Association between Dietary Manganese Intake and Mortality from Cardiovascular Disease in Japanese Population: The Japan Collaborative Cohort Study

Aim: Manganese (Mn) is an essential element in the human body, and it has a significant impact on cardiovascular risk factors such as diabetes, blood pressure, and cholesterol levels. However, no research has been conducted on the association between Mn and cardiovascular disease (CVD), to the best of our knowledge. This study thus examined the association between dietary Mn intake and CVD mortality in the general Japanese population. Methods: The CVD mortality among 58,782 participants from the Japan Collaborative Cohort Study (JACC) aged 40–79 years was determined during a median follow-up period of 16.5 years. The Mn intake was estimated using a food frequency questionnaire at the baseline (1989–1990), and multivariate-adjusted hazard ratios (HRs) for mortality were computed according to quintiles of energy-adjusted Mn intake. Results: During the follow-up period, a total of 3408 CVD deaths were recorded. Participants in the highest quintile of Mn intake had a lower risk of mortality from total stroke (HR:95% CI, 0.76: 0.64–0.90), ischemic stroke (HR: 0.77, 0.61–0.97), ischemic heart disease (HR: 0.76, 0.58–0.98), and total CVD (HR: 0.86, 0.76–0.96) compared with those in the lowest quintile. The reduced risk of mortality from intraparenchymal hemorrhage with high Mn intake was observed among women (HR: 0.60, 0.37–0.96) but not men (HR: 0.93, 0.59–1.47). The observed associations were more robust in postmenopausal than in premenopausal women. Conclusions: Our study is the first to show the prospective association between dietary Mn intake and reduced risk of mortality from CVD in the Japanese population.     

A prospective study of dietary fiber intake and risk of cardiovascular disease among women.

OBJECTIVES: This study was designed to examine the hypothesis that higher intake of dietary fiber is inversely related to the risk of cardiovascular disease (CVD) and myocardial infarction (MI) in a large prospective cohort of women. BACKGROUND: Although dietary fiber has been suggested to reduce the risk of coronary disease, few prospective studies have examined the association between the types and amounts of dietary fiber and CVD risk, particularly among women. METHODS: In 1993, we used a semi-quantitative food frequency questionnaire to assess dietary fiber intake among 39,876 female health professionals with no previous history of CVD or cancer. Women were subsequently followed for an average of six years for incidence of nonfatal MI, stroke, percutaneous transluminal coronary angioplasty, coronary artery bypass graft or death due to CVD confirmed by medical records or death certificates. RESULTS: During 230,006 person-years of follow-up, 570 incident cases of CVD were documented, including 177 MIs. After adjustment for age and randomized treatment status, a significant inverse association was observed between dietary fiber intake and CVD risk. Comparing the highest quintile of fiber intake (median: 26.3 g/day) with the lowest quintile (median: 12.5 g/day), the relative risks (RR) were 0.65 (95% confidence interval [CI]: 0.51, 0.84) for total CVD and 0.46 (95% CI: 0.30, 0.72) for MI. Additional adjustment for CVD risk factors reduced the RRs to 0.79 (95% CI: 0.58, 1.09) for total CVD and 0.68 (95% CI: 0.36, 1.22) for MI. The inverse trends across categories generally remained, although they were no longer statistically significant. Inverse relations were observed between both soluble and insoluble fiber and risk of CVD and MI, and among those who had never smoked and those with body mass index <25. CONCLUSIONS: A higher intake of dietary fiber was associated with a lower risk of CVD and MI, although the association was not statistically significant after further adjusting for multiple confounding factors. Nevertheless, these prospective data generally support current dietary recommendations to increase the consumption of fiber-rich whole grains and fruits and vegetables as a primary preventive measure against CVD.     

