Nonfasting triglycerides and risk of cardiovascular death in men and women from the Norwegian Counties Study

The association between nonfasting triglycerides and cardiovascular disease (CVD) has recently been actualized. The aim of the present study was to investigate nonfasting triglycerides as a predictor of CVD mortality in men and women. A total of 86,261 participants in the Norwegian Counties Study 1974–2007, initially aged 20–50 years and free of CVD were included. We estimated hazard ratios (HRs) for deaths from CVD, ischemic heart disease (IHD), stroke and all causes by level of nonfasting triglycerides. Mean follow-up was 27.0 years. A total of 9,528 men died (3,620 from CVD, 2,408 IHD, 543 stroke), and totally 5,267 women died (1,296 CVD, 626 IHD, 360 stroke). After adjustment for CVD risk factors other than HDL-cholesterol, the HRs (95% CI) per 1 mmol/l increase in nonfasting triglycerides were 1.16 (1.13–1.20), 1.20 (1.14–1.27), 1.26 (1.19–1.34) and 1.09 (0.96–1.23) for all cause mortality, CVD, IHD, and stroke mortality in women. Corresponding figures in men were 1.03 (1.01–1.04), 1.03 (1.00–1.05), 1.03 (1.00–1.06) and 0.99 (0.92–1.07). In a subsample where HDL-cholesterol was measured (n = 40,144), the association between CVD mortality and triglycerides observed in women disappeared after adjustment for HDL-cholesterol. In a model including the Framingham CHD risk score the effect of triglycerides disappeared in both men and women. In conclusion, nonfasting triglycerides were associated with increased risk of CVD death for both women and men. Adjustment for major cardiovascular risk factors, however, attenuated the effect. Nonfasting triglycerides added no predictive information on CVD mortality beyond the Framingham CHD risk score in men and women.     

Effects of physical activity,body mass index,waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort

The health benefits of physical activity (PA) have been well documented. However, there is less research investigating whether or not these health benefits might differ among males and females or among subjects characterized by different levels of body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC). Baseline total PA, BMI, WHR and waist circumference were measured in 14,585 men and 26,144 women who participated in the Swedish National March. Their effects on all-cause mortality were analyzed with a follow-up time of almost 10 years. Sedentary men with a BMI ≥ 30 had a 98% (95% CI: 30–201%) increased risk of mortality compared to normal weight men with a high level of total PA. The same trend was observed for sedentary men with high WHR or waist circumference, compared to lean and highly active men. Sedentary women with a waist circumference of 88 cm or more had almost doubled, i.e. 97% (95% CI: 35–189%) increased mortality risk compared to physically active women with a waist circumference below 80 cm. BMI in men, but waist circumference in women better forecast all-cause mortality. We found no substantial effect modification between different measures of adiposity and physical activity—physical inactivity and obesity seem to increase total mortality risk independently and additively.     

Association between domains of physical activity and all-cause,cardiovascular and cancer mortality

Few studies have investigated the independent effects of domain-specific physical activity on mortality. We sought to investigate the association of physical activity performed in different domains of daily living on all-cause, cardiovascular (CVD) and cancer mortality. Using a prospective cohort design, 4,672 men and women, aged 25–74 years, who participated in the baseline examination of the MONICA/KORA Augsburg Survey 1989/1990 were classified according to their activity level (no, light, moderate, vigorous). Domains of self-reported physical activity (work, transportation, household, leisure time) and total activity were assessed by the validated MOSPA (MONICA Optional Study on Physical Activity) questionnaire. After a median follow-up of 17.8 years, a total of 995 deaths occurred, with 452 from CVD and 326 from cancer. For all-cause mortality, hazard ratios and 95% confidence interval (HR, 95% CI) of the highly active versus the inactive reference group were 0.69 (0.48–1.00) for work, 0.48 (0.36–0.65) for leisure time, and 0.73 (0.59–0.90) for total activity after multivariable adjustments. Reduced risks of CVD mortality were observed for high levels of work (0.54, 0.31–0.93), household (0.80, 0.54–1.19), leisure time (0.50, 0.31–0.79) and total activity (0.75, 0.55–1.03). Leisure time (0.36, 0.23–0.59) and total activity (0.62, 0.43–0.88) were associated with reduced risks of cancer mortality. Light household activity was related to lower all-cause (0.82, 0.71–0.95) and CVD (0.72, 0.58–0.89) mortality. No clear effects were found for transportation activities. Our findings suggest that work, household, leisure time and total physical activity, but not transportation activity, may protect from premature mortality.     

