Adult height and risk of death from all-cause,cardiovascular, and cancer-specific disease: The Rural Chinese Cohort Study

Background and aimsWe aimed to evaluate the sex-specific association of height and all-cause and cause-specific mortality in rural Chinese adults.Methods and resultsA total of 17,263 participants (10,448 women) ≥18 years old were randomly enrolled during 2007–2008 and followed up during 2013–2014. Sex-specific hazard ratios (HRs) for the height–mortality association, assessed in quintiles or 5 cm increments, were calculated by Cox proportional-hazards models. For both men and women, tall participants showed a baseline prevalence of high levels of socioeconomic factors including income and education but low systolic blood pressure and total cholesterol level. During a median of 6.01 years of follow-up, 620 men (in 39,993.45 person-years) and 490 women (in 61,590.10 person-years) died. With increasing height, the risk of all-cause mortality decreased in a curvilinear trend after adjustment for baseline age, socioeconomic and behavioral factors, and anthropometric and laboratory measurements. For men, height was inversely associated with all-cause mortality (HR per 5 cm increase: 0.89, 95% CI: 0.83–0.96) and cardiovascular mortality (HR per 5 cm increase: 0.81, 95% CI: 0.72–0.91). For women, height was inversely associated with all-cause mortality (HR per 5 cm increase: 0.88, 95% CI: 0.81–0.96) and other mortality (HR per 5 cm increase: 0.82, 95% CI: 0.71–0.96).ConclusionsOur study demonstrated a sex-specific inverse effect of height on mortality from different major causes in rural Chinese adults.     

Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality--16 y follow-up of middle-aged and elderly men and women

OBJECTIVE: To investigate the independent associations and the possible interaction of body mass index (BMI), leisure time physical activity (LTPA) and perceived physical fitness and functional capability with the risk of mortality. DESIGN: Prospective 16y follow-up study. SUBJECTS: A regionally representative cohort of 35-63-y-old Finnish men (n= 1,090) and women (n= 1,122). MEASUREMENTS: All-cause, cardiovascular disease (CVD) and coronary heart disease (CHD) mortality were derived from the national census data until the end of September 1996 while the initial levels of BMI, LTPA, physical fitness and function were determined from self-administered questionnaires. RESULTS: After adjustment for age, marital and employment status, perceived health status, smoking and alcohol consumption, the Cox proportional hazards model showed that BMI was not associated with the risk of death among the men or the women. Compared with the most active subjects the men and women with no weekly vigorous activity had relative risks of 1.61 (95% confidence interval, CI, 0.98-2.64) and 4.68 (95% CI, 1.41-15.57), respectively, for CVD mortality, and for the men there was a relative risk of 1.66 (95% CI, 0.92-2.99) for CHD mortality. When compared with the men who perceived their fitness as better than their age-mates, the men with the 'worse' assessment had a relative risk of 3.29 (95% CI, 1.80-6.02) for all-cause mortality and 4.37 (95% CI, 1.80-10.6) for CVD mortality. Men with at least some difficulty in walking a distance of 2 km had a relative risk of 1.62 (95% CI, 1.05-2.50) for all-cause mortality when compared with those who had no functional difficulties. In addition, in the comparison with subjects with no functional difficulties, the men and women who had some difficulty climbing several flights of stairs had relative risks of 1.47 (95% CI, 0.97-2.23) and 2.39 (95% CI, 1.25-4.60) for all-cause mortality, respectively. For CVD mortality the relative risks were 1.85 (95% CI, 1.04-3.30) and 3.38 (1.22-9.41), respectively. CONCLUSIONS: Although BMI did not prove to be an independent risk factor for mortality from CVD, CHD or from all causes combined, perceived physical fitness and functional capability did. An increase in LTPA seems to have a similar beneficial effect on the mortality risk of obese and nonobese men and women, and the effect also seems to be similar for fit and unfit subjects.     

Blood pressure, smoking and body mass in relation to mortality from stroke and coronary heart disease in the elderly. A 10-year follow-up in Norway.

