairE levels with CVD, which was confirmed by our meta-analysis for HairF (eight studies, SMD = 0.48, 95% confidence intervals [CIs]: 0.16-0.79, p = 0.0095). Moreover, these relationships appear largely independent of standard risk factors. Age seems relevant as the effect seems stronger in younger individuals. Results regarding the associations of HairF and HairE with MetS were inconsistent. Altogether, long-term biological stress, measured as HairF and HairE, is associated with the presence of CVD, and less consistently with MetS. Prospective studies need to evaluate the directionality of this relationship and determine whether HairF and HairE can be used in addition to standard risk factors in predicting future cardiometabolic deterioration.
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Affiliation(s)
- Susanne Kuckuck
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin Lengton
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mariëtte R Boon
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Oyama S, Duckham RL, Pomer A, Rivara AC, Kershaw EE, Wood A, Fidow UT, Naseri T, Reupena MS, Viali S, McGarvey ST, Hawley NL. Association between age at menarche and cardiometabolic risk among Samoan adults. Am J Hum Biol 2024; 36:e23982. [PMID: 37668413 PMCID: PMC10845161 DOI: 10.1002/ajhb.23982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES Recent studies suggest that early menarche may increase cardiometabolic morbidity and mortality. Yet few studies have examined this association in the Pacific Islands, where obesity prevalence is among the highest globally. We sought to examine associations between age at menarche and cardiometabolic risk in Samoa. METHODS Participants were from the Soifua Manuia study (n = 285, age 32-72 years) conducted in Samoa from 2017 to 2019. Logistic regressions were conducted to estimate odds of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome per one-year increase in age at menarche. Linear regressions were conducted to examine associations between age at menarche and continuous measures of adiposity, blood pressure, insulin resistance, and serum lipids. RESULTS Median age at menarche was 14 years (IQR = 2). After controlling for relevant covariates, each one-year increase in age at menarche was associated with a 15% decrease (OR = 0.85, 95% CI: 0.72-1.01, p = .067) in odds of hypertension, but a 21% increase (OR = 1.21, 95% CI: 1.01-1.45, p = .044) in odds of diabetes and 18% increase (OR = 1.18, 95% CI: 0.98-1.42, p = .081) in odds of high total cholesterol. Each additional year in age at menarche was associated with a 1.60 ± 0.52 kg (p = .002) decrease in lean mass and 1.56 ± 0.51 kg (p = .003) decrease in fat-free mass. CONCLUSIONS Associations between age at menarche and cardiometabolic risk may be population-specific and are likely influenced by both current and historical nutritional and epidemiological contexts. Prospective studies are needed to clarify the role of childhood adiposity and other early life exposures on age at menarche and subsequent cardiometabolic risk.
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Affiliation(s)
- Sakurako Oyama
- Yale School of Medicine, New Haven, Connecticut, USA
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
| | - Rachel L Duckham
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
- Australian Institute for Musculoskeletal Sciences, Department of Medicine, Western Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Erin E Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashlee Wood
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ulai T Fidow
- Department of Obstetrics & Gynecology, Tupua Tamasese Meaole Hospital, Apia, Samoa
| | | | | | | | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Nicola L Hawley
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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16
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Wang FM, Cainzos-Achirica M, Ballew SH, Coresh J, Folsom AR, Howard CM, Post WS, Wagenknecht L, Budoff MJ, Blaha MJ, Matsushita K. Defining Demographic-specific Coronary Artery Calcium Percentiles in the Population Aged ≥75: The ARIC Study and MESA. Circ Cardiovasc Imaging 2023; 16:e015145. [PMID: 37655462 PMCID: PMC10721116 DOI: 10.1161/circimaging.122.015145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Current clinical guidelines recommend a coronary artery calcium (CAC) score of 100 Agatston Units or demographic-specific 75th percentile as high-risk thresholds for guiding atherosclerotic cardiovascular disease preventive therapy. Meanwhile, low CAC can help derisk individuals who may safely defer statin therapy. However, limited data from the early 2000s, including just 208 older Black individuals, inform CAC percentiles for adults aged 75 to 85 years, and none have been established in adults aged ≥85 years. This study aims to characterize the distribution of CAC and establish demographic-specific CAC percentiles in the population aged ≥75 years. METHODS We assessed 2886 participants aged ≥75 years without clinical coronary heart disease from the ARIC study (Atherosclerosis Risk in Communities) visit 7 (2018-2019; n=2217) and the MESA (Multi-Ethnic Study of Atherosclerosis) visit 5 (2010-2011; n=669). Prevalence of any CAC >0 and sex- and race-specific CAC percentiles across age were estimated nonparametrically with locally weighted regression models and pooled residual ranking. RESULTS The median age was 80 (interquartile interval, 77-83) years, and 60% were female. The prevalence of zero CAC was lowest in White males (4%), followed by Black males (13%), White females (14%), and highest in Black females (18%). Regardless of sex and race, most participants had CAC>100 (62.5%). CAC scores increased with age, with CAC identified in ≈95% of participants aged ≥90 years across sex-race subgroups. The 75th percentile corresponded to higher CAC scores for Black older adults (n=741), especially females, than currently used thresholds. CONCLUSIONS In community-dwelling adults aged ≥75 years free of clinical coronary heart disease, the prevalence of zero CAC was 11%, and CAC >100 as a threshold for high ASCVD risk would categorize most of this older population as high risk. Demographic-specific CAC percentiles from this study are a valuable tool for interpreting CAC in the population aged ≥75 years.
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Affiliation(s)
- Frances M. Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Miguel Cainzos-Achirica
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Cardiovascular Prevention and Wellness, Houston Methodist, Houston, TX
| | - Shoshana H. Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Candace M. Howard
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Wendy S. Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lynne Wagenknecht
- Wake Forest University Population Health Sciences, Winston Salem, NC
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA
| | - Michael J. Blaha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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17
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Woolcott OO, Seuring T. Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study. BMJ Open 2023; 13:e071295. [PMID: 37591649 PMCID: PMC10441088 DOI: 10.1136/bmjopen-2022-071295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES The body mass index (BMI) largely underestimates excess body fat, suggesting that the prevalence of obesity could be underestimated. Biologically, women are known to have higher body fat than men. This study aimed to compare the temporal trends in general obesity by sex, ethnicity and age among adults in the USA using the relative fat mass (RFM), a validated surrogate for whole-body fat percentage and BMI. DESIGN Population-based study. SETTING US National Health and Nutrition Examination Survey, from 1999-2000 to 2017-March 2020. PARTICIPANTS A representative sample of adults 20-79 years in the USA. MAIN OUTCOME MEASURES Age-adjusted prevalence of general obesity. RFM-defined obesity was diagnosed using validated cut-offs to predict all-cause mortality: RFM≥40% for women and ≥30% for men. BMI-defined obesity was diagnosed using a cut-off of 30 kg/m2. RESULTS Analysis included data from 47 667 adults. Among women, RFM-defined obesity prevalence was 64.7% (95% CI 62.1% to 67.3%) in 2017-2020, a linear increase of 13.9 percentage points (95% CI 9.0% to 18.9%; p<0.001) relative to 1999-2000. In contrast, the prevalence of BMI-defined obesity was 42.2% (95% CI 39.4% to 45.0%) in 2017-2020. Among men, the corresponding RFM-defined obesity prevalence was 45.8% (95% CI 42.0% to 49.7%), a linear increase of 12.0 percentage points (95% CI 6.6% to 17.3%; p<0.001). In contrast, the prevalence of BMI-defined obesity was 42.0 (95% CI 37.8% to 46.3%). The highest prevalence of RFM-defined obesity across years was observed in older adults (60-79 years) and Mexican Americans, in women and men. Conversely, the highest prevalence of BMI-defined obesity across years was observed in middle-age (40-59 years) and older adults, and in African American women. CONCLUSIONS The use of a surrogate for whole-body fat percentage revealed a much higher prevalence of general obesity in the USA from 1999 to 2020, particularly among women, than that estimated using BMI, and detected a disproportionate higher prevalence of general obesity in older adults and Mexican Americans.
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Affiliation(s)
- Orison O Woolcott
- Ronin Institute, Montclair, New Jersey, USA
- Institute for Globally Distributed Open Research and Education (IGDORE), Los Angeles, California, USA
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
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18
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Howard G, Banach M, Kissela B, Cushman M, Muntner P, Judd SE, Howard VJ. Age-Related Differences in the Role of Risk Factors for Ischemic Stroke. Neurology 2023; 100:e1444-e1453. [PMID: 36653179 PMCID: PMC10104611 DOI: 10.1212/wnl.0000000000206837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/06/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Reports assessing the association of stroke risk factors with incident stroke have generally assumed a uniform magnitude of associations across the age spectrum, an assumption we assess in this report. METHODS Participants enrolled 2003-2007 in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study who were stroke free at baseline were followed for incident stroke. Associations of traditional stroke risk factors with incident stroke were assessed using (1) proportional hazards analysis based on the baseline age of the participant and (2) Poisson regression analysis assessing associations based on the changing age of the participant during their follow-up (age at exposure). In each analysis, age strata were selected to have a similar number of strokes in each stratum, specifically 45-64, 65-73, and 74+ years for the proportional hazards analysis and 45-69, 70-79, and 80+ years for Poisson regression. RESULTS A total of 1,405 ischemic stroke events occurred among 28,235 participants over a median follow-up of 11.3 years, with a total of 276,074 person-years exposure. For both analytic approaches, the magnitude of the association with stroke was significantly less at older ages for diabetes (hazard or relative risk decreasing from ≈2.0 in younger strata to ≈1.3 in older strata), heart disease (from ≈2.0 to ≈1.3), and hypertension defined at a threshold of 140/90 mm Hg (from ≈1.80 to ≈1.50); however, there was no age-related difference in the magnitude of the association for smoking, atrial fibrillation, or left ventricular hypertrophy. DISCUSSION Hypertension and diabetes are 2 of the more important risk factors for stroke; however, their association with stroke risk appears substantially less at older ages. That the magnitude of the association for smoking, atrial fibrillation, and left ventricular hypertrophy does not decrease with age suggests their relative importance in determining stroke risk likely increases with age.
