Dietary fat and risk of coronary heart disease: possible effect modification by gender and age

In a 16-year follow-up study (ending in 1998) of 3,686 Danish men and women aged 30-71 years at recruitment, the association between energy intake from dietary fat and the risk of coronary heart disease was evaluated while assessing the possible modifying role of gender and age. In the models used, total energy and protein intake were fixed. Differences in intake of energy from fat thus reflected complementary differences in intake of energy from carbohydrates. A 5% higher level of energy from saturated fat intake was associated with a 36% greater risk of coronary heart disease among women (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 0.98, 1.88). No overall association between saturated fat and coronary heart disease was found among men. However, age-dependent analyses showed that saturated fat was positively associated with coronary heart disease among the younger men (HR = 1.29, 95% CI: 0.87, 1.91) and the younger women (HR = 2.68, 95% CI: 1.40, 5.12) but not among the older men (HR = 0.94, 95% CI: 0.70, 1.28) and the older women (HR = 1.22, 95% CI: 0.86, 1.71). Polyunsaturated fat was inversely associated with coronary heart disease among women and men, although not significantly. In conclusion, the present study suggests that coronary heart disease risk relates to both the quantity and the quality of dietary fats.     

Waist circumference and mortality

The authors examined the association between waist circumference and mortality among 154,776 men and 90,757 women aged 51-72 years at baseline (1996-1997) in the NIH-AARP Diet and Health Study. Additionally, the combined effects of waist circumference and body mass index (BMI; weight (kg)/height (m)(2)) were examined. All-cause mortality was assessed over 9 years of follow-up (1996-2005). After adjustment for BMI and other covariates, a large waist circumference (fifth quintile vs. second) was associated with an approximately 25% increased mortality risk (men: hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.15, 1.29; women: HR = 1.28, 95% CI: 1.16, 1.41). The waist circumference-mortality association was found in persons with and without prevalent disease, in smokers and nonsmokers, and across different racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians). Compared with subjects with a combination of normal BMI (18.5-<25) and normal waist circumference, those in the normal-BMI group with a large waist circumference (men: > or =102 cm; women: > or =88 cm) had an approximately 20% higher mortality risk (men: HR = 1.23, 95% CI: 1.08, 1.39; women: HR = 1.22, 95% CI: 1.09, 1.36). The finding that persons with a normal BMI but a large waist circumference had a higher mortality risk in this study suggests that increased waist circumference should be considered a risk factor for mortality, in addition to BMI.     

Weight cycling and mortality in a large prospective US study

Weight cycling has been associated with an increased risk of death in some studies, but few studies differentiated weight cycling initiated by intentional weight loss from that initiated by illness. The association of weight cycling with death was examined among 55,983 men and 66,655 women in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2008. A weight cycle was defined as an intentional loss of 10 or more pounds (≥4.5 kg) followed by regain of that weight, and the lifetime number of weight cycles was reported on a questionnaire administered at enrollment in 1992. A total of 15,138 men and 10,087 women died during follow-up, which ended in 2008. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression models. When the models were adjusted for age only, weight cycling was positively associated with mortality (P for trend < 0.0001). However, after adjustment for body mass index and other risk factors, low numbers of weight cycles (1-4 cycles) were associated with slightly lower mortality rates (hazard ratio (HR) = 0.93, 95% confidence interval (CI): 0.89, 0.97 in men and HR = 0.93, 95% CI: 0.89, 0.98 in women), whereas high numbers of weight cycles (≥20 cycles) were not associated with mortality (HR = 1.03, 95% CI: 0.89, 1.19 in men and HR = 0.99, 95% CI: 0.88, 1.12 in women). These results do not support an increased risk of mortality associated with weight cycling.     

