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Prugger C, Perier MC, Gonzalez-Izquierdo A, Hemingway H, Denaxas S, Empana JP. Incidence of 12 common cardiovascular diseases and subsequent mortality risk in the general population. Eur J Prev Cardiol 2023; 30:1715-1722. [PMID: 37294923 DOI: 10.1093/eurjpc/zwad192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Incident events of cardiovascular diseases (CVDs) are heterogenous and may result in different mortality risks. Such evidence may help inform patient and physician decisions in CVD prevention and risk factor management. AIMS This study aimed to determine the extent to which incident events of common CVD show heterogeneous associations with subsequent mortality risk in the general population. METHODS AND RESULTS Based on England-wide linked electronic health records, we established a cohort of 1 310 518 people ≥30 years of age initially free of CVD and followed up for non-fatal events of 12 common CVD and cause-specific mortality. The 12 CVDs were considered as time-varying exposures in Cox's proportional hazards models to estimate hazard rate ratios (HRRs) with 95% confidence intervals (CIs). Over the median follow-up of 4.2 years (2010-16), 81 516 non-fatal CVD, 10 906 cardiovascular deaths, and 40 843 non-cardiovascular deaths occurred. All 12 CVDs were associated with increased risk of cardiovascular mortality, with HRR (95% CI) ranging from 1.67 (1.47-1.89) for stable angina to 7.85 (6.62-9.31) for haemorrhagic stroke. All 12 CVDs were also associated with increased non-cardiovascular and all-cause mortality risk but to a lesser extent: HRR (95% CI) ranged from 1.10 (1.00-1.22) to 4.55 (4.03-5.13) and from 1.24 (1.13-1.35) to 4.92 (4.44-5.46) for transient ischaemic attack and sudden cardiac arrest, respectively. CONCLUSION Incident events of 12 common CVD show significant adverse and markedly differential associations with subsequent cardiovascular, non-cardiovascular, and all-cause mortality risk in the general population.
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Affiliation(s)
- Christof Prugger
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marie-Cécile Perier
- INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Diseases, Université Paris Cité, 56 rue Leblanc, 75015 Paris, France
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Road, NW1 2DA London, UK
- Health Data Research UK, 215 Euston Road, NW1 2DA London, UK
- UCL Hospitals Biomedical Research Centers (BRC), 270 Tottenham Court Road, 215 Euston Road, NW1 2BE London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, NW1 2DA London, UK
- Health Data Research UK, 215 Euston Road, NW1 2DA London, UK
- UCL Hospitals Biomedical Research Centers (BRC), 270 Tottenham Court Road, 215 Euston Road, NW1 2BE London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, NW1 2DA London, UK
- Health Data Research UK, 215 Euston Road, NW1 2DA London, UK
- UCL Hospitals Biomedical Research Centers (BRC), 270 Tottenham Court Road, 215 Euston Road, NW1 2BE London, UK
- British Heart Foundation Data Science Center, 215 Euston Road, NW1 2BE London, UK
| | - Jean-Philippe Empana
- INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Diseases, Université Paris Cité, 56 rue Leblanc, 75015 Paris, France
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Oh J, Choi S, Han C, Lee DW, Ha E, Kim S, Bae HJ, Pyun WB, Hong YC, Lim YH. Association of long-term exposure to PM 2.5 and survival following ischemic heart disease. ENVIRONMENTAL RESEARCH 2023; 216:114440. [PMID: 36208782 DOI: 10.1016/j.envres.2022.114440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/10/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Numerous studies have suggested that long-term exposure to particulate matter ≤2.5 μm (PM2.5) may cause cardiovascular morbidity and mortality. However, susceptibility among those with a history of ischemic heart disease is less clearly understood. We aimed to evaluate whether long-term PM2.5 exposure is related to mortality among patients with ischemic heart disease. METHODS We followed up 306,418 patients hospitalized with ischemic heart disease in seven major cities in South Korea between 2008 and 2016 using the National Health Insurance Database. We linked the modeled PM2.5 data corresponding to each patient's administrative districts and estimated hazard ratios (HRs) of cause-specific mortality associated with the long-term