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Jargin SV. Back to the topic: high cardiovascular mortality in Russia. J Epidemiol Community Health 2020; 75:311. [PMID: 33130577 DOI: 10.1136/jech-2020-215683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Sergei V Jargin
- Department of Public Health, Peoples' Friendship University of Russia, Moskva, Russian Federation
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2
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Lakunchykova O, Averina M, Wilsgaard T, Watkins H, Malyutina S, Ragino Y, Keogh RH, Kudryavtsev AV, Govorun V, Cook S, Schirmer H, Eggen AE, Hopstock LA, Leon DA. Why does Russia have such high cardiovascular mortality rates? Comparisons of blood-based biomarkers with Norway implicate non-ischaemic cardiac damage. J Epidemiol Community Health 2020; 74:698-704. [PMID: 32414935 PMCID: PMC7577103 DOI: 10.1136/jech-2020-213885] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/13/2020] [Indexed: 02/06/2023]
Abstract
Background Russia has one of the highest rates of mortality from cardiovascular disease (CVD). At age 35–69 years, they are eight times higher than in neighbouring Norway. Comparing profiles of blood-based CVD biomarkers between these two populations can help identify reasons for this substantial difference in risk. Methods We compared age-standardised mean levels of CVD biomarkers for men and women aged 40–69 years measured in two cross-sectional population-based studies: Know Your Heart (KYH) (Russia, 2015–2018; n=4046) and the seventh wave of the Tromsø Study (Tromsø 7) (Norway, 2015–2018; n=17 646). A laboratory calibration study was performed to account for inter-laboratory differences. Results Levels of total, low-density lipoprotein-, high-density lipoprotein-cholesterol and triglycerides were comparable in KYH and Tromsø 7 studies. N-terminal pro-b-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity C-reactive protein (hsCRP) were higher in KYH compared with Tromsø 7 (NT-proBNP was higher by 54.1% (95% CI 41.5% to 67.8%) in men and by 30.8% (95% CI 22.9% to 39.2%) in women; hs-cTnT—by 42.4% (95% CI 36.1% to 49.0%) in men and by 68.1% (95% CI 62.4% to 73.9%) in women; hsCRP—by 33.3% (95% CI 26.1% to 40.8%) in men and by 35.6% (95% CI 29.0% to 42.6%) in women). Exclusion of participants with pre-existing coronary heart disease (279 men and 282 women) had no substantive effect. Conclusions Differences in cholesterol fractions cannot explain the difference in CVD mortality rate between Russia and Norway. A non-ischemic pathway to the cardiac damage reflected by raised NT-proBNP and hs-cTnT is likely to contribute to high CVD mortality in Russia.
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Affiliation(s)
- Olena Lakunchykova
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Maria Averina
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Sofia Malyutina
- Novosibirsk State Medical University, Russian Ministry of Health, Novosibirsk, Russian Federation.,Research Institute of Internal and Preventive Medicine, Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Yulia Ragino
- Research Institute of Internal and Preventive Medicine, Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexander V Kudryavtsev
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Innovative Programs, Northern State Medical University, Arkhangelsk, Russian Federation
| | - Vadim Govorun
- Federal Research and Clinical Center of Physical-Chemical Medicine of the Federal Medical Biological Agency of Russia, Moskva, Russian Federation
| | - Sarah Cook
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Cardiology, Akershus University Hospital, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | | | - David A Leon
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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3
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Jonsson M, Ljungman P, Härkönen J, Van Nieuwenhuizen B, Møller S, Ringh M, Nordberg P. Relationship between socioeconomic status and incidence of out-of-hospital cardiac arrest is dependent on age. J Epidemiol Community Health 2020; 74:726-731. [PMID: 32385129 PMCID: PMC7577091 DOI: 10.1136/jech-2019-213296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 04/02/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
Abstract
Background The association between socioeconomic status (SES) and incidence of out-of-hospital cardiac arrest (OHCA) is not fully understood. The aim of this study was to see if area-level socioeconomic differences, measured in terms of area-level income and education, are associated with the incidence of OHCA, and if this relationship is dependent on age. Methods We included OHCAs that occurred in Stockholm County between the 1st of January 2006 and the 31st of December 2017, the victims being confirmed residents (n=10 574). We linked the home address to a matching neighbourhood (base unit) via available socioeconomic and demographic information. Socioeconomic variables and incidence rates were assessed by using cross-sectional values at the end of each year. We used zero-inflated negative binomial regression to calculate incidence rate ratios (IRRs). Results Among 1349 areas with complete SES information, 10 503 OHCAs occurred between 2006 and 2017. The IRR in the highest versus the lowest SES area was 0.61 (0.50–0.75) among persons in the 0–44 age group. Among patients in the 45–64 age group, the corresponding IRR was 0.55 (0.47–0.65). The highest SES areas versus the lowest showed an IRR of 0.59 (0.50–0.70) in the 65–74 age group. In the two highest age groups, no significant association was seen (75–84 age group: 0.93 (0.80–1.08); 85+ age group: 1.05 (0.84–1.23)). Similar crude patterns were seen among both men and women. Conclusions Areas characterised by high SES showed a significantly lower incidence of OHCA. This relationship was seen up to the age of 75, after which the relationship disappeared, suggesting a levelling effect.