OBJECTIVES: To examine the association between blood pressure, smoking and body mass index (BMI) and cerebro- and cardiovascular mortality in a population of healthy elderly. DESIGN: Ten-year mortality follow-up of elderly men and women who participated in the Nord-Tr?ndelag Health Study 1984-86. SETTING: Nord-Tr?ndelag county, Norway. SUBJECTS: 3121 men and 3271 women aged 70 years and older, free from any diagnosed atherosclerotic diseases or diabetes at baseline. MAIN OUTCOME MEASURES: Relative risk of cerebro- and cardiovascular mortality and all-cause mortality according to blood pressure, smoking and BMI. RESULTS: There was a consistent, positive association between systolic and diastolic blood pressure and cerebro- and cardiovascular mortality. The association persisted after adjustment for potential confounding factors, and was strongest for cerebrovascular mortality; the adjusted relative risks for systolic blood pressure categories 160-179 mmHg and > or = 180 mmHg in men were 1.63 (95% confidence interval, CI 1.06-2.53) and 2.19 (95% CI 1.39-3.44) compared to blood pressure < 140 mmHg. In women, the corresponding relative risks were 1.54 (95% CI 0.93-2.56) and 2.12 (95% CI 1.29-3.50). For diastolic blood pressure the adjusted relative risks in categories 100-109 and > or = 110 mmHg in men were 1.88 (95% CI 1.19-2.95) and 3.06 (95% CI 1.79-5.21) compared to pressure <90 mmHg. The corresponding relative risks in women were 1.75 (95% CI 1.05-2.91) and 2.02 (95% CI 1.04-3.93). Current smoking increased cardiovascular mortality in both men and women, and among women, BMI was negatively associated with all-cause mortality. CONCLUSIONS: These findings add to the growing evidence that hypertension is a major risk factor for mortality from stroke and coronary heart disease among the elderly and the very old.     

Ethnic differences in cardiovascular and all-cause mortality in Birmingham, England: the Birmingham Factory Screening Project

OBJECTIVES: To compare cardiovascular and all-cause mortality, among white Europeans, African-Caribbeans and South-Asians, in relation to baseline demographic characteristics and blood pressure variables. DESIGN: Observational follow-up study. SETTING: Community settings in Birmingham, UK. PARTICIPANTS: Two thousand and eighty-nine white European and 340 African-Caribbean men and women, and 195 South-Asian men whose survival status on 31 December 2003 was known. INTERVENTIONS: Follow-up for assessment of all-cause and cardiovascular mortality over a mean (SD) 20.3 (4.2) years. MAIN OUTCOME MEASURES: All-cause and cardiovascular mortality. RESULTS: There were no significant ethnic differences in all-cause or cardiovascular mortality for men [adjusted hazard ratio (HR) = 1.02; 95% confidence interval (CI), 0.80-1.28 and HR = 1.33; 95% CI, 0.99-1.79, respectively] or women (adjusted HR = 0.61; 95% CI, 0.29-1.32 and HR = 1.19; 95% CI, 0.41-3.45, respectively) in either univariate or multivariate analyses. The only independent predictors of both all-cause and cardiovascular mortality were age, sex, smoking and mean systolic blood pressure or hypertension. CONCLUSIONS: It appears that ethnicity per se is not an independent risk factor for all-cause and cardiovascular mortality between white Europeans and African-Caribbeans in the present study. The data concerning ethnic differences in all-cause and cardiovascular mortality for South-Asians is limited, given that significantly fewer South-Asian men could be traced by the Office for National Statistics (ONS), hence we do not know their survival status, and the total lack of data on South-Asian women.     

Waist and hip circumferences and all-cause mortality: usefulness of the waist-to-hip ratio?

OBJECTIVE: To investigate whether waist and hip circumferences, in addition to body mass index (BMI), are related to all-cause mortality. We studied these associations and tested the usefulness of the waist-to-hip ratio for mortality prediction. DESIGN: A Danish prospective cohort study with data collected between 1993 and 1997. SUBJECTS: A total of 27 179 men and 29 875 women born in Denmark and aged 50-64 years were followed for a median of 6.8 years. MEASUREMENTS: BMI, waist and hip circumferences at baseline. RESULTS: The associations between hip circumference and all-cause mortality were inverse for both men and women, but only after adjustment for waist circumference, or BMI, or both. The mortality rate ratios of mutually adjusted waist and hip circumferences were 0.63 (95% CI: 0.56, 0.71), and 0.70 (95% CI: 0.63, 0.79) times higher per 10% larger hip circumference in men and women, respectively, and 1.45 (95% CI: 1.34, 1.57) and 1.22 (95% CI: 1.14, 1.31) times higher per 10% larger waist circumference. The adequacy of the waist-to-hip ratio as a substitute for separate measurements of waist and hip circumferences depended on which other variables the analysis was adjusted for, indicating that the waist-to-hip ratio should be used with precaution. CONCLUSION: When mutually adjusted, waist and hip circumferences show opposite associations with all-cause mortality, probably due to different effects of adipose tissue in the abdominal and gluteofemoral regions. The waist-to-hip ratio cannot always capture these relations adequately.     

Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study

Aims/hypothesis

The aim of this study was to examine the association of physical activity (PA) with all-cause mortality and incident and prevalent cardiovascular disease (CVD) among patients with type 1 diabetes.

Methods

The EURODIAB Prospective Complications Study is a cohort including 3,250 male and female patients with type 1 diabetes (mean age 32.7?±?10.2 years) from 16 European countries, of whom 1,880 participated in follow-up examinations. In analysis 1 (longitudinal), the association of baseline PA (based on the reported number of hours per week spent in mild, moderate and vigorous PA) with all-cause mortality and incident CVD was examined by performing survival analysis. In analysis 2 (cross-sectional), we focused on the association between PA at follow-up (data on sports, walking distance and regular bicycling) and prevalent CVD by performing logistic regression analysis. Adjustments were made for age, sex, BMI, smoking, consumption of alcohol, consumption of certain nutrients and diabetic complications.

Results

Analysis 1 (longitudinal): participation in moderate or vigorous PA once a week or more was borderline inversely associated with all-cause mortality (men and women combined) (HR 0.66, 95% CI 0.42, 1.03) and incident CVD (women only) (HR 0.66, 95% CI 0.40, 1.08). No association was found in men. Analysis 2 (cross-sectional): total PA (indexed by sports, walking, bicycling) and distance walked were inversely associated with prevalent CVD (OR_totalPA 0.66, 95% CI 0.45, 0.97; and OR_walking 0.61, 95% CI 0.42, 0.89).

Conclusions/interpretation

PA showed a borderline inverse association with both all-cause mortality (both sexes) and incident CVD (women only) in patients with type 1 diabetes. Since this is an under-researched clinical population, future longitudinal studies with objective PA measurements are needed to expand on these results.     

Gender differences in the impact of metabolic syndrome components on mortality in older people: A systematic review and meta-analysis

Background and aimsThe influence of metabolic syndrome (MetS) on mortality may be influenced by age- and gender-related changes affecting the impact of individual MetS components. We investigated gender differences in the association between MetS components and mortality in community-dwelling older adults.Methods and resultsProspective studies were identified through a systematic literature review up to June 2019. Random-effect meta-analyses were run to estimate the pooled relative risk (RR) and 95% confidence intervals (95% CI) of all-cause and cardiovascular (CV) mortality associated with the presence of MetS components (abdominal obesity, high triglycerides, low HDL cholesterol, high fasting glycemia, and high blood pressure) in older men and women. Meta-analyses considering all-cause (103,859 individuals, 48,830 men, 55,029 women; 10 studies) and CV mortality (94,965 individuals, 44,699 men, 50,266 women; 8 studies) did not reveal any significant association for abdominal obesity and high triglycerides in either gender. Low HDL was associated with increased all-cause (RR = 1.16, 95% CI: 1.02–1.32) and CV mortality (RR = 1.34, 95% CI: 1.03–1.74) among women, while weaker results were found for men. High fasting glycemia was associated with higher all-cause mortality in older women (RR = 1.35, 95% CI: 1.22–1.50) more than in older men (RR = 1.21, 95% CI: 1.13–1.30), and CV mortality only in the former (RR = 1.36, 95% CI: 1.04–1.78). Elevated blood pressure was associated with increased all-cause mortality (RR = 1.16, 95% CI: 1.03–1.32) and showed marginal significant results for CV death only among women.ConclusionsThe impact of MetS components on mortality in older people present some gender differences, with low HDL cholesterol, hyperglycemia, and elevated blood pressure being more strongly associated to all-cause and CV mortality in women.     