Impacts of educational level and employment status on mortality for Japanese women and men: the Jichi Medical School cohort study

The objective of this study was to examine educational levels and employment status as independent determinants of overall and cause-specific mortality in a Japanese population. Participants were 4,301 men and 6,780 women in a multi-center community-based prospective study, and data of the baseline survey was collected between 1992 and 1995. The participants were followed up until December 31, 2002 (the average follow-up period was 9.17 years). Early termination of education was associated with an increased risk of mortality from all causes for both men and women. This tendency was more prominent in women aged 59 and younger (hazard ratio (HR) = 3.82, 95% confidence interval (CI): 1.18–12.34), after adjusting for confounding factors using the Cox proportional hazard models. Similar trends were shown for men; specifically, cardiovascular disease mortality for all men was increased by early termination of education (HR = 2.97, 95% CI: 1.17–7.52) compared to later termination. For employment status, unemployed men showed increased mortality from all causes compared to white-collar workers (HR = 1.51, 95% CI: 1.00–2.28). Female farmers and forestry workers showed reduced mortality from all causes compared to white-collar workers (HR = 0.55, 95% CI: 0.33–0.93). Male farmers and forestry workers also showed reduced mortality from cardiovascular diseases compared to white-collar workers (HR = 0.34, 95% CI: 0.14–0.82). Educational level and employment status may affect mortality for Japanese women and men.Funding: The Foundation for the Development of the Community, Tochigi, Japan.     

Childhood and adult socioeconomic conditions and 31-year mortality risk in women

Links between low socioeconomic position and poor health are well established. Most previous research, however, has focused on middle-aged males and has relied on limited socioeconomic data, usually measured at one point over the life course. This paper examines all-cause, cardiovascular, and noncardiovascular mortality in women in relation to socioeconomic position at different stages of the life course. Information was collected in 1965, 1974, 1983, and 1994 and included recalled father's occupation and education as a measure of childhood socioeconomic position and the respondent's household income, education and occupation, and spouse's occupation from a sample of 3,087 women participating in the Alameda County Study. Cox regression models were used to estimate hazard ratios for risk of death. Lower childhood socioeconomic position was associated with an increased mortality due to cardiovascular disease (hazard ratio (HR) = 1.29, 95% confidence interval (CI): 1.09, 1.54) but was unrelated to death due to other causes (HR = 0.97, 95% CI: 0.82, 1.15). Overall mortality was higher among women reporting the lowest level of education (HR = 1.17, 95% CI: 0.99, 1.39), but education was most strongly related to noncardiovascular disease-related deaths (HR = 1.41, 95% CI: 1.10, 1.81). Low household income was also associated with higher mortality, for both cardiovascular disease-related (HR = 1.47, 95% CI: 1.14, 1.91) and noncardiovascular disease-related (HR = 1.30, 95% CI: 1.03, 1.63) deaths. Both early and later life indicators of socioeconomic position contribute to increased mortality risk among socioeconomically disadvantaged women, but these effects appear stronger for cardiovascular mortality.     

Social inequalities in mortality in a retrospective cohort of civil servants in Barcelona

BACKGROUND: The objective of this study is to describe the inequalities in mortality by occupational category and sex in a retrospective cohort of civil servants working in the city council of Barcelona (Spain). METHODS: The cohort was followed for the period 1984-1993. There were 11 647 men and 9001 women. Age-adjusted hazard ratios (HR) of death for occupational categories and manual versus non-manual groups and 95% CI were derived from Cox proportional hazards models. RESULTS: For total deaths in males, compared with high-level professionals, auxiliary workers (HR = 1.30, 95% CI: 0.96-1.77), skilled manual workers (HR = 1.29, 95% CI: 0.95-1.77), unskilled manual workers (HR = 1.46, 95% CI: 1.07-1.98) and police and fire manual workers (HR = 1.42, 95% CI: 1.08-1.87) had higher risk of death. Among women, for all causes of mortality, only police manual workers had higher mortality (HR = 5.63, 95% CI: 1.89-16.7) whereas auxiliary workers had the lowest HR (HR = 0.51, 95% CI: 0.25-1.05). The HR comparing manual and non-manual categories for all causes of death was 1.29 for males (95% CI: 1.09-1.52) and 1.07 for females (95% CI: 0.77-1.49). Among males, whereas manual workers had lower cardiovascular mortality (HR = 0.85, 95% CI: 0.63-1.15), cancer mortality was higher in the manual category. No association between manual category and mortality was found among women. CONCLUSIONS: This study provides an analysis of social inequalities in mortality in a cohort from a Southern European urban area.     