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Affiliation(s)
- George Howard
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL.
| | - Maciej Banach
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Brett Kissela
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Mary Cushman
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Paul Muntner
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Suzanne E Judd
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Virginia J Howard
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL.
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19
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Lind L, Salihovic S, Lind PM. Mixtures of environmental contaminants and diabetes. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 859:159993. [PMID: 36356760 DOI: 10.1016/j.scitotenv.2022.159993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Many studies have been published on the relationships between different environmental contaminants and diabetes. In these studies, the environmental contaminants have most often been evaluated one by one, but in real life we are exposed to a mixture of contaminants that interact with each other. OBJECTIVE The major aim of this study was to see if a mixture of contaminants could improve the prediction of incident diabetes, using machine learning. METHODS In the Prospective Investigation of the Vasculature in Uppsala (PIVUS) study (988 men and women aged 70 years), circulating levels of 42 contaminants from several chemical classes were measured at baseline. Incident diabetes was followed for 15 years. Six different machine-learning models were used to predict prevalent diabetes (n = 115). The variables with top importance were thereafter used to predict incident diabetes (n = 83). RESULTS Boosted regression trees performed best regarding prediction of prevalent diabetes (area under the ROC-curve = 0.70). Following removal of correlated contaminants, the addition of nine selected contaminants (Cd, Pb, Trans-nonachlor the phthalate MiBP, Hg, Ni, PCB126, PCB169 and PFOS) resulted in a significant improvement of 6.0 % of the ROC curve (from 0.66 to 0.72, p = 0.018) regarding incident diabetes (n = 51) compared with a baseline model including sex and BMI when the first 5 years of the follow-up was used. No such improvement in prediction was seen over 15 years follow-up. The single contaminant being most closely related to incident diabetes over 5 years was Nickel (odds ratio 1.44 for a SD change, 95 % CI 1.05-1.95, p = 0.022). CONCLUSION This study supports the view that machine learning was useful in finding a mixture of important contaminants that improved prediction of incident diabetes. This improvement in prediction was seen only during the first 5 years of follow-up.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
| | - Samira Salihovic
- Inflammatory Response and Infection Susceptibility Centre, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - P Monica Lind
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
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20
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Bergström G, Rosengren A, Bacsovics Brolin E, Brandberg J, Cederlund K, Engström G, Engvall JE, Eriksson MJ, Gonçalves I, Hagström E, James SK, Jernberg T, Lilja M, Magnusson M, Persson A, Persson M, Sandström A, Schmidt C, Skoglund Larsson L, Sundström J, Swahn E, Söderberg S, Torén K, Östgren CJ, Lampa E, Lind L. Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS. Atherosclerosis 2023; 373:46-54. [PMID: 36813601 DOI: 10.1016/j.atherosclerosis.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change. METHODS We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS). RESULTS The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p < 0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women. CONCLUSIONS Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.
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Affiliation(s)
- Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Elin Bacsovics Brolin
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio S:t Göran Hospital, Stockholm, Sweden
| | - John Brandberg
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Jan E Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Isabel Gonçalves
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Cardiovascular Research Translational Studies, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Hypertension in Africa Research Team HART, North-West University, Potchefstroom, South Africa
| | - Anders Persson
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anette Sandström
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Caroline Schmidt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Eva Swahn
- Department of Cardiology and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Östgren
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
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Marcellaud E, Jost J, Tchalla A, Magne J, Aboyans V. Statins in Primary Prevention in People Over 80 Years. Am J Cardiol 2023; 187:62-73. [PMID: 36459749 DOI: 10.1016/j.amjcard.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/24/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
Abstract
In the much older population (≥80 years), the management of cardiovascular diseases requires specific research to avoid a plain transposition of medical practice from younger populations. Whether statins are useful in primary prevention in this population is not clear. The 3 intricate issues requiring attention are (1) the impact of hypercholesterolemia on mortality and major adverse cardiovascular events in subjects >80 years, (2) the efficacy of statins to prevent cardiovascular events at this age, and (3) the safety and tolerance of statins in this population. Three systematic reviews were performed using a search on EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases including publication until January 2021. Among the 7,617 references identified, 29 were finally retained. Regarding the first objective (16 studies, 121,250 participants), 7 studies (10,241 participants) did not find total cholesterol and low-density lipoprotein levels associated with an increased rate of major cardiovascular events in octogenarians. A total of 6 studies (14,493 participants) found increased levels associated with events, whereas 3 studies (96,516 participants) found the opposite, with increased risk of major adverse cardiovascular events with lower levels of cholesterol. In 8 studies (436,005 participants) addressing the efficacy of statins, most did not indicate a significant decrease in the rate of major cardiovascular events in these subjects. Finally, regarding tolerance (9 studies, 217,088 participants), the most important side effects in this population were muscular, hepatic, and gastrointestinal disorders. These events were more frequent than in the younger population. In conclusion, in the absence of convincing evidence, the benefit of statins in primary prevention for much older patients is not certain. Their prescription in this setting should only be considered case by case, taking into consideration physiological status, co-morbidities, level of risk, and expected life expectancy. Specific trials are mandatory.
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Affiliation(s)
- Elodie Marcellaud
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Unit of Clinical Pharmacy, Division of Hospital Pharmacy, Limoges Hospital Center, Limoges, France.
| | - Jeremy Jost
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Unit of Clinical Pharmacy, Division of Hospital Pharmacy, Limoges Hospital Center, Limoges, France
| | - Achille Tchalla
- Division of Geriatrics, Limoges Hospital Center, Limoges, France; VIESANTE, UR 24134 Ageing Frailty Prevention e-Health, OmegaHealth Institute, University of Limoges, Limoges, France
| | - Julien Magne
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Division of Cardiology, Limoges Hospital Center, Limoges, France
| | - Victor Aboyans
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Division of Cardiology, Limoges Hospital Center, Limoges, France
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22
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Vilela de Sousa T, Cavalcante AMRZ, Lima NX, Souza JS, Sousa ALL, Brasil VV, Vieira FVM, Guimarães JV, de Matos MA, Silveira EA, Pagotto V. Cardiovascular risk factors in the elderly: a 10-year follow-up survival analysis. Eur J Cardiovasc Nurs 2023; 22:43-52. [PMID: 35574942 DOI: 10.1093/eurjcn/zvac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 01/14/2023]
Abstract
AIMS Cardiovascular risk factors present a high prevalence and have an impact on the morbimortality of the elderly; however, studies evaluating the impact of cardiovascular risk factors in the elderly have had short follow-up times and have not allowed specific analyses of the effects of these factors in the aged population, including how they affect the survival of the elderly. This study aimed to analyse the survival of elderly individuals living in the community, considering the presence of cardiovascular risk factors. METHODS AND RESULTS A prospective 10-year follow-up was initiated in 2008 with a cohort of 418 elderly people living in a community in Central Brazil. The Kaplan-Meier method and the Cox proportional hazards model were used to examine the association between survival and cardiovascular risk factors. The mean age of the participants was 70.6 (±7.1) years; most participants were hypertensive (81.6%) and participated in irregular physical activity (44%), and 43.3% smoked. After a mean follow-up of 8.38 (±2.82) years, 59.3% had survived and 34.1% had died; among the deaths, 14.1% were due to cardiovascular causes. Age [hazard ratio (HR) 1.067, 95% confidence interval (CI) 1.027-1.109], hypertension (HR 3.178, 95% CI 1.144-8.826), and smoking (HR 2.235, 95% CI 1.253-3.987) were confirmed as risk factors for reduced survival, whereas physical activity was a protective factor (HR 0.456, 95% CI 0.206-1.007). CONCLUSION The results from this study highlight the need for educational policies towards hypertension and smoking prevention among elderly people, and participation in physical activity needs to be encouraged.
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Affiliation(s)
- Thaís Vilela de Sousa
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Agueda Maria Ruiz Zimmer Cavalcante
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Nathália Xavier Lima
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Jennifer Siqueira Souza
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Ana Luiza Lima Sousa
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Virginia Visconde Brasil
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Flaviana Vely Mendonça Vieira
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Janaína Valadares Guimarães
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Marcos André de Matos
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Erika Aparecida Silveira
- 2 College of Medicine, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
| | - Valéria Pagotto
- 1 College of Nursing, Universidade Federal de Goias, 227 Street, Viela Q. 68, S/N - Sector Leste Universitario, Goiania, GO 74605-080, Brazil
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Peralta M, Dias CM, Marques A, Henriques-Neto D, Sousa-Uva M. Longitudinal association between grip strength and the risk of heart diseases among European middle-aged and older adults. Exp Gerontol 2023; 171:112014. [PMID: 36347359 DOI: 10.1016/j.exger.2022.112014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/16/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Few multi-country European studies have investigated the association between grip strength and heart diseases incidence. Thus, the aim of this study is to analyse the longitudinal relationship between grip strength and the diagnosis of heart diseases in European middle-aged and older adults. METHOD A prospective cohort study was conducted using data from the Survey of Health, Aging and Retirement in Europe (2004-2017). Participants were 20,829 middle-aged and older adults from 12 countries. GS was objectively measured by a dynamometer and heart diseases diagnosis was self-reported. Incidence rate of heart diseases was calculated and a Cox proportional hazard regression was performed. RESULTS The heart diseases incidence rate decreased from 930 per 100,000 person-years in the lowest quartile to 380 per 100,000 person-years in the highest grip strength quartile. During the 13 years of follow-up, compared to being in the lowest grip strength quartile, being in the highest quartile decreased the hazard of being diagnosed with a heart disease in 36 % (95 % confidence interval [CI]: 0.53, 0.78) for the whole sample, 35 % (95 % CI: 0.51, 0.84) for men and 46 % (95 % CI: 0.40, 0.73) for women. CONCLUSIONS Grip strength seems to be inversely associated with the incidence of heart diseases among European middle-aged and older adults. Scientific evidence has highlighted the potential role of grip strength as a risk stratifying measure for heart diseases, suggesting its potential to be included in the cardiovascular risk scores used in primary care. However, further research is still needed to clarify it.
