Genetically predicted body composition in relation to cardiometabolic traits: a Mendelian randomization study

European Journal of Epidemiology - Fat mass and fat-free mass are found to be associated with different health outcomes in observational studies, but the underlying causality remains unclear. We...     

Water constituents and trace elements in relation to cardiovascular diseases

Significant inverse correlations between the hardness of drinking water and local cardiovascular mortality rates are found consistently in major national studies and less consistently within smaller regions. A number of bulk and trace constituents of finished water at the treatment plant show correlations with mortality of equal but not greater magnitude to the correlations of hardness with mortality. Little is known about these relationships with tap water, but levels of several trace metals of biological significance are known to vary markedly within water distribution systems and are probably related to types of pipe and the corrosiveness of the water supplied. Tap water studies and studies of localities within smaller regions are recommended to disentangle the association of water quality and health from the associations of both to other regionally distributed factors. Rainfall is one such factor which may influence the content of both drinking water and soil and thus human mineral intake. A number of other environmental and social factors seem unlikely to be intermediaries from the results of several multivariate studies.     

同型半胱氨酸与心脑血管疾病高危因素的孟德尔随机化研究

目的 采用孟德尔随机化方法,探讨同型半胱氨酸(Hcy)含量与心脑血管疾病高危因素间的潜在因果关联.方法 基于常州市武进区自然人群队列的2611个研究样本,采用全基因组芯片进行基因分型,选取全基因组关联研究确定的18个Hcy含量相关的单核苷酸多态性位点(Single Nucleotide Polymorphisms,SNPs)作为工具变量,构建Hcy的加权遗传评分(wGRS),分析Hcy相关wGRS与血压、空腹血糖、血脂等高危因素的关系.结果 孟德尔随机化研究结果显示,未发现Hcy相关wGRS与血压、血脂存在显著关联.在不饮酒者中,wGRS与血糖水平表现为正性统计学关联(β=0.33,95％ CI:0.03～0.63,P＜0.05);在饮酒者中,wGRS与血糖水平表现为负性统计学关联(β=-0.28,95％CI:-0.55～0.00,P＜0.05).结论 Hcy相关wGRS与血压、血脂无统计学关联,但对血糖的影响在不同饮酒状态者中的效应存在差别.     

Challenges for research and prevention in relation to work and cardiovascular diseases

The purpose of this paper is to discuss future challenges for research and prevention in the field of work environment and cardiovascular diseases (CVD). First, research on CVD and work during the last half of the 20th century is discussed. Second, the theories dominating the last 20 years are presented. Third, cardiovascular and occupational epidemiology are compared, and it is stressed that occupational epidemiology should avoid the individualistic bias of mainstream cardiovascular epidemiology. Finally, future challenges are discussed, and improvements are recommended concerning the use of intermediate end points, intervention research, theories about chemical and physical risk factors, the use of a unifying model for society, stress, and health, and the application of integrated prevention. It is concluded that research on CVD and work can play an important part in the development of integrated prevention strategies for the next century.     

Prevalence of cardiovascular diseases in Punjab,Pakistan: a cross-sectional study

Aim

The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan.

Subjects

Cardiovascular diseases (CVDs) are the leading cause of sudden death. CVDs are a major health problem in Pakistan, and the number of patients is increasing daily.

Aim

The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan.

Method

A cross-sectional study was conducted to investigate the prevalence of cardiovascular diseases in the local population of 53 cities in Punjab, Pakistan. A total of 6351 individuals were contacted to collect data using a questionnaire from October 2014 to September 2015. Data were collected directly by meeting the participants or indirectly through relatives and friends.

Results

Of the participants, 49.2% (3127/6351) were male and 50.8% (3224/6351) female. The data showed that 17.5% (1109/6351) of the population had CVDs with 16.6% (519/3127) being male and 18.3% (590/3224) female.

Conclusion

This study concluded that CVDs are a serious problem for both genders and affected 17.5% of the studied population. Diseases are more common in females than males with young age of onset. An inactive lifestyle, low level of activity and family history of disease could be disease risk factors in the study area.

     

Disability due to cardiovascular diseases

Extension of the time limits of temporary disability (TD) is an important method in preventing the disablement due to the key cardiac-and-vascular pathologies. Thus, the extension of TD term for patients with favorable clinical and labor prognostications and realization, during the same time period, of active all-possible therapeutic-and-recovery measures enabled a majority of such patients to catch up with their ability to work and to resume their former occupations.     