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Affiliation(s)
- Martin Jonsson
- Center for Resusctitation Science, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Juho Härkönen
- Department of Political and Social Sciences, European University Institute, Florence, Italy.,Department of Sociology, Stockholm University, Stockholm, Sweden
| | | | - Sidsel Møller
- Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Mattias Ringh
- Center for Resusctitation Science, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Center for Resusctitation Science, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Alabas OA, Hall M, Dondo TB, Rutherford MJ, Timmis AD, Batin PD, Deanfield JE, Hemingway H, Gale CP. Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study. J Epidemiol Community Health 2017; 71:25-32. [PMID: 27307468 DOI: 10.1136/jech-2016-207402] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/20/2016] [Accepted: 05/25/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The long-term excess risk of death associated with diabetes following acute myocardial infarction is unknown. We determined the excess risk of death associated with diabetes among patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) after adjustment for comorbidity, risk factors and cardiovascular treatments. METHODS Nationwide population-based cohort (STEMI n=281 259 and NSTEMI n=422 661) using data from the UK acute myocardial infarction registry, MINAP, between 1 January 2003 and 30 June 2013. Age, sex, calendar year and country-specific mortality rates for the populace of England and Wales (n=56.9 million) were matched to cases of STEMI and NSTEMI. Flexible parametric survival models were used to calculate excess mortality rate ratios (EMRR) after multivariable adjustment. This study is registered at ClinicalTrials.gov (NCT02591576). RESULTS Over 1.94 million person-years follow-up including 120 568 (17.1%) patients with diabetes, there were 187 875 (26.7%) deaths. Overall, unadjusted (all cause) mortality was higher among patients with than without diabetes (35.8% vs 25.3%). After adjustment for age, sex and year of acute myocardial infarction, diabetes was associated with a 72% and 67% excess risk of death following STEMI (EMRR 1.72, 95% CI 1.66 to 1.79) and NSTEMI (1.67, 1.63 to 1.71). Diabetes remained significantly associated with substantial excess mortality despite cumulative adjustment for comorbidity (EMRR 1.52, 95% CI 1.46 to 1.58 vs 1.45, 1.42 to 1.49), risk factors (1.50, 1.44 to 1.57 vs 1.33, 1.30 to 1.36) and cardiovascular treatments (1.56, 1.49 to 1.63 vs 1.39, 1.36 to 1.43). CONCLUSIONS At index acute myocardial infarction, diabetes was common and associated with significant long-term excess mortality, over and above the effects of comorbidities, risk factors and cardiovascular treatments.
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Affiliation(s)
- O A Alabas
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - M Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - T B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - M J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A D Timmis
- The National Institute for Health Biomedical Research Unit, Barts Health, London, UK
| | - P D Batin
- Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - J E Deanfield
- National Institute for Cardiovascular Outcomes Research, University College London, London, UK
| | - H Hemingway
- The Farr Institute, University College London, London, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- York Teaching Hospital NHS Foundation Trust, York, UK
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5
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Backholer K, Peters SAE, Bots SH, Peeters A, Huxley RR, Woodward M. Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis. J Epidemiol Community Health 2016; 71:550-557. [PMID: 27974445 DOI: 10.1136/jech-2016-207890] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low socioeconomic status (SES) is a known risk factor for cardiovascular disease (CVD) but whether its effects are comparable in women and men is unknown. METHODS PubMed MEDLINE was systematically searched. Studies that reported sex-specific estimates, and associated variability, of the relative risk (RR) for coronary heart disease (CHD), stroke or CVD according to a marker of SES (education, occupation, income or area of residence), for women and men were included. RRs were combined with those derived from cohort studies using individual participant data. Data were pooled using random effects meta-analyses with inverse variance weighting. Estimates of the ratio of the RRs (RRR), comparing women with men, were computed. RESULTS Data from 116 cohorts, over 22 million individuals, and over 1 million CVD events, suggest that lower SES is associated with increased risk of CHD, stroke and CVD in women and men. For CHD, there was a significantly greater excess risk associated with lower educational attainment in women compared with men; comparing lowest with highest levels, the age-adjusted RRR was 1.24 (95% CI 1.09 to 1.41) and the multiple-adjusted RRR was 1.34 (1.09 to 1.63). For stroke, the age-adjusted RRR was 0.93 (0.72 to 1.18), and the multiple-adjusted was RRR 0.79 (0.53 to 1.19). Corresponding results for CVD were 1.18 (1.03 to 1.36), 1.23 (1.03 to 1.48), respectively. Similar results were observed for other markers of SES for all three outcomes. CONCLUSIONS Reduction of socioeconomic inequalities in CHD and CVD outcomes might require different approaches for men and women.