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Affiliation(s)
- Miguel Peralta
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal; ISAMB, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Matias Dias
- CISP, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal; ISAMB, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Duarte Henriques-Neto
- Research Center in Sports Sciences, Health Sciences and Human Development, Maia University, Maia, Portugal; School of Higher Education, Polytechnic Institute of Porto, Porto, Portugal
| | - Mafalda Sousa-Uva
- CISP, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
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24
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Stroke risk in older British men: Comparing performance of stroke-specific and composite-CVD risk prediction tools. Prev Med Rep 2022; 31:102098. [PMID: 36820364 PMCID: PMC9938339 DOI: 10.1016/j.pmedr.2022.102098] [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: 09/23/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
Stroke risk is currently estimated as part of the composite risk of cardiovascular disease (CVD). We investigated if composite-CVD risk prediction tools QRISK3 and Pooled Cohort Equations-PCE, derived from middle-aged adults, are as good as stroke-specific Framingham Stroke Risk Profile-FSRP and QStroke for capturing the true risk of stroke in older adults. External validation for 10y stroke outcomes was performed in men (60-79y) of the British Regional Heart Study. Discrimination and calibration were assessed in separate validation samples (FSRP n = 3762, QStroke n = 3376, QRISK3 n = 2669 and PCE n = 3047) with/without adjustment for competing risks. Sensitivity/specificity were examined using observed and clinically recommended thresholds. Performance of FSRP, QStroke and QRISK3 was further compared head-to-head in 2441 men free of a range of CVD, including across age-groups. Observed 10y risk (/1000PY) ranged from 6.8 (hard strokes) to 11 (strokes/transient ischemic attacks). All tools discriminated weakly, C-indices 0.63-0.66. FSRP and QStroke overestimated risk at higher predicted probabilities. QRISK3 and PCE showed reasonable calibration overall with minor mis-estimations across the risk range. Performance worsened on adjusting for competing non-stroke deaths. However, in men without CVD, QRISK3 displayed relatively better calibration for stroke events, even after adjustment for competing deaths, including in oldest men. All tools displayed similar sensitivity (63-73 %) and specificity (52-54 %) using observed risks as cut-offs. When QRISK3 and PCE were evaluated using thresholds for CVD prevention, sensitivity for stroke events was 99 %, with false positive rate 97 % suggesting existing intervention thresholds may need to be re-examined to reflect age-related stroke burden.
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Key Words
- AF, atrial fibrillation
- BRHS, British Regional Heart Study
- CHD, coronary heart disease
- CIF, cumulative incidence function
- CPI, centred prognostic index
- CVD, cardiovascular disease
- Calibration
- Cardiovascular disease
- Discrimination
- FSRP, Framingham stroke risk profile
- HF, heart failure
- KM, Kaplan-Meier
- MI, myocardial infarction
- NICE, National Institute For Health And Care Excellence
- Older adults
- PCE, pooled cohort equations
- PI, prognostic index
- Risk prediction
- SCORE, systematic coronary risk evaluation
- Sn/Sp, percent sensitivity/percent specificity
- Stroke
- TIA, transient ischemic attack
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25
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Gao L, He Z, Wu Y. Advances in Anti-metabolic Disease Treatments Targeting CD47. Curr Pharm Des 2022; 28:3720-3728. [PMID: 36201266 DOI: 10.2174/1381612828666221006123144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 01/28/2023]
Abstract
Metabolic disorders include a cluster of conditions that result from hyperglycemia, hyperlipidemia, insulin resistance, obesity, and hepatic steatosis, which cause the dysfunction of immune cells and innate cells, such as macrophages, natural killer cells, vascular endothelial cells, hepatocytes, and human kidney tubular epithelial cells. Besides targeting the derangements in lipid metabolism, therapeutic modulations to regulate abnormal responses in the immune system and innate cell dysfunctions may prove to be promising strategies in the management of metabolic diseases. In recent years, several targets have been explored for the CD47 molecule (CD47), a glycosylated protein, which was originally reported to transmit an anti-phagocytic signal known as "don't eat me" in the atherosclerotic environment, hindering the efferocytosis of immune cells and promoting arterial plaque accumulation. Subsequently, the role of CD47 has been explored in obesity, fatty liver, and lipotoxic nephropathy, and its utility as a therapeutic target has been investigated using anti-CD47 antibodies or inhibitors of the THBS1/CD47 axis and the CD47/SIRPα signaling pathway. This review summarizes the mechanisms of action of CD47 in different cell types during metabolic diseases and the clinical research progress to date, providing a reference for the comprehensive targeting of CD47 to treat metabolic diseases and the devising of potential improvements to possible side effects.
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Affiliation(s)
- Li Gao
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Center for Scientific Research of Anhui Medical University, Hefei 230022, China
| | - Zhe He
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yonggui Wu
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Center for Scientific Research of Anhui Medical University, Hefei 230022, China
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26
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Katajamäki TT, Koivula MK, Hilvo M, Lääperi MTA, Salminen MJ, Viljanen AM, Heikkilä ETM, Löppönen MK, Isoaho RE, Kivelä SL, Jylhä A, Viikari L, Irjala KM, Pulkki KJ, Laaksonen RMH. Ceramides and Phosphatidylcholines Associate with Cardiovascular Diseases in the Elderly. Clin Chem 2022; 68:1502-1508. [DOI: 10.1093/clinchem/hvac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/09/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The ceramide- and phospholipid-based cardiovascular risk score (CERT2) has been found to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular mortality. In the present study, our aim was to estimate the predictive ability of CERT2 for mortality of CVD, coronary artery disease (CAD), and stroke in the elderly and to compare these results with those of conventional lipids.
Methods
We conducted a prospective study with an 18-year follow-up period that included a total of 1260 participants ages ≥64 years. Ceramides and phosphatidylcholines were analyzed using a LC-MS. Total cholesterol and triglycerides were performed by enzymatic methods and HDL cholesterol was determined by a direct enzymatic method. Concentrations of LDL-cholesterol were calculated according to the Friedewald formula.
Results
A higher score of CERT2 was significantly associated with higher CVD, CAD, and stroke mortality during the 18-year follow-up both in unadjusted and adjusted Cox regression models. The unadjusted hazard ratios (HRs) of CERT2 (95% CI) per SD for CVD, CAD, and stroke were 1.72 (1.52–1.96), 1.76 (1.52–2.04), and 1.63 (1.27–2.10), respectively, and the corresponding adjusted HRs (95% CI) per SD for CERT2 were 1.48 (1.29–1.69), 1.50 (1.28–1.75), and 1.41 (1.09–1.83). For conventional lipids, HRs per SD were lower than for CERT2.
Conclusions
The risk score CERT2 associated strongly with CVD, CAD, and stroke mortality in the elderly, while the association between these events and conventional lipids was weak.