Risk factors for inguinal hernia among adults in the US population

The authors examined risk factors for incident inguinal hernia among US adults (5,316 men and 8,136 women) participating in the First National Health and Nutrition Examination Survey (1971-1975) who were followed through 1992-1993 for a hospital (International Classification of Diseases, Ninth Revision, Clinical Modification, code 550) or physician diagnosis of inguinal hernia. Ninety-six percent of the baseline cohort was recontacted, with a median follow-up of 18.2 years (range, 0.02-22.1 years). Because the cumulative incidence of inguinal hernia was higher among men (13.9%) than among women (2.1%), more detailed analyses were conducted in men. Among men in multivariate analysis, a higher incidence (p < 0.05) of inguinal hernia was associated with an age of 40-59 years (hazard ratio (HR) = 2.2, 95% confidence interval (CI): 1.7, 2.8), an age of 60-74 years (HR = 2.8, 95% CI: 2.2, 3.6), and hiatal hernia (HR = 1.8, 95% CI: 1.2, 2.7), while Black race (HR = 0.58, 95% CI: 0.42, 0.79), being overweight (HR = 0.79, 95% CI: 0.66, 0.95), and obesity (HR = 0.51, 95% CI: 0.36, 0.71) were associated with a lower incidence. Among women, older age, rural residence, greater height, chronic cough, and umbilical hernia were associated with inguinal hernia. In the United States, inguinal hernias are common among men, especially with aging. The lower risk among heavier men was unexpected and bears further study.     

Temporary employment and risk of overall and cause-specific mortality

The number of nonpermanent employees is rising, but mortality in this group has received little attention. The authors examined the associations between temporary employment and all-cause and cause-specific mortality. Longitudinal data from 10 towns in Finland related to 26,592 men and 65,759 women, of whom 1,332 died between 1990 and 2001. Cox proportional hazards models adjusted for age, occupational status, salary, and change in occupational title showed that overall mortality was 1.2-1.6 times higher among male and female temporary employees compared with permanent employees. Temporary employment was associated with increased deaths from alcohol-related causes (hazard ratio (HR) = 2.0, 95% confidence interval (CI): 1.4, 2.9 for men; HR = 1.7, 95% CI: 1.1, 2.5 for women) and, for men, smoking-related cancer (HR = 2.8, 95% CI: 1.3, 6.0). Corresponding risks were greater for the unemployed. Moving from temporary to permanent employment was associated with a lower risk of death than remaining continuously in permanent employment (HR = 0.7, 95% CI: 0.5, 0.9 for men and women combined). These findings suggest that the conventional research practice of treating the employed as a single group may attenuate the associations between employment status and mortality.     

女性老年人认知障碍与死亡风险的相关性研究

目的 研究女性老年人认知障碍与其死亡风险之间的关系。方法 利用2002-2011年中国老年健康长寿跟踪调查数据,运用Cox回归模型,以是否认知障碍为因变量,调整基线人口学特征（年龄、性别、居住地、民族、婚姻和教育程度）和健康变量（日常生活能力、高血压、中风和糖尿病,以及乐观和快活）,分析女性老年人认知障碍与死亡风险的关系。结果 认知障碍组死亡风险是非认知障碍组的2.22倍（HR=2.22,95%CI：2.08~2.37,P<0.001）;在校正混杂因素后,认知障碍仍然与高死亡风险相关联（HR=1.14,95%CI：1.05~1.22,P=0.001））,农村女性认知障碍与高死亡风险无统计学意义（HR=1.09,95%CI：0.99~1.20,P=0.075）,城镇女性认知障碍仍然与高死亡风险相关（HR=1.21,95%CI：1.08~1.36,P=0.001）。结论 女性老年人认知障碍与高死亡风险相关,且具有城乡差异。通过干预影响认知障碍发生发展的因素,能够在一定程度上提高我国老年人的健康寿命和生活质量。     

Incidence and Predictors of Hypertension Among Rural Chinese Adults: Results From Liaoning Province

