Longitudinal Anthropometric Measures and Risk of New-Onset Atrial Fibrillation Among Community-Dwelling Men and Women

ObjectiveTo assess the sex-specific evolution of various anthropometric measures and the association of their longitudinal trajectories with new-onset atrial fibrillation (AF).MethodsAmong 5266 men and 7218 women free of AF at baseline from the prospective population-based Rotterdam Study, each anthropometric measure was measured 1 to 5 times from 1989 to 2014. Anthropometric measures were standardized to obtain hazard ratios per 1 SD increase to enable comparison. Joint models were used to assess the longitudinal association between anthropometric measures and incident AF. Use of the joint models is a preferred method for simultaneous analyses of repeated measurements and survival data for conferring less biased estimates.ResultsMean (SD) age was 63.9 (8.9) years for men and 64.9 (9.8) years for women. Median follow-up time was 10.5 years. Longitudinal evolution of weight, height, waist circumference, hip circumference, and body mass index was associated with an increased risk of new-onset AF in both men and women. In joint models, larger height in men (hazard ratio [95% credible interval] per 1 SD, 1.27 [1.17 to 1.38]) and weight in women (1.24 [1.16 to 1.34]) showed the largest associations with AF. In joint models, waist to hip ratio was significantly associated with incident AF only in women (1.10 [1.03 to 1.18]).ConclusionConsidering the entire longitudinal trajectories in joint models, anthropometric measures were positively associated with an increased risk for new-onset AF among men and women in the general population. Increase in measure of central obesity showed a stronger association with increased risk of AF onset among women compared with men.     

Effects of Weight Loss Among Metabolically Healthy Obese Men and Women

OBJECTIVE

Weight loss among metabolically healthy obese (MHO) individuals may be unnecessary or result in elevated cardio-metabolic risk. We studied the effects of exercise- or diet-induced weight loss on cardio-metabolic risk among MHO and metabolically abnormal obese (MAO) adults.

RESEARCH DESIGN AND METHODS

Participants were 63 MHO and 43 MAO adults who took part in 3 to 6 months of exercise- or diet-induced weight loss intervention. Changes in anthropometry, adipose tissue distribution, and cardio-metabolic risk factors were assessed.

RESULTS

Body weight, waist circumference, and total abdominal and visceral adipose tissue were reduced in all subjects (P < 0.05). Improvements in insulin sensitivity were observed in MHO and MAO men and women (P < 0.05), but were greater in the MAO individuals (P < 0.05). Fasting insulin was the only other cardio-metabolic improvement among MHO individuals (P < 0.05).

CONCLUSIONS

Lifestyle-induced weight loss among MHO subjects is associated with a reduction in total and abdominal obesity and improvement in selected cardio-metabolic risk factors.Weight loss among metabolically healthy obese (MHO) individuals characterized by low cardio-metabolic risk and low prospective risk of type 2 diabetes and cardiovascular disease may be unnecessary and paradoxically may actually increase health risk (1,2). That weight reduction may be contraindicated for MHO individuals is at odds with the standing recommendation from leading health authorities that weight loss be the primary treatment strategy for all obese patients, regardless of cardio-metabolic status (3). We sought to investigate the effects of exercise- and diet-induced weight reduction on cardio-metabolic risk factors among MHO and metabolically abnormal obese (MAO) adults.     

The Association between Unintended Pregnancy and Violence among Incarcerated Men and Women

Background: In this article, we examine the association between unintended pregnancy and individual and community level indicators of violence in a population of both women and men in the criminal justice system.

Methods: We conducted a cross-sectional survey with 290 women and 306 men in 3 correctional facilities in Kansas City and used logistic regression models to assess relationships between key independent variables and unintended pregnancy.

Findings: In gender-specific logistic regression models, women with a history of intimate partner violence were 2.02 times more likely (CI 1.15, 3.56), and those with a history of sexual abuse before age 16 were 1.23 times more likely (CI 1.02–1.49) to have experienced unintended pregnancy. Men or their family members who were victimized by neighborhood violence were 1.82 times more likely to have experienced unintended pregnancy (CI 1.01, 3.28).

Discussion: These findings suggest the need for gender and community-specific interventions that address the relationship between violence and unintended pregnancy.     