All-cause Mortality and Mortality of Myocardial Infarction for 989 Legally Castrated Men

Background: Male gender is an independent coronary risk factor. Method: Long-term follow-up of 989 Danish men who underwent legal castration between 1929 and 1968. Results: The legally castrated men were unmarried and belonged to social class IV and V more often than were Danish men in general. During the follow-up until 2000, 835 of the 989 (85%) castrated men died, including 148 who died of myocardial infarction. In multiple Poisson regression analyses, the men had a standardized mortality rate (SMR) for all-cause mortality of 1.30 (95% CI: 1.26–1.36) and a SMR for mortality of myocardial infarction of 1.08 (95% CI: 1.04–1.16). Thus, the castrated men had a lower proportion of deaths of myocardial infarction (148/792, 18.7% (95% CI: 16.0–21.6%)) than was expected based on the mortality rates for the Danish male population (136/608, 22.4%). The castrated men had discordant changes for the SMR for all-cause mortality and mortality of myocardial infarction whereas subgroups of the Danish population previously has been found to have concordant changes for the two SMRs. Conclusion: The castrated men had fewer deaths of myocardial infarction than expected, so men may not have increased risk of coronary heart disease from unphysiologically low levels of endogenous androgens. An erratum to this article is available at .     

Body mass index and mortality: results of a cohort of 184,697 adults in Austria

There is still a debate about the role of body mass index (BMI) as a risk factor for all-cause mortality. Most investigations with large sample sizes focused on populations from the United States, studies from Central-European cohorts are not available. We investigated the association between BMI and all-cause mortality and cause-specific mortality within a cohort in Austria. Design of this article is “Cohort study”. The Subjects used were 184,697 men and women (mean age 41.7 ± 15.4 years). Weight and height were measured. Cox proportional hazards models were used to estimate hazard ratios (HR). During a median follow-up of 15.1 years 15,557 deaths (6,077 from cardiovascular disease, 4,443 from cancer and 606 from respiratory disease) were seen. A U-shaped association between BMI and all-cause mortality was observed in men and women. Compared with the reference category (BMI 22.5–24.9 kg/m2) high risks were found both in the highest category of BMI (≥35 kg/m²) with HR of 2.13 (95% CI, 1.82–2.48) in men and 1.60 (95% CI, 1.42–1.81) in women and in the lowest category (<18.5 kg/m2) with HR of 2.57 (95% CI, 2.17–3.05) in men and 1.40 (95% CI, 1.21–1.62) in women. Similar patterns were seen among ever-smokers and non-smokers. Increased mortality with increasing BMI was driven by cardiovascular diseases and to a lesser extent by cancers. Respiratory diseases contributed to mortality in the lowest BMI category independently from smoking status. Underweight and obesity were both associated with higher all-cause mortality in men and women. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Vital exhaustion as a risk factor for ischaemic heart disease and all-cause mortality in a community sample. A prospective study of 4084 men and 5479 women in the Copenhagen City Heart Study

BACKGROUND: Vital exhaustion, a psychological measure characterized by fatigue and depressive symptoms, has been suggested to be an independent risk factor for ischaemic heart disease (IHD) but the generality of the phenomenon remains in question. The aim of this study is to describe prevalence of these symptoms in a community sample and determine whether they prospectively predict increased risk of IHD and all-cause mortality in men and women. METHODS: The study base was 4084 men and 5479 women aged 20-98 free of IHD examined in 1991-1993 in the Copenhagen City Heart Study. Events were ascertained through record linkage until 1998 for IHD and September 2000 for all-cause mortality. There were 483 first hospital admissions and deaths caused by IHD and 1559 deaths from all causes during follow-up. RESULTS: The 17 items on the vital exhaustion questionnaire were frequently endorsed with prevalence ranging from 6 to 47 per cent, higher in women. All but 4 of the 17 items were significantly associated with IHD with significant relative risks (RR) ranging between 1.36 (95% CI: 1.08, 1.72) and 2.10 (95% CI: 1.63, 2.71). Associations with all-cause mortality were also observed, but were weaker. RR of both IHD and all-cause mortality increased with increasing item sum score and were similar in men and women. For IHD, RR reached a maximum of 2.57 (95% CI: 1.65, 4.00) for subjects endorsing >9 items. The similar RR for all-cause mortality was 2.50 (95% CI: 2.09, 2.99). Multivariate adjustment for biological, behavioural, and socioeconomic risk factors did not substantially affect the association for IHD but attenuated the association with all-cause mortality. CONCLUSIONS: Measures of fatigue and depression were common symptoms in this population sample and convey increased risk of IHD and of all-cause mortality. We propose this knowledge begin to be implemented in risk assessment in clinical practice.     