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Affiliation(s)
- Kathryn Backholer
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Sophie H Bots
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Anna Peeters
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachel R Huxley
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
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MacKenzie G, Greig M, Hay I, Pemberton J. Competing risk analysis of factors related to long-term incidence of CHD. J Epidemiol Community Health 2016; 71:33-36. [PMID: 27485052 DOI: 10.1136/jech-2016-207347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/29/2016] [Accepted: 06/29/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The 5-year follow-up results for the 1202 middle-aged men prospective study of coronary heart disease (CHD) incidence were published in 1980. This paper extends the follow-up, relating the development of CHD to 10 risk factors. METHODS The population studied comprised all men born in the 10-year period 1909-1918 aged 45-64 years at baseline who were registered in 6 group practices in Belfast. Some 1202 CHD-free men entered the study. Study end points included: (a) the development of CHD, (b) the development of myocardial infarction, (c) the development of angina pectoris, (d) death from myocardial infarction and (e) death from other causes. The men were followed for an average of 6.9 years, and the influence of 10 risk factors was assessed by Cox's proportional hazards model in a competing risk framework. RESULTS The analysis of first major CHD event identified four risk factors-diastolic blood pressure, serum cholesterol, T wave abnormality and tobacco index. First myocardial infarction depended on diastolic blood pressure, ST abnormality and tobacco index, while time to first angina pectoris depended on serum cholesterol, T abnormality, tobacco index and age at entry. These findings do not support the hypothesis of a common risk factor profile in the myocardial infarction and angina pectoris groups. The sensitivity of all models was poor. DISCUSSION The study confirms the role of known risk factors in the development of first CHD event. It also suggests that the risk factors involved in developing myocardial infarction and angina pectoris differ. The poor sensitivity of models suggests the presence of unmeasured risk factors in the aetiology of CHD.
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Affiliation(s)
- Gilbert MacKenzie
- Centre of Biostatistics, University of Limerick, Limerick, Ireland.,Department of Statistics (CREST), ENSAI, Bruz, France.,The Department of Community Medicine, The Queen's University of Belfast, Belfast, UK
| | - Mary Greig
- The Department of Community Medicine, The Queen's University of Belfast, Belfast, UK
| | - Iris Hay
- The Department of Community Medicine, The Queen's University of Belfast, Belfast, UK
| | - John Pemberton
- The Department of Community Medicine, The Queen's University of Belfast, Belfast, UK
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7
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Savitsky B, Manor O, Friedlander Y, Burger A, Lawrence G, Calderon-Margalit R, Siscovick DS, Enquobahrie DA, Williams MA, Hochner H. Associations of socioeconomic position in childhood and young adulthood with cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-Up Study. J Epidemiol Community Health 2016; 71:43-51. [PMID: 27417428 DOI: 10.1136/jech-2014-204323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/30/2015] [Accepted: 06/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several stages in the life course have been identified as important to the development of cardiovascular disease. This study aimed to assess the associations of childhood and adulthood socioeconomic position (SEP) and social mobility with cardiometabolic risk factors (CMRs) later in life. METHODS We conducted follow-up examinations of 1132 offspring, aged 32, within a population-based cohort of all births in Jerusalem from 1974 to 1976. SEP was indicated by parents' occupation and education, and adulthood SEP was based on offspring's occupation and education recorded at age 32. Linear regression models were used to investigate the associations of SEP and social mobility with CMRs. RESULTS Childhood-occupational SEP was negatively associated with body mass index (BMI; β=-0.29, p=0.031), fat percentage (fat%; β=-0.58, p=0.005), insulin (β=-0.01, p=0.031), triglycerides (β=-0.02, p=0.024) and low-density lipoprotein cholesterol (LDL-C; β=-1.91, p=0.015), independent of adulthood SEP. Adulthood-occupational SEP was negatively associated with waist-to-hip ratio (WHR; β=-0.01, p=0.002), and positively with high-density lipoprotein cholesterol (HDL-C; β=0.87, p=0.030). Results remained similar after adjustment for smoking and inactivity. Childhood-educational SEP was associated with decreased WHR and LDL-C level (p=0.0002), and adulthood-educational SEP was inversely associated with BMI (p=0.001), waist circumference (p=0.008), WHR (p=0.001) and fat% (p=0.0002) and positively associated with HDL-C (p=0.030). Additionally, social mobility (mainly upward) was shown to have adverse cardiometabolic outcomes. CONCLUSIONS Both childhood and adulthood SEP contribute independently to CMR. The match-mismatch hypothesis may explain the elevated CMRs among participants experiencing social mobility. Identification of life-course SEP-related aspects that translate into social inequality in cardiovascular risk may facilitate efforts for improving health and for reducing disparities in cardiovascular disease.