The Association Between Different A1C-Based Measures of Glycemia and Risk of Cardiovascular Disease Hospitalization

OBJECTIVE

We tested whether average monthly glycemic burden (AMGB), a marker of hyperglycemia that is a function of the extent and duration that A1C exceeded 7%, indicated greater risk of cardiovascular disease (CVD) than traditional A1C measures.

RESEARCH DESIGN AND METHODS

Using a case-control design, we studied 2,456 members of Kaiser Permanente Northwest with type 2 diabetes: 1,228 who experienced a CVD hospitalization, matched on age, sex, and duration of diabetes to 1,228 patients who were not hospitalized for CVD. We calculated AMGB from diabetes diagnosis until CVD hospitalization as a function of the difference between each actual or interpolated A1C measurement and 7%, resulting in an area under the curve estimate of hyperglycemic exposure, adjusted for number of months of observation. We used conditional logistic regression to compare the association between several A1C-based measures of glycemia and CVD, controlling for clinical characteristics and comorbidities.

RESULTS

AMGB was associated with increased CVD risk of 29% (odds ratio 1.29 [95% CI 1.16–1.44]; P < 0.001), while mean A1C was associated with a 22% risk increase (1.22 [1.09–1.37]; P < 0.001). A1C ever exceeding 7% was associated with increased CVD risk of 39% (1.39 [1.08–1.79]; P = 0.010). No model with a glycemia measure provided substantially more information than an identical model without a glycemia measure.

CONCLUSIONS

AMGB demonstrated somewhat greater CVD risk than mean A1C, but its clinical usefulness may be limited. A1C ever rising above 7% (53 mmol/mol) was a simple predictor of CVD risk that may have important clinical ramifications for newly diagnosed patients.     

Factors Associated With Sexually Transmitted Infections in Men and Women

Background: Sexually transmitted infections (STIs) remains a serious healthcare problem costing approximately 13 billion dollars annually to treat. Men and women who contract STIs have a higher risk for reinfection and for developing human immunodeficiency virus (HIV). Determining the risk factors associated with STIs in a community would be helpful in designing culturally appropriate tailored interventions to reduce spread of STIs. Purpose: The purpose of this retrospective chart review was to determine the frequency and type of STIs, as well as to determine the predictor variables associated with STIs among those seeking treatment at a local inner city health unit. Method: A total of 237 medical records were reviewed from a STI clinic. The sample comprised 119 men and 118 women, of whom 70.9% were African American. The mean age was 27, and 38% had a prior STI. Men used significantly more condoms (χ² = 24.28, p = 0.000), had more sexual partners (χ² = 18.36, p = 0.003), and had more prior infections of gonorrhea (χ² = 10.04, p =0.002) than women. Women had significantly more prior infections of Chlamydia (χ² = 11.74, p = 0.001). Using no type of birth control measures (pills, diaphragm, implants) was a significant predictor of number of sexual partners (t = 2.441, p < 0.015), but negatively associated with condom use (t = ?12.290, p < 0.000). Conclusions: Over one-third had a prior STI, indicating that individuals do not perceive themselves to be at risk for another STI, and choose not to use condoms. Reasons why individuals continue to put themselves at risk need to be explored in gender specific focus groups so that tailored sexual risk reduction programs can be designed to meet the needs of different communities.     