Long-term survival and prognostic implications after coronary artery bypass grafting in Chinese patients with coronary artery disease

OBJECTIVES: This hospital-based study was conducted to determine the survival rates of patients after coronary artery bypass grafting (CABG) surgery and the associated prognostic factors related to all-cause mortality during a 7-year follow-up in Taiwan. METHODS AND RESULTS: Between January 1997 and December 2003, the medical records of 1877 patients who underwent primary, isolated CABG surgery were studied. The Kaplan-Meier method was used to estimate survival. Multiple Cox regression was used to investigate the independence of prognostic factors associated with all-cause mortality. Of the 1877 patients who underwent CABG surgery, 192 expired during the 7-year study period.The overall patient survival rate was 85.96% (95% CI: 83.74-88.16). Using multiple Cox regression analysis, in addition to female gender, older age at surgery, pulmonary oedema, longer ischaemic time, longer cardiopulmonary bypass time, and poorer postoperative left ventricular ejection fraction were significant factors associated with all-cause mortality for both men and women. Associated prognostic factors varied by gender. For men, smoking (RR = 2.82, 95% CI: 1.06-4.16), respiratory failure (RR = 6.88, 95% CI: 3.29-14.40) and cardiogenic shock (RR = 4.04, 95% CI: 2.13-7.67) were significantly related to all-cause mortality, but not for women. Sepsis (RR = 8.97,95% CI: 1.19-19.81) and ICU stay (RR = 1.03,95% CI: 1.01-1.05) were significantly related to all-cause mortality among female patients only. CONCLUSIONS: Several gender-related differences were noted pertaining to all-cause mortality and the relationships between smoking, sepsis, respiratory failure, cardiogenic shock, and ICU stay.     

Usefulness of cardiorespiratory fitness as a predictor of all-cause and cardiovascular disease mortality in men with systemic hypertension

There is an inverse gradient of mortality across levels of cardiorespiratory fitness in healthy adults; however, the association of fitness to mortality in persons with comorbidities such as hypertension is not fully understood. This study quantifies the relation of cardiorespiratory fitness to all-cause mortality and cardiovascular disease (CVD) mortality in hypertensive men. In this observational cohort study, we calculated death rates for low, moderate, and high fitness categories in normotensive (n = 15,726) and hypertensive (n = 3,184) men, and in men without a history of hypertension but with elevated blood pressure (BP) (systolic BP > or = 140 or diastolic BP > or = 90 mm Hg) at baseline (n = 3,257). The participants were 22,167 men (average age 42.6 +/- 9.2 years [mean +/- SD]) who underwent a medical examination that included a maximal exercise test during 1970 to 1993, with mortality follow-up to December 31, 1994. We identified 628 deaths (188 from CVD) during 224,173 man-years of observation. There was an inverse linear trend across fitness groups for all-cause and CVD mortality. The relative risk (95% confidence interval [CI]), using the low fitness group as reference, for all-cause mortality in hypertensive men was 0.45 (95% CI 0.31 to 0.65) and 0.42 (95% CI 0.27 to 0.66) for moderate and high fitness groups, respectively, and in men with elevated BP, 0.49 (95% CI 0.34 to 0.70) and 0.44 (95% CI 0.29 to 0.68) for moderate and high fitness groups, respectively. The pattern of results was similar for CVD mortality. There was an inverse linear relation between fitness and death rate for all-cause mortality in both the uncontrolled and controlled hypertensive groups. This study provides evidence that moderate to high levels of cardiorespiratory fitness provide protection against all-cause and CVD mortality in hypertensive men and men without a history of hypertension but with elevated BP at examination.     

Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population.

AIMS: Chronic kidney disease (CKD) was found to be an independent risk factor for all-cause mortality as well as adverse cardiovascular disease (CVD) events in high-risk populations. Findings from population-based studies are scarce and inconsistent. We investigated the gender-specific association of CKD with all-cause mortality, cardiovascular mortality, and incident myocardial infarction (MI) in a population-based cohort. METHODS AND RESULTS: The study was based on 3860 men and 3674 women (aged 45-74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. CKD was defined by an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m(2). Hazard ratios (HRs) were estimated from Cox proportional hazard models. In this study, 890 total deaths, 400 CVD deaths, and 321 incident MIs occurred in men up to 31 December 2002; the corresponding numbers in women were 442, 187, and 102. In multivariable analyses, the HR for women with CKD compared to women with preserved renal function was significant for incident MI [HR 1.67; 95% confidence interval (CI) 1.07-2.61] and CVD mortality (HR 1.60; 95% CI 1.17-2.18). In men, CKD was also significantly associated with incident MI (HR 1.51; 95% CI 1.09-2.10) and CVD mortality (HR 1.48; 95% CI 1.15-1.92) after adjustment for common CVD risk factors. In contrast, men and women with CKD had no significant increased risk of all-cause mortality. CONCLUSION: CKD was strongly associated with an increased risk of incident MI and CVD mortality independent from common cardiovascular risk factors in men and women from the general population.     