Mortality after myocardial infarction: impact of gender and smoking status

We have shown previously that smoking causes a first myocardial infarction (MI) to occur significantly more prematurely in women than in men. The aim of the study was to investigate mortality after MI with special emphasis on the impact of smoking and gender. The study included 2,281 consecutive patients (36.8% women) who died or were discharged from a central hospital with a diagnosis of MI from 1998 to 2005; the median follow-up of survivors was 7 years. Death after MI was adjusted for confounders. Mean age for women was 5.8 years older than for men (76.0 vs. 70.2 years) and women were less likely to have been smokers. In-hospital mortality for the first MI was 8.9% for men and 13.3% for women, and total mortality rates for all indexed MI after 7 years were 47% for men and 61% for women. Using Cox regression analysis, with all indexed MIs included, the after-discharge mortality for women was significantly lower than for men (hazard ratio 0.82; 95% confidence interval 0.70–0.96; P = 0.015). Compared with non-smokers, patients who were smokers on admission had significantly increased seven-year mortality after discharge (hazard ratio 1.30; 95% confidence interval 1.03–1.63; P = 0.002). In conclusion, current smoking at the time of the indexed MI was associated with increased mortality after 7 years follow-up. The smoking effect was independent of gender. Female gender was associated with a moderately lower risk of death during the same follow-up period.     

Wine intake, ABO phenotype, and risk of ischemic heart disease and all-cause mortality: the Copenhagen Male Study—a 16-year follow-up

The association of alcohol intake with ischemic heart disease (IHD) and all-cause mortality may depend on ABO phenotype. We tested this hypothesis in a 16-year follow-up of 3,022 Caucasian men aged 53-74 years without overt cardiovascular disease. Potential risk factors and confounders included were ABO phenotypes, alcohol intake (wine, beer, and spirits), tobacco smoking history, leisure-time physical activity, social class, and age. During 16 years, 1985-1986 to end of 2001, 197 subjects (6.5%) died due to IHD, and 1,204 (39.8%) from all causes. Among non-O phenotypes (A, B, and AB) significantly fewer men who died due to IHD were wine consumers, 43.9% versus 55.7%, P < .01; with respect to all-cause mortality corresponding figures were 47.0% versus 60.1%, P < .001. No difference was found among men with phenotype O. Among men with phenotype A, compared to alcohol abstainers, in Cox analysis, the hazard ratio (HR) (95% confidence limit) for men drinking up to 8 beverages/wk was 0.5 (0.3-1.02), and among men consuming >8 beverages/wk (the highest quintile) the HR was 0.3 (0.2-0.8), P < .01. Among men with phenotype O, the association of wine intake with IHD mortality was slightly and not significantly U-shaped. The difference in the predictive role of wine intake between phenotype O and phenotype A men was supported in a statistical test for interaction. A similar association was found for all-cause mortality. The results suggest that the effect of wine intake on IHD and all-cause mortality among middle-aged and elderly men may depend on ABO phenotypes.     

Physical activity,morbidity and mortality in twins: a 24-year prospective follow-up