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Affiliation(s)
- B Savitsky
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Y Friedlander
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - A Burger
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - G Lawrence
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - R Calderon-Margalit
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - D S Siscovick
- Cardiovascular Health Research Unit, Department of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - D A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - M A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Hochner
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Zheng R, Zhou D, Zhu Y. The long-term prognosis of cardiovascular disease and all-cause mortality for metabolically healthy obesity: a systematic review and meta-analysis. J Epidemiol Community Health 2016; 70:1024-31. [PMID: 27126492 DOI: 10.1136/jech-2015-206948] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/15/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Metabolically healthy obese phenotype (MHO) refers to obese individuals with absence of metabolic abnormalities such as dyslipidaemia, insulin resistance and hypertension. Many studies reported the long-term prognosis of MHO on diseases and mortality with inconsistent results. METHODS We performed a meta-analysis to assess the risks of cardiovascular (CV) events and all-cause mortality for MHO individuals. Original prospective observational studies were searched in Medline, EMBASE, Web of Science and Cochrane library up to 30 September 2015. In this meta-analysis, the relative risk (RR) calculated on the basis of the incident number of disease events and deaths in participants and the corresponding multivariable-adjusted HR were both extracted to calculate pooled risk estimates. A random-effects model was used if there was heterogeneity among studies; otherwise, the fixed-effects model was used. RESULTS 22 prospective studies, involving 584 799 participants, were archived in the analyses. With metabolically healthy normal weight as the reference, the MHO phenotype was associated with a higher risk of CV events (RR 1.50, 95% CI 1.27 to 1.77; HR 1.60, 95% CI 1.38 to 1.84). However, MHO individuals were not associated with increased risk of all-cause mortality (RR 1.18, 95% CI 0.83 to 1.66; HR 1.07, 95% CI 0.92 to 1.25). CONCLUSIONS The meta-analysis confirms a positive association between a metabolically healthy obese phenotype and the risk of CV events. However, higher risk for all-cause mortality is not evident in metabolically healthy obese individuals.
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Affiliation(s)
- Ruizhi Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Dan Zhou
- Department of pathophysiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
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9
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Zhao J, Booth H, Dear K, Tu EJC. Cardiovascular mortality sex differentials in selected East Asian and Western populations. J Epidemiol Community Health 2016; 70:983-9. [PMID: 27048151 DOI: 10.1136/jech-2015-206577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/16/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Explaining patterns in the sex ratio (male/female) of cardiovascular disease (CVD) mortality would improve understanding of mortality transitions under modernisation. Little research has examined secular trends in this ratio across populations, taking age and cohort into account. We examine cohort effects in the ratios of CVD mortality (including ischaemic heart disease and cerebrovascular disease) among 4 East Asian populations that vary in the timing of their modernisation, and assess the effect of smoking on these patterns in comparison with Western populations. METHODS The sequential method for log-linear models is applied to analyse age, period and cohort effects for sex ratios. Age and cohort effects are fitted first, with population as offset; period effects are fitted in a second model using the fitted values from the first model as the offset. Lung cancer mortality serves as a proxy for smoking. RESULTS Increases in sex ratios of CVD mortality began in earlier cohorts in Western than in East Asian populations. Once begun, increases were more rapid in East Asia. The cohort effect for the sex ratio of CVD mortality differs from that for lung cancer mortality. Trends in sex ratios of CVD mortality by cohort are similar before and after adjustment for lung cancer mortality in East Asia; the increasing trend across 1900-1945 cohorts is maintained in Western populations after adjustment. CONCLUSIONS The sex ratio of CVD mortality has increased across successive cohorts living in increasingly modernised environments. There is scant evidence that this increase is attributable to changing sex-specific rates of smoking.
