Association of systolic blood pressure levels with cardiovascular events and all-cause mortality among older adults taking antihypertensive medication

Introduction

The aim of the study was to identify the association of systolic blood pressure (SBP) levels with cardiovascular events, all-cause mortality, and falls among elderly persons taking antihypertensive medication.

Methods

US adults ≥ 45 years of age taking antihypertensive medication enrolled in the REGARDS study were categorized into 3 age groups: 55–64, 65–74 and ≥ 75 years old and baseline on-treatment SBP levels. Our primary analyses focused on incident cardiovascular disease (CVD) (n = 9787) and all-cause mortality (n = 13,948).

Results

During follow-up, 530 (5.4%) participants had CVD events and 2095 (15%) participants died. After multivariable adjustment among participants ≥ 75, the incidence of CVD per 1000 person-years (95% confidence interval) was 16.9 (11.1–25.7), 13.4 (9.2–19.7), 11.6 (7.6–17.7), 17.8 (11.2–27.5) and 36.7 (26.6–50.8) at SBP levels of < 120, 120–129, 130–139, 140–149, and ≥ 150 mm Hg, respectively. For the same SBP categories, the adjusted CVD incidence rates were 9.3 (7.2–12.0), 10.0 (8.1–12.3), 9.4 (7.5–11.8), 14.0 (11.0–17.8), and 16.4 (12.5–21.4), respectively, among participants 55–64 years, and 16.5 (13.6–21.5), 17.4 (14.8–20.6), 19.2 (16.4–22.5), 22.3 (18.6–26.9), and 27.6 (22.7–33.4), respectively, for participants 65–74 years. Among participants aged 55–64 and 65–74 years, a linear association was present between higher SBP categories and all-cause mortality risk (each p-trend < 0.001). In contrast, for participants ≥ 75 years no association was present between SBP and all-cause mortality (p-trend = 0.319). No association was observed between SBP and falls among participants in all age groups.

Conclusions

Among adults aged ≥ 55 taking antihypertensive medication, SBP between 120 and 139 mm Hg was significantly associated with a reduced risk for cardiovascular and all-cause mortality outcomes.     

阻塞性睡眠呼吸暂停和心血管事件相关性的Mate分析

目的前期研究表明阻塞性睡眠呼吸暂停(OSA)可能会增加心血管疾病的风险,但基于各种条件的限制,该结论尚无定论。本研究旨在于通过系统性评估前瞻性队列研究来进一步分析OSA与心血管事件的相关性。方法系统性检索PubMed与EMbase等电子数据库,查找关于OSA与成年人冠状动脉粥样硬化性心脏病(CHD,冠心病)、卒中及总心血管疾病(CVD)发生率之间的前瞻性队列研究。结果本研究共计纳入14项研究。与对照组相比,OSA组的心血管死亡率(OR=2.16,95%CI:1.4~3.18,P=0.03)、冠心病发病率(OR=1.49,95%CI:1.16~1.91,P=0.002)及高血压发生率(OR=1.82,95%CI:1.24~2.68,P=0.002)上存在统计学差异,而在心血管事件(OR=1.25,95%CI:0.38~4.13,P=0.72)、卒中发生率(OR=1.17,95%CI:0.75~1.82,P=0.50)及高脂血症发生率(OR=2.06,95%CI:0.96~4.44,P=0.06)方面,两组间无统计学差异。在亚组中,体质指数(BMI)≥30的OSA人群(OR=3.82,95%CI:1.90~7.68,P=0.0002)、OSA持续10年以上(OR=3.66,95%CI:2.07~6.47,P<0.00001)及中重度OSA患者(OR=3.52,95%CI:1.59~7.79,P<0.05)具有更高的心血管死亡率。结论这项研究证实OSA会增加心血管事件的死亡率,同时增加心血管事件的相关风险,尤其是中重度OSA患者。     

2014 Global geographic analysis of mortality from ischaemic heart disease by country,age and income: Statistics from World Health Organisation and United Nations

Background

Ischaemic heart disease (IHD) is the leading cause of death worldwide and its prevention is a public health priority.

Method

We analysed worldwide IHD mortality data from the World Health Organisation as of February 2014 by country, age and income. Age-standardised mortality rates by country were calculated. We constructed a cartogram which is an algorithmically transformed world map that conveys numbers of deaths in the form of spatial area.