The aim of this study was to find out whether persistent leisure-time physical activity, adjusted for genetic liability and childhood experiences, protect against occurrence of specific chronic diseases and all-cause mortality. Study design was a 24-year prospective follow-up after 6-year physical activity discordance in twin pairs. From 5,663 healthy adult twin pairs, 146 pairs (including 29 mozygotic) discordant for both intensity and volume of leisure physical activity at baseline in both 1975 and 1981 were systematically identified. Mortality and occurrence of chronic diseases (diabetes, hypertension, coronary heart disease defined according to reimbursable medication status) were followed for the period 1.1.1983–31.12.2006 for mortality and 1.1.1983–31.12.2004 for diseases. By end of follow-up, 19 inactive and 10 active co-twins had died. In the whole sample, HR of death adjusted for social class was 2.08 (95% CI 1.06–4.09) for inactive vs. active co-twins, the HR being 2.67 (95% CI 1.15–6.20) among DZ pairs with no mortality difference among the smaller number of discordant MZ pairs. The reimbursable medication analyses showed a tendency of higher risk for inactive vs. active co-twins. Among DZ pairs, HR of diabetes medication adjusted for social class was 2.73 (95% CI 0.62–12.00) and HR of hypertension medication was 2.14 (95% CI 0.94–4.89). This study supports the earlier findings that physical activity is associated with reduced mortality. However the difference was seen only in DZ pairs and therefore some residual genetic confounding effects on mortality cannot be excluded.     

Blood pressure,hypertension and mortality from circulatory disease in men and women who survived the siege of Leningrad

The population of Leningrad suffered from severe starvation, cold and psychological stress during the siege in 1941–1944. We investigated long-term effects of the siege on cardiovascular risk factors and mortality in surviving men and women. 3905 men born 1916–1935 and 1729 women born 1910–1940, resident in St Petersburg (formerly Leningrad) between 1975 and 1982, of whom a third experienced the siege as children, adolescents or young adults, were examined for cardiovascular risk factors in 1975–1977 and 1980–1982 respectively and followed till end 2005. Effects of siege exposure on blood pressure, lipids, body size, and mortality were studied in multivariate analysis stratified by gender and period of birth, adjusted for age, smoking, alcohol and social characteristics. Women who were 6–8 years-old and men who were 9–15 years-old at the peak of starvation had higher systolic blood pressure compared to unexposed subjects born during the same period of birth (fully adjusted difference 8.8, 95% CI: 0.1–17.5 mm Hg in women and 2.9, 95% CI: 0.7–5.0 mm Hg in men). Mean height of women who were exposed to siege as children appeared to be greater than that of unexposed women. Higher mortality from ischaemic heart disease and cerebrovascular disease was noted in men exposed at age 6–8 and 9–15, respectively. The experience of severe stress and starvation in childhood and puberty may have long-term effects on systolic blood pressure and circulatory disease in surviving men and women with potential gender differences in the effect of siege experienced at pre-pubertal age.     

Differential Mortality Patterns Between Nicaraguan Immigrants and Native-born Residents of Costa Rica

Background This study describes the all-cause and cause-specific mortality of Nicaraguan-born and native-born inhabitants of Costa Rica and examines the influence of socioeconomic and demographic factors on differential mortality risks. Methods We analyzed Costa Rican vital records for the years 1996–2005 with negative binomial regression models to determine the relative mortality risks of Nicaraguan immigrants versus Costa Rican natives with adjustments for age, urbanization, unemployment, poverty, education, and residential segregation. Results Nicaraguan-born men and women had reduced mortality risks of 32% and 34% relative to their Costa Rican-born counterparts. Excess homicide mortality was found among Nicaraguan-born men [rate ratio (RR) = 1.35, 95% CI: 1.19–1.53] and women (RR = 1.41, 95% CI: 1.02–1.95). Discussion The Nicaraguan-born population had a reduced all-cause mortality risk versus Costa Rican-born people over the years 1996–2005, due to markedly lower disease mortality. Homicide is a major source of excess mortality among Nicaraguan-born immigrants versus Costa Rican natives.     

N-terminal pro B-type natriuretic peptide as prognostic marker for mortality in coronary patients without clinically manifest heart failure

Brain natriuretic peptide (BNP) and its inactive N-terminal fragment (NT-proBNP) are strong prognostic markers in patients with manifest heart failure and acute coronary syndromes. We aimed to establish the association between NT-proBNP and all-cause mortality in patients with stable chronic coronary heart disease. Three-hundred-eighty-five patients, 6–24 months after acute coronary syndrome or coronary revascularisation, but without history or symptoms of chronic heart failure, were included into the cohort study. The NT-proBNP was measured at baseline and all-cause mortality was ascertained after more than 6 years of follow-up. Patients with NT-proBNP above 862 pmol/l (i.e. in top quintile) showed significantly higher mortality rates, than patients with lower NT-proBNP; the adjusted odds ratio (and 95% confidence intervals) for all-cause death was in patients with NT-proBNP >862 pmol/l 3.26 (1.40–7.62). In conclusion, the asymptomatic elevation of NT-proBNP provides prognostic information also in stable coronary patients not yet manifesting any symptoms of heart failure.     

Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines

OBJECTIVE: To examine predictors of coronary heart disease (CHD) and all-cause mortality in Aboriginal Australians. METHOD: In 1988-89, a survey of Western Australian Aborigines (256 women, 258 men) aged 15-88 years documented diet, alcohol and smoking habits. Linkage to mortality and hospital admissions to the end of 2002 provided longitudinal data for modelling of coronary heart disease endpoints and all-cause mortality using Cox regression. RESULTS: Coronary heart disease risk increased with smoking (HR 2.62, 95% CI: 1.19, 5.75), consumption of processed meats >once/week (HR 2.21, 95% CI: 1.05, 4.63), eggs >twice/week (HR 2.59, 95% CI: 1.11, 6.04) and using spreads on bread (HR 3.14. 95% CI: 1.03, 9.61). All-cause mortality risk was lower with exercise >once/week (HR 0.51, 95% CI 0.26, 1.05), increased in ex-drinkers (HR 3.66, 95% CI: 1.08, 12.47), heavy drinkers (HR 5.26, 95% CI: 1.46, 7.52) and with consumption of take away foods >nine times/month (HR 1.78, 95% CI 0.96, 3.29). Greater alcohol intake, smoking and adverse dietary choices clustered in 53% of men and 56% of women and increased risk of coronary heart disease (HR 2.1, 95% CI: 1.1, 4.0) and all-cause mortality (HR 2.3, 95% CI: 1.2, 4.2). CONCLUSION: Lifestyle in Aboriginal Australians predicts coronary heart disease and all-cause mortality. Clustering of adverse behaviours is common and increases risk of coronary heart disease and death.     

Effects of annual influenza vaccination on mortality and hospitalization in elderly patients with ischemic heart disease: a nationwide population-based study

Objective

The effects of influenza vaccination on ischemic heart disease (IHD) patients remain controversial. The purpose of this study was to evaluate the effects of influenza vaccination on all-cause mortality and hospitalization for cardiovascular disease in elderly IHD patients.

Methods

Elderly patients (> 65 years old) with IHD, including ischemic heart failure and coronary artery disease between January 1997 and September 2002 were identified by using the Taiwan National Health Insurance Research Database. The association between influenza vaccination and all-cause mortality and hospitalization due to cardiovascular disease was analyzed.

Results

We included 5048 patients. During the influenza season, influenza vaccination was associated with a reduced risk of all-cause mortality [hazard ratio (HR), 0.42; 95% confidence interval (CI) 0.35-0.49] and hospitalization for cardiovascular disease (HR, 0.84; 95% CI, 0.76-0.93). During the non-influenza season, vaccination was associated with a reduced risk of mortality (HR, 0.78; 95% CI, 0.68-0.90) in elderly IHD patients.

Conclusion

Influenza vaccination was associated with a reduced risk of all-cause mortality in elderly IHD patients throughout the whole year, as well as a reduced risk of hospitalization during the influenza season.     

Mortality risks among heavy-smokers with special reference to women: a long-term follow-up of an urban population

Increased mortality risks associated with smoking are well established among men. There are very few population-based studies comprising a sufficient number of heavily smoking women, measuring the direct effect of smoking on mortality risks. Between 1974 and 1992, 8,499 women and 13,888 men attended a health screening programme including reporting of smoking habits. Individuals were followed for total mortality until 2005. All-cause, cancer, cardiovascular, lung cancer and respiratory mortality were calculated in smoking categories <10 g per day, 10–19 g per day, and ≥20 g per day with never-smokers as a reference group and with adjustments for co-morbidities, socio-economic and marital status. For respiratory mortality and lung cancer adjustments for FEV₁, socio-economic and marital status were performed. Smoking was associated with a two to almost threefold increased mortality risk among women and men. The relative risk (RR) with 95% confidence interval, (CI) for women who smoked 10–19 g per day was 2.44 (2.07–2.87), and for those who smoked 20 g per day or more the RR (95% CI) was 2.42 (2.00–2.92). Smoking was a strong risk factor for cardiovascular mortality among women, the RR (95% CI) for women who smoked 10–19 g per day was 4.52 (3.07–6.64). Ex-smoking women showed increased risks of all-cause mortality; RR (95% CI) 1.26 (1.04–1.52) cancer (excluding lung cancer); RR (95% CI) 1.42 (1.07–1.88) and lung cancer RR (95% CI) 2.71 (1.02–7.23) mortality. However, the cardiovascular; RR (95% CI) 1.18 (0.69–2.00) and respiratory; RR (95% CI) 0.79 (0.16–3.84) mortality risks were not statistically significant. This study confirms that as for men, middle-aged heavily smoking women have a two to threefold increased mortality risk. Adjustments for co-morbidity, socio-economic and marital status did not change these results.     