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Affiliation(s)
- Jiaying Zhao
- The Institute for Asian Demographic Research, School of Sociology and Political Science, Shanghai University, Shanghai, China School of Demography, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Heather Booth
- School of Demography, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Keith Dear
- Duke Global Health Institute, Duke University and Duke Kunshan University, Kunshan, China
| | - Edward Jow-Ching Tu
- Division of Social Science, The Hong Kong University of Science and Technology, Hong Kong, Hong Kong
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10
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Sharashova E, Wilsgaard T, Mathiesen EB, Løchen ML, Njølstad I, Brenn T. Resting heart rate predicts incident myocardial infarction, atrial fibrillation, ischaemic stroke and death in the general population: the Tromsø Study. J Epidemiol Community Health 2016; 70:902-9. [PMID: 26951324 DOI: 10.1136/jech-2015-206663] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/21/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Elevated resting heart rate (RHR) increases risk of death overall, but a comprehensive picture of the associations between RHR, cardiovascular morbidity and mortality events has not yet been presented. We aimed to investigate the effect of RHR on the risk of 5 cardiovascular events: incident myocardial infarction (MI), incident atrial fibrillation (AF), incident ischaemic stroke, total death and cardiovascular death in a general population from Norway. METHODS We followed 24 489 men and women from the Tromsø Study 1994-1995, a population-based cohort study, for 18 years, and analysed the association between RHR and the investigated cardiovascular events. Sex-specific Cox regression with time-dependent covariates was applied with the best-fitting fractional polynomials of RHR. RESULTS Among men, an independent positive relationship was observed for MI and AF (adjusted HR for AF per 20 bpm increase=1.14; 95% CI 1.02 to 1.27). In women, the corresponding HR for MI was 1.23 (1.09 to 1.40). A J-shaped association was observed for ischaemic stroke in women when compared with a RHR of 70 bpm (HR for 50 bpm=1.31; 0.90 to 1.90; HR for 100 bpm=1.32; 1.04 to 1.69). Total and cardiovascular death showed a strong positive association with RHR in men. In women, the pattern for total death was similar. CONCLUSIONS RHR is an independent risk factor for several cardiovascular events. A novel finding is the positive association between RHR and AF in men and the sex difference in association with ischaemic stroke.
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Affiliation(s)
- Ekaterina Sharashova
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tormod Brenn
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Faeh D, Moser A, Panczak R, Bopp M, Röösli M, Spoerri A. Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment. J Epidemiol Community Health 2016; 70:798-806. [PMID: 26791518 DOI: 10.1136/jech-2015-206210] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Living at higher altitude was dose-dependently associated with lower risk of ischaemic heart disease (IHD). Higher altitudes have different climatic, topographic and built environment properties than lowland regions. It is unclear whether these environmental factors mediate/confound the association between altitude and IHD. We examined how much of the altitude-IHD association is explained by variations in exposure at place of residence to sunshine, temperature, precipitation, aspect, slope and distance to main road. METHODS We included 4.2 million individuals aged 40-84 at baseline living in Switzerland at altitudes 195-2971 m above sea level (ie, full range of residence), providing 77 127 IHD deaths. Mortality data 2000-2008, sociodemographic/economic information and coordinates of residence were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. Environment information was modelled to residence level using Weibull regression models. RESULTS In the model not adjusted for other environmental factors, IHD mortality linearly decreased with increasing altitude resulting in a lower risk (HR, 95% CI 0.67, 0.60 to 0.74) for those living >1500 m (vs<600 m). This association remained after adjustment for all other environmental factors 0.74 (0.66 to 0.82). CONCLUSIONS The benefit of living at higher altitude was only partially confounded by variations in climate, topography and built environment. Rather, physical environment factors appear to have an independent effect and may impact on cardiovascular health in a cumulative way. Inclusion of additional modifiable factors as well as individual information on traditional IHD risk factors in our combined environmental model could help to identify strategies for the reduction of inequalities in IHD mortality.
