Chylomicronemia risk factors ranked by importance for the individual and community in 108 711 women and men

Background

Hypertriglyceridemia prevalence is increasing as more individuals become obese, and chylomicronemia risk factors for the individual and community have not been described previously.

Objective

To describe chylomicronemia risk factors in the general population for individuals and community.

Methods

A total of 108 711 individuals from the Copenhagen General Population Study were grouped as unlikely chylomicronemia (nonfasting triglycerides <2 mmol L^?1 (177 mg dL ^?1)), possible chylomicronemia (2–4.99 mmol L^?1 (177–442 mg dL ^?1)), probable chylomicronemia (5–9.99 mmol L^?1 (443–885 mg dL ^?1)) and definite chylomicronemia (≥10 mmol L^?1 (≥ 886 mg dL ^?1)). Relative risk (RR ) from Poisson regression ranked dichotomized chylomicronemia risk factors for individuals, and population attributable fractions (PAF ) for the community: type 2 diabetes, alcohol intake, obesity, fat intake, hypothyroidism, kidney function, education, sedentary lifestyle, menopause and hormone replacement (women).

Results

For women and men, chylomicronemia was unlikely in 81% and 64%, possible in 18% and 33%, probable in 1% and 3% and definite in 0.03% and 0.14%, respectively. For the individual, the three top‐ranked risk factors for probable/definite versus unlikely chylomicronemia in women were type 2 diabetes (RR : 4.21; 95% confidence interval: 3.30–5.36), menopause (RR : 3.74; 2.62–5.36) and obesity (RR : 3.44; 2.81–4.21). Corresponding top‐ranked risk factors in men were obesity (RR : 3.86; 3.46–4.30), type 2 diabetes (RR : 1.88; 1.61–2.19) and reduced kidney function (RR : 1.86; 1.48–2.34). For the community, top‐ranked risk factors in women were menopause (PAF : 63%), obesity (PAF : 29%) and type 2 diabetes (PAF : 15%). Corresponding top‐ranked risk factors in men were obesity (PAF : 29%), type 2 diabetes (PAF : 6.4%) and sedentary lifestyle (PAF : 6.0%).

Conclusions

Obesity and type 2 diabetes were the most important modifiable chylomicronemia risk factors in women and men, both for the individual and community. This could influence chylomicronemia prevention and help design randomized trials aimed at reducing triglycerides.

     

Coronary risk factors and incidence of coronary death in relation to physical fitness. Seven-year follow-up study of middle-aged and elderly men

Physical fitness was assessed in relation to a near maximalbicycle exercise test in two populations; population 1: 122middle aged and elderly cross-country skiers with a documentedvery high physical performance, and population 2: 2014 apparentlyhealthy men 40–59 years of age. All were without knownor suspected heart disease at the baseline study. A number ofso-called coronary risk factors were studied simultaneously.The total incidence of coronary heart disease (CHD) events werenoted as was the total 7 year incidence of death from CHD amongmen from population 2. By subdividing the latter in quartilesof physical fitness within each 5 year age group—and studyinglevels of coronary risk factors and CHD deaths within these16 subgroups—the following findings were made: All coronaryrisk factors were favourably and strongly associated with highphysical fitness and vice versa in consistent way. Death frommyocardial infarction and sudden, unexpected death followedthe same pattern in an inverse way. The skiers as a group closelyfollowed the most fit men from population 2 in all respects.Thus we have noted a strong, graded, positive association betweenphysical fitness and a number of coronary risk factors, andan inverse relationship between high physical fitness and therisk of dying from CHD. These findings hold true for a periodof 7 years among middle aged men free fromknown orsuspectedheart disease.     

Coronary heart disease: from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s.

AIMS: To analyse secular changes in the prevalence of coronary heart disease (CHD) and to assess changes in the burden of CHD at population level. METHODS AND RESULTS: Data were used from two large cross-sectional health examination surveys representing the entire Finnish adult population in 1980 and 2000. In the 1978-80 survey, the sample covered 5101 individuals aged > or =45, of whom 88% participated. The 2000-2001 survey comprised 5310 individuals in the same age range. Participation rate in the health examination was 87%. Prevalence of CHD decreased in men and women under the age of 65 and increased among those aged > or =75. Prevalence of large Q-waves indicating previous myocardial infarction decreased in all male age groups and in women aged 65-74. The total estimated number of persons with CHD increased by 18% (95% CI=6-30) during the past 20 years in Finland. In 1980, the most dominant CHD group was men aged 45-64, whereas in 2000, women aged > or =75 comprised the largest CHD group. CONCLUSION: Although the prevalence of CHD has decreased among middle-aged persons, the number of CHD cases has increased during the past 20 years in Finland.     