Early age at menarche associated with increased all-cause mortality

The objective was to examine the association between age at menarche and all-cause mortality. A population-based prospective study involving 55,128 Japanese women aged 40–79 years in 1988–1990 and followed up to December 2006 was used. A total of 6,967 deaths occurred during the follow-up. Hazard ratios (HR) and 95% confidence intervals (CI) adjusted for age, smoking and drinking status, exercise, sleeping hours, parity, menopausal status, and body mass index at baseline were calculated by Cox proportional hazards model. The HRs (95% CI) of all-cause mortality were 1.16 (1.01–1.32), 1.01 (0.92–1.11), 1.00, 0.97 (0.90–1.05), 0.98 (0.91–1.05), 0.92 (0.84–1.01), and 1.05 (0.96–1.14) for women with menarche aged 9–12, 13, 14 (referent), 15, 16, 17, 18–20 years, respectively, indicating an inverse J-shaped association (P for quadratic trend <.01). Moreover, women with menarche aged ≤12 years have a significantly high risk of all-cause mortality compared with those with menarche aged ≥13 years (HR 1.17, 95% CI 1.03–1.33). Comparing between women with menarche aged ≤13 years and ≥14 years, those with earlier age at menarche had borderline significantly high risk of all-cause mortality in both comparisons (HR 1.07, 95% CI 0.99–1.15, P = .082). Japanese women with early age at menarche of ≤12 years were associated with increased risk of all-cause mortality and those with late age at menarche of ≥18 years also had a slightly higher mortality risk. These associations were independent of lifestyle, anthropometric, and reproductive factors.     

Obesity but not overweight is associated with increased mortality risk

The association between body mass index (BMI) and survival has been described in various populations. However, the results remain controversial and information from low-prevalence Western countries is sparse. Our aim was to examine this association and its public health impact in Switzerland, a country with internationally low mortality rate and obesity prevalence. We included 9,853 men and women aged 25–74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983–1992) and could be followed up for survival until 2008 by using anonymous record linkage. Cox regression models were used to calculate mortality hazard ratios (HRs) and to estimate excess deaths. Independent variables were age, sex, survey wave, diet, physical activity, smoking, educational class. After adjustment for age and sex the association between BMI and all-cause mortality was J shaped (non-smokers) or U shaped (smokers). Compared to BMI 18.5–24.9, among those with BMI ≥ 30 (obesity) HR for all-cause mortality was 1.41 (95% confidence interval: 1.23–1.62), for cardiovascular disease (CVD) 2.05 (1.60–2.62), for cancer 1.29 (1.04–1.60). Further adjustment attenuated the obesity-mortality relationship but the associations remained statistically significant. No significant increase was found for overweight (BMI 25–29.9). Between 4 and 6.5% of all deaths, 8.8–13.7% of CVD deaths and 2.4–3.9% of cancer deaths could be attributed to obesity. Obesity, but not overweight was associated with excess mortality, mainly because of an increased risk of death from CVD and cancer. Public health interventions should focus on preventing normal- and overweight persons from becoming obese.     