The apparent inverse association between dietary carotene intake and risk of cardiovascular mortality disappeared after adjustment for other cardioprotective dietary intakes: The Japan collaborative cohort study

Background and purposeAn effect of dietary carotenes on risk of cardiovascular disease (CVD) is uncertain. We aimed to investigate whether the association between dietary carotenes intake and risk of CVD mortality will persist after controlling for the intakes of potential cardioprotective dietary factors that correlate with dietary alpha- and/or beta-carotenes.Methods and resultsWe followed up a total of 58,646 Japanese between 1988 and 1990 and 2009. We used a food frequency questionnaire (FFQ) to determine the dietary intakes of carotenes, and estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) of CVD mortality in relation to carotene intake by the proportional hazard regression developed by David Cox. During 965,970 person-years of follow-up (median 19.3 years), we identified 3388 total CVD deaths. After adjusting for demographic and lifestyle factors, dietary intakes of alpha-carotene were significantly associated with the reduced risk of mortality from coronary heart disease (CHD); adjusted HR (95% CI) in the highest versus lowest quintiles of intake was 0.75 (0.58–0.96; P-trend = 0.02) and dietary intakes of beta-carotene were significantly associated with the reduced risk of mortality from CVD, CHD, and other CVD; adjusted HRs (95% CIs) were 0.88 (0.79–0.98; P-trend = 0.04), 0.78 (0.61–0.99; P-trend = 0.01), and 0.81 (0.67–0.98; P-trend = 0.04), respectively. However, after further adjusting for the dietary intakes of potassium, calcium, vitamins C, E, or K, these associations disappeared.Conclusions—Dietary alpha- and beta-carotene intakes were not associated with risk of CVD mortality after controlling for intakes of other potential cardioprotective nutrients.     

Low-carbohydrate diet and cardiovascular diseases in Iranian population: Tehran Lipid and Glucose Study

Background and aimsStudies indicated that the risk of cardiovascular disease (CVD) in association to greater adherence to low-carbohydrate diet (LCD) differs in various populations. In this study, we aimed to assess the association of LCD score with the risk of CVD events in a prospective population-based study.Methods and resultsCVD-free participants (n = 2188) were recruited from the Tehran Lipid and Glucose Study (2006–2008) and followed for a mean of 6.7 years. Using a valid and reliable 168 item semi-quantitative food frequency questionnaire, the LCD score was determined based on the percentage of energy as carbohydrate, protein, and fat, which ranged from 0 to 12. Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the hazard ratios (HRs) and 95% confidence interval (CI) of CVD across tertiles of LCD score in women and men.Mean ± SD age of participants (44.8% male) was 38.8 ± 13.0 years, and median (25–75, interquartile range) of the LCD score was 6 (4–8) at baseline. During follow-up, 77 (3.5%) new cases of CVD were identified. After adjustment for sex, age, body mass index, physical activity, smoking, energy intake, diabetes, and hypertension, there was no association between the LCD score and risk of CVD outcomes in all participants (HR = 0.93; 95% CI: 0.86–1.02) and women (HR = 1.13; 95% CI: 0.94–1.36); however, the LCD score was associated with an 11% reduced incidence of CVD events in men (HR = 0.89; 95% CI: 0.80–0.98), (P for trend: 0.028).ConclusionFindings showed that higher adherence to LCD may be associated with a lower risk of CVD outcomes in men but not in women.     

Hard drinking water does not protect against cardiovascular disease: new evidence from the British Regional Heart Study.

BACKGROUND: It has been previously suggested that hard drinking water in general, and in particular high calcium and magnesium intake from drinking water, protect against cardiovascular disease. DESIGN: Prospective study of men from 24 British towns, with widely differing levels of hardness in drinking water. METHODS: A total of 7,735 men aged 40-59 years were recruited during 1978-1980. Estimates of town-level water hardness were available and tap water samples, taken from 947 participants who also answered a questionnaire about water consumption, were used to calculate individual calcium and magnesium intakes. Men were followed for incident of major coronary heart disease (CHD) and stroke, and CHD mortality for 25 years. RESULTS: Water hardness varied from 0.27 to 5.28 mmol/l in the 24 towns. A weak inverse association was found between water hardness and incidence of cardiovascular disease (CVD) [hazard ratio (HR), 0.96 per two-fold increase, 95% confidence interval (CI), 0.91-1.01, P=0.08 after adjustment for age and seven established coronary risk factors]. No association was observed with CHD incidence (adjusted HR, 0.99, 95% CI, 0.94-1.04, P=0.62) or mortality (adjusted HR, 0.96, 95% CI, 0.90-1.02, P=0.18). Individual magnesium intake showed a positive, rather than an inverse, association with CHD incidence (adjusted HR, 1.10 per two-fold increase, 95% CI, 1.01-1.20, P=0.045); individual calcium intake was unrelated to CHD or CVD end points. CONCLUSIONS: This study suggests that neither high water hardness, nor high calcium or magnesium intake appreciably protect against CHD or CVD. Initiatives to add calcium and magnesium to desalinated water cannot be justified by these findings.     