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Affiliation(s)
- Taina T Katajamäki
- Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, Turku University , Turku , Finland
- Department of Clinical Chemistry, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland , Turku , Finland
| | - Marja-Kaisa Koivula
- HUS Diagnostic Center, Helsinki University Hospital, Hospital District of Helsinki and Uusimaa , Helsinki , Finland
- Clinical Chemistry and Hematology, Faculty of Medicine, University of Helsinki , Helsinki , Finland
| | | | | | - Marika J Salminen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital , Turku , Finland
- Welfare Division, Turku City Hospital , Turku , Finland
| | - Anna M Viljanen
- Municipality of Lieto, Health Care Center , Lieto , Finland
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku , Turku , Finland
| | - Elisa T M Heikkilä
- Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, Turku University , Turku , Finland
- Department of Clinical Chemistry, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland , Turku , Finland
| | | | - Raimo E Isoaho
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital , Turku , Finland
- Social and Health Care , Vaasa , Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital , Turku , Finland
- Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki , Helsinki , Finland
| | | | - Laura Viikari
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku , Turku , Finland
- Welfare Division, Turku City Hospital , Turku , Finland
| | - Kerttu M Irjala
- Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, Turku University , Turku , Finland
| | - Kari J Pulkki
- HUS Diagnostic Center, Helsinki University Hospital, Hospital District of Helsinki and Uusimaa , Helsinki , Finland
- Clinical Chemistry and Hematology, Faculty of Medicine, University of Helsinki , Helsinki , Finland
| | - Reijo M H Laaksonen
- Zora Biosciences Oy , Espoo , Finland
- Finnish Cardiovascular Research Center, University of Tampere , Tampere , Finland
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Abdel-Rahman N, Calderon-Margalit R, Cohen A, Elran E, Golan Cohen A, Krieger M, Paltiel O, Valinsky L, Ben-Yehuda A, Manor O. Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease: A Nationwide Population-Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes. J Am Heart Assoc 2022; 11:e025603. [PMID: 36129044 DOI: 10.1161/jaha.122.025603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. Methods and Results We conducted a population-based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006-2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011-2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person-years of follow-up, 19 246 patients experienced cardiac disease. An inverse dose-response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low-density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low-density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49-1.72) and 1.23 (95% CI, 1.14-1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50-1.69) for cardiac outcomes. Conclusions Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ronit Calderon-Margalit
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | | | - Michal Krieger
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ora Paltiel
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | - Orly Manor
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
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Lind L, Zethelius B, Byberg L. Self-reported physical activity and different cardiovascular diseases—Results from updated measurements over 40 years. PLoS One 2022; 17:e0269402. [PMID: 35657994 PMCID: PMC9165764 DOI: 10.1371/journal.pone.0269402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background Self-reported leisure-time physical activity (PA) has previously been linked to risk of cardiovascular disease (CVD). We now aim to investigate the strength of associations between PA and different CVDs and how the risk varies with age. Methods PA and traditional CV risk factors assessed by a questionnaire on a four-level scale in 2,175 men at age 50 years in the ULSAM study. Examinations were thereafter repeated at ages 60, 70, and 77. Results During 40 years follow-up, 883 individuals experienced a CVD (myocardial infarction, stroke, or heart failure). Using data from all four examinations, a graded reduction in risk of incident CVD was seen with increasing PA (HR 0.84, 95%CI; 0.77–0.93, p = 0.001 for trend test). PA was related to myocardial infarction (HR 0.84, 95%CI; 0.74–0.95, 490 cases), heart failure (HR 0.79, 95%CI; 0.68–0.91, 356 cases), but only of borderline significance vs ischemic stroke (HR 0.85, 95%CI; 0.73–1.00, 315 cases) when the CVDs were analyzed separately. Adjusting for traditional CV risk factors attenuated all relationships between PA and incident CVD, and PA did not improve discrimination of CVD when added on top of risk factors. When 10-year risk was calculated from each examination, age 70 was the time-point when PA was most closely related to incident CVD. Conclusion Leisure-time physical activity is related to future CVD. This was most evident at 70 years of age. If a causal relationship between self-reported PA and CVD exists, this relationship might to a major degree be mediated by traditional risk factors.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Björn Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences/Medical Epidemiology, Faculty of Medicine, Uppsala University, Uppsala, Sweden
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29
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Koh AS, Siau A, Gao F, Chioh FW, Leng S, Zhao X, Zhong L, Tan RS, Koh PL, Kovalik JP, Lim WS, Lee GS, Koh WP, Cheung C. Left Atrial Phasic Function in Older Adults Is Associated with Fibrotic and Low-Grade Inflammatory Pathways. Gerontology 2022; 69:47-56. [PMID: 35316808 PMCID: PMC9492896 DOI: 10.1159/000522632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/15/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Concomitant risk factors challenge the mechanistic understanding of cardiac aging. We determined the degree to which the left atrial function could be distinguished by advanced cardiac magnetic resonance (CMR) imaging in older adults and assessed associations between the left atrial function and the plasma biomarkers related to biological aging and cardiovascular disease [serum monocyte chemoattractant protein-1 (MCP1), matrix metallopeptidase 9 (MMP-9), B-type natriuretic peptides (BNPs), galectin-3 (Gal-3), high-sensitivity cardiac troponin I (hsTn1), high-sensitivity C-reactive protein (hs-CRP), and soluble urokinase plasminogen activator receptor (sUPAR)]. METHODS Among a cross-sectional population-based cohort of older adults, longitudinal LA strain including reservoir strain (εs), conduit strain (εe), and booster strain (εa) as well as peak strain rates (SRs, SRe, SRa) were determined using CMR and studied in association with blood biomarkers. RESULTS We studied 243 community adults (42.8% female, mean age 70.3 ± 9.5 years). In bivariate analysis, εe and SRe were reduced in gradation with increasing risk factors (all p values <0.0001). Corresponding levels of sUPAR (ng/mL) were quantitatively higher in older adults with <2 risk factors (2.5 ± 1.6 vs. 1.7 ± 1.3, p = 0.0005), in those with ≥2 risk factors (3.3 ± 2.4 vs. 1.7 ± 1.3, p < 0.0001), compared to young adults; including between older adults with ≥2 risk factors and older adults with <2 risk factors (3.3 ± 2.4 vs. 2.5 ± 1.6, p = 0.017). Based on multivariate analysis, sUPAR was significantly associated with both εe (OR 1.52, p = 0.006) and SRe decline (OR 1.5, p = 0.019). The associations between Gal-3 and εe reduction (OR 1.2, p = 0.022) and between BNP and SRe decline were generally weaker (OR 1.03, p = 0.027). The addition of sUPAR to a model consisting of age, risk factors, Gal-3, and BNPs increased the area under the curve of εe from 0.72 to 0.77 (p = 0.015). CONCLUSION By advanced CMR imaging, a panel of circulating biomarkers comprising galectin, MMP-9 and sUPAR were associated with left atrial dysfunction in older adults. Higher levels of Gal-3 and MMP-9 may be suggestive of fibrotic mechanisms in left atrial aging while impairments in left atrial strain seen in association with circulating sUPAR may be related to immune activation in the left atrium in response to left atrial remodeling and fibrotic processes.
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Affiliation(s)
- Angela S. Koh
- National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, Singapore, Singapore,*Angela S. Koh,
| | - Anthony Siau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, Singapore, Singapore
| | - Florence W.J. Chioh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, Singapore, Singapore
| | | | - Jean-Paul Kovalik
- Duke-NUS Medical School, Singapore, Singapore,Singapore General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gina S. Lee
- National Heart Centre Singapore, Singapore, Singapore
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore,**Christine Cheung,
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30
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Salinero-Fort MA, Mostaza J, Lahoz C, Cárdenas-Valladolid J, Vicente-Díez JI, Gómez-Campelo P, de Miguel-Yanes JM. All-cause mortality and cardiovascular events in a Spanish nonagenarian cohort according to type 2 diabetes mellitus status and established cardiovascular disease. BMC Geriatr 2022; 22:224. [PMID: 35303825 PMCID: PMC8931574 DOI: 10.1186/s12877-022-02893-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the progressive aging of the population in industrialized countries, few studies have focused on the natural history of cardiovascular disease in the very old, and recommendations on prevention of cardiovascular disease in this population are lacking. We aimed to analyze all-cause mortality and cardiovascular events according to prevalent type 2 diabetes mellitus and established cardiovascular disease in nonagenarians from a Mediterranean population. Methods We analyzed the primary health records of all nonagenarians living in the Community of Madrid (N = 59,423) and collected data for 4 groups: Group 1, individuals without T2DM or established CVD (T2DM-, CVD-); Group 2, individuals without T2DM but with established CVD (T2DM-, CVD +); Group 3, individuals with T2DM but without established CVD (T2DM + , CVD-); and Group 4, individuals with both T2DM and established CVD (T2DM + , CVD +), taking into account the influence of sex on the outcomes. Follow-up was 2.5 years. The primary outcomes were cumulative incidence and incidence density rates for all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (the first composite primary outcome [CPO1]), combined with heart failure (CPO2). We evaluated the adjusted effect of each group on all-cause mortality (Cox regression). Results Mean age was 93.3 ± 2.8 years (74.2% women). Hypertension, dyslipidemia, heart failure, albuminuria, and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were significantly more prevalent in G4 than in the other groups (all p values < 0.001). We observed significantly higher cumulative incidence rates for all-cause mortality, CPO1, and CPO2 in participants belonging to G4 (all p values ≤ 0.001). People in G2 presented higher rates of all-cause mortality, heart failure, CPO1, and CPO2 than people in G3 (all p values ≤ 0.001). In the fully adjusted model, G4 independently predicted all-cause mortality (HR = 1.48 [95% CI, 1.40 to 1.57] vs reference G1 [p < 0.01]). In addition, significant HRs were recorded for cardiovascular disease alone (G2) and type 2 diabetes mellitus alone (G3) (1.13 and 1.14, respectively; both p values < 0.01). Conclusions In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred a modest risk of all-cause mortality. However, the simultaneous presence of both conditions conferred the highest risk of all-cause mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02893-z.
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Affiliation(s)
- M A Salinero-Fort
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain. .,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Subdirección General de Investigación y Documentación, Consejería de Sanidad, Madrid, Spain.
| | - J Mostaza
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - C Lahoz
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - J Cárdenas-Valladolid
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Sistemas de Información, Madrid, Spain.,Universidad Alfonso X El Sabio, Madrid, Spain
| | - J I Vicente-Díez
- Centro de Salud Monóvar, Comunidad de Madrid Servicio Madrileño de Salud, Madrid, Spain
| | - P Gómez-Campelo
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain
| | - J M de Miguel-Yanes
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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31
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Liu Y, Zhou Z, Yin L, Zhu M, Wang F, Zhang L, Wang H, Zhou Z, Zhu H, Huang C, Fan S. Tangeretin promotes lifespan associated with insulin/insulin-like growth factor-1 signaling pathway and heat resistance in Caenorhabditis elegans. Biofactors 2022; 48:442-453. [PMID: 34580918 DOI: 10.1002/biof.1788] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/14/2021] [Indexed: 12/27/2022]
Abstract
Tangeretin is a polymethoxylated flavonoid naturally occurred in citrus fruits with many pharmacological activities, such as anti-inflammatory, antiproliferative, and neuroprotective properties. A previous study reported that tangeretin-enriched orange extract could prolong the lifespan in Caenorhabditis elegans. However, the antiaging effect of tangeretin remains uncertain. In this study, we used the model organism C. elegans to conduct a lifespan test, observed the aging-related functional changes of nematodes, the fluorescence changes of stress-related proteins (DAF-16 and HSP-16.2) and its response to stress assay, and monitored the effect of tangeretin on the mRNA expression levels. The results showed that tangeretin supplementation (30 and 100 μM) extended the mean lifespan, slowed aging-related functional declines, and increased the resistance against heat-shock stress. Furthermore, tangeretin upregulated the mRNA expression of daf-16, hsp-16.2, and hsp-16.49, promoted the nuclear localization of DAF-16, and enhanced the fluorescence intensity of HSP-16.2, while it had no effect on the lifespan of daf-2, age-1, and daf-16 mutants. The current findings suggest that tangeretin can significantly extend the lifespan and enhance heat stress tolerance in an insulin/insulin-like growth factor signaling dependent manner.