A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study

PURPOSE: To describe the effect of atrial fibrillation on long-term morbidity and mortality. SUBJECTS AND METHODS: The Renfrew/Paisley Study surveyed 7052 men and 8354 women aged 45-64 years between 1972 and 1976. All hospitalizations and deaths occurring during the subsequent 20 years were analyzed by the presence or absence of atrial fibrillation at baseline. Lone atrial fibrillation was defined in the absence of other cardiovascular signs or symptoms. Cox proportional hazards models were used to adjust for age and cardiovascular conditions. RESULTS: After 20 years, 42 (89%) of the 47 women with atrial fibrillation had a cardiovascular event (death or hospitalization), compared with 2276 (27%) of the 8307 women without this arrhythmia. Among men, 35 (66%) of 53 with atrial fibrillation had an event, compared with 3151 (45%) of 6999 without atrial fibrillation. In women, atrial fibrillation was an independent predictor of cardiovascular events (rate ratio [RR] = 3.0; 95% confidence interval [CI]: 2.1-4.2), fatal or nonfatal strokes (RR = 3.2; 95% CI: 1.0-5.0), and heart failure (RR = 3.4; 95% CI: 1.9-6.2). The rate ratios among men were 1.8 (95% CI: 1.3-2.5) for cardiovascular events, 2.5 (95% CI: 1.3-4.8) for strokes, and 3.4 (95% CI: 1.7-6.8) for heart failure. Atrial fibrillation was an independent predictor of all-cause mortality in women (RR = 2.2; 95% CI: 1.5-3.2) and men (RR = 1.5; 95% CI: 1.2-2.2). However, lone atrial fibrillation (which occurred in 15 subjects) was not associated with a statistically significant increase in either cardiovascular events (RR = 1.5; 95% CI: 0.6-3.6) or mortality (RR = 1.8; 95% CI: 0.9-3.8). CONCLUSIONS: Atrial fibrillation is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality, especially in women.     

Proteinuria as a risk factor for cardiovascular disease and mortality in older people: a prospective study

BACKGROUND: The prognostic significance of proteinuria in older people is not well defined. We examined the associations between proteinuria and incident coronary heart disease, cardiovascular mortality, and all-cause mortality in older people.SUBJECTS AND METHODS: Casual dipstick proteinuria was determined in 1,045 men (mean [+/- SD] age 68 +/- 7 years) and 1,541 women (mean age 69 +/- 7 years) attending the 15th biennial examination of the Framingham Heart Study. Participants were divided by grade of proteinuria: none (85.3%), trace (10.2%), and greater-than-trace (4.5%). Cox proportional hazards analyses were used to determine the relations of baseline proteinuria to the specified outcomes, adjusting for other risk factors, including serum creatinine level.RESULTS: During 17 years of follow-up, there were 455 coronary heart disease events, 412 cardiovascular disease deaths, and 1,214 deaths. In men, baseline proteinuria was associated with all-cause mortality (hazards ratio [HR] = 1.3, 95% confidence interval [CI] 1.0 to 1.7 for trace proteinuria; HR = 1.3, 95% CI 1.0 to 1.8 for greater-than-trace proteinuria; P for trend = 0.02). In women, trace proteinuria was associated with cardiovascular disease death (HR = 1. 6, 95% CI 1.1 to 2.4), and all-cause mortality (HR = 1.4, 95% CI 1.1 to 1.7).CONCLUSION: Proteinuria is a significant, although relatively weak, risk factor for all-cause mortality in men and women, and for cardiovascular disease mortality in women.     