Egg Consumption and Risk of Type 2 Diabetes in Men and Women

OBJECTIVE—Whereas limited and inconsistent findings have been reported on the relation between dietary cholesterol or egg consumption and fasting glucose, no previous study has examined the association between egg consumption and type 2 diabetes. This project sought to examine the relation between egg intake and the risk of type 2 diabetes in two large prospective cohorts.RESEARCH DESIGN AND METHODS—In this prospective study, we used data from two completed randomized trials: 20,703 men from the Physicians'' Health Study I (1982–2007) and 36,295 women from the Women''s Health Study (1992–2007). Egg consumption was ascertained using questionnaires, and we used the Cox proportional hazard model to estimate relative risks of type 2 diabetes.RESULTS—During mean follow-up of 20.0 years in men and 11.7 years in women, 1,921 men and 2,112 women developed type 2 diabetes. Compared with no egg consumption, multivariable adjusted hazard ratios for type 2 diabetes were 1.09 (95% CI 0.87–1.37), 1.09 (0.88–1.34), 1.18 (0.95–1.45), 1.46 (1.14–1.86), and 1.58 (1.25–2.01) for consumption of <1, 1, 2–4, 5–6, and ≥7 eggs/week, respectively, in men (P for trend <0.0001). Corresponding multivariable hazard ratios for women were 1.06 (0.92–1.22), 0.97 (0.83–1.12), 1.19 (1.03–1.38), 1.18 (0.88–1.58), and 1.77 (1.28–2.43), respectively (P for trend <0.0001).CONCLUSIONS—These data suggest that high levels of egg consumption (daily) are associated with an increased risk of type 2 diabetes in men and women. Confirmation of these findings in other populations is warranted.Type 2 diabetes is highly prevalent and is associated with high health care costs and societal burden (1). Therefore, it is important to identify modifiable risk factors that may help reduce the risk of type 2 diabetes. Eggs are not only major sources of dietary cholesterol (∼200 mg/egg) but also contain other important nutrients such as minerals, vitamins, proteins, carotenoids, and saturated (∼1.5 g/egg), polyunsaturated (∼0.7 g/egg), and monounsaturated (∼1.9 g/egg) fatty acids (2,3). Whereas several of these nutrients have been associated with an increased risk of type 2 diabetes (i.e., saturated fat and cholesterol [4,5]), other nutrients may confer a lower risk of type 2 diabetes (i.e., polyunsaturated fat [4]).Whereas egg consumption was not associated with coronary heart disease (CHD) or stroke overall, Hu et al. (6) reported a twofold increased risk of CHD for egg consumption of more than one per week among men with type 2 diabetes in the Health Professionals’ Follow-up Study and a 49% increased risk of CHD among women in the Nurses’ Health Study, compared with intake of less than one per week. Furthermore, we have reported similar findings in U.S. male physicians with type 2 diabetes but not in those without type 2 diabetes (7), suggesting that frequent egg consumption may have negative health effects among individuals with type 2 diabetes. However, it is not known whether egg consumption increases the risk of type 2 diabetes itself. In animal experiments, a diet rich in fat has been shown to induce hyperglycemia and hyperinsulinemia (8). In addition, a diet enriched with egg yolk was associated with elevated plasma glucose compared with a control diet in rats (9). Data from the Zutphen Study (10) have indicated a positive association between egg consumption or dietary cholesterol and fasting glucose. However, in a randomized trial of 28 overweight or obese patients on a carbohydrate-restricted diet, consumption of three eggs per day had no effects on fasting glucose compared with abstention from eggs (11). Current data on the effects of dietary cholesterol on serum cholesterol have been inconsistent, ranging from positive associations (2,12) to lack of effect (12–14) and may be partly due to a large variability in individual response to dietary cholesterol (14,15).To our knowledge, no previous study has examined the association between egg consumption and the incidence of type 2 diabetes in a large prospective cohort of men and women. Because eggs can serve as a good source for vitamins, proteins, and other nutrients in the U.S., it is important to determine the net degree of benefit and harm of egg consumption on the risk of type 2 diabetes. The current study examines the association between egg consumption and incident type 2 diabetes among men and women who participated in two large completed randomized control trials.     

Inter- and Intraday Variability in Major Electrocardiogram Intervals and Amplitudes in Healthy Men and Women

DOTA, C.D., et al. : Inter- and Intraday Variability in Major Electrocardiogram Intervals and Amplitudes in Healthy Men and Women. The ECG may vary during the day (intra-day), and between days (interday), for the same subject. Variability in ECG characteristic measurements between different investigators is well documented and is often large. During days 1–6 of each placebo period of a two-way crossover Phase I study, digital ECGs were recorded at about 8 and 12 am in 16 healthy volunteers (8 men, 8 women). Two observers independently analyzed leads V₂ and V₆ using EClysis software. The durations and amplitudes of major ECG waves and the intervals between major electrocardiographic events were analyzed in a mixed model ANOVA, in which subject, observer, time, and day were treated as random factors. The influence of various corrections for heart rate on the variability of QT intervals was investigated. The difference among subjects explained between 44–81% of the total variability in ECG intervals and amplitudes. Overall, inter- and intraday variability was not statistically significant for any variable. The individualized exponential correction of the QT interval for heart rate eliminated the QT interval dependence on the RR interval in all subjects. Changes in T wave morphology and shortening of the QT interval from morning to noon were observed in ten subjects. The interobserver variability was close to zero   (SD < 0.005 ms)   for all variables except the PQ interval (SD 1.4 ms). The various sources of variability in determinations of ECG wave characteristics should be considered in the design of clinical studies. The use of EClysis software for ECG measurements in this study made the results highly observer independent. (PACE 2003; 26[Pt. II]:361–366)     