Results

Of the countries that provided mortality data, Russia, the United States of America and Ukraine contributed the largest numbers of deaths. India and China were estimated to have even larger numbers of deaths. Death rates from IHD increase rapidly with age. Crude mortality rates appear to be stable whilst age-standardised mortality rates are falling. Over half of the world's countries (113/216) have provided IHD mortality data for 2008 or later. Of these, 13 countries provided data in 2012. No countries have yet provided 2013 data. Of the 103 remaining countries, 24 provided data in 2007 or earlier, and 79 have never provided data in the ICD9 or ICD10 format.

Conclusions

In the countries for which there are good longitudinal data, predominantly European countries, recent years have shown a continuing decline in age-standardised IHD mortality. However, the progressive aging of populations has kept crude IHD mortality high. It is not known whether the pattern is consistent globally because many countries have not provided regular annual data including wealthy countries such as the United Arab Emirates and large countries such as India and China.     

Plasma N-terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men.

AIMS: The prognostic significance of N-terminal pro-A-type (NT-proANP) and pro-B-type natriuretic peptides (NT-proBNP) is not well documented in population-based prospective studies. We, therefore, studied if both NT-proANP and NT-proBNP are predictive for overall death, cardiovascular events, and atrial fibrillation (AF) among middle-aged men without heart failure or AF at baseline. METHODS AND RESULTS: Plasma NT-proANP and NT-proBNP were measured in a representative population-based sample of 905 men (age 46-65 years) from eastern Finland. There were 110 deaths [58 cardiovascular and 40 coronary heart disease (CHD)] and 59 cases of AF during a follow-up of 10 years. The multivariable adjusted risk for overall was 1.35-fold (95% CI 1.15-1.57) and 1.52-fold (95% CI 1.21-1.91) for CHD death for each SD (160.8 pmol/L) increment in NT-proANP. The respective risks were 1.26-fold (95% CI 1.12-1.42) and 1.44-fold (95% CI 1.22-1.60) for each SD (58.9 pmol/L) increment in NT-proBNP. The adjusted risks for future AF were 1.46 (P<0.001) and 1.72-fold (P<0.001) for each SD increment in NT-proANP and NT-proBNP, respectively. CONCLUSION: The main finding of the present study is that NT-proANP and NT-proBNP are strong predictors of death from cardiovascular and other causes including AF. These natriuretic peptides add to the prognostic value of conventional risk factors and provide a non-invasive measure for identifying men with high risk of death and its co-morbidities.     

Estimation of 10-Year Risk of Death from Coronary Heart Disease,Stroke, and Cardiovascular Disease in a Pooled Analysis of Japanese Cohorts: EPOCH-JAPAN

Aims: We aimed to develop and validate risk prediction models to estimate the absolute 10-year risk of death from coronary heart disease (CHD), stroke, and cardiovascular disease (CVD). Methods: We evaluated a total of 44,869 individuals aged 40–79 years from eight Japanese prospective cohorts to derive coefficients of risk equations using cohort-stratified Cox proportional hazard regression models. Discrimination (C-index) of the equation was examined in each cohort and summarised using random-effect meta-analyses. Calibration of the equation was assessed using Hosmer-Lemeshow chi-squared statistic. Results: Within a median follow-up of 12.7 years, we observed 765 deaths due to CVD (276 CHDs and 489 strokes). After backward selection, age, sex, current smoking, systolic blood pressure (SBP), proteinuria, prevalent diabetes mellitus, the ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDLC), interaction terms of age by SBP, and age by current smoking were retained as predictors for CHD. Sex was excluded in the stroke equation. We did not consider TC/HDLC as a risk factor for the stroke and CVD equations. The pooled C-indices for CHD, stroke, and CVD were 0.83, 0.80, and 0.81, respectively, and the corresponding p -values of the Hosmer-Lemeshow tests were 0.18, 0.003, and 0.25, respectively. Conclusions: Risk equations in the present study can adequately estimate the absolute 10-year risk of death from CHD, stroke, and CVD. Future work will evaluate the system as an education and risk communication tool for primary prevention of CHD and stroke.     

Fasting blood glucose and risk of coronary heart disease, stroke, and all-cause mortality: a 17-year follow-up study of men born in 1913

This report concerns the relationship between baseline levels of fasting blood glucose (FBG) in non-diabetics and the subsequent 17-year incidence of coronary heart disease (CHD), stroke and all-cause mortality. In 1963, 973 men aged 50 years were recruited from a general Swedish urban population for a prospective study of risk factors for CHD. Eight hundred and fifty-five (88%) men agreed to participate and have been observed for 17 years. The 832 men who had no history of myocardial infarction, stroke, diabetes mellitus or who had a fasting blood glucose below 7.0 mmol/l at baseline were selected for this analysis. CHD occurred in 106 men, 35 developed a stroke and 137 died during follow-up. When quintiles and deciles of the FBG distribution were considered, no trend of 17-year incidence of CHD, stroke or death was apparent. However, for men with an FBG above the 95th percentile (greater than 5.7 mmol/l) a non-significant trend towards increasing risk was indicated.     