Associations of dietary protein intake with all-cause,cardiovascular disease,and cancer mortality: A systematic review and meta-analysis of cohort studies

Background and aimsThe relationships between dietary protein intake and risk of all-cause, cardiovascular disease (CVD), and cancer mortality are still unclear. We conducted a systematic review with meta-analysis of cohort studies to summarize the evidence.Methods and resultsWe searched PubMed and Web of Science for relevant studies through February 2020. The associations of total, animal, and plant proteins with all-cause, CVD, and cancer mortality were evaluated. Study-specific relative risks (RR) were pooled using the fixed effect model when no significant heterogeneity was detected; otherwise the random effect model was employed. Twelve cohort studies were eligible for the study. Increased total protein showed no clear association with risk of all-cause, CVD, and cancer mortality. In the stratified analysis by protein sources, higher plant protein intake was associated with a reduced risk of all-cause mortality (highest vs lowest intake: RR = 0.92; 95% CI: 0.88, 0.96; each 3% increment of intake: RR = 0.97; 95% CI: 0.94, 0.99), and may be associated with a reduced risk of CVD mortality (highest vs lowest intake: RR = 0.90; 95% CI: 0.80, 1.01; each 3% increment of intake: RR = 0.95; 95% CI: 0.91, 0.99). Moreover, higher intake of animal protein may be associated with an increased risk of CVD mortality (highest vs lowest intake: RR = 1.11; 95% CI: 1.01, 1.22; each 3% increment of intake: RR = 1.02; 95% CI: 0.98, 1.06).ConclusionThis study demonstrates that higher plant protein intake is associated with a reduced risk of all-cause and CVD-related mortality. Persons should be encouraged to increase their plant protein intake to potentially decrease their risk of death.     

Risk factors for primary prevention of cardiovascular disease and risk reduction by lipid control: the OMEGA study risk factor sub-analysis

To identify risk factors for cardiovascular disease (CVD) in hypertensive patients with no history of CVD being treated with antihypertensive drugs, we examined subgroup data (n?=?13?052) from the prospective, observational Olmesartan Mega Study to Determine the Relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement (OMEGA) study. Risk factors for CVD, stroke and coronary heart disease (CHD) were examined using a Cox proportional hazards model. In addition, the effect of statin therapy at baseline on CHD prevention was analyzed in dyslipidemic patients. The factors significantly related to CVD were female (hazard ratio [HR]?=?0.637, 95% confidence interval [CI] 0.428–0.948), older age (65–69 years: HR?=?2.165, 95% CI 1.214–3.861; 70–74 years: HR?=?2.324, 95% CI 1.294–4.174; ≥75 years: HR?=?2.448, 95% CI 1.309–4.578), family history of CHD (HR?=?1.993, 95% CI 1.249–3.179), diabetes (HR?=?2.287, 95% CI 1.700–3.078), current smoking (HR?=?2.289, 95% CI 1.512–3.466) and alcohol drinking socially (HR?=?0.589, 95% CI 0.379–0.913). Diabetes was a risk factor for both stroke and CHD, while age, family history of CHD, and sodium intake score were risk factors for stroke alone. Sex, dyslipidemia, smoking and exercise habits were risk factors for CHD alone. The risk of CHD in dyslipidemic patients on statin treatment was comparable to the risk in patients without dyslipidemia (HR?=?1.134, 95% CI 0.604–2.126). However, in dyslipidemic patients not on statin treatment, the HR increased to 1.807 (95% CI 1.156–2.825). In conclusion, some risk factors for CVD in hypertensive patients being treated with antihypertensive drugs with no history of CVD differed between CHD and stroke. These results suggest the importance of managing dyslipidemia with a statin for primary prevention of CHD, as well as the importance of hypertension therapy.     