Organizational justice and insomnia: a prospective cohort study examining insomnia onset and persistence

Purpose

Insomnia is one of the most common health problems and causes a large social burden. Psychosocial work-related factors are reported to be associated with both insomnia onset and insomnia persistence. However, the association between organizational justice (OJ) and insomnia remains unclear. The objective of this study was to examine the effect of OJ on insomnia persistence, as well as insomnia onset.

Methods

A prospective cohort study with a 1-year observational period was conducted. Self-reported questionnaire data from 1588 employees were analyzed. OJ was measured using the Japanese version of the OJ questionnaire, which has four components (distributive, procedural, interpersonal, and informational). Insomnia was assessed with the Athens Insomnia Scale. Logistic regression analysis was used to explore the effects of OJ on insomnia.

Results

Among non-insomniac subjects at the baseline (n = 1236), low overall OJ was a risk of insomnia onset even after adjustment for lifestyle and work-related variables (adjusted odds ratio 0.66; 95% confidence interval 0.51–0.85). The procedural, interpersonal, and informational justice components were also associated with insomnia onset. Among insomniac subjects at the baseline (n = 352), low overall OJ, as well as the procedural and interpersonal justice components, was associated with insomnia persistence. Although these associations became insignificant after adjustment, the interpersonal justice component showed a marginally significant association with insomnia persistence (p = 0.058).

Conclusions

OJ, especially interpersonal justice, was revealed as an associated factor for both insomnia onset and persistence. These findings may provide useful information for prevention of insomnia among working population.

     

Age at menarche and lung function: a Mendelian randomization study

A trend towards earlier menarche in women has been associated with childhood factors (e.g. obesity) and hypothesised environmental exposures (e.g. endocrine disruptors present in household products). Observational evidence has shown detrimental effects of early menarche on various health outcomes including adult lung function, but these might represent spurious associations due to confounding. To address this we used Mendelian randomization where genetic variants are used as proxies for age at menarche, since genetic associations are not affected by classical confounding. We estimated the effects of age at menarche on forced vital capacity (FVC), a proxy for restrictive lung impairment, and ratio of forced expiratory volume in one second to FVC (FEV1/FVC), a measure of airway obstruction, in both adulthood and adolescence. We derived SNP-age at menarche association estimates for 122 variants from a published genome-wide meta-analysis (N = 182,416), with SNP-lung function estimates obtained by meta-analysing three studies of adult women (N = 46,944) and two of adolescent girls (N = 3025). We investigated the impact of departures from the assumption of no pleiotropy through sensitivity analyses. In adult women, in line with previous evidence, we found an effect on restrictive lung impairment with a 24.8 mL increase in FVC per year increase in age at menarche (95% CI 1.8–47.9; p = 0.035); evidence was stronger after excluding potential pleiotropic variants (43.6 mL; 17.2–69.9; p = 0.001). In adolescent girls we found an opposite effect (?56.5 mL; ?108.3 to ?4.7; p = 0.033), suggesting that the detrimental effect in adulthood may be preceded by a short-term post-pubertal benefit. Our secondary analyses showing results in the same direction in men and boys, in whom age at menarche SNPs have also shown association with sexual development, suggest a role for pubertal timing in general rather than menarche specifically. We found no effect on airway obstruction (FEV1/FVC).     

Blood pressure, the prevalence of cardiovascular diseases, and exposure to cadmium: a population study.

In a population study conducted from 1985 to 1989 in Belgium, the authors investigated whether exposure to cadmium is associated with blood pressure elevation and with an increased prevalence of cardiovascular diseases. The participants, aged 20-88 years, constituted a random sample of the households living in two low exposure areas (n = 803) and two high exposure areas (n = 1,283). For each exposure level, a rural and an urban district were selected. The cadmium levels in blood (8.5 vs. 11.0 nmol/liter) and urine (7.2 vs. 8.7 nmol/24 hours) were significantly (p less than 0.001) raised in the two high exposure areas compared with the two low exposure areas (p less than 0.001). Systolic pressure was similar in both rural areas, but in the urban area with high exposure systolic pressure was 5 mmHg (p less than 0.001) higher than in the control town. Diastolic pressure was similar in the four districts and the same was true for the prevalence of hypertension and of other cardiovascular diseases. Adjustment of systolic pressure for blood and urinary cadmium did not remove the difference in systolic pressure between both urban areas, suggesting that it was not related to the cadmium burden on the environment. Further analyses in individual subjects showed that neither blood pressure nor the presence of cardiovascular diseases were significantly and positively correlated with blood and urinary cadmium. Thus, the present population study did not confirm the hypothesis that increased exposure of the population to cadmium is associated with blood pressure elevation and with a higher prevalence of cardiovascular diseases.     