Leisure-time physical activity,cardiovascular risk factors and mortality during a 34-year follow-up in men

The inverse relationship between physical activity and mortality may be confounded by socioeconomic factors, cardiovascular risk factors and inverse causality. We investigated long-term association between self-reported regular physical activity and mortality in a socioeconomically homogeneous, initially healthy middle-aged (mean age 47) male cohort (the Helsinki Businessmen Study). In 1974, the men were assessed with questionnaires, clinical and laboratory examinations. Cardiovascular disease (CVD) risk factors (including body mass index [BMI], age, cholesterol, glucose, systolic blood pressure and smoking) and details of physical activity of 782 men were available. Leisure time physical activity was collapsed into 3 categories: low (n = 148), moderate (n = 398) and high activity (n = 236). Physical activity was also briefly assessed in questionnaire surveys in 1985–1986 and in 2000. Total mortality up to 2007 was retrieved from the Central Population Register. Altogether 295 men (37.7%) died during the 34-year follow-up, and leisure-time physical activity was significantly related to mortality in a step-wise manner: 45.9% (n = 68), 37.7% (n = 150), and 32.6% (n = 77) died in the low, moderate, and high activity groups, respectively (P < 0.001). With high activity group as referent and adjusted for midlife CVD risk, perceived health and fitness at baseline, hazard ratio for total mortality was 1.21 (95% confidence interval: 0.90, 1.62), and 1.61 (95% confidence interval: 1.13, 2.30) in the moderate and low activity groups, respectively. Conclusion: During the 34-year follow-up, leisure-time physical activity in initially healthy middle-aged men had a graded association with reduced mortality that was independent of CVD risk, glucose and BMI.     

Work and leisure time physical activity and mortality in men and women from a general population sample.

PURPOSE: The purpose of this study was to examine the long-term relationships between total physical activity and mortality from all causes and coronary heart disease (CHD) in the general population. METHODS: A prospective design was used, following participants for 29 years, beginning in 1960. The study population consisted of a randomly selected sample of white male (n = 698) and female (n = 763) residents of Buffalo, New York with a 79.0% participation rate and follow-up rates of 96.0% and 90.2% in males and females, respectively. At baseline, comprehensive information was obtained regarding participants' usual physical activity at work and during leisure time. RESULTS: As of December 31, 1989, three hundred and two (43.3%) men and 276 (41.0%) women died, 109 (15.6%) and 81 (10.6%) from CHD, respectively. In men, a significant interaction was found between activity and body mass index (BMI) for both outcomes. In women, a significant activity by age interaction was observed. In non-obese men (BMI<27.02), activity was inversely associated with all-cause [relative risk (RR) = 0.59; 95% confidence interval (CI), 0.39-0.89] and CHD mortality (RR = 0.39; 95% CI, 0.18-0.83), independent from the effects of age and education. No such associations were found in obese men and increased risks could not be ruled out. Among women, younger participants (age <60 years) had a significantly reduced risk of CHD death with increased activity (RR = 0.26; 95% CI, 0.07-0.99). No other significant associations were observed. CONCLUSIONS: Physical activity favorably influences mortality risks in non-obese men and younger women. Gender-specific factors should be considered for potential effect modification.     

Mortality Excess in Individuals with Elevated IgA Anti-Transglutaminase Antibodies: The KORA/MONICA Augsburg Cohort Study 1989–1998

Objectives : Immunoglobulin A (IgA) autoantibodies to tissue transglutaminase (tTG) are commonly used for screening and diagnosing of celiac disease. We examined the hypothesis that elevated IgA anti-tTG antibodies were associated with higher all-cause mortality risk. Methods The cohort, 2333 men and 2300 women, was based on the follow-up of participants of a representative population-based survey in Southern Germany (KORA/MONICA Augsburg project) conducted in 1989–1990. The endpoint for the vital status with cause of death was the year 1998. The sera drawn at baseline and stored at −80 °C, were recently screened with an IgA enzyme-linked immunosorbent assay (ELISA) using human recombinant tTG. Age-standardized mortality rates and age-adjusted hazard ratios were calculated. Results From the 4633 sera analyzed, 63 had an IgA anti-tTG concentration ≥7 AU/ml. Of these 63 individuals, 15 died between 1989 and 1998. The age-adjusted hazard ratio (HR_a) of all-cause mortality was 1.86 (95% CI: 1.01–3.41) and 3.92 (95% CI: 1.44–10.71) for men and women, respectively. The excess of cancer mortality was even higher with an HR_a of 2.47 (95% CI: 0.89–6.83) in men and of 6.65 (95% CI: 2.04–21.63) in women. Conclusions: Individuals with elevated IgA anti-tTG antibodies had a highly increased mortality risk, particularly due to cancer. New studies are necessary to clarify if this increased risk is due to undiagnosed celiac disease or/and if this elevated IgA anti-tTG antibodies level is a marker of serious diseases like cancer, chronic liver disease or end-stage heart failure.