Smoking, lipoproteins and coronary heart disease risk: Data from the Munster Heart Study (PROCAM)

Aims The mechanism of the increase in coronary heart disease riskassociated with smoking is unclear, but may partly be due tosmoking-related changes in intermediate risk factors such aslipid levels, fibrinogen and blood pressure. We therefore examinedthe distribution of these variables among smokers and non-smokersin the Münster Heart Study. Methods 20696 men, aged 41·7±2·7 years (mean±SD)and 10212 women, aged 37·0±2·6 years, wereenrolled between 1978 and 1995. Thirty-two percent of womenand 36% of men smoked. Compared to non-smokers, mean levelsof low density lipoprotein cholesterol, total cholesterol, triglyceridesand fibrinogen were increased, respectively, by 1·4%,0·9%, 15% and 12·1% in male and by 2·0%,5·5%, 12% and 3·4% in female smokers. Mean highdensity lipoprotein cholesterol levels, body mass index andblood pressure were reduced, respectively, by 6·4%, 3·8%,and 2% in male, and by 6·7% 1·2% and 2% in femalesmokers. In the subgroup of 4639 men aged 40 to 65 with 8 yearsof follow-up, the coronary event rate (definite myocardial infarction,sudden cardiac death) in cigarette smokers was more than twicethat of non-smokers with otherwise identical risk factors. Conclusion In the Münster Heart Study, smoking was associated withadverse changes in lipids (of greater magnitude in women), andfibrinogen (of greater magnitude in men). However, these changesexplained only a small part of the smoking-related increasein coronary heart disease risk.The European Society of Cardiology     

Framingham risk function overestimates risk of coronary heart disease in men and women from Germany--results from the MONICA Augsburg and the PROCAM cohorts.

BACKGROUND: The prediction of the absolute risk of coronary heart disease (CHD) is commonly based on risk prediction equations that originate from the Framingham Heart Study. However, differences in population risk levels compromise the external validity of these risk functions. SETTING AND STUDY POPULATION: Participants aged 35-64 years from the MONICA Augsburg (2861 men and 2925 women) and the PROCAM (5527 men and 3155 women) cohorts were followed-up with regard to incident non-fatal myocardial infarction (MI) and fatal coronary events. For each participant, the predicted absolute risk of fatal plus non-fatal events was derived using Framingham risk equations. Predicted and actually observed risks were compared. RESULTS: The two cohorts were similar in their baseline characteristics. Coronary risk predicted by the Framingham risk function substantially exceeded the risk actually observed in the German cohorts, irrespective of gender. The difference between predicted and observed absolute CHD risk increased with age while the ratio of predicted over observed risk remained constant at about a value of 2. Taking potentials for underascertainment in the German cohorts due to unrecognised MI and sudden deaths into account, the residual magnitude of risk overestimation by the Framingham risk function is probably at least 50%. CONCLUSIONS: Local guidelines for the management of patients with risk factors need to correct for this overestimation to avoid inadequate initiation of treatment and inflation of costs in primary prevention. Similar studies should be conducted in other populations with the aim of defining appropriate factors that calibrate absolute risk predictions to local population levels of CHD risk.     

Complement factor H (Y402H) polymorphism and risk of coronary heart disease in US men and women.

AIMS: Complement factor H (CFH) Y402H polymorphism is located in a region that binds C-reactive protein and may affect inflammatory processes and risk of coronary heart disease (CHD). We assessed the association between Y402H and risk of CHD in nested case-control studies among two large prospective cohorts of US male health professionals and female nurses. METHODS AND RESULTS: Among participants who were disease-free at baseline, we confirmed 266 (men) and 249 (women) incident CHD deaths and non-fatal myocardial infarctions (MIs) over 6 and 8 years of follow-up, respectively. Using risk-set sampling, controls were matched 2:1 on the basis of age, smoking, and date of blood draw. Comparing homozygous HH with YY, the relative risk (RR) of CHD was 0.94 [95% confidence interval (CI) 0.59-1.49] among men and 0.51 (95% CI 0.29-0.89) among women (pooled RR 0.73, 95% CI 0.51-1.04). The HH genotype was inversely associated with CHD among those <65 years at onset (men: RR 0.39, 95% CI 0.16-0.95; women: 0.21, 95% CI 0.07-0.65; pooled: 0.30, 95% CI 0.15-0.61), but not among those > or =65 years (pooled RR 1.09, 95% CI 0.71-1.68). CONCLUSION: CFH Y402H was inversely associated with CHD among women, but not men. This inverse association was observed in both populations with earlier age of CHD.     