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Affiliation(s)
- Yalei Liu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhenyu Zhou
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liufang Yin
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengnan Zhu
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Fei Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lijun Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongqing Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiqin Zhou
- College of Horticulture and Landscape Architecture, Southwest University, Chongqing, China
| | - Huanhu Zhu
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Cheng Huang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shengjie Fan
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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32
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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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Cho SMJ, Jeon JY, Yoo TH, Lee HY, Lee YH, Kim HC. Ideal cardiovascular health duration and risk of chronic kidney disease and cardiovascular disease. Heart 2021; 108:523-528. [PMID: 34916271 DOI: 10.1136/heartjnl-2021-320180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/18/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Increasing number of clinical guidelines are adopting comprehensive cardiovascular risk assessment tools for treatment decision and disease management. Yet, little is known regarding cardiovascular risks associated with the length of favourable cardiometabolic profile. In this context, we examined whether the duration of strictly ideal cardiovascular health (CVH), based on body mass index, blood pressure, fasting glucose, total cholesterol, cigarette smoking, alcohol drinking and physical activity, in middle age is associated with risk of developing chronic kidney disease (CKD) and cardiovascular disease (CVD) in mid-to-late life. METHODS From the Korean Genome and Epidemiology Study Ansung-Ansan cohort, we included 8020 participants (median age 50.0 years, 47.9% male), of whom, 7854 without CKD and 7796 without CVD at baseline. Cox proportional hazards models were employed to assess CKD and CVD risks, adjusting for age, sex, education level, examination sites and renal markers. RESULTS Over a median follow-up of 15.0 years, 1401 cases of CKD and 493 cases of CVD were newly developed. Compared with participants with <5 years of ideal CVH duration, HR (95% CI) of those who maintained for 5-<10 years or ≥10 years had negatively graded risks for CKD (5-<10 years, 0.63 (0.39 to 0.93); ≥10 years, 0.33 (0.15 to 0.74)) and CVD (5-<10 years, 0.83 (0.54 to 1.27); ≥10 years, 0.22 (0.08 to 0.60)). In parallel, participants with delayed decline to suboptimal level had lower disease risks compared with counterparts with consistently suboptimal CVH. CONCLUSION Our findings confer that maintaining favourable health behaviours and clinical risk factor levels in midlife will improve later-life cardiovascular outcomes.
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Affiliation(s)
- So Mi Jemma Cho
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Justin Y Jeon
- Sport Industry Studies, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Kidney Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Chang Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea .,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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34
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Cho SMJ, Lee H, Kim HC. Sex- and Age-Specific Trends in Cardiovascular Health in Korea, 2007-2018. Korean Circ J 2021; 51:922-935. [PMID: 34719898 PMCID: PMC8558568 DOI: 10.4070/kcj.2021.0211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We illustrated sex- and age-specific temporal trends in cardiovascular health among Korean adults. METHODS From the Korean National Health and Nutrition Examination Survey 2007-2018, we included 61,408 participants aged 20 years or older. The ideal levels of 6 components of cardiovascular health metrics were defined as never-smoking, ≥75 min/week of vigorous or ≥150 min/week of moderate-to-vigorous physical activity, body mass index (BMI) <23 kg/m², total cholesterol <200 mg/dL, blood pressure (BP) <120/80 mmHg, and fasting glucose <100 mg/dL. Temporal trends in the number of ideal cardiovascular health components and distribution of each component were assessed by sex and age. RESULTS The average number of ideal cardiovascular health components decreased from 3.37 in 2007-2009 to 2.86 in 2016-2018. Never smoking increased from 56.0% to 59.2%, largely contributed by young men. Ideal physical activity halved (41.4-21.3%); such decline was more pronounced in women and with older age. Ideal BMI decreased from 44.3% to 42.2%, more apparently in young and elderly men. In contrast, ideal BMI increased in middle-aged and elderly women. Ideal cholesterol decreased from 65.5% to 50.3%, profoundly in young adults and relatively greater in men. Ideal BP declined from 55.1% to 46.9%, more evidently in men. However, ideal BP discernibly increased in middle-aged women. Ideal glucose decreased from 74.6% to 66.0%, comparatively greater and earlier in men. CONCLUSIONS The proportion of Korean adults with ideal cardiovascular health decreased between 2007 and 2018, but the course of responsible factors differed across sex and age groups.
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Affiliation(s)
- So Mi Jemma Cho
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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35
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Secci R, Hartmann A, Walter M, Grabe HJ, Van der Auwera-Palitschka S, Kowald A, Palmer D, Rimbach G, Fuellen G, Barrantes I. Biomarkers of geroprotection and cardiovascular health: An overview of omics studies and established clinical biomarkers in the context of diet. Crit Rev Food Sci Nutr 2021; 63:2426-2446. [PMID: 34648415 DOI: 10.1080/10408398.2021.1975638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The slowdown, inhibition, or reversal of age-related decline (as a composite of disease, dysfunction, and, ultimately, death) by diet or natural compounds can be defined as dietary geroprotection. While there is no single reliable biomarker to judge the effects of dietary geroprotection, biomarker signatures based on omics (epigenetics, gene expression, microbiome composition) are promising candidates. Recently, omic biomarkers started to supplement established clinical ones such as lipid profiles and inflammatory cytokines. In this review, we focus on human data. We first summarize the current take on genetic biomarkers based on epidemiological studies. However, most of the remaining biomarkers that we describe, whether omics-based or clinical, are related to intervention studies. Then, because of their promising potential in the context of dietary geroprotection, we focus on the effects of berry-based interventions, which up to now have been mostly described employing clinical markers. We provide an aggregation and tabulation of all the recent systematic reviews and meta-analyses that we could find related to this topic. Finally, we present evidence for the importance of the "nutribiography," that is, the influence that an individual's history of diet and natural compound consumption can have on the effects of dietary geroprotection.
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Affiliation(s)
- Riccardo Secci
- Junior Research Group Translational Bioinformatics, Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock University Medical Center, Rostock, Germany
| | - Alexander Hartmann
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Rostock, University of Rostock, Rostock, Germany
| | - Michael Walter
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Rostock, University of Rostock, Rostock, Germany.,Institute of Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry, Charite University Medical Center, Berlin, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Sandra Van der Auwera-Palitschka
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Axel Kowald
- Institute for Biostatistics and Informatics in Medicine and Aging Research, Rostock University Medical Center, Rostock, Germany
| | - Daniel Palmer
- Institute for Biostatistics and Informatics in Medicine and Aging Research, Rostock University Medical Center, Rostock, Germany
| | - Gerald Rimbach
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - Georg Fuellen
- Institute for Biostatistics and Informatics in Medicine and Aging Research, Rostock University Medical Center, Rostock, Germany
| | - Israel Barrantes
- Junior Research Group Translational Bioinformatics, Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock University Medical Center, Rostock, Germany
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36
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Calling S, Johansson SE, Nymberg VM, Sundquist J, Sundquist K. Trajectories of body mass index and risk for coronary heart disease: A 38-year follow-up study. PLoS One 2021; 16:e0258395. [PMID: 34618872 PMCID: PMC8496839 DOI: 10.1371/journal.pone.0258395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Obesity is a well-known risk factor for coronary heart disease (CHD), but there is little evidence on the effect of long-term trajectories of body mass index (BMI) over the life course. By using repeated assessments, the aim was to study the risk of CHD in adults during 38 years in different trajectories of BMI. METHODS A sample of 2129 men and women, aged 20-59 years at baseline, took part in four repeated interviews between 1980 and 2005. Data on BMI, medical history, lifestyle and socioeconomy were collected. Based on the World Health Organization categories of BMI, life course trajectories of stable normal weight, stable overweight, stable obesity, increasing BMI and fluctuating BMI were created. The individuals were followed through national registers for first hospitalization of CHD (389 events) until the end of 2017, and Hazard Ratios (HRs) were calculated, adjusted for age, sex, socioeconomic factors, lifestyle factors and metabolic comorbidities. RESULTS Stable normal weight in all assessments was the reference group. Those who had an increase in BMI from normal weight in the first assessment to overweight or obesity in later assessments had no increased risk of CHD, HR 1.04 (95% CI: 0.70-1.53). The HR for individuals with fluctuating BMI was 1.25 (0.97-1.61), for stable overweight 1.43 (1.03-1.98), for stable obesity 1.50 (0.92-2.55), and for stable overweight or obesity 1.45 (1.07-1.97), after full adjustments. CONCLUSION Having a stable overweight or obesity throughout adult life was associated with increased CHD risk but changing from normal weight at baseline to overweight or obesity was not associated with increased CHD risk. Prevention of obesity early in life may be particularly important to reduce CHD risk.