老年脑梗死患者继发血管性痴呆的危险因素分析

[目的]探讨老年脑梗死患者继发血管性痴呆(VD)的危险因素.[方法]在两院就诊的193例老年脑梗死患者根据是否发生VD将患者分为VD组(74例)与非VD组(119例),比较两组患者一般资料,采用Logistic回归分析影响患者发生VD的危险因素;采用受试者工作特征曲线(ROC)分析计量指标诊断VD发生的效能;采用Pea...     

The Effects of Exercise Therapy on CVD Risk Factors in Women

[Purpose] The purpose of this study was to search for the association of Type D personality and CVD risk factors through comparison of the association of exercise participation with CVD risk factors in women. [Subjects] The research subjects were randomly assigned to four groups: Type D+Exercise (n=12), Type D+non-exercise (n=12), non-Type D+Exercise (n=12), and non-Type D+non-exercise (n=10). The study consisted of 46 participants. [Methods] An aerobic exercise program and meditation were conducted in parallel for 10 months. Stretching was performed for 10 min as a warm-up, and then walking and running on a treadmill at 60 to 70% of HRmax were performed for 40 min three times a week. Blood samples were processed according to standard laboratory procedures. The concentrations of TG and HDL cholesterol were determined enzymatically using a clinical chemistry analyzer (Hitachi High-Technologies Corporation, Tokyo, Japan). [Results] The weight, percentage of body fat, waist circumference, triglyceride concentration, HDL cholesterol concentration, systolic blood pressure, and diastolic blood pressure showed a significant difference between measurement times in the exercise groups. [Conclusion] In conclusion, there were significant differences between groups in terms of cardiovascular disease risk factors.Key words: Exercise, CVD, Risk factor     

妊娠期糖尿病的危险因素分析

【目的】探讨妊娠期糖尿病（GDM）的危险因素。【方法】采用病例对照研究对引发GDM可能的15项危险因素,进行单因素、多因素Logistic回归分析。【结果】11项因素与GDM有关,其中有意识体育锻炼为保护因素,其他均为危险因素。【结论】高龄妊娠等是GDM发病的常见社会危险因素;孕妇有糖尿病家族史等是GDM的生理危险因素。     

The Association of Clinic-Based Mobility Tasks and Measures of Community Performance and Risk

Introduction

Gait speed is recognized as an important predictor of adverse outcomes in older people. However, it is unknown whether other more complex mobility tasks are better predictors of such outcomes.

Impaired Fasting Glucose and Risk of Cardiovascular Disease in Korean Men and Women: The Korean Heart Study

OBJECTIVE

The relationship between impaired fasting glucose (IFG) and risk of cardiovascular disease (CVD) or ischemic heart disease (IHD) varies widely according to sex and ethnicity. We evaluated the relationship between IFG and CVD or IHD among Korean men and women.

RESEARCH DESIGN AND METHODS

A total of 408,022 individuals who underwent voluntary private health examinations in 17 centers in South Korea were followed for 10 years. Data regarding CVD or IHD events were obtained from the Korean National Health Insurance database. IFG was categorized as grade 1 (fasting glucose 100–109 mg/dL) or grade 2 (110–125 mg/dL).