Dietary fiber intake and reduced risk of coronary heart disease in US men and women: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study

BACKGROUND: Prospective studies suggest that dietary fiber intake, especially water-soluble fiber, may be inversely associated with the risk of coronary heart disease (CHD). METHODS: We examined the relationship between total and soluble dietary fiber intake and the risk of CHD and cardiovascular disease (CVD) in 9776 adults who participated in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study and were free of CVD at baseline. A 24-hour dietary recall was conducted at the baseline examination, and nutrient intakes were calculated using Food Processor software. Incidence and mortality data for CHD and CVD were obtained from medical records and death certificates during follow-up. RESULTS: During an average of 19 years of follow-up, 1843 incident cases of CHD and 3762 incident cases of CVD were documented. Compared with the lowest quartile of dietary fiber intake (median, 5.9 g/d), participants in the highest quartile (median, 20.7 g/d) had an adjusted relative risk of 0.88 (95% confidence interval [CI], 0.74-1.04; P =.05 for trend) for CHD events and of 0.89 (95% CI, 0.80-0.99; P =.01 for trend) for CVD events. The relative risks for those in the highest (median, 5.9 g/d) compared with those in the lowest (median, 0.9 g/d) quartile of water-soluble dietary fiber intake were 0.85 (95% CI, 0.74-0.98; P =.004 for trend) for CHD events and 0.90 (95% CI, 0.82-0.99; P =.01 for trend) for CVD events. CONCLUSION: A higher intake of dietary fiber, particularly water-soluble fiber, reduces the risk of CHD.     

Does self-reported history of hypertension predict cardiovascular death? Comparison with blood pressure measurement in a 19-year prospective study

OBJECTIVES: Hypertension as assessed by blood pressure (BP) measurement is one of the most important risk factors for cardiovascular diseases (CVD). Self-reported history of hypertension (self-reported HT) is an easy way to obtain information on BP and is known to have a certain sensitivity and high specificity for hypertension confirmed by BP measurement (confirmative HT). Thus, it might predict CVD mortality, but few studies have reported on this relationship. METHODS: We followed 6427 participants aged 30-59 years without a history of CVD for 19 years. The multivariate-adjusted hazard ratio (HR) of CVD mortality was estimated by the Cox proportional hazard model. RESULTS: The sensitivity and specificity of self-reported HT for confirmative HT were 52-65% and 95%, respectively. The multivariate-adjusted HR of self-reported HT for CVD death was 2.49 [95% confidence interval (CI) = 1.72-3.61]. Compared to participants with neither self-reported HT nor confirmative HT, those with confirmative HT showed a consistently higher HR for CVD mortality. Self-reported HT without confirmative HT was also significantly related to CVD mortality (HR = 2.10, 95% CI = 1.04-4.26). These tendencies were unchanged when we further adjusted for systolic BP (SBP) level. The age-adjusted mortality rate of individuals with self-reported HT corresponded to the age-adjusted mortality rate of individuals whose SBP was 160-179 mmHg. CONCLUSION: Self-reported HT could screen one-half of the participants for confirmative HT and was significantly associated with CVD mortality. These results indicate that self-reported HT can be a useful tool to screen for individuals with high BP if it is difficult to perform BP measurements continuously among all members of a community.     