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Affiliation(s)
- Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Region Skåne, Sweden
| | - Sven-Erik Johansson
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Region Skåne, Sweden
| | - Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Region Skåne, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Region Skåne, Sweden
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37
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Lind L, Ingelsson M, Sundstrom J, Ärnlöv J. Impact of risk factors for major cardiovascular diseases: a comparison of life-time observational and Mendelian randomisation findings. Open Heart 2021; 8:openhrt-2021-001735. [PMID: 34518286 PMCID: PMC8438838 DOI: 10.1136/openhrt-2021-001735] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background This study compared the strength and causality of associations between major risk factors for cardiovascular disease (CVD) and the four major CVDs: myocardial infarction, ischaemic stroke, heart failure and atrial fibrillation. Both a long-term follow-up in an observational cohort and Mendelian randomisation (MR) were used for this aim. Methods In the Uppsala Longitudinal Study of Adult Men study, 2322 men, all aged 50 years, were assessed for CVD risk factors and then followed for four decades regarding incident CVDs. The two-sample MR part used public available Genome-Wide Association Study (GWAS) data. Results In multivariate analyses, systolic blood pressure was overall by far the most important risk factor, since it was related to all four CVDs, both in observational and MR analyses. Body mass index was the second most overall important risk factor, being linked to all four CVDs, except ischaemic stroke, both in observational and MR analyses. Smoking was an important risk factor for ischaemic stroke and heart failure, both in observational and MR analyses, while low-density lipoprotein-cholesterol mainly was related to myocardial infarction. Diabetes was mainly a causal risk factor for incident myocardial infarction and heart failure. Neither HDL-cholesterol nor triglycerides were of major importance as risk factors in these multivariable models. Conclusion By combining long-term observational data with genetic data, we show that the impact and causal role of specific established cardiovascular risk factors varies between different major CVDs. Systolic blood pressure was causally related to all four cardiovascular outcomes and was therefore, overall, the most important risk factor.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Johan Sundstrom
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden.,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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38
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Saeed S, Waje-Andreassen U, Naess H, Fromm A, Nilsson PM. The impact of age and 24-h blood pressure on arterial health in acute ischemic stroke patients: The Norwegian stroke in the young study. J Clin Hypertens (Greenwich) 2021; 23:1922-1929. [PMID: 34492149 PMCID: PMC8678672 DOI: 10.1111/jch.14361] [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: 07/17/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
The impact of age and 24‐h ambulatory blood pressure (ABPM) on arterial stiffness and carotid intima‐media thickness (cIMT) in ischemic stroke patients younger than 60 years of age is poorly explored. A total of 385 acute ischemic stroke patients (aged 49.6±9.7 years, 68% men) were prospectively included and grouped in younger (15–44 years, n = 93) and middle‐aged (45–60 years, n = 292). Arterial stiffness was measured by carotid‐femoral pulse wave velocity (PWV), and cIMT by carotid ultrasound. 24‐h ABPM was recorded. The middle‐aged stroke patients had higher prevalence of smoking, hypertension, diabetes mellitus, metabolic syndrome and hypercholesterolemia, and had higher PWV and cIMT (all p < .05). In multivariable linear regression analyses adjusted for sex, BMI, smoking, diabetes mellitus, total cholesterol, high‐density lipoprotein cholesterol, triglycerides, eGFR, systolic BP and concomitant antihypertensive treatment, 1SD (4.4 years) higher age was associated with higher PWV (β = 0.44,R2 = 0.46, p < .001) in the younger group, and with higher mean cIMT (β = 0.16, R2 = 0.21, p = .01) in the middle‐aged group. In the middle‐aged group, 24‐h pulse pressure had a significant association with PWV (β = 0.18, R2 = 0.19, p = .009), while the association with cIMT was attenuated (β = 0.13, R2 = 0.16, p = .065). 24‐h diastolic BP was associated with higher cIMT in the middle‐aged group (β = 0.24, p < .001, R2 = 0.23), but not with PWV in either age groups. Among ischemic stroke patients < 60 years, higher age was associated with increased arterial stiffness for patients up to age 44 years, and with cIMT in middle‐aged patients. 24‐h pulse pressure was associated with arterial stiffness, and 24‐h diastolic BP was associated with cIMT only in middle‐aged patients.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
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Pickering ME. Cross-Talks between the Cardiovascular Disease-Sarcopenia-Osteoporosis Triad and Magnesium in Humans. Int J Mol Sci 2021; 22:ijms22169102. [PMID: 34445808 PMCID: PMC8396464 DOI: 10.3390/ijms22169102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
Magnesium (Mg) is a pivotal and very complex component of healthy aging in the cardiovascular-muscle-bone triad. Low Mg levels and low Mg intake are common in the general aging population and are associated with poorer outcomes than higher levels, including vascular calcification, endothelial dysfunction, osteoporosis, or muscle dysfunction/sarcopenia. While Mg supplementation appears to reverse these processes and benefit the triad, more randomized clinical trials are needed. These will allow improvement of preventive and curative strategies and propose guidelines regarding the pharmaceutical forms and the dosages and durations of treatment in order to optimize and adapt Mg prescription for healthy aging and for older vulnerable persons with comorbidities.
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Affiliation(s)
- Marie-Eva Pickering
- Rheumatology Department, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France
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40
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Lind L, Zethelius B, Lindberg E, Pedersen NL, Byberg L. Changes in leisure-time physical activity during the adult life span and relations to cardiovascular risk factors-Results from multiple Swedish studies. PLoS One 2021; 16:e0256476. [PMID: 34411192 PMCID: PMC8375969 DOI: 10.1371/journal.pone.0256476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/06/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate how self-reported leisure-time physical activity (PA) changes during the adult life span, and to study how PA is related to cardiovascular risk factors using longitudinal studies. METHODS Several Swedish population-based longitudinal studies were used in the present study (PIVUS, ULSAM, SHE, and SHM, ranging from hundreds to 30,000 participants) to represent information across the adult life span in both sexes. Also, two cross-sectional studies were used as comparison (EpiHealth, LifeGene). PA was assessed by questionnaires on a four or five-level scale. RESULTS Taking results from several samples into account, an increase in PA from middle-age up to 70 years was found in males, but not in females. Following age 70, a decline in PA was seen. Young adults reported both a higher proportion of sedentary behavior and a higher proportion high PA than the elderly. Females generally reported a lower PA at all ages. PA was mainly associated with serum triglycerides and HDL-cholesterol, but also weaker relationships with fasting glucose, blood pressure and BMI were found. These relationships were generally less strong in elderly subjects. CONCLUSION Using data from multiple longitudinal samples the development of PA over the adult life span could be described in detail and the relationships between PA and cardiovascular risk factors were portrayed. In general, a higher or increased physical activity over time was associated with a more beneficial cardiovascular risk factor profile, especially lipid levels.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences/Respiratory, Allergy and Sleep Medicine, Uppsala University, Uppsala, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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41
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Tokgozoglu L, Torp-Pedersen C. Redefining cardiovascular risk prediction: is the crystal ball clearer now? Eur Heart J 2021; 42:2468-2471. [PMID: 34120165 DOI: 10.1093/eurheartj/ehab310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lale Tokgozoglu
- Hacettepe University Faculty of Medicine, Department of Cardiology Ankara, Turkey
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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42
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Steger A, Dommasch M, Müller A, Sinnecker D, Huster KM, Gotzler T, Gotzler O, Hapfelmeier A, Ulm K, Barthel P, Hnatkova K, Laugwitz KL, Malik M, Schmidt G. Polyscore of autonomic parameters for risk stratification of the elderly general population: the Polyscore study. Europace 2021; 23:789-796. [PMID: 33276379 PMCID: PMC8139819 DOI: 10.1093/europace/euaa359] [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: 07/19/2020] [Accepted: 11/09/2020] [Indexed: 11/14/2022] Open
Abstract
Aims Present society is constantly ageing and elderly frequently suffer from conditions that are difficult and/or costly to treat if detected late. Effective screening of the elderly is therefore needed so that those requiring detailed clinical work-up are identified early. We present a prospective validation of a screening strategy based on a Polyscore of seven predominantly autonomic, non-invasive risk markers. Methods and results Within a population-based survey in Germany (INVADE study), participants aged ≥60 years were enrolled between August 2013 and February 2015. Seven prospectively defined Polyscore components were obtained during 30-min continuous recordings of electrocardiogram, blood pressure, and respiration. Out of 1956 subjects, 168 were excluded due to atrial fibrillation, implanted pacemaker, or unsuitable recordings. All-cause mortality over a median 4-year follow-up was prospectively defined as the primary endpoint. The Polyscore divided the investigated population (n = 1788, median age: 72 years, females: 58%) into three predefined groups with low (n = 1405, 78.6%), intermediate (n = 326, 18.2%), and high risk (n = 57, 3.2%). During the follow-up, 82 (4.6%) participants died. Mortality in the Polyscore-defined risk groups was 3.4%, 7.4%, and 17.5%, respectively (P < 0.0001). The Polyscore-based mortality prediction was independent of Framingham score, diabetes, chronic kidney disease, and major stroke and/or myocardial infarction history. It was particularly effective in those aged <75 years (n = 1145). Conclusion The Polyscore-based mortality risk assessment from short-term non-invasive recordings is effective in the elderly general population, especially those aged 60–74 years. Implementation of a comprehensive Polyscore screening of this age group is proposed to advance preventive medical care.