RESULTS

Incidence rates of CVD (per 100,000 person-years) were 2,203 for diabetes. Age-adjusted hazard ratios (HRs) for CVD were 1.17 (95% CI 1.13–1.20) for grade 1 IFG, 1.30 (1.24–1.35) for grade 2 IFG, and 1.81 (1.75–1.86) for diabetes. The increased risk for women was similar to that of men. Age-adjusted HRs for IHD and ischemic stroke were also significantly increased for men and women with IFG and diabetes. After multivariate adjustment of conventional risk factors (hypertension, dyslipidemia, smoking, obesity, and family history of CVD), the overall risk of CVD was greatly attenuated in all categories. However, the HRs for IHD and ischemic stroke remained significantly increased in men for grade 2 IFG but not in women.

CONCLUSIONS

In Korea, grade 2 IFG is associated with increased risk of IHD and ischemic stroke, independent of other conventional risk factors, in men but not in women.It is well-established that type 2 diabetes is associated with a marked increase in the risk of cardiovascular disease (CVD) and ischemic heart disease (IHD) (1–4). Studies suggest that atherosclerosis develops before the onset of clinical diabetes (5,6). Supporting this possibility, many studies have reported that impaired glucose tolerance (IGT) is associated with increased cardiovascular morbidity and mortality (7,8). However, the association between impaired fasting glucose (IFG) and risk of CVD and/or IHD remains unclear (7–18). Although some studies have reported that IFG was associated with a greater risk of IHD/CVD in women than in men (17,19), others have reported similar risks for men and women (18).There has also been considerable debate regarding the threshold glucose level associated with increased CVD risk. In 2003, the American Diabetes Association (ADA) lowered the fasting plasma glucose (FPG) cutoff point for IFG from 110 to 100 mg/dL (20). Some studies have reported that FPG levels of 110–125 mg/dL were associated with significantly higher rates CVD morbidity or mortality, but that FPG levels of 100–109 mg/dL were not (12,13). However, other investigators reported that the relationship between CVD risk and fasting glucose was continuous or J-shaped rather than showing a threshold effect at high glucose levels (18,21). However, most studies were based mainly on Caucasian populations, and only a few studies have assessed the relationship between IFG and CVD risk in Asian populations (13,14,18). Furthermore, most of these studies analyzed IHD and stroke together as CVD, whereas few studies have analyzed IHD, ischemic stroke, and hemorrhagic stroke separately (14,22).The primary purpose of this study was to determine whether IFG is associated with increased risk of CVD, IHD, and/or stroke in the Korean population. We also assessed potential sex differences, which have been shown in some previous studies (17,19). Finally, we evaluated whether the CVD risk associated with fasting serum glucose (FSG) levels of 100–109 mg/dL is similar to the risk associated with FSG levels of 110–125 mg/dL (the 1997 ADA definition of IFG).     

年轻女性早期子宫内膜癌临床高危因素分析

目的：通过比较年轻女性子宫内膜癌（endometrialcarcinoma,EC）与子宫内膜息肉（endometrialpolyps,EP）的相关发病因素、早期临床表现、辅助检查等的异同,来揭示年轻女性EC的临床高危因素。方法：以复旦大学附属妇产科医院2008年1月2011年12月收治的48例年龄≤40岁的年轻女性早期EC作为研究组,与同期收治的80例年龄≤40岁的EP（对照组）进行回顾性分析。结果：研究组肥胖者占42％,不孕不育者36％,平时月经稀发者29％,对照纽分别为35％、21％、8％,除肥胖在两组差异无显著性外,其余在两组的差异均有统计学意义（P〈O．05）。研究组合并糖尿病6％,高血压15％,肿瘤家族史6％,多囊卵巢综合症13％;对照组分别为1％、3％、4％、1％;其中合并高血压及多囊卵巢综合症患者比例的差异有统计学意义（P〈0．05）。研究组主诉月经失调者占92％,对照组为32％,差异有统计学意义（P〈0．01）。研究组贫血者17％,B超提示宫腔内实质结构者40％,内膜欠均者52％;对照组分别为1％、93％、6％,差异有统计学意义（P〈0．01）。结论：肥胖,不孕不育,长期月经稀发,有高血压、多囊卵巢综合症等病史,月经失调尤其月经过多伴经期延长、月经紊乱继发贫血者及月经稀发者,B超提示宫腔实质结构或内膜回声欠均等是年轻女性早期EC的临床高危因素,以上多种因素存在时应尽早行诊刮或宫腔镜检查,以便早期诊断EC,并合理治疗。