Dietary sodium to potassium ratio and the incidence of hypertension and cardiovascular disease: A population-based longitudinal study

ABSTRACT

Objective: There is an interaction between dietary sodium/potassium intake in the pathogenesis of hypertension (HTN) and cardiovascular disease (CVD). The aim of this study was to investigate the association of dietary sodium to potassium (Na/K) ratio and the risk of HTN and CVD in a general population of Iranian adults. Methods: In this prospective cohort study, adults men and women with complete baseline data were selected from among participants of the Tehran Lipid and Glucose Study and were followed up for 6.3 years for incidence of HTN and CVD outcomes. Dietary sodium and potassium were assessed using a valid and reliable 168-item food frequency questionnaire. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between dietary sodium, potassium and their ratio and risk of outcomes. Results: During the study follow-up, 291 (15.1%) and 79 (5.0%) new cases of HTN and CVD were identified, respectively. No significant association was observed between usual intakes of sodium, potassium and dietary Na/K ratio with the incidence of HTN. There was no significant association between dietary intakes of sodium and potassium per se and the risk of CVD, whereas when dietary sodium to potassium ratio was considered as exposure in the fully-adjusted Cox regression model, and participants in the highest compared to lowest tertile had a significantly increased risk of CVD (HR = 2.19, 95% CI = 1.16–4.14). Conclusions: Our findings suggest that high dietary Na/K ratio could contribute to increased risk of CVD events.     

Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium

ObjectivesThis study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk.BackgroundAlthough CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate.MethodsThe CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD.ResultsDuring the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0.ConclusionsAcross the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.     

Impact of lung‐function measures on cardiovascular disease events in older adults with metabolic syndrome and diabetes

Background

Individuals with metabolic syndrome (MetS) and diabetes (DM) are more likely to have decreased lung function and are at greater risk of cardiovascular disease (CVD).

Hypothesis.

Lung‐function measures can predict CVD events in older persons with MetS, DM, and neither condition.

Methods

We followed 4114 participants age ≥ 65 years with and without MetS or DM in the Cardiovascular Health Study. Cox regression examined the association of forced vital capacity (FVC) and 1‐second forced expiratory volume (FEV₁; percent of predicted values) with incident coronary heart disease and CVD events over 12.9 years.

Results

DM was present in 537 (13.1%) and MetS in 1277 (31.0%) participants. Comparing fourth vs first quartiles for FVC, risk of CVD events was 16% (HR: 0.84, 95% CI: 0.59–1.18), 23% (HR: 0.77, 95% CI: 0.60–0.99), and 30% (HR: 0.70, 95% CI: 0.58–0.84) lower in DM, MetS, and neither disease groups, respectively. For FEV₁, CVD risk was lower by 2% (HR: 0.98, 95% CI: 0.70–1.37), 26% (HR: 0.74, 95% CI: 0.59–0.93), and 31% (HR: 0.69, 95% CI: 0.57–0.82) in DM. Findings were strongest for predicting congestive heart failure (CHF) in all disease groups. C‐statistics increased significantly with addition of FEV₁ or FVC over risk factors for CVD and CHF among those with neither MetS nor DM.

Conclusions

FEV₁ and FVC are inversely related to CVD in older adults with and without MetS, but not DM (except for CHF); however, their value in incremental risk prediction beyond standard risk factors is limited mainly to metabolically healthier persons.     

Dietary patterns and 5-year incidence of cardiovascular disease: a multivariate analysis of the ATTICA study

Background and aimsThe 5-year incidence of cardiovascular disease (CVD) in relation to dietary habits, among men and women from Greece, was evaluated.Methods and resultsFrom May 2001 to December 2002, 1514 men and 1528 women (>18 years) without any clinical evidence of CVD, living in the Attica area, Greece, were enrolled in the ATTICA study. In 2006, a group of experts performed the 5-year follow-up (941 of the 3042 participants were lost). Development of CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) during the follow-up period was defined according to WHO ICD-10 criteria. Principal Components Analysis was applied, and 15 dietary patterns were extracted (71% of total information explained) from 26 foods or food groups.The 5-year incidence of CVD was 11.0% in men and 6.1% in women (p < 0.001); the case fatality rate was 1.6%. Multi-adjusted analysis revealed that the dietary pattern that was mainly characterized by cereals, small fish, hardtack and olive oil intake, was associated with lower CVD risk (HR per 1 unit = 0.72, 95% CI 0.52–1.00); the pattern that was characterized by fruits, vegetables intake and olive oil use in daily cooking was associated with lower CVD risk (HR per 1 unit = 0.80, 95% CI 0.66–0.97); while patterns that were mainly characterized by sweets, red meat, margarine, salty nuts intake, and hard cheese, as well as alcohol intake, were associated with higher CVD risk (HR per 1 unit = 1.26, 95% CI 1.01–1.56, and HR per 1 unit = 1.32, 95% CI 1.05–1.66, respectively).ConclusionsMultivariate statistical methods revealed dietary patterns based on empirical epidemiological data which were associated with the development of CVD.     