The relationship between educational level and mortality. The Reykjavík Study

OBJECTIVE: Epidemiological studies have indicated an association between socioeconomic factors and health. It has not been clearly established whether this association is wholly or partly independent of classical risk factors. Our objective was to estimate the relationship between educational level and coronary artery disease (CAD), mortality and all-cause mortality. The Reykjavík Study involving 18 912 participants followed-up 4-30 years provides an ideal opportunity to address this question. DESIGN AND SUBJECTS: The participants were aged 33-81 years and living in the Reykjavík area. They were divided into four groups according to education. The standard risk factors were assessed on entry and mortality, and cause of death registered during follow-up. Multiple Cox regression analysis was applied to assess the relationship between age at examination, year of examination, educational level and mortality. RESULTS: The all-cause mortality and CAD mortality was significantly related to education, even after adjustment for classical risk factors. For men, 14% (95% CI: 2-24) reduction was found in CAD mortality for those having high school education relative to elementary school. The figures for junior college and university education were 17% (95% CI: 1-31) and 38% (95% CI: 21-32), respectively. These figures were only slightly lower when major CAD risk factors were controlled for and still significant. Similar figures were found for all-cause mortality. For women 34% (95% CI: 18-48) reduction was found in CAD mortality for high school education and 55% (95% CI: 22-74) for junior college, but too few had university education for reliable results. The figures were lower for all-cause mortality, but significant. The figures were reduced when major CAD risk factors were controlled for, but still significant. CONCLUSION: Education is a strong protective factor both for all-cause and CAD mortality. Only a small part of this effect can be explained through conventional risk factors.     

Relation of heart rate parameters during exercise test to sudden death and all-cause mortality in asymptomatic men

Heart rate (HR) profile during exercise predicts all-cause mortality. However, less is known about its relation to sudden (vs nonsudden) death in asymptomatic people. The relation of exercise HR parameters (HR at rest, target HR achievement, HR increase, and HR recovery) with sudden death, coronary heart disease (CHD) death, myocardial infarction, and all-cause mortality was assessed in 12,555 men who participated in MRFIT. Subjects were 35 to 57 years old without clinical CHD, but with higher than average Framingham risk. Trial follow-up was 7 years, and extended follow-up after the trial for all-cause mortality was 25 years. After adjusting for cardiac risk factors, having to stop exercise before achieving 85% of age-specific maximal HR was associated with increased risk of sudden death (hazard ratio 1.8, 95% confidence interval [CI] 1.3 to 2.5, p = 0.001), CHD death (hazard ratio 1.4, 95% CI 1.2 to 1.5, p <0.001), and all-cause mortality (hazard ratio 1.3, 95% CI 1.2 to 1.4, p <0.001). Increased HR at rest (p = 0.001), attenuated HR increase (p = 0.02), delayed HR recovery (p = 0.04), and exercise duration (p <0.0001) were independent predictors of all-cause death in the overall study population and also in the subgroup that achieved target HR. In conclusion, middle-aged men without clinical CHD who stopped exercise before reaching 85% of maximal HR had a higher risk of sudden death. Other exercise HR parameters and exercise duration predicted all-cause mortality.     

Relationship of walking to mortality among US adults with diabetes

BACKGROUND: Walking is associated with reduced diabetes incidence, but few studies have examined whether it reduces mortality among those who already have diabetes. OBJECTIVE: To estimate the association between walking and the risk for all-cause and cardiovascular disease (CVD) mortality among persons with diabetes. DESIGN: Prospective cohort study of a representative sample of the US population. SETTING: Interviewer-administered survey in the general community. PARTICIPANTS: We sampled 2896 adults 18 years and older with diabetes as part of the 1990 and 1991 National Health Interview Survey. MAIN OUTCOME MEASURE: All-cause and CVD mortality for 8 years. RESULTS: Compared with inactive individuals, those who walked at least 2 h/wk had a 39% lower all-cause mortality rate (hazard rate ratio [HRR], 0.61; 95% confidence interval [CI], 0.48-0.78; 2.8% vs 4.4% per year) and a 34% lower CVD mortality rate (HRR, 0.66; 95% CI, 0.45-0.96; 1.4% vs 2.1% per year). We controlled for sex, age, race, body mass index (calculated as weight in kilograms divided by the square of height in meters), smoking, and comorbid conditions. The mortality rates were lowest for persons who walked 3 to 4 h/wk (all-cause mortality HRR, 0.46; 95% CI, 0.29-0.71; CVD mortality HRR, 0.47; 95% CI, 0.24-0.91) and for those who reported that their walking involved moderate increases in heart and breathing rates (all-cause mortality HRR, 0.57; 95% CI, 0.41-0.80; CVD mortality HRR, 0.69; 95% CI, 0.43-1.09). The protective association of physical activity was observed for persons of varying sex, age, race, body mass index, diabetes duration, comorbid conditions, and physical limitations. CONCLUSIONS: Walking was associated with lower mortality across a diverse spectrum of adults with diabetes. One death per year may be preventable for every 61 people who could be persuaded to walk at least 2 h/wk.     

Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study

BACKGROUND: The Mediterranean diet has been suggested to play a beneficial role for health and longevity. However, to our knowledge, no prospective US study has investigated the Mediterranean dietary pattern in relation to mortality. METHODS: Study participants included 214,284 men and 166,012 women in the National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study. During follow-up for all-cause mortality (1995-2005), 27,799 deaths were documented. In the first 5 years of follow-up, 5,985 cancer deaths and 3,451 cardiovascular disease (CVD) deaths were reported. We used a 9-point score to assess conformity with the Mediterranean dietary pattern (components included vegetables, legumes, fruits, nuts, whole grains, fish, monounsaturated fat-saturated fat ratio, alcohol, and meat). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using age- and multivariate-adjusted Cox models. RESULTS: The Mediterranean diet was associated with reduced all-cause and cause-specific mortality. In men, the multivariate HRs comparing high to low conformity for all-cause, CVD, and cancer mortality were 0.79 (95% CI, 0.76-0.83), 0.78 (95% CI, 0.69-0.87), and 0.83 (95% CI, 0.76-0.91), respectively. In women, an inverse association was seen with high conformity with this pattern: decreased risks that ranged from 12% for cancer mortality to 20% for all-cause mortality (P = .04 and P < .001, respectively, for the trend). When we restricted our analyses to never smokers, associations were virtually unchanged. CONCLUSION: These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes, including deaths due to CVD and cancer, in a US population.     

Weight change and mortality: the Nord-Trøndelag Health Study

Objectives. The prevalence of obesity is increasing. Overweight and obese people have increased mortality compared with normal weight people. We investigated the effect of weight change on mortality. Design. Prospective population study. Setting. We utilized data from two large population-based health studies conducted in 1984–86 and 1995–97 respectively. Cox proportional hazards models were used to calculate mortality rate ratios (RRs) with 95% confidence intervals (CIs) between people with a stable weight and people who lost or gained weight. Subjects. Totally 20 542 men and 23 712 women aged 20 years or more, without cardiovascular disease or diabetes at the first survey and without a history of cancer at the second survey were followed up on all-cause mortality for 5 years after the second survey. Results. We found no association between weight gain and mortality. People who lost weight had a higher total mortality rate compared with those who were weight stable [RR was 1.6 (95% CI: 1.4–1.8) in men and 1.7 (95% CI: 1.5–2.0) in women]. Similar associations were found for cardiovascular and noncardiovascular mortality. Additional analysis showed a linear increase in mortality rates across categories of weight loss for both men and women (P < 0.001). There was a statistically significant interaction between weight change and initial BMI, but only amongst men (P = 0.001). Conclusions. Weight loss, but not weight gain, was associated with increased mortality amongst men and women. Although underlying undiagnosed disease is the most plausible explanation for this finding, the similar associations found for total mortality, cardiovascular mortality, and noncardiovascular mortality makes the causal pathway somewhat enigmatic.     

Sex-related differences in long-term mortality and heart failure in a contemporary cohort of patients with NSTEACS. The cardiochus-HSUJ registry