Contribution of changes in incidence and mortality to trends in the prevalence of coronary heart disease in the UK: 1996 2005.

Aims: To assess how trends in the incidence of coronary heart disease (CHD) and mortality rates among people with CHD have affected the prevalence of CHD in the UK. METHODS AND RESULTS: A time trend analysis using computerized general practice clinical records of people aged 35 years and over was performed. From 1996 to 2005, age-standardized incidence of CHD decreased by 2.2% in men and 2.3% in women per year (average percentage change). Age-standardized all-cause mortality among those with CHD decreased by 4.5% in men and 3.4% in women per year (average percentage change). Age-standardized prevalence increased by 1.3% in men and 1.7% in women per year (average percentage change). Although the decline in incidence had some impact on limiting the increase in prevalence, its effect was offset by the increase in prevalence occurring as a result of improved survival among people with CHD. CONCLUSION: The results suggest that increasing prevalence is largely due to decreasing mortality among people with CHD. Further increases in prevalence are likely even if the incidence of CHD continues to fall.     

Outdoor air pollution, mortality, and hospital admissions from coronary heart disease in Sheffield, UK: a small-area level ecological study.

AIMS: To examine the hypothesis that coronary heart disease mortality and emergency hospital admission rates are higher in areas with higher outdoor air pollution levels. METHODS AND RESULTS: Modelled nitrogen oxides (NO(x)), particulate matter (PM(10)), and carbon monoxide (CO) levels were interpolated to 1030 census enumeration districts using an ecological study design. Results, based on 6857 deaths and 11,407 admissions from 1994-98 and a population of 199,682 aged >or=45 years, were adjusted for age, sex, deprivation, and smoking prevalence. Mortality rate ratios were 1.17 (95% CI 1.06-1.29), 1.08 (95% CI 0.96-1.20), and 1.05 (95% CI 0.95-1.16) in the highest relative to the lowest NO(x), PM(10), and CO quintile categories, respectively. Corresponding admission rate ratios were 1.00 (95% CI 0.90-1.10), 1.01 (95% CI 0.90-1.14), and 0.88 (95% CI 0.79-0.98). CONCLUSION: The results are consistent with an excess risk of coronary heart disease mortality in areas with high outdoor NO(x), a proxy for traffic-related pollution, but residual confounding cannot be ruled out. If causality were assumed, 6% of coronary heart disease deaths would have been attributable to outdoor NO(x,) and targeting pollution reduction measures at high pollution areas would be an option for coronary mortality prevention.     

Relationship of elevated casual blood glucose level with coronary heart disease, cardiovascular disease and all-cause mortality in a representative sample of the Japanese population. NIPPON DATA80

Aims/hypothesis High fasting blood glucose is one of the well-known risk factors for CHD. However, in certain settings, patients cannot always be expected to fast. For example, community screenings for cardiovascular disease (CVD) risk factors in Japan are performed under non-fasting conditions to achieve high participation rates. Thus, we examined a representative cohort of the Japanese population (n = 9,444, follow-up period 17.3 years) to clarify whether high casual blood glucose (CBG) can predict CVD mortality. Methods We defined CBG groups as follows: high CBG ≥ 11.1 mmol/l or participants with a history of diabetes mellitus; borderline high, 7.77 ≤ CBG < 11.1 mmol/l; higher normal, 5.22 ≤ CBG < 7.77 mmol/l); and lower normal, CBG < 5.22 mmol/l. The multivariate-adjusted hazard ratios (HRs) for CHD, CVD and all-cause mortality were calculated. Results The crude CHD mortality rate was 0.84 per 1,000 person-years. Age- and sex-adjusted HRs for CHD mortality were high among participants with CBG levels  ≥ 7.77 mmol/l, regardless of time since last meal. Multivariate-adjusted HRs (95% CI) of CHD mortality in high and borderline high CBG groups were 2.62 (1.46–4.67) and 2.43 (1.29–4.58), respectively. Similar results were observed for both CVD and all-cause mortality. Even within the normal blood glucose range, each 1 mmol/l increase in CBG was associated with a statistically significant increase in the HR for CVD mortality (1.12, 95% CI 1.02–1.22). Population-attributable fractions of the combined groups of high and borderline high CBG for CHD, CVD and all-cause mortality were 12.0, 4.9 and 3.5%, respectively. Conclusions/interpretation Increases in CBG, even within the normal range, predict CVD mortality. Electronic supplementary material The online version of this article (doi:) contains a full list of the NIPPON DATA research group members, which is available to authorised users.     