Association between dietary fiber intake and risk of incident aortic stenosis

Background and aimsAlthough aortic stenosis is the most common valvular heart disease requiring intervention in Europe, the role that diet plays in development of the disease is largely unknown. The pathophysiology of aortic stenosis is however similar to other cardiovascular diseases that fiber intake has been associated with. The aim of this study was consequently to investigate the association between dietary fiber intake as well as the main food sources of fiber, i.e. fruit and vegetables and whole grains, and risk of incident aortic stenosis.Methods and resultsThe Malmö Diet and Cancer Study is a Swedish prospective population-based cohort study with baseline data collection performed between year 1991–1996. Dietary habits were recorded through seven-day food diaries, 168-item diet questionnaires, and interviews, and data on incident aortic stenosis was collected through national registers. Among the 26,063 participants, 672 cases were ascertained during a mean follow-up period of 20 years. Cox regression was used to estimate the association between dietary intakes and incident aortic stenosis. No associations were found between incident aortic stenosis and intake of dietary fiber (HR for the highest vs lowest quintile: 0.93; 95% CI: 0.72–1.24), fruit and vegetables (HR: 0.98; 95% CI: 0.76–1.28), or whole grains (HR: 1.00; 95% CI: 0.79–1.26) in the main model.ConclusionThe findings of this study do not indicate that consumption of dietary fiber or fiber rich foods are associated with incident aortic stenosis.     

Prediction of cardiovascular mortality in middle-aged men by dietary and serum linoleic and polyunsaturated fatty acids

BACKGROUND: Substitution of dietary polyunsaturated for saturated fat has long been recommended for the primary prevention of cardiovascular disease (CVD), but only a few prospective cohort studies have provided support for this advice. METHODS: We assessed the association of dietary linoleic and total polyunsaturated fatty acid (PUFA) intake with cardiovascular and overall mortality in a population-based cohort of 1551 middle-aged men. Dietary fat composition was estimated with a 4-day food record and serum fatty acid composition. RESULTS: During the 15-year follow-up, 78 men died of CVD and 225 of any cause. Total fat intake was not related to CVD or overall mortality. Men with an energy-adjusted dietary intake of linoleic acid (relative risk [RR] 0.39; 95% confidence interval [CI], 0.21-0.71) and PUFA (RR, 0.38; 95% CI, 0.20-0.70) in the upper third were less likely to die of CVD than men with intake in the lower third after adjustment for age. Multivariate adjustment weakened the association somewhat. Mortality from CVD was also lower for men with proportions of serum esterified linoleic acid (RR, 0.42; 95% CI, 0.21-0.80) and PUFA (RR, 0.25; 95% CI, 0.12-0.50) in the upper vs lower third, with some attenuation in multivariate analyses. Serum and to a lesser extent dietary linoleic acid and PUFA were also inversely associated with overall mortality. CONCLUSIONS: Dietary polyunsaturated and more specifically linoleic fatty acid intake may have a substantial cardioprotective benefit that is also reflected in overall mortality. Dietary fat quality seems more important than fat quantity in the reduction of cardiovascular mortality in men.     