Angiotensinogen mutations and risk for ischemic heart disease, myocardial infarction, and ischemic cerebrovascular disease. Six case-control studies from the Copenhagen City Heart Study

BACKGROUND: The M235T and T174M angiotensinogen mutations have been linked to increased risk for ischemic heart and cerebrovascular disease. OBJECTIVE: To determine whether angiotensinogen mutations are associated with ischemic heart disease, myocardial infarction, and ischemic cerebrovascular disease. DESIGN: Six case-control studies from the Copenhagen City Heart Study. SETTING: Copenhagen, Denmark. PARTICIPANTS: Participants in the Copenhagen City Heart Study and patients from the same hospital with ischemic heart disease (n = 866 and n = 943, respectively), myocardial infarction (n = 519 and n = 493, respectively), or ischemic cerebrovascular disease (n = 489 and n = 434, respectively) and 7975 controls without these conditions. MEASUREMENTS: Genotypes for the M235T and T174M angiotensinogen mutations were compared between controls and Copenhagen City Heart Study participants with ischemic heart disease, myocardial infarction, and cerebrovascular disease (studies 1a, 1b, and 1c) and patients from Copenhagen University Hospital with the same conditions (studies 2a, 2b, and 2c). RESULTS: Relative allele frequencies of 235T and 174M in the general population were 0.41 and 0.12, respectively. Genotype was not associated with increased risk for ischemic heart or ischemic cerebrovascular disease in studies of either mutation alone or combined in women or men. Among compound heterozygotes (235MT /174TM ), women in case-control study 2a had decreased risk for ischemic heart disease in age-adjusted analysis; however, this decreased risk was not seen in multifactorial-adjusted or matched analyses, in men, or in case-control study 1a. Among double homozygotes (235TT /174MM ), women in case-control study 2b had increased risk for myocardial infarction in matched analysis; however, this increased risk was not seen in age- or multifactorial-adjusted analyses, in men, or in case-control study 1b. Among single homozygotes (235TT /174TT ), men in case-control study 2b had increased risk for myocardial infarction in multifactorial-adjusted and matched analyses. This risk was not present in age-adjusted analysis, in women, or in case-control study 1b. In addition, male single homozygotes had decreased risk for ischemic cerebrovascular disease in case-control study 2c in age- and multifactorial-adjusted analyses, but this finding was not seen in matched analysis, in women, or in case-control study 1c. CONCLUSIONS: In six large case-control studies, the M235T and T174M angiotensinogen mutations were not consistently associated with increased (or decreased) risk for ischemic heart disease, myocardial infarction, or ischemic cerebrovascular disease. Statistically significant associations may represent chance findings rather than real phenomena.     

Fibrinogen as a risk factor for coronary heart disease and mortality in middle-aged men and women: The Scottish Heart Health Study

Aims Fibrinogen was measured in 5095 men and 4860 men aged 40–59in a random population sample from 25 districts of Scotlandrecruited during 1984–87: the Scottish Heart Health Study.Fibrinogen was then related to the chance of fatal and non-fatalcoronary events and death from any cause during a subsequentfollow-up period of around 8 years. Methods and results Fibrinogen was measured by the Clauss assay.The effect of fibrinogen on coronary heart disease and deathwas assessed through age-adjusted means and Cox proportionalhazards regression models, accounting for age, cotinine (a measureof tobacco smoke inhalation) and 11 other major coronary riskfactors. Fibrinogen was found to be an important risk factorfor coronary heart disease in men and women, with and withoutpre-existing coronary heart disease. There appears to be a thresholdeffect, with those in the highest fifth of the distributionhaving a much increased risk. Estimated age- adjusted hazardratios by sex and pre-existing coronary heart disease groupfor the highest to lowest fifth of fibrinogen range between1·93 and 4·86. Fibrinogen is also important asa risk factor for coronary death and all-causes mortality, witha similar threshold effect. Comparing the two extreme fifths,the hazard ratios for coronary death are 3·01 and 3·42,and for all-cause mortality are 2·59 and 2·20,for men and women respectively. Adjustment for cotinine reducesthe hazard ratios, but further adjustment for the other 11 riskfactors has little effect for coronary heart disease events.After full adjustment there is a remaining significant (P<0·05)hazard ratio for coronary death and death from any cause andfor a coronary heart disease event for those free of coronaryheart disease at baseline, amongst men, comparing the highestto the lowest fifth. Conclusion Fibrinogen is a strong predictor of coronary heartdisease, fatal or non-fatal, new or recurrent, and of deathfrom an unspecified cause, for both men and women. Its effectis only partially attributable to other coronary risk factors,the most important of which is smoking.     

Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality. A prospective population study.

AIMS: To assess the risk of death from coronary disease, and all causes associated with body mass index and weight gain from age 20 to middle age. METHODS AND RESULTS: In this study, 6874 men aged 47 to 55 years at baseline and free of a history of myocardial infarction were followed with respect to mortality from coronary disease and from all causes over an average follow-up of 19.7 years, and with respect to non-fatal myocardial infarction for 11.8 years. High body mass index predicted death from coronary disease, but only at levels above 27.5 m.kg-2. Men with stable weight (defined as +/- 4% change from age 20) had the lowest death rate from coronary disease and the lowest risk of non-fatal myocardial infarction. Relative risk of coronary death increased with increasing weight gain, from 1.57 (1.14-2.15) (after adjustment for age, physical activity, and smoking) in the group who gained 4 to 10%, to 2.76 (1.97-3.85) in men with a weight gain of more than 35% (P for trend 0.0001), compared to men who remained stable. After further adjustment for serum cholesterol, systolic blood pressure, and diabetes, relative risks were reduced but still significantly elevated in all weight gain groups (P for trend 0.004). Data concerning non-fatal myocardial infarction were available for the first 11.8 years and showed a relative risk of 3.35 (2.05-5.47) after adjustment for age, physical activity, and smoking in men with a weight gain of more than 35%. CONCLUSION: Weight gain from age 20, even a very moderate increase, is strongly associated with an increased risk of coronary death and non-fatal myocardial infarction.     

Typical and atypical coronary heart disease deaths and their different relationships with risk factors. The Gubbio residential cohort Study

Objectives

The Seven Countries Study showed that fatal coronary heart disease (CHD) with only chronic heart failure, arrhythmia or blocks (atypical CHD, A-CHD) may represent a distinct disease as compared to fatal CHD cases with angina pectoris, acute myocardial infarction (AMI) or sudden death (typical CHD, T-CHD). We aimed at validating this, using identical diagnostic criteria, in a separate residential cohort first examined in 1983–85 in Gubbio, central Italy.

Material and methods

Forced Cox's models were run to assess 9 classic risk factors and their 20-year predictivity of A-CHD versus T-CHD, in the entire cohort or separately for men and women.

Results

There were 3229 subjects aged 30–79 years. Entry mean age was slightly higher in women than men although age at death was lower in men than in women for both T-CHD (71.99 ± 11.38 versus 81.20 ± 9.35 years, p < 0.0001) and A-CHD (80.22 ± 9.44 versus 84.98 ± 8.13 years, p < 0.0001). T-CHDs were predicted by male gender, age, continued smoke, systolic blood pressure (SBP), blood glucose, total and HDL-cholesterol (protective). A-CHDs were predicted by age, continued smoke, SBP, body mass index and blood glucose but neither total nor HDL-cholesterol or gender was significant. In the entire cohort and in men there were predictive differences of T-CHD versus A-CHD fatalities only in relation to age (p < 0.01), SBP (p < 0.05) and total cholesterol (p < 0.01).

Conclusion

As age, SBP and total cholesterol had a different predictive role of T-CHD versus A-CHD fatalities also in the Gubbio cohort, the possibility is reinforced that a different etiology exists between these entities.     

Association of lipoprotein-associated phospholipase A2 levels with coronary artery disease risk factors, angiographic coronary artery disease, and major adverse events at follow-up.