Introduction and objectivesThere is insufficient data regarding sex-related prognostic differences in patients with a non-ST elevation acute coronary syndrome (NSTEACS). We performed a sex-specific analysis of cardiovascular outcomes after NSTEACS using a large contemporary cohort of patients from two tertiary hospitals.MethodsThis work is a retrospective analysis from a prospective registry, that included 5,686 consecutive NSTEACS patients from two Spanish University hospitals between the years 2005 and 2017. We performed a propensity score matching to obtain a well-balanced subset of individuals with the same clinical characteristics, resulting in 3,120 patients. Cox regression models performed survival analyses once the proportional risk test was verified.ResultsAmong the study participants, 1,572 patients (27.6%) were women. The mean follow-up was 60.0 months (standard deviation of 32 months). Women had a higher risk of cardiovascular mortality compared with men (OR (Odds ratio) 1.27, CI (confidence interval) 95% 1.08-1.49), heart failure (HF) hospitalization (OR 1.39, CI 95% 1.18-1.63) and risk of all-cause mortality (OR 1.10, CI 95% 1.08-1.49). After a propensity score matching, female gender was associated with a significant reduction in the risk of total mortality (OR 0.77, CI 95% 0.65-0.90) with a similar risk of cardiovascular mortality (OR 0.86, CI 0.71-1.03) and HF hospitalization (OR 0.92, CI 95% 0.68-1.23). After baseline adjustment, the risk of all-cause mortality and cardiovascular mortality was lower in women, whereas the risk of HF remained similar among sexes.ConclusionsIn a contemporary cohort of patients with NSTEACS, women are at similar risk of developing early and late HF admissions, and have better survival compared with men, with a lower risk of all-cause mortality and cardiovascular mortality. The implementation of NSTEACS guideline recommendations in women, including early revascularization, seems to be accompanied by improved early and long-term prognosis.     

Waist circumference and body composition in relation to all-cause mortality in middle-aged men and women

OBJECTIVE: Waist circumference is directly related to all-cause mortality when adjusted for body mass index (BMI). Body fat and fat-free body mass, when mutually adjusted, show with increasing values an increasing and decreasing relation to all-cause mortality. We investigated the association of waist circumference and body composition (body fat and fat-free mass), mutually adjusted, to all-cause mortality. DESIGN: A Danish prospective cohort study with a median follow-up period of 5.8 y. SUBJECTS: In all, 27 178 men and 29 875 women, born in Denmark, aged 50-64 y, and without diagnosis of cancer at the time of invitation. MEASUREMENTS: Waist circumference and body composition estimated from impedance measurements. Cox's regression models were used to estimate the mortality rate ratios (RR). RESULTS: Waist circumference was strongly associated with all-cause mortality after adjustment for body composition; the mortality RR was 1.36 (95% confidence intervals (CI): 1.22-1.52) times higher per 10% larger waist circumference among men and 1.30 (95% CI: 1.17-1.44) times higher among women. Adjustment for waist circumference eliminated the association between high values of the body fat mass index (BFMI) and all-cause mortality. The association between fat-free mass index (FFMI) and mortality remained unaltered. CONCLUSION: Waist circumference accounted for the mortality risk associated with excess body fat and not fat-free mass. Waist circumference remained strongly and directly associated with all-cause mortality when adjusted for total body fat in middle-aged men and women, suggesting that the increased mortality risk related to excess body fat is mainly due to abdominal adiposity.     

Hypertension Control as Predictor of Mortality in Treated Men and Women,Followed for up to 30 Years

Purpose: To examine the prognosis of treated, hypertensive individuals in the Reykjavik StudyMethods: A population-based longitudinal study of 9328 men and 10 062 women. Subjects were included in the study during the period 1967-1996. Two groups of treated, hypertensive subjects were defined at baseline: with controlled blood pressure and with uncontrolled blood pressure. Main outcome measures were cardiovascular disease (CVD) mortality and all-cause mortality.Results: Of the hypertensive men 24.8% were treated, and of those 38.3% were controlled, and of the hypertensive women 45.3% were treated, and of those 52.7% were controlled. Comparing treated and uncontrolled (systolic blood pressure (SBP) ≥160 mmHg and/or diastolic blood pressure (DBP) ≥95 mmHg) versus treated and controlled hypertensive subjects, followed for up to 30 years, the uncontrolled men and women were at significantly higher risk of CVD mortality, hazard ratio (HR) = 1.47 (95% confidence interval (CI): 1.06-2.02) and HR 1.70 (CI: 1.23–2.36), respectively, showing the benefit of hypertension control. The risk of all-cause mortality was increased for treated, uncontrolled men and women, compared with those who were treated and controlled, but did not reach significance. When analyzing blood pressure as a continuous variable among treated, hypertensive subjects, SBP was a better predictor than DBP of CVD mortality and all-cause mortality in women. This was not the case in men.Conclusions: Control of blood pressure among hypertensive-treated subjects at baseline was associated with a lower risk of CVD mortality during follow-up. SBP was the single best predictor of CVD mortality and all-cause mortality in treated women. The uncontrolled women were at a higher risk than the uncontrolled men.