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Affiliation(s)
- David Faeh
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - André Moser
- Department of Geriatrics, Bern University Hospital, and Spital Netz Bern Ziegler, and University of Bern, Bern, Switzerland Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Martin Röösli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Jones MR, Diez-Roux AV, O’Neill MS, Guallar E, Sharrett AR, Post W, Kaufman JD, Navas-Acien A. Ambient air pollution and racial/ethnic differences in carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA). J Epidemiol Community Health 2015; 69:1191-8. [PMID: 26142402 PMCID: PMC4763882 DOI: 10.1136/jech-2015-205588] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/17/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the USA, ethnic disparities in atherosclerosis persist after accounting for known risk factors. Ambient air pollution is associated with increased levels of atherosclerosis and differs in the USA by race/ethnicity. We estimated the influence of ambient air pollution exposure to ethnic differences in common carotid intima-media thickness (IMT). METHODS We cross-sectionally studied 6347 Caucasian-American, African-American, Hispanic and Chinese adults across 6 US cities in 2000-2002. Annual ambient air pollution concentrations (fine particulate matter [PM2.5] and oxides of nitrogen [NOX]) were estimated at each participant's residence. IMT was assessed by ultrasound. RESULTS The mean IMT was 19.4 and 37.6 μm smaller for Hispanic women and men, 53.6 and 7.1 μm smaller for Chinese women and men, and 23.4 and 38.7 μm higher for African-American women and men compared with Caucasian-American women and men. After adjustment for PM2.5, the differences in IMT remained similar for Hispanic and African-American participants but was even more negative for Chinese participants (mean IMT difference of -58.4 μm for women and -15.7 μm for men) compared with Caucasian-American participants. The IMT difference in Chinese participants compared with Caucasian-American participants related to their higher PM2.5 exposures was 4.8 μm (95% CI 0.2 to 10.8) for women and 8.6 μm (95% CI 3.4 to 15.3) for men. NOX was not related to ethnic differences in IMT. CONCLUSIONS The smaller carotid IMT levels in Chinese participants were even smaller after accounting for higher PM2.5 concentrations in Chinese participants compared with Caucasian-American participants. Air pollution was not related to IMT differences in African-American and Hispanic participants compared with Caucasian-American participants.
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Affiliation(s)
- Miranda R Jones
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana V Diez-Roux
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Marie S O’Neill
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Eliseo Guallar
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wendy Post
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joel D Kaufman
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Ana Navas-Acien
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Sims M, Diez-Roux AV, Gebreab SY, Brenner A, Dubbert P, Wyatt S, Bruce M, Hickson D, Payne T, Taylor H. Perceived discrimination is associated with health behaviours among African-Americans in the Jackson Heart Study. J Epidemiol Community Health 2015; 70:187-94. [PMID: 26417003 DOI: 10.1136/jech-2015-206390] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 09/11/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Using Jackson Heart Study data, we examined associations of multiple measures of perceived discrimination with health behaviours among African-Americans (AA). METHODS The cross-sectional associations of everyday, lifetime and burden of discrimination with odds of smoking and mean differences in physical activity, dietary fat and sleep were examined among 4925 participants aged 35-84 years after adjustment for age and socioeconomic status (SES). RESULTS Men reported slightly higher levels of everyday and lifetime discrimination than women and similar levels of burden of discrimination as women. After adjustment for age and SES, everyday discrimination was associated with more smoking and a greater percentage of dietary fat in men and women (OR for smoking: 1.13, 95% CI 1.00 to 1.28 and 1.19, 95% CI 1.05 to 1.34; mean difference in dietary fat: 0.37, p<0.05 and 0.43, p<0.01, in men and women, respectively). Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (mean difference for everyday discrimination: -0.08, p<0.05 and -0.18, p<0.001, respectively; and mean difference for lifetime discrimination: -0.08, p<0.05 and -0.24, p<0.001, respectively). Burden of discrimination was associated with more smoking and fewer hours of sleep in women only. CONCLUSIONS Higher levels of perceived discrimination were associated with select health behaviours among men and women. Health behaviours offer a potential mechanism through which perceived discrimination affects health in AA.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ana V Diez-Roux
- School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Samson Y Gebreab
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute (NHGRI), Bethesda, Maryland, USA
| | - Allison Brenner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Patricia Dubbert
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, North Little Rock, Arkansas, USA
| | - Sharon Wyatt
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Marino Bruce