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Affiliation(s)
- Alexander Steger
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Michael Dommasch
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Müller
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel Sinnecker
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Katharina M Huster
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Teresa Gotzler
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Othmar Gotzler
- INVADE Study Group, Karl-Böhm-Str. 32, 85598 Baldham, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Grillparzerstr. 18, 81675 Munich, Germany
| | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Grillparzerstr. 18, 81675 Munich, Germany
| | - Petra Barthel
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W120NN, UK
| | - Karl-Ludwig Laugwitz
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W120NN, UK.,Department of Internal Cardiology Medicine, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic
| | - Georg Schmidt
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
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Koohi F, Ahmadi N, Hadaegh F, Safiee S, Azizi F, Khalili D. Trajectories of cardiovascular disease risk and their association with the incidence of cardiovascular events over 18 years of follow-up: The Tehran Lipid and Glucose study. J Transl Med 2021; 19:309. [PMID: 34271961 PMCID: PMC8284005 DOI: 10.1186/s12967-021-02984-2] [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: 04/02/2021] [Accepted: 07/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding long-term patterns (trajectories) of cardiovascular diseases (CVD) risk and identifying different sub-groups with the same underlying risk patterns could help facilitate targeted cardiovascular prevention programs. METHODS A total of 3699 participants of the Tehran Lipid and Glucose Study (TLGS) (43% men, mean age = 53.2 years), free of CVD at baseline in 1999-2001 and attending at least one re-examination cycle between the second (2002-2005) and fourth cycles (2009-2011) were included. We examined trajectories of CVD risk, based on the ACC/AHA pooled cohort equation, over ten years and subsequent risks of incident CVD during eight years later. We estimated trajectories of CVD risk using group-based trajectory modeling. The prospective association of identified trajectories with CVD was examined using Cox proportional hazard model. RESULTS Three distinct trajectories were identified (low-low, medium-medium, and high-high risk). The high-high and medium-medium CVD risk trajectories had an increasing trend of risk during the time; still, this rising trend was disappeared after removing the effect of increasing age. Upon a median 8.4 years follow-up, 146 CVD events occurred. After adjusting for age, the medium-medium and high-high trajectories had a 2.4-fold (95% CI 1.46-3.97) and 3.46-fold (95% CI 1.56-7.70) risk of CVD compared with the low-low group, respectively. In all trajectory groups, unfavorable increasing in fasting glucose, but favorable raising in HDL and decreasing smoking and total cholesterol happened over time. CONCLUSIONS Although the risk trajectories were stable during the time, different risk factors varied differently in each trajectory. These findings emphasize the importance of attention to each risk factor separately and implementing preventive strategies that optimize CVD risk factors besides the CVD risk.
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Affiliation(s)
- Fatemeh Koohi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Ahmadi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siavash Safiee
- Faculty of Medicin, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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44
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Cooper H, Wells S, Mehta S. Are competing-risk models superior to standard Cox models for predicting cardiovascular risk in older adults? Analysis of a whole-of-country primary prevention cohort aged ≥65 years. Int J Epidemiol 2021; 51:604-614. [PMID: 34109395 DOI: 10.1093/ije/dyab116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both cardiovascular disease (CVD) risk and deaths from non-CVD causes, which may preclude a CVD event, increase with age. We evaluated whether accounting for the competing risk of non-CVD death improves the performance of CVD risk-prediction equations in older adults. METHODS All New Zealanders aged ≥65 years in 2012 without a prior CVD hospitalization were identified by anonymized linkage of eight routinely collected national health data sets. Sex-specific equations estimating the 5-year risk of a fatal or non-fatal CVD event were constructed using standard Cox and Fine-Gray (competing-risk) approaches. The pre-specified predictors were: age, ethnicity, deprivation level, diabetes, atrial fibrillation and baseline preventive pharmacotherapy. Model performance was evaluated by assessing calibration and discrimination in the overall cohort and in ethnic and age-specific subgroups. RESULTS Among 360 443 people aged ≥65 years with 1 615 412 person-years of follow-up, 14.6% of men and 12.1% of women had a first CVD event, whereas 8.5% of men and 7.6% of women died from a non-CVD cause. Standard Cox models overestimated the mean predicted the 5-year CVD risk by ∼1% overall and by 5-6% in the highest risk deciles. The mean predicted CVD risk from the Fine-Gray models approximated the observed risk overall, although slight underestimation occurred in some subgroups. Discrimination was similar for both models. CONCLUSIONS In a whole-of-country primary prevention cohort aged ≥65 years, standard Cox models overestimated the 5-year CVD risk whereas the Fine-Gray models were generally better calibrated. New CVD risk equations that take competing risks into account should be considered for older people.
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Affiliation(s)
- Hannah Cooper
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Sue Wells
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Suneela Mehta
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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45
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Sinnaeve PR, Schwartz GG, Wojdyla DM, Alings M, Bhatt DL, Bittner VA, Chiang CE, Correa Flores RM, Diaz R, Dorobantu M, Goodman SG, Jukema JW, Kim YU, Pordy R, Roe MT, Sy RG, Szarek M, White HD, Zeiher AM, Steg PG. Effect of alirocumab on cardiovascular outcomes after acute coronary syndromes according to age: an ODYSSEY OUTCOMES trial analysis. Eur Heart J 2021; 41:2248-2258. [PMID: 31732742 PMCID: PMC7308542 DOI: 10.1093/eurheartj/ehz809] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/12/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk irrespective of age, but the evidence is less strong for older patients. Methods and results This prespecified analysis from ODYSSEY OUTCOMES compared the effect of alirocumab vs. placebo in 18 924 patients with recent acute coronary syndrome (ACS) according to age. We examined the effect of assigned treatment on occurrence of the primary study outcome, a composite of coronary heart disease death, myocardial infarction, ischaemic stroke, or unstable angina requiring hospitalization [major adverse cardiovascular event (MACE)] and all-cause death. Relative risk reductions were consistent for patients ≥65 vs. <65 years for MACE [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.68–0.91 vs. 0.89, 0.80–1.00; Pinteraction = 0.19] and all-cause death [HR 0.77, 0.62–0.95 vs. 0.94, 0.77–1.15; Pinteraction = 0.46], and consistent for MACE when dichotomizing at age 75 years (HR 0.85, 0.64–1.13 in ≥75 vs. 0.85, 0.78–0.93 in <75, Pinteraction = 0.19). When considering age as a continuous variable in regression models, advancing age increased risk of MACE, as well as the absolute reduction in MACE with alirocumab, with numbers-needed-to-treat for MACE at 3 years of 43 (25–186) at age 45 years, 26 (15–97) at age 75 years, and 12 (6–81) for those at age 85 years. Although adverse events were more frequent in older patients, there were no differences between alirocumab and placebo. Conclusion In patients with recent ACS, alirocumab improves outcomes irrespective of age. Increasing absolute benefit but not harm with advancing age suggests that LDL-C lowering is an important preventive intervention for older patients after ACS. ![]()
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Affiliation(s)
- Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Gregory G Schwartz
- Division of Cardiology, University of Colorado School of Medicine, Box B130, Aurora, CO 80045, USA
| | - Daniel M Wojdyla
- Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, 200 Morris Street, Durham, NC 27701, USA
| | - Marco Alings
- Department of Cardiology, Amphia Ziekenhuis Molengracht, 4818 CK Breda, Netherlands
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Vera A Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Shih-Pai Road, 11217 Taipei, Taiwan
| | - Roger M Correa Flores
- Department of Internal Medicine, Cardiology, Alberto Sabogal Sologuren, ESSALUD, Jirón Colina 1081, Bellavista - Callao, Lima CA01, Peru
| | - Rafael Diaz
- Cardiology Department, Instituto Cardiovascular de Rosario, Paraguay 160, Santa Fe, Rosario 2000, Argentina
| | - Maria Dorobantu
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 8 Calea Floreasca, ET 6 014461 Bucharest, Romania
| | - Shaun G Goodman
- Canadian VIGOUR Centre, University of Alberta, 87 Ave NW, Edmonton, Alberta T6G 2E1, Canada.,Division of Cardiology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands
| | - Yong-Un Kim
- R&D Clinical Development, Sanofi, 1 avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Robert Pordy
- Clinical Sciences - Cardiovascular & Metabolism Therapeutics, Regeneron Pharmaceuticals Inc., 777 Old Saw Mill River Rd, Tarrytown, NY 10591, USA
| | - Matthew T Roe
- Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, 200 Morris Street, Durham, NC 27701, USA
| | - Rody G Sy
- Cardiovascular Institute, Cardinal Santos Medical Center, Wilson Street, San Juan, 1502 Metro Manila, Philippines
| | - Michael Szarek
- Downstate School of Public Health, State University of New York, 450 Clarkson Avenue, MS 43, Brooklyn, NY 11203 USA
| | - Harvey D White
- Green Lane Cardiovascular Services, Auckland 20 City Hospital, Auckland, New Zealand
| | - Andreas M Zeiher
- Department of Medicine III, Goethe University, Frankfurt am Main, Germany
| | - Ph Gabriel Steg
- Hopital Bichat, Universiteé de Paris, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Assistance Publique-Hopitaux de Paris, Paris, France.,National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK
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Liberale L, Montecucco F, Tardif JC, Libby P, Camici GG. Inflamm-ageing: the role of inflammation in age-dependent cardiovascular disease. Eur Heart J 2021; 41:2974-2982. [PMID: 32006431 DOI: 10.1093/eurheartj/ehz961] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/10/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
Abstract
The ongoing worldwide increase in life expectancy portends a rising prevalence of age-related cardiovascular (CV) diseases in the coming decades that demands a deeper understanding of their molecular mechanisms. Inflammation has recently emerged as an important contributor for CV disease development. Indeed, a state of chronic sterile low-grade inflammation characterizes older organisms (also known as inflamm-ageing) and participates pivotally in the development of frailty, disability, and most chronic degenerative diseases including age-related CV and cerebrovascular afflictions. Due to chronic activation of inflammasomes and to reduced endogenous anti-inflammatory mechanisms, inflamm-ageing contributes to the activation of leucocytes, endothelial, and vascular smooth muscle cells, thus accelerating vascular ageing and atherosclerosis. Furthermore, inflamm-ageing promotes the development of catastrophic athero-thrombotic complications by enhancing platelet reactivity and predisposing to plaque rupture and erosion. Thus, inflamm-ageing and its contributors or molecular mediators might furnish targets for novel therapeutic strategies that could promote healthy ageing and conserve resources for health care systems worldwide. Here, we discuss recent findings in the pathophysiology of inflamm-ageing, the impact of these processes on the development of age-related CV diseases, results from clinical trials targeting its components and the potential implementation of these advances into daily clinical practice.