OBJECTIVE We wanted to determine the incidence of hypertension and its risk factors among rural Chinese adults.METHODS A population-based sample of 24,360 rural Chinese adults aged 35 years and older and free from hypertension at baseline was observed from 2004–2006 to 2008. Incident hypertension was defined as a systolic pressure of 140 mm Hg or greater, diastolic pressure of 90 mm Hg or greater, or current use of antihypertensive medication.RESULTS During a mean follow-up period of 28 months, 29.6% of men and 23.4% of women developed hypertension. The age-adjusted incidence was higher in men (12.75 per 100 person-years) than in women (10.04 per 100 person-years). Among men, independent predictors of incident hypertension were baseline age (hazard ratio [HR] = 1.11; 95% confidence interval [CI], 1.10–1.13), Mongolian ethnicity (HR = 1.09; 95% CI, 1.01–1.18), use of alcohol, (HR = 1.14; 95% CI, 1.06–1.23), high income vs low income (HR = 1.11; 95% CI, 1.00–1.22; and HR = 1.11; 95% CI, 1.03–1.20), prehypertension vs normotension (HR = 1.18; 95% CI, 1.08–1.28), overweight and obesity (HR = 1.28; 95% CI, 1.17–1.40), baseline salt intake (HR = 1.00; 95% CI, 1.00–1.01) and family history of hypertension (HR = 1.14; 95% CI, 1.03–1.27). With the exception of use of alcohol and mean income, the results were similar for women, except that low physical activity was shown as a risk factors as well. The awareness, treatment, and control rates for newly developed hypertension were 29.9%, 19.5%, and 1.5%, respectively.CONCLUSIONS These data indicate that the incidence of hypertension is high among these rural Chinese adults and that it is associated with many risk factors. Our findings further suggest that most newly developed hypertension cases are not treated. The increases in hypertension are probably related to rapid social changes in our country and may apply to other areas of the developing world. These findings call for urgent improvements in hypertension prevention and control programs in rural China.     

Fruit and vegetable intake and mortality from cardiovascular disease are inversely associated in Japanese women but not in men

Some epidemiological studies undertaken in Western countries have demonstrated that high intake of fruit and vegetables results in decreased risk of cardiovascular disease (CVD). The objective of this study was to examine the hypothesis that high intake of fruit and vegetables lowers CVD mortality in a population-based cohort of Japanese subjects. In 1992, fruit and vegetable intake was assessed in 13,355 men and 15,724 women in Takayama, Gifu, Japan using a validated FFQ. During the follow-up (1992-99), 200 men and 184 women died from CVD. For women, the highest quartile of vegetable intake compared with the lowest was marginally significant and inversely associated with CVD mortality after adjusting for total energy, age, and nondietary and dietary covariates [hazard ratio (HR) = 0.62; 95% CI, 0.36-1.08; P-trend = 0.007]. An inverse trend with borderline significance was also observed in fruit intake, excluding CVD deaths in the first 2 y of this study, after adjusting for the above-mentioned covariates (HR = 0.83; 95% CI, 0.51-1.34; P-trend = 0.10). In men, CVD death was not associated with fruit (HR = 1.16; 95% Cl, 0.77-1.74; P-trend = 0.61) and vegetable (HR = 0.81, 95% CI: 0.49-1.34; P-trend = 0.47) intake. These data suggest that higher intake of vegetables is associated with reduced risk of death from CVD for women.     

Mediterranean Alcohol-Drinking Patterns and All-Cause Mortality in Women More Than 55 Years Old and Men More Than 50 Years Old in the “Seguimiento Universidad de Navarra” (SUN) Cohort

Background: Most of the available epidemiological evidence on alcohol and chronic disease agrees on recommending alcohol abstention to young people, but some controversy exists about the most appropriate recommendation for alcohol abstention for people of older ages. A growing body of evidence suggests that the pattern of alcohol consumption is likely to be a strong effect modifier. The Mediterranean Alcohol Drinking Pattern (MADP) represents a score integrating several dimensions of drinking patterns (moderation, preference for red wine, drinking with meals, and avoiding binge drinking). Our aim was to clarify this issue and provide more precise recommendations on alcohol consumption. Methods: We prospectively followed-up 2226 participants (men older than 50 years and women older than 55 years at baseline) in the Seguimiento Universidad de Navarra (SUN) cohort. We classified participants into three categories of adherence to the MADP score (low, moderate, and high), and we added a fourth category for abstainers. Cox regression models estimated multivariable-adjusted hazard ratios (HR) of all-cause death and 95% confidence intervals (CI) using low MADP adherence as the reference category. Results: The strongest reduction in risk of mortality was observed for those with high adherence to the MADP, with an HR of 0.54 (95% CI: 0.37–0.80). The moderate adherence group (HR = 0.65, 95% CI: 0.44–0.96) and the abstention group (HR = 0.60, 95% CI: 0.36–0.98) also exhibited lower risks of mortality than the low MADP adherence group. Conclusions: based on the available evidence, a public health message can be provided to people older than 50 years as follows: among those who drink alcohol, high adherence to the MADP score could substantially reduce their risk of all-cause mortality.     