- Department of Sociology and Criminology, Jackson State University, Jackson, Mississippi, USA
| | - DeMarc Hickson
- Center for Research, Evaluation and Environmental & Policy Change, My Brother's Keeper, Inc, Jackson, Mississippi, USA
| | - Tom Payne
- Department of Otolaryngology & Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
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Buitrago-Lopez A, van den Hooven EH, Rueda-Clausen CF, Serrano N, Ruiz AJ, Pereira MA, Mueller NT. Socioeconomic status is positively associated with measures of adiposity and insulin resistance, but inversely associated with dyslipidaemia in Colombian children. J Epidemiol Community Health 2015; 69:580-7. [PMID: 25691273 DOI: 10.1136/jech-2014-204992] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/13/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Low socioeconomic status (SES) has been associated with higher risk of cardiometabolic diseases in developed societies, but investigation of SES and cardiometabolic risk in children in less economically developed populations is sparse. We aimed to examine associations among SES and cardiometabolic risk factors in Colombian children. METHODS We used data from a population-based study of 1282 children aged 6-10 years from Bucaramanga, Colombia. SES was classified according to household wealth, living conditions and access to public utilities. Anthropometric and biochemical parameters were measured at a clinic visit. Cardiometabolic risk factors were analysed continuously using linear regression and as binary outcomes-according to established paediatric cut points-using logistic regression to calculate OR and 95% CIs. RESULTS Mean age of the children was 8.4 (SD 1.4) and 51.1% of the sample were boys. Odds of overweight/obesity, abdominal obesity and insulin resistance were greater among higher SES. Compared with the lowest SES stratum, children in the highest SES had higher odds of overweight/obesity (OR=3.25, 95% CI 1.89 to 5.57), abdominal obesity (OR=2.74, 95% CI 1.41 to 5.31) and insulin resistance (OR=2.60, 95% CI 1.81 to 3.71). In contrast, children in the highest SES had lower odds of hypertriglyceridaemia (triglycerides ≥90th centile; OR=0.28, 95% CI 0.14 to 0.54) and low (≤10th centile) high-density lipoprotein (HDL) cholesterol (OR=0.35, 95% CI 0.15 to 0.78). CONCLUSIONS In Colombian children, SES is directly associated with obesity and insulin resistance, but inversely associated with dyslipidaemia (hypertriglyceridaemia and low HDL cholesterol). Our findings highlight the need to analyse cardiometabolic risk factors separately in children and to carefully consider a population's level of economic development when studying their social determinants of cardiometabolic disease.
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Affiliation(s)
- Adriana Buitrago-Lopez
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Edith H van den Hooven
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Christian F Rueda-Clausen
- Department of Medicine, University of Alberta, Li Ka Shing Centre for Heath Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Norma Serrano
- Division of Research, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia
| | - Alvaro J Ruiz
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota DC, Colombia
| | - Mark A Pereira
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Noel T Mueller
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA Institute of Human Nutrition and Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
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Jahangir E, Lipworth L, Edwards TL, Kabagambe EK, Mumma MT, Mensah GA, Fazio S, Blot WJ, Sampson UKA. Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study. J Epidemiol Community Health 2015; 69:481-8. [PMID: 25563744 DOI: 10.1136/jech-2014-204920] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/17/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a leading cause of death in the USA. We evaluated the incidence and predictors of AAA in a prospectively followed cohort. METHODS We calculated age-adjusted AAA incidence rates (IR) among 18 782 participants aged ≥65 years in the Southern Community Cohort Study who received Medicare coverage from 1999-2012, and assessed predictors of AAA using multivariable Cox proportional hazards models, overall and stratified by sex, adjusting for demographic, lifestyle, socioeconomic, medical and other factors. HRs and 95% CIs were calculated for AAA in relation to factors ascertained at enrolment. RESULTS Over a median follow-up of 4.94 years, 281 cases were identified. Annual IR was 153/100,000, 401, 354 and 174 among blacks, whites, men and women, respectively. AAA risk was lower among women (HR 0.48, 95% CI 0.36 to 0.65) and blacks (HR 0.51, 95% CI 0.37 to 0.69). Smoking was the strongest risk factor (former: HR 1.91, 95% CI 1.27 to 2.87; current: HR 5.55, 95% CI 3.67 to 8.40), and pronounced in women (former: HR 3.4, 95% CI 1.83 to 6.31; current: HR 9.17, 95% CI 4.95 to 17). A history of hypertension (HR 1.44, 95% CI 1.04 to 2.01) and myocardial infarction or coronary artery bypass surgery (HR 1.9, 95% CI 1.37 to 2.63) was negatively associated, whereas a body mass index ≥25 kg/m(2) (HR 0.72; 95% CI 0.53 to 0.98) was protective. College education (HR 0.6, 95% CI 0.37 to 0.97) and black race (HR 0.44, 95% CI 0.28 to 0.67) were protective among men. CONCLUSIONS Smoking is a major risk factor for incident AAA, with a strong and similar association between men and women. Further studies are needed to evaluate benefits of ultrasound screening for AAA among women smokers.