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Affiliation(s)
- Luca Liberale
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland.,Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, v.le Benedetto XV 10, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, L.go Rosanna Benzi 10, 16132 Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, v.le Benedetto XV 10, 16132 Genoa, Italy
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montreal, Rue Bélanger 5000, Montreal, QC H1T 1C8, Canada
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Francis Street 75, Boston, MA 02115, USA
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Research and Education, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Lind L, Sundström J, Ärnlöv J, Ingelsson M, Henry A, Lumbers RT, Lampa E. Life-Time Covariation of Major Cardiovascular Diseases: A 40-Year Longitudinal Study and Genetic Studies. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2021; 14:e002963. [PMID: 33635119 PMCID: PMC8284356 DOI: 10.1161/circgen.120.002963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is known that certain cardiovascular diseases (CVD) are associated, like atrial fibrillation and stroke. However, for other CVDs, the links and temporal trends are less studied. In this longitudinal study, we have investigated temporal epidemiological and genetic associations between different CVDs. METHODS The ULSAM (Uppsala Longitudinal Study of Adult Men; 2322 men aged 50 years) has been followed for 40 years regarding 4 major CVDs (incident myocardial infarction, ischemic stroke, heart failure, and atrial fibrillation). For the genetic analyses, publicly available data were used. RESULTS Using multistate modeling, significant relationships were seen between pairs of all of the 4 investigated CVDs. However, the risk of obtaining one additional CVD differed substantially both between different CVDs and between their temporal order. The relationship between heart failure and atrial fibrillation showed a high risk ratio (risk ratios, 24-26) regardless of the temporal order. A consistent association was seen also for myocardial infarction and atrial fibrillation but with a lower relative risk (risk ratios, 4-5). In contrast, the risk of receiving a diagnosis of heart failure following a myocardial infarction was almost twice as high as for the reverse temporal order (risk ratios, 16 versus 9). Genetic loci linked to traditional risk factors could partly explain the observed associations between the CVDs, but pathway analyses disclosed also other pathophysiological links. CONCLUSIONS During 40 years, all of the 4 investigated CVDs were pairwise associated with each other regardless of the temporal order of occurrence, but the risk magnitude differed between different CVDs and their temporal order. Genetic analyses disclosed new pathophysiological links between CVDs.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences (L.L., J.S.), Uppsala University, Sweden
| | - Johan Sundström
- Department of Medical Sciences (L.L., J.S.), Uppsala University, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (J.S.)
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Huddinge (J.A.)
- School of Health and Social Sciences, Dalarna University, Falun, Sweden (J.A.)
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences/Geriatrics (M.I.), Uppsala University, Sweden
| | - Albert Henry
- Institute of Cardiovascular Science (A.H.), University College London
- British Heart Foundation Research Accelerator (A.H., R.T.L.), University College London
- Institute of Health Informatics (A.H., R.T.L.), University College London
| | - R. Thomas Lumbers
- British Heart Foundation Research Accelerator (A.H., R.T.L.), University College London
- Institute of Health Informatics (A.H., R.T.L.), University College London
- Health Data Research UK London (R.T.L.), University College London
- Bart’s Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (R.T.L.)
| | - Erik Lampa
- Uppsala Clinical Research Centre (UCR) (E.L.), Uppsala University, Sweden
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Tang O, Matsushita K, Coresh J, Hoogeveen RC, Windham BG, Ballantyne CM, Selvin E. High-Sensitivity Cardiac Troponin I for Risk Stratification in Older Adults. J Am Geriatr Soc 2021; 69:986-994. [PMID: 33150614 PMCID: PMC8049956 DOI: 10.1111/jgs.16912] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Traditional cardiovascular risk factors are less predictive in older age. High-sensitivity cardiac troponin I (hs-cTnI) is a marker of subclinical cardiomyocyte damage associated with cardiovascular risk in middle-aged adults. We hypothesized hs-cTnI would be indicative of mortality and cardiovascular risk beyond traditional cardiovascular risk factors in older adults and may be more discriminatory compared to hs-troponin T (hs-cTnT). DESIGN Prospective cohort study. SETTING Population-based Atherosclerosis Risk in Communities (ARIC) Study. PARTICIPANTS We included 5,876 ARIC participants at Visit 5 (2011-2013). OUTCOMES AND MEASURES We used Cox regression for the association of hs-cTnI categories (women: <4, 4-<10, ≥10 ng/ml; men: <6, 6-<12, ≥12 ng/ml, prevalent cardiovascular disease (CVD)) with mortality and incident CVD (atherosclerotic CVD [ASCVD]: coronary heart disease or stroke, or heart failure). RESULTS Participants were ages 66 to 90, 23% black, 42% male, and 24% had prevalent CVD. There were 1,053 (321 CVD) deaths (median follow-up 6.3 years). Participants with elevated hs-cTnI and no CVD (7% of participants) had mortality risk similar to those with a history of CVD (55.6 vs 55.7 deaths/1,000 person-years, P = .99). After adjustment, elevated hs-cTnI and no CVD (hazard ratio (HR) = 2.38, 95% confidence interval (CI) = 1.85-3.06) and prevalent CVD (HR = 2.21, 95% CI = 1.90-2.57) remained associated with mortality, compared to low hs-cTnI and no CVD. Elevated hs-cTnI was independently associated with incident CVD (HR = 3.41, 95% CI = 2.58-4.51), ASCVD (HR = 2.02, 95% CI = 1.36-2.98), and heart failure (HR = 6.16, 95% CI = 4.24-8.95). The addition of hs-cTnI significantly improved C-statistics for all outcomes and added greater discrimination than hs-cTnT for cardiovascular mortality and incident heart failure. CONCLUSIONS Hs-cTnI improves mortality and CVD risk stratification in older adults beyond traditional risk factors and improved model discrimination more than hs-cTnT for certain outcomes. Elevated hs-cTnI without CVD identifies a high-risk group with comparable mortality risk as those with a history of clinical CVD.
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Affiliation(s)
- Olive Tang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ron C. Hoogeveen
- Department of Medicine, Baylor College of Medicine, and Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - B. Gwen Windham
- Department of Geriatric Medicine, University of Mississippi School of Medicine, Jackson, Michigan
| | - Christie M. Ballantyne
- Department of Medicine, Baylor College of Medicine, and Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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A longitudinal study over 40 years to study the metabolic syndrome as a risk factor for cardiovascular diseases. Sci Rep 2021; 11:2978. [PMID: 33536506 PMCID: PMC7858618 DOI: 10.1038/s41598-021-82398-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/12/2021] [Indexed: 12/20/2022] Open
Abstract
The impact of most, but not all, cardiovascular risk factors decline by age. We investigated how the metabolic syndrome (MetS) was related to cardiovascular disease (CVD) during 40 years follow-up in the Uppsala Longitudinal Study of Adult Men (ULSAM, 2,123 men all aged 50 at baseline with reinvestigations at age 60, 70, 77 and 82). The strength of MetS as a risk factor of incident combined end-point of three outcomes (CVD) declined with ageing, as well as for myocardial infarction, ischemic stroke and heart failure when analysed separately. For CVD, the risk ratio declined from 2.77 (95% CI 1.90-4.05) at age 50 to 1.30 (95% CI 1.05-1.60) at age 82. In conclusion, the strength of MetS as a risk factor of incident CVD declined with age. Since MetS was significantly related to incident CVD also at old age, our findings suggest that the occurrence of MetS in the elderly should not be regarded as innocent. However, since our data were derived in an observational study, any impact of MetS in the elderly needs to be verified in a randomized clinical intervention trial.
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50
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Rooney MR, Tang O, Pankow JS, Selvin E. Glycaemic markers and all-cause mortality in older adults with and without diabetes: the Atherosclerosis Risk in Communities (ARIC) study. Diabetologia 2021; 64:339-348. [PMID: 32990802 PMCID: PMC7855037 DOI: 10.1007/s00125-020-05285-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS There is controversy regarding the performance of HbA1c in old age. We evaluated the prognostic value of HbA1c and other glycaemic markers (fructosamine, glycated albumin, fasting glucose) with mortality risk in older adults (66-90 years). METHODS This was a prospective analysis of 5636 participants (31% with diagnosed diabetes, mean age 76, 58% female, 21% black) in the Atherosclerosis Risk in Communities (ARIC) study, baseline 2011-2013. We used Cox regression to examine associations of glycaemic markers (modelled in categories) with mortality risk, stratified by diagnosed diabetes status. RESULTS During a median of 6 years of follow-up, 983 deaths occurred. Among older adults with diabetes, 30% had low HbA1c (<42 mmol/mol [<6.0%]) and 10% had high HbA1c (≥64 mmol/mol [≥8.0%]); low (HR 1.32 [95% CI 1.04, 1.68]) and high (HR 1.86 [95% CI 1.32, 2.62]) HbA1c were associated with mortality risk vs HbA1c 42-52 mmol/mol (6.0-6.9%) after demographic adjustment. Low fructosamine and glycated albumin were not associated with mortality risk. Both low and high fasting glucose were associated with mortality risk. After further adjustment for lifestyle and clinical risk factors, high HbA1c (HR 1.81 [95% CI 1.28, 2.56]), fructosamine (HR 1.96 [95% CI 1.43-2.69]), glycated albumin (HR 1.81 [95% CI 1.33-2.47]) and fasting glucose (HR 1.81 [95% CI 1.24, 2.66]) were associated with mortality risk. Low HbA1c and fasting glucose were no longer significantly associated with mortality risk. Among participants without diabetes, associations of glycaemic markers with mortality risk were less robust. CONCLUSIONS/INTERPRETATION Elevated HbA1c, fructosamine, glycated albumin and fasting glucose were associated with risk of mortality in older adults with diabetes. Low HbA1c and fasting glucose may be markers of poor prognosis but are possibly confounded by health status. Our findings support the clinical use of HbA1c in older adults with diabetes. Graphical abstract.
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Affiliation(s)
- Mary R Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
| | - Olive Tang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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