AIMS: We aimed to evaluate the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) with coronary artery disease (CAD) risk factors, with the severity of angiographic CAD, and with the incidence of major adverse events. METHODS AND RESULTS: We measured Lp-PLA2 levels in 504 consecutive patients undergoing clinically indicated coronary angiography. Mean age was 60+/-11 years and 38% were women. The mean (+/-SD) Lp-PLA2 level (ng/mL) was 245+/-91. Lp-PLA2 levels correlated with male gender, LDL, HDL, and total cholesterol, fibrinogen, and creatinine. Lp-PLA2 levels correlated with the extent of angiographic CAD on univariate but not on multivariable analysis. During a median follow-up of 4.0 years, 72 major adverse events occurred in 61 of 466 (13%) contacted patients (20 deaths, 14 myocardial infarctions, 28 coronary revascularizations, and 10 strokes). Higher Lp-PLA2 levels were associated with a greater risk of events: the hazard ratio per SD was 1.28 (95% CI 1.06-1.54, P=0.009), and remained significant after adjusting for clinical and lipid variables and C-reactive protein. CONCLUSION: Higher Lp-PLA2 levels were associated with a higher incidence of major adverse events at follow-up, independently of traditional CAD risk factors and C-reactive protein.     

The metabolic syndrome and coronary heart disease in older women: findings from the British Women's Heart and Health Study.

AIMS: To compare two proposed definitions of the metabolic syndrome and to determine the clinical importance of the syndrome with respect to its association with coronary heart disease (CHD). METHODS: Cross-sectional study of 3770 women aged 60-79 years randomly selected from 23 British towns. RESULTS: The prevalence of the metabolic syndrome was high in this population and similar with both definitions: 28.2% (95% confidence interval 26.8, 29.7%) of the women had metabolic syndrome according to a modified version of the WHO definition, and 29.2% (27.7, 30.7%) had the ATP III-defined syndrome. There was reasonable agreement between the two definitions, with 79% of the participants being similarly classified by both definitions. The syndrome was associated with prevalent CHD, with the magnitude of the association with CHD being similar for both definitions. The odds ratio (95% confidence interval) for the age, smoking, physical activity, adult and childhood social class adjusted association of the WHO defined syndrome with prevalent CHD was 1.45 (1.19, 1.75) and for the ATP III-defined syndrome was 1.53 (1.27, 1.85). Insulin resistance alone, hypertension alone and dyslipidaemia alone were all associated with CHD, with the magnitudes of these associations being similar to those for the WHO and ATP III-defined syndrome with CHD. CONCLUSIONS: The prevalence of the metabolic syndrome is high in older British women and is associated with CHD. There is reasonable agreement between a modified version of the WHO definition and the ATP III definition of the syndrome, and both are similarly associated with CHD. Single components of the syndrome are associated with CHD to a similar magnitude as the syndrome.     

Insulin sensitivity, proinsulin and insulin as predictors of coronary heart disease. A population-based 10-year, follow-up study in 70-year old men using the euglycaemic insulin clamp

Aims/hypothesis The association between CHD and insulin sensitivity (Si) measured by the euglycaemic insulin clamp has not been examined previously. Earlier studies found a relationship between CHD and elevated plasma insulin, an analysis that may have been confounded by co-determination of proinsulin, which has evolved as a stronger predictor of CHD. The aim was to determine the longitudinal relationships between Si, intact proinsulin, 32–33 split proinsulin, specific insulin and subsequent CHD.Methods This was a population-based cohort study of 815 men in Uppsala, Sweden, aged 70 years at baseline with a follow-up of up to 10 years. Baseline insulin sensitivity was determined by euglycaemic insulin clamp. Fasting proinsulin, 32–33 split proinsulin and specific insulin concentrations were analysed using specific two-site immunometric assays. CHD was taken as diagnosed, if stated (in the event of death) on the Cause of Death Registry, or for subjects hospitalised for the first time with CHD, if CHD was recorded in the Hospital-Discharge Registry. The associations were analysed using Coxs proportional hazards, presented as hazard ratios (HRs) with their 95% CIs for a one-SD increase in the predictor.Results In multivariate analysis, Si (HR:0.80, CI:0.65–0.97) adjusted for serum cholesterol, systolic blood pressure, fasting plasma glucose, BMI and smoking predicted CHD. Intact proinsulin (HR:1.18, CI:1.01–1.38), adjusted as the model above, predicted CHD, whereas 32–33 split proinsulin (HR:1.13, CI:0.95–1.35) or specific insulin (HR:1.07, CI:0.89–1.30) did not.Conclusions/interpretation Insulin resistance measured by the euglycaemic insulin clamp predicts subsequent CHD in elderly men. Proinsulin provides a better prediction of CHD than insulin.     