exposure to PM2.5 in time-varying Cox proportional hazard models after adjusting for individual- and area-level characteristics. We also estimated HRs by sex, age group (65-74 vs. ≥75 years), and household income. RESULTS Of the patients with ischemic heart disease, mean age at the discharge was 76.8 years, and 105,913 died during a mean follow-up duration of 21.4 months. The HR of all-cause mortality was 1.10 [95% confidence intervals (CI): 1.07, 1.14] per 10 μg/m3 increase in a 12-month moving average PM2.5. The HRs of cardiovascular, stroke, and ischemic heart disease were 1.17 (95% CI: 1.11, 1.24), 1.17 (95% CI: 1.06, 1.30), and 1.25 (95% CI: 1.15, 1.35), respectively. The subgroup analyses showed that participants aged 65-74 years were more susceptible to adverse effects of PM2.5 exposure. We did not observe any differences in the risk by sex and household income. CONCLUSION Mortality from all-cause and cardiovascular disease following hospitalization due to ischemic heart disease was higher among individuals with greater PM2.5 exposure in seven major cities in South Korea. The result supports the association of long-term exposure to air pollution with poor prognosis among patients with ischemic heart disease.
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Affiliation(s)
- Jongmin Oh
- Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sangbum Choi
- Department of Statistics, Korea University, Seoul, Republic of Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Dong-Wook Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunhee Ha
- Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea; Graduate Program in System Health Science and Engineering, Ewha Womans University, Ewha Medical Research Institute, College of Medicine, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Soontae Kim
- Department of Environmental Engineering, Ajou University, Suwon, Republic of Korea
| | - Hyun-Joo Bae
- Korea Environment Institute, Sejong, Republic of Korea
| | - Wook Bum Pyun
- Department of International Medicine, Division of Cardiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Savira F, Wang BH, Kompa AR, Ademi Z, Owen AJ, Liew D, Zomer E. The impact of coronary heart disease prevention on work productivity: a 10-year analysis. Eur J Prev Cardiol 2020; 28:418-425. [PMID: 33624015 DOI: 10.1093/eurjpc/zwaa037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022]
Abstract
AIMS To determine the impact of preventing new (incident) cases of coronary heart disease (CHD) on years of life and productivity, using the novel measure 'productivity-adjusted life year' (PALY), over the next 10 years. METHODS AND RESULTS A dynamic life table model was constructed for the total Australian working-age population (15-69 years) over 10 years (2020-2029), separated by CHD status. Productivity estimates were sourced from the literature. The PALY was ascribed a financial value in terms of gross domestic product (GDP) per equivalent full-time worker. The total number of years lived, PALYs, and economic burden (in terms of GDP per PALY) were estimated. The model simulation was repeated assuming incidence was reduced, and the differences represented the impact of CHD prevention. All outcomes were discounted by 5% per annum. Over 10 years, the total projected years lived and PALYs in the Australian working-age population (with and without CHD) were 133 million and 83 million, respectively, amounting to A$17.2 trillion in GDP. We predicted more than 290 000 new (incident) CHD cases over the next 10 years. If all new cases of CHD could be prevented during this period, a total of 4 000 deaths could be averted, resulting in more than 8 000 years of life saved and 104 000 PALYs gained, equivalent to a gain of nearly A$21.8 billion (US$14.8 billion) in GDP. CONCLUSION Prevention of CHD will prolong years of life lived and productive life years, resulting in substantial economic benefit. Policy makers and employers are encouraged to engage in preventive measures addressing CHD.
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Affiliation(s)
- Feby Savira
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Bing H Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Andrew R Kompa
- Department of Medicine, University of Melbourne, St Vincent's Hospital, 37 Regent St, Fitzroy, VIC 3065, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
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