Unemployment and cardiovascular diseases: a causal relationship?

Unemployment has become a socio-political problem of great importance in the Western industrialised countries. Although negative effects on social life and psyche resulting from unemployment are regarded as scientifically accepted today, a possible causal relationship between job loss and somatic illnesses is still a matter of controversy. A possible target organ is the cardiovascular system. The aim of this study was therefore to check by means of extensive literature analysis to what extent unemployment can be seen to influence cardiovascular morbidity. Particular attention was paid to the methods used and the clinical relevance of the results. Person-related epidemiological studies published since 1980 which investigated changes in cardiovascular risk factors associated with unemployment or prevalence rates of manifest disease influenced by unemployment were included in the final evaluation. In some cases statistically significant associations were found between unemployment and the increase in cholesterol levels or systolic/diastolic blood pressure, but the clinical relevance of such slight changes is questionable. To consider unemployment as an independent, social, cardiovascular risk factor is at present unwarranted. An increase in the prevalence rates of coronary heart disease or arterial hypertension causally linked in some studies with unemployment is scientifically questionable due to severe methodological shortcomings. On the basis of the currently available methodologically acceptable studies, the question of a quantitative contribution of unemployment to cardiovascular disease cannot be answered conclusively. Received: 2 September 1996 / Accepted: 9 December 1996     

Genetic and environmental contributions to cardiovascular disease risk in American Indians: the strong heart family study

The aims of the Strong Heart Family Study are to clarify the genetic determinants of cardiovascular disease (CVD) risk in American Indians and to map and identify genes for CVD susceptibility. The authors describe the design of the Strong Heart Family Study (conducted between 1998 and 1999) and evaluate the heritabilities of CVD risk factors in American Indians from this study. In the first phase of the study, approximately 950 individuals, aged 18 years or more, in 32 extended families, were examined. The examination consisted of a personal interview, physical examination, laboratory tests, and an ultrasound examination of the carotid arteries. The phenotypes measured during the physical examination included anthropometry, lipoproteins, blood pressure, glycemic status, and clotting factors. Heritabilities for CVD risk factor phenotypes were estimated using a variance component approach and the program SOLAR. After accounting for the effects of covariates, the authors detected significant heritabilities for many CVD risk factor phenotypes (e.g., high density lipoprotein cholesterol (heritability = 0.50) and diastolic blood pressure (heritability = 0.34)). These results suggest that heredity explains a substantial proportion of the variability of CVD risk factors and that these heritabilities are large enough to warrant a search for major risk factor genes.     

Decrease in hospital admissions due to cardiovascular diseases

Since the late 1970s there has been a decline in cardiovascular mortality in the Netherlands. In recent years, the number of hospital admissions due to cardiovascular disease has decreased, whereas short-stay admissions and outpatients' visits are increasing. One explanation for this phenomenon, suggested by Koek et al. in this issue, is the limited availability and closure of hospital beds in recent years. However, there are other possible reasons for the decrease in cardiovascular mortality. First of all, there has been a substantial improvement in survival following acute myocardial infarction, mainly as a result of advances in the treatment. As all patients with an acute myocardial infarction are admitted anyway, the observed decrease in hospital admissions due to acute myocardial infarction reflects a decrease in the incidence as opposed to a decrease in the availability of hospital beds. Secondly, primary preventive measures aimed at modifying risk factors have been shown to result in a clear decrease in cardiovascular mortality. Lastly, mortality and morbidity due to chronic cardiovascular disease, such as heart failure, have decreased significantly. The range of options to adequately treat this category of patients has expanded considerably with, for example, the introduction of new drugs and biventricular pacemakers. There are many factors, other than the closure of hospital beds, which could explain the observed decline in the number of admissions due to cardiovascular disease.     

Anticoagulants in cardiovascular diseases

Anticoagulants form an important group of drugs in the management of cardiovascular diseases. These drugs are being increasingly employed but the indications and therapeutic regimens for their use remain unclear in certain situations. This review summarizes the currently accepted practice and aims to provide a balanced view of the ill-defined areas of anticoagulant therapy in cardiovascular diseases.