C-reactive protein and electrocardiographic ST-segment depression additively predict mortality: the Strong Heart Study

OBJECTIVES: This study was designed to examine whether high-sensitivity C-reactive protein (CRP) and electrocardiographic (ECG) ST-segment depression (STD) have additive utility for predicting cardiovascular disease (CVD) death and all-cause death (ACD). BACKGROUND: C-reactive protein, a marker of systemic inflammation, and ECG STD, an index of myocardial ischemia and hypertrophy, independently predict mortality. METHODS: Electrocardiograms and CRP levels were examined in 2,155 American Indian participants in the second Strong Heart Study examination. ST-segment depression >/=50 microV (n = 127) and CRP >7.0 mg/l (defining the upper quartile of CRP levels, n = 540) were considered abnormal. RESULTS: After 5.2 +/- 1.2 years follow-up there were 95 CVD deaths and 310 ACD. In univariate Cox analyses, the combination of CRP and ECG STD improved risk stratification compared to either alone, with the presence of both CRP >7.0 and ECG STD associated with a 7.7-fold increased risk of CVD death (95% confidence interval [CI] 3.3 to 18.2) and a 6.5-fold increased risk of ACD (95% CI 4.1 to 10.3). After adjustment for age, gender, and relevant risk factors, the combination of high CRP and STD remained predictive of CVD death and ACD, with the presence of both abnormal CRP and STD associated with the highest risks of CVD death (hazard ratio [HR] 3.2, 95% CI 1.1 to 10.5) and ACD (HR 3.9, 95% CI 2.1 to 7.2) and the presence of either high CRP or abnormal STD associated with intermediate risks of CVD death (HR 2.2, 95% CI 1.4 to 3.4) and ACD (HR 1.5, 95% CI 1.2 to 2.0). CONCLUSIONS: The combination of ECG STD and CRP increases the risk of mortality, demonstrating the additive impacts of active inflammation and preclinical CVD on prognosis.     

Plasma Carboxymethyl-Lysine, an Advanced Glycation End Product, and All-Cause and Cardiovascular Disease Mortality in Older Community-Dwelling Adults

OBJECTIVES: To determine whether older adults with high plasma carboxymethyl-lysine (CML), an advanced glycation end product, are at higher risk of all-cause and cardiovascular disease (CVD) mortality.
DESIGN: Prospective cohort study.
SETTING: Population-based sample of adults aged 65 and older residing in Tuscany, Italy.
PARTICIPANTS: One thousand thirteen adults participating in the Invecchiare in Chianti study.
MEASUREMENTS: Anthropometric measures, plasma CML, fasting plasma total, high-density and low-density lipoprotein cholesterol, triglycerides, glucose, creatinine. Clinical measures: medical assessment, diabetes mellitus, hypertension, coronary heart disease, heart failure, stroke, cancer. Vital status measures: death certificates and causes of death according to the International Classification of Diseases . Survival methods were used to examine the relationship between plasma CML and all-cause and CVD mortality, adjusting for potential confounders.
RESULTS: During 6 years of follow-up, 227 (22.4%) adults died, of whom 105 died with CVD. Adults with plasma CML in the highest tertile had greater all-cause (hazard ratio (HR)=1.84, 95% confidence interval) CI)=1.30–2.60, P <.001) and CVD (HR=2.11, 95% CI=1.27–3.49, P =.003) mortality than those in the lower two tertiles after adjusting for potential confounders. In adults without diabetes mellitus, those with plasma CML in the highest tertile had greater all-cause (HR=1.68, 95% CI=1.15–2.44, P =.006) and CVD (HR=1.74, 95% CI=1.00–3.01, P =.05) mortality than those in the lower two tertiles after adjusting for potential confounders.
CONCLUSION: Older adults with high plasma CML are at higher risk of all-cause and CVD mortality.     