Association between metabolic syndrome and mortality in patients with COVID-19: A nationwide cohort study

ObjectivesWe investigated the association between metabolic syndrome (MetS) and mortality among coronavirus disease 2019 (COVID-19) patients in Korea.MethodsWe analyzed 3876 individuals aged ≥ 20 years who were confirmed with COVID-19 from January 1 to June 4, 2020 based on the Korea National Health Insurance Service (NHIS)-COVID-19 database and had undergone health examination by NHIS between 2015 and 2017. Multivariable Cox proportional hazard regression analyses were performed.ResultsOf total participants, the prevalence of MetS was 21.0% (n = 815). During 58.6 days of mean follow-up, 3.1 % (n = 120) of the participants died. Compared to individuals without MetS, COVID-19 patients with MetS had a significantly increased mortality risk after adjusting for confounders in total participants (hazard ratio [HR]: 1.68, 95 % confidence interval [CI]: 1.14–2.47) and women (HR: 2.41, 95 % CI: 1.17–4.96). A low high-density lipoprotein cholesterol level in total participants (HR: 1.63, 95 % CI: 1.12–2.37) and hyperglycemia in women (HR: 1.97, 95 % CI: 1.01–3.84) was associated with higher mortality risk. The mortality risk increased as the number of MetS components increased among total participants and women (P for trend = 0.009 and 0.016, respectively). In addition, MetS groups had higher mortality risk in aged ≥ 60 years (HR: 1.60, 95 % CI: 1.07–2.39), and never-smokers (2.08, 1.21–3.59).ConclusionsThe presence of MetS and greater number of its components were associated with increased mortality risks particularly in female patients with COVID-19. Managing MetS may contribute to better outcomes of COVID-19.     

Successful Aging and Mortality Risk: The Korean Longitudinal Study of Aging (2006-2014)

ObjectivesThe aim of this study is to examine the association of successful aging with mortality and further find gender differences in the effect of components of successful aging on mortality risks.DesignRetrospective cohort study.Setting and participantsA total of 3848 adults aged 65 and older from the Korean Longitudinal Study of Aging (2006-2014) data.MeasuresSuccessful aging was defined as success in the following 7 components: absence of major disease, no depression, no freedom from disability, high cognitive and physical function, active social engagement, and satisfaction with life. All-cause mortality was measured by death certificate and family interview.ResultsIn both genders, the mortality rate was higher in the older adults who did not achieve successful aging than in their counterparts (men: hazard ratio [HR] = 1.69, 95% confidence interval [CI] 1.18-2.43; and women: HR = 2.37, 95% CI 1.21-4.63). All components of no successful aging were associated with an increased risk of mortality except for no satisfaction with life in females. Mortality rates were predominant in major disease (HR = 1.86, 95% CI 1.54-2.25) and depressive symptoms (HR = 1.62, 95% CI 1.26-2.10) in males, and disability (HR = 2.08, 95% CI 1.68-2.57) and low physical functioning (HR = 2.31, 95% CI 1.79-2.98) were predominant in females.Conclusion/ImplicationWe found that older Koreans who did not achieve successful aging had a higher risk of all-cause mortality than successful agers. There were gender differences in mortality risks across all components of successful aging.     

Self-reported diabetes mellitus and risk of mortality from all causes, cardiovascular disease, and cancer in Takayama: a population-based prospective cohort study in Japan

Background

Diabetes mellitus has been reported to be a major risk factor for cardiovascular disease (CVD), and higher risk of CVD among women than that among men has been observed in many studies. Further, the association of diabetes with increasing risk of cancer has also been reported. Well-designed studies conducted among men and women in the general Japanese population remain scarce.