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Affiliation(s)
- Eiman Jahangir
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA John Ochsner Heart and Vascular Institute, Ochsner Clinical School- The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Loren Lipworth
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd L Edwards
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edmond K Kabagambe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael T Mumma
- International Epidemiology Institute, Rockville, Maryland, USA
| | - George A Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sergio Fazio
- Center of Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - William J Blot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA International Epidemiology Institute, Rockville, Maryland, USA
| | - Uchechukwu K A Sampson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
BACKGROUND There is inconsistent evidence on population mortality, especially cardiovascular disease mortality, on match days of national soccer teams during particular international tournaments. This study examines the number of deaths in Germany on match days of the national soccer team during a long-term period including several tournaments. METHODS We analysed all registered daily deaths in Germany from 1995 to 2009 (11 225 966 cases) using time series analysis methods. Following the Box/Jenkins approach, we applied a seasonal autoregressive integrated moving average model. To assess the effect of match days, we performed an intervention analysis by including a transfer function model representing match days of the national team in the statistical analyses. We conducted separate analyses for all matches and for matches during international tournaments (European and World Championships) only. Time series and results were stratified in terms of sex, age (<50 years, 50-70 years, >70 years) and cause of death (cardiovascular deaths, injuries, others). We performed a further independent analysis focusing only on the effect of match results (victory, loss, draw) and kind of tournament (international championships, qualifications, friendly matches). RESULTS Most of the results did not indicate a distinct effect of matches of the national team on general mortality. Moreover, all null value deviations were small when compared with the average number of daily deaths (n=2270). CONCLUSIONS There is no relevant increase or decrease in mortality on match days of the German national soccer team.
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Affiliation(s)
- D Medenwald
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, University of Halle-Wittenberg, Halle (Saale), Germany
| | - O Kuss
- German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometry and Epidemiology, Düsseldorf, Germany Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany
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Graff-Iversen S, Wilsgaard T, Mathiesen EB, Njølstad I, Løchen ML. Long-term cardiovascular consequences of Rose angina at age 20-54 years: 29-years' follow-up of the Tromsø Study. J Epidemiol Community Health 2014; 68:754-9. [PMID: 24687910 DOI: 10.1136/jech-2013-203642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Rose Angina Questionnaire (RAQ) was constructed in the 1960s for assessing the population burden of angina. Studies have found that screening positivity by RAQ conferred an elevated risk of coronary heart disease (CHD). It is, however, not clear to what extent Rose angina represents early CHD in relatively young adults who are free of known CHD. If representing CHD, Rose angina is expected to carry prognostic information in addition to the risk conferred by other risk factors. METHODS The Tromsø Study is a population-based cohort study in Northern Norway. All men aged 20-54 years (n=8238) and women aged 20-49 years (n=8001), free of known cardiovascular disease (CVD), who participated in a survey 1979-1980, were followed throughout 2010 for incident myocardial infarction (MI), and for incident MI or stroke used as proxy for incident CVD. HRs were estimated using a Cox proportional hazard regression model. RESULTS In age-adjusted analyses, Rose angina predicted MI and CVD in both sexes. The excess risk was substantially accounted for by CVD risk factors, leaving no significantly elevated MI risk above the risk explained by these factors (adjusted HR 1.31; 95% CI 0.95 to 1.80 in men, HR 1.20; 95% CI 0.69 to 2.10 in women). A similar pattern was seen for CVD (adjusted HR 1.16; 95% CI 0.87 to 1.55 in men and 1.30; 95% CI 0.82 to 2.06 in women). CONCLUSIONS Rose angina predicted MI and CVD in a 29-years' follow-up of a relatively young population. Established CVD risk factors were important mediators.
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Affiliation(s)
- Sidsel Graff-Iversen
- Norwegian Institute of Public Health, Oslo, Norway Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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