Effect of xuezhikang on cardiovascular events and mortality in elderly patients with a history of myocardial infarction: a subgroup analysis of elderly subjects from the China Coronary Secondary Prevention Study

OBJECTIVES: To evaluate whether lipid-lowering therapy with xuezhikang reduces the risk of coronary events and total mortality in patients with coronary heart disease (CHD) aged 65 and older. DESIGN: Subgroup analysis of the China Coronary Secondary Prevention Study, a randomized, double-blind, placebo-controlled, clinical trial. SETTING: Sixty-six hospitals in China. PARTICIPANTS: A total of 1,445 patients, aged 65 to 75, were chosen from 4,780 patients with a history of myocardial infarction. INTERVENTION: The patients were randomized to the xuezhikang (n=735) or the placebo (n=710) group and followed for a mean of 4 years. MEASUREMENTS: The primary endpoint was recurrent coronary events; the secondary endpoint was all-cause mortality and other clinical events, including adverse effects. RESULTS: Elderly patients were at greater risk for coronary events, death from coronary events, all-cause mortality, and malignancies than younger patients. Xuezhikang therapy reduced the incidence of coronary events 36.9% (P=.001), death from coronary heart disease 31.0% (P=.04), all-cause mortality 31.9% (P=.01), stroke 44.1% (P=.04), the need for a percutaneous coronary intervention or coronary artery bypass graft 48.6% (P=.07), and malignancies 51.4% (P=.03). Based on the treatment of elderly patients with xuezhikang for an average of 4 years, the number needed to treat (NNT) to prevent one coronary event, one coronary death, and one mortality due to all causes was estimated to be 18, 33, and 23, respectively. In a like manner, the estimated NNT to prevent one coronary event, one coronary death, and one mortality due to all causes in younger patients was 23, 82, and 51, respectively. There was not a significantly greater number of adverse effects in the xuezhikang group than in the placebo group. CONCLUSION: This is the first study demonstrating that treatment with xuezhikang capsules is safe and effective for the secondary prevention of CHD in older Chinese people.     

<Emphasis Type="Italic">TCF7L2</Emphasis> single nucleotide polymorphisms,cardiovascular disease and all-cause mortality: the Atherosclerosis Risk in Communities (ARIC) study

Aims/hypothesis We hypothesised that TCF7L2 single nucleotide polymorphisms (SNPs) are associated with cardiovascular disease (CVD) and that the associations differ in diabetic and non-diabetic persons. Methods Our analysis included black and white participants from the Atherosclerosis Risk in Communities study who were free of prevalent CVD at baseline and had been genotyped for rs7903146, rs12255372, rs7901695, rs11196205 and rs7895340 (n = 13,369). Cox proportional hazard regression was used to estimate the associations between polymorphisms and incident events; logistic and linear regression were used for associations with baseline risk factor levels. Results TCF7L2 SNPs were not significantly associated with incident coronary heart disease, ischaemic stroke, CVD, prevalent peripheral artery disease (PAD) or all-cause mortality in the full cohort or when stratified by race. Conclusions/interpretation In the whole cohort, TCF7L2 SNPs were not associated with incident CVD, all-cause mortality or prevalent PAD. This result suggests that the increased health risk associated with rs7903146 genotype is specific to diabetes.     

All-cause and cardiovascular mortality in diabetic subjects increases significantly with reduced estimated glomerular filtration rate (eGFR): 10 years' data from the South Tees Diabetes Mortality study.

AIMS: To investigate the association between estimated glomerular filtration rate (eGFR) and total and cardiovascular mortality in a population-based cohort of diabetic subjects. METHODS: A longitudinal study using a population-based district diabetes register comprising 3288 subjects in South Tees, UK. The eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) study equation. Patients were stratified by baseline eGFR into five stages as per the National Kidney Foundation guidelines: Stage 1, eGFR > 90; Stage 2, eGFR 60-89; Stage 3, eGFR 30-59; Stage 4, eGFR 15-29; and Stage 5, eGFR < 15 ml/min per 1.73 m(2). Main outcome was all-cause and cardiovascular mortality between 1 January 1994 and 31 July 2004. RESULTS: At baseline, mean age (58.4 years) differed between groups. Persons with lower eGFR were older (P < 0.001). Thirty-six percent (n = 1193, males 56%) had died by 10 years (cardiovascular cause in 60%). Median follow-up was 10.5 years amounting to 28 342 person years. Stages 4 and 5 (eGFR 相似文献