Risk factors for ischaemic heart disease in a Greek population. A cross-sectional study of men and women living in the village of Spili in Crete.

We have established a research project in primary health care in Crete with the aim of surveying the cardiovascular risk profile of a defined 'low-risk' population. The study population comprised all men and women aged 15-79 years in the village of Spili (n = 445); the overall attendance rate was 77% (greater than or equal to 82% in those aged 45 years and above). In this cross-sectional study we found a high (44%) prevalence of smoking in men aged 45-64 years as well as a high alcohol intake (48% drank greater than or equal to 210 g of pure alcohol every week). Furthermore, there was a high cholesterol level (6.2 mmol.l-1), and a high prevalence of hypertension and diabetes. Against this background it is somewhat surprising that we did not find any signs of post-myocardial infarction in Spili men aged 63 and under. It is possible that positive factors, i.e. the closely knit social networks, the low unemployment rate, the hard water, and some of the dietary habits, e.g. the high consumption of olive oil, may counter-balance the negative factors mentioned above. It is also possible that the low risk factors in the past explain the low incidence of myocardial infarction today, and that this will change in the years to come.     

Diabetes mellitus and risk of fatal ischaemic heart disease by gender: 18 years follow-up of 74,914 individuals in the HUNT 1 Study.

AIM: To study long-term mortality from ischaemic heart disease (IHD) in subjects with and without diabetes and how the association between diabetes and fatal IHD is influenced by gender and established cardiovascular disease (CVD). METHODS AND RESULTS: In 1984-86, all inhabitants aged 20 years or older in Nord-Tr?ndelag County, Norway were invited to the HUNT Study. A total of 74,914 participated in our study, 2100 of them with prevalent diabetes. During 18 years of follow-up, 19,967 persons died. Among people without diabetes or CVD at baseline, men had twice (HR 2.20, CI 2.00-2.41) the rate of fatal IHD compared with women. With diabetes present, the gender gap was substantially reduced (HR 1.25, CI 0.9-1.72), and if both diabetes and CVD were present, IHD mortality in men and women was identical (HR 1.1, CI 0.79-1.64). Gender specific analyses showed a stronger association of diabetes with IHD mortality in women (HR 2.71, CI 2.33-3.16) compared with men (HR 1.98, CI 1.70-2.30, test for interaction, P < 0.01). CONCLUSION: Diabetes is a stronger predictor for IHD mortality in women than in men, and diabetes attenuates the usual gender gap in IHD mortality. With both diabetes and established CVD present, the gender gap is fully attenuated.     

The association between meat intake and the risk of coronary heart disease in Korean men using the Framingham risk score: A prospective cohort study

Background and aimsResearch suggests that meat intake may increase the risk of coronary heart disease (CHD), but most studies take place in Western countries, where the types and amount of meat products consumed differ from those in Asian countries. We aimed to identify the association between meat intake and CHD risk in Korean male adults, using the Framingham risk score.Methods and resultsWe used data from the Korean Genome and Epidemiology Study (KoGES) Health Examinees (HEXA) study, including 13,293 Korean male adults. We estimated the association of meat intake with ≥20% 10-year CHD risk using Cox proportional hazards regression models to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Subjects with the highest total meat intake had a 53% (model 4: HR 1.53, 95% CI 1.05–2.21) increased 10-year CHD risk compared to those with the lowest intake. Those with the highest red meat intake had a 55% (model 3: HR 1.55, 95% CI 1.16–2.06) increased 10-year CHD risk compared to those with the lowest intake. No association was observed between poultry or processed meat intake and 10-year CHD risk.ConclusionsConsumption of total meat and red meat was associated with a higher risk of CHD in Korean male adults. Further studies are needed to provide criteria for the appropriate meat intake by meat type to reduce CHD risk.     

Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort

AimsTo estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes.MethodsA prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated.ResultsMean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60 mL/min/1.73 m² or less was 11.4% (95% CI 4.8–18.3) for all-cause mortality, 9.2% (95% CI 5.3–13.4) for coronary heart disease, and 2.6% (95% CI ?1.8 to 7.4) for stroke.ConclusionsReduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.