The dietary and lifestyle indices of insulin resistance are associated with increased risk of cardiovascular diseases: A prospective study among an Iranian adult population

Background and aimsPrevious studies have introduced insulin resistance (IR) as a major risk factor for poor cardiovascular diseases (CVDs) outcomes. Diet, body weight, and physical activity are three key pillars of lifestyle that can significantly impact the IR status. We aimed to assess the possible link between the empirical dietary index for IR (EDIR) and the empirical lifestyle index for IR (ELIR) with the risk of chronic heart disease (CHD) and CVDs.Methods and resultsThis study was conducted on 4980 participants aged ≥30 years (follow-up rate: 99.85%). Dietary intake data was collected using a validated food frequency questionnaire. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence intervals (HRs and 95% CIs) of CVDs and CHD across tertiles of EDIR and ELIR scores. In the final model, after adjusting for all potential confounding variables, participants in the highest tertile of EDIR had a higher risk of CVD (HR:1.36, 95%CI:1.03–1.80, P-trend = 0.016) and CHD (HR:1.36, 95% CI:1.01–1.83, P-trend = 0.023) compared to the lowest tertile. Also, participants with a higher score of ELIR had a higher risk of CVD (HR: 1.64, 95%CI:1.24–2.16, P-trend=<0.001) and CHD (HR: 1.72, 95%CI:1.28–2.32, P-trend=<0.001).ConclusionA greater adherence to the lifestyle and diet with a higher EDIR and ELIR may be associated with an increased risk of CVD and CHD outcomes in the adult population.     

Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: A 24-year follow-up of NIPPON DATA80

BackgroundDietary intake of long-chain n-3 PUFA (LCn3FA) among Japanese is generally higher than that in Western populations. However, little is known whether an inverse association of LCn3FA with cardiovascular disease (CVD) risk exists in a population with higher LCn3FA intake.ObjectiveTo investigate the association between LCn3FA intake and the long-term risk of CVDs in a Japanese general population.MethodsWe followed-up a total of 9190 individuals (56.2% women, mean age 50.0 years) randomly selected from 300 areas across Japan and free from CVDs at baseline. Dietary LCn3FA intake was estimated using household weighed food records. Cox models were used to calculate multivariate-adjusted hazard ratios (HR) and confidence intervals (CI) according to sex specific quartiles of LCn3FA intake.ResultsDuring 24-year follow-up (192,897 person-years), 879 cardiovascular deaths were observed. The median daily intake of LCn3FA was 0.37% kcal (0.86 g/day). Adjusted HR for CVD mortality was lower in the highest quartile of LCn3FA intake (HR 0.80; 95% CI 0.66–0.96) compared with the lowest quartile, and the trend was statistically significant (P = 0.038). The similar but statistically non-significant trends were observed for coronary heart disease death and stroke death. In analyses by age groups, the inverse associations of LCn3FA intake with the risk of total CVD death and stroke death were significant in younger individuals (30–59 years at baseline).ConclusionLCn3FA intake was inversely and independently associated the long-term risk of total CVD mortality in a representative sample of Japanese with high LCn3FA intake.     

Body Mass Index and Survival in Men and Women Aged 70 to 75

OBJECTIVES: To examine in an older population all‐cause and cause‐specific mortality associated with underweight (body mass index (BMI)<18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25.0–29.9), and obesity (BMI≥30.0). DESIGN: Cohort study. SETTING: The Health in Men Study and the Australian Longitudinal Study of Women's Health. PARTICIPANTS: Adults aged 70 to 75, 4,677 men and 4,563 women recruited in 1996 and followed for up to 10 years. MEASUReMENTS: Relative risk of all‐cause mortality and cause‐specific (cardiovascular disease, cancer, and chronic respiratory disease) mortality. RESULTS: Mortality risk was lowest for overweight participants. The risk of death for overweight participants was 13% less than for normal‐weight participants (hazard ratio (HR)=0.87, 95% CI=0.78–0.94). The risk of death was similar for obese and normal‐weight participants (HR=0.98, 95% CI=0.85–1.11). Being sedentary doubled the mortality risk for women across all levels of BMI (HR=2.08, 95% CI=1.79–2.41) but resulted in only a 28% greater risk for men (HR=1.28 (95% CI=1.14–1.44). CONCLUSION: These results lend further credence to claims that the BMI thresholds for overweight and obese are overly restrictive for older people. Overweight older people are not at greater mortality risk than those who are normal weight. Being sedentary was associated with a greater risk of mortality in women than in men.