Methods

Our cohort consisted of 13355 men and 15724 women residing in Takayama, Japan, in 1992. At the baseline, the subjects reported diabetes in a questionnaire. Any deaths occurring in the cohort until 1999 were noted by using data from the Office of the National Vital Statistics. The risk of mortality was separately assessed for men and women by using a Cox proportional hazard model after adjusting for age; smoking status; body mass index (BMI); physical activity; years of education; history of hypertension; and intake of total energy, vegetables, fat, and alcohol.

Results

Diabetes significantly increased the risk of mortality from all causes [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.11-1.64] and from coronary heart disease (CHD) (HR: 2.96, 95% CI: 1.59-5.50) among men, and that from all causes (HR: 1.74, 95% CI: 1.34-2.26) and cancer (HR: 1.88, 95% CI: 1.16-3.05) among women. Diabetes was not significantly associated with mortality from CHD among women.

Conclusion

The findings suggest that diabetes increases the risk of mortality from CVD among men and that from cancer among women. The absence of increased risk of mortality from CHD among women may suggest a particular pattern in the Japanese population.Key words: Diabetes mellitus, Mortality, Cardiovascular disease, Cancer, Cohort study     

Clustering of behavior-related risk factors and its association with subjective health

OBJECTIVES: To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health. METHODS: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 18-64 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor). RESULTS: Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women). CONCLUSIONS: Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.     

Anthropometric measures and risk of all-cause and cardiovascular mortality: An 18 years follow-up

BackgroundThe contribution of anthropometric measures to predict mortality in normal-weight subjects is unclear. We aimed to study the association of central obesity measures, e.g., waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), with the risk of all-cause and CVD mortality.MethodsIn a prospective population-based Tehran Lipid and Glucose Study, 8287 participants aged ≥30 y, followed for a median of 18 years. The association of WC, WHR and WHtR with the risk for mortality was estimated using multivariate Cox proportional hazard models in different BMI groups.ResultsWe documented 821 deaths, of which 251 were related to CVD mortality. Normal weight individuals with central obesity were significantly at increased risk of all-cause (HR: 1.5; 95% CI: 1.10, 2.1) and CVD mortality (HR: 1.6; 95% CI: 0.92, 2.9) compared with normal-weight individuals without central obesity; the risk remained significant only in women. Also, normal-weight women (not men) with high WHR were at increased risk of all-cause (HR: 1.7; 95% CI: 1.0, 2.8) and CVD mortality (HR: 5.9; 95% CI: 1.5, 23.2). High WHtR increased the risk of all-cause (HR: 1.5; 95% CI: 1.2, 1.8) and CVD mortality (HR: 1.8; 95% CI: 1.2, 2.7) which remained significant in normal-weight men and women. All central obesity indicators were significantly associated with all-cause and CVD mortality in subjects aged under 65.ConclusionEven in normal-weight individuals, WC and WHR in women and WHtR in both sexes are predictors of all-cause and CVD mortality. WHtR shows a stronger association, especially in the population aged under 65.     

Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: the Chicago Heart Association Detection Project in Industry

In a prospective cohort study, associations of resting heart rate with risk of coronary, cardiovascular disease, cancer, and all-cause mortality in age-specific cohorts of black and white men and women were examined over 22 years of follow-up. Participants were employees from 84 companies and organizations in the Chicago, Illinois, area who volunteered for a screening examination. Participants included 9,706 men aged 18-39 years, 7,760 men aged 40-59 years, 1,321 men aged 60-74 years, 6,928 women aged 18-39 years, 6,915 women aged 40-59 years, and 1,151 women aged 60-74 years at the baseline examination in 1967-1973. Vital status was ascertained through 1992. For fatal coronary disease, multivariate-adjusted relative risks associated with a 12 beats per minute higher heart rate (one standard deviation) were as follows: for men aged 18-39 years, relative risk (RR) = 1.27 (95% confidence interval (CI) 1.08-1.48); for men aged 40-59 years, RR = 1.13 (95% CI 1.05-1.21); for men aged 60-74 years, RR = 1.00 (95% CI 0.89-1.12); for women aged 40-59 years, RR = 1.21 (95% CI 1.07-1.36); and for women aged 60-74 years, RR = 1.16 (95% CI 0.99-1.37). Corresponding risks for all fatal cardiovascular diseases were similar to those for coronary death alone. Deaths from cancer were significantly associated with heart rate in men and women aged 40-59 years. All-cause mortality was associated with higher heart rate in men aged 18-39 years (RR = 1.11, 95% CI 1.01-1.20), men aged 40-59 years (RR = 1.16, 95% CI 1.11-1.21), and women aged 40-59 years (RR = 1.20, 95% CI 1.13-1.27). Heart rate was not associated with mortality in women aged 18-39 years. In summary, heart rate was a risk factor for mortality from coronary disease, all cardiovascular diseases, and all causes in younger men and in middle-aged men and women, and for cancer mortality in middle-aged men and women.     

Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus

Aims To compare short- and long-term mortality after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus. Methods and results A nationwide cohort of 2,018 diabetic and 19,547 nondiabetic patients with a first hospitalized AMI in 1995 was identified through linkage of the national hospital discharge register and the population register. Follow-up for mortality lasted until the end of 2000. At 28 days and 5 years respectively, absolute mortality risks were 18 and 53% in diabetic men, 12 and 31% in nondiabetic men, 22 and 58% in diabetic women, and 19 and 42% in nondiabetic women. Crude mortality was significantly higher in diabetic patients than in nondiabetic patients in both men (28-day hazard ratio (HR) 1.55; 95% confidence interval (CI) 1.32–1.81, 5-year HR 2.01; 95% CI 1.84–2.21) and women (28-day HR 1.19; 95% CI 1.03–1.37, 5-year HR 1.53; 95% CI 1.40–1.67). After multivariate adjustment, risk differences became nonsignificant at 28 days, but diabetes was still associated with a significantly higher long-term mortality in both men (28-day HR 1.16; 95% CI 0.99–1.36, 5-year HR 1.49; 95% CI 1.36–1.64) and women (28-day HR 1.12; 95% CI 0.97–1.28, 5-year HR 1.39; 95% CI 1.27–1.52). The interaction between diabetes mellitus and gender did not reach significance in the analyses. Conclusion Our findings in an unselected cohort covering a complete nation show a significantly higher long-term mortality after a first acute myocardial infarction in diabetic patients. Yet, short-term mortality is not significantly higher in diabetic patients. Risks appear to be equally elevated in men and women.     

Lifelong socioeconomic trajectory and premature mortality (35-65 years) in France: findings from the GAZEL Cohort Study

BACKGROUND: Studies conducted in the UK and Scandinavia show an inverse association between lifetime socioeconomic position and adult mortality. However, there are virtually no data from other countries and few investigations have examined non-cardiovascular mortality in men and women. METHODS: Lifelong socioeconomic trajectories (father's occupation, own occupation in young adulthood and in mid-life) and premature (< or = 65 years) mortality (all-cause, smoking-related cancer, diseases of the circulatory system and external causes) in the French GAZEL Cohort Study (14,972 men and 5,598 women, followed up between 1990 and 2004) were studied. Hazard ratios (HRs) were estimated using Cox's regression models adjusted for age, marital status, tobacco smoking, alcohol consumption, body mass index, and fruit and vegetable consumption. RESULTS: Men and women who experienced lifelong disadvantage or downward intergenerational mobility were at high risk of dying prematurely compared with those with a favourable trajectory (age-adjusted HRs for all-cause mortality: cumulative disadvantage: HR 1.61, 95% confidence interval (CI) 1.26 to 2.06 in men and HR 1.95, 95% CI 1.10 to 3.47 in women; downward mobility: HR 1.87, 95% CI 1.35 to 2.58 in men and HR 2.05, 95% CI 1.12 to 3.75 in women). Associations were strongest for mortality due to chronic diseases (smoking-related cancers and diseases of the circulatory system). These associations were partly explained by marital status, body mass index, alcohol consumption, cigarette smoking, and fruit and vegetable consumption. CONCLUSIONS: In France, where the leading cause of premature death is cancer, lifelong socioeconomic position is associated with the risk of dying before the age of 65 years. Adult factors seem more relevant than childhood socioeconomic circumstances.