Burden of cardiovascular disease in Canada

BACKGROUND: This report updates the death estimates for cardiovascular disease (CVD) in Canada and introduces a population-based perspective on disease prevalence and health-related quality of life (HRQOL) burden. METHODS: The Canadian Mortality Database was used to estimate the mortality of men and women in different age groups for the 139 Canadian health regions from 1950 to 1999. Heart disease prevalence and its impact on HRQOL were estimated using the 2000-2001 Canadian Community Health Survey (CCHS). Life table techniques were used to estimate the impact of heart disease on life and health expectancy. RESULTS: Although CVD remains the leading cause of death in Canada, between 1950 and 1999 the death rates from CVD dropped from 702 per 100,000 to 288 per 100,000 men, and from 562 per 100,000 to 175 per 100,000 women. Results from the CCHS indicated that 5.4% of men and 4.6% of women reported having heart disease as diagnosed by a medical professional. Of these individuals, 14% of men and 21% of women reported difficulty ambulating - about six times more than people without heart disease. In total, 4.5 years of life expectancy and 2.8 years of health expectancy were lost due to CVD. The study also found large differences in the burden of CVD among men and women and across the 139 Canadian health regions. CONCLUSIONS: CVD is a major disease burden in terms of both mortality and HRQOL and is an important source of health inequalities between populations in Canada. Any attempt to improve the health of Canadians or to reduce health inequalities should include interventions to reduce CVD mortality and morbidity. Given the present impact of CVD on HRQOL, reducing or eliminating heart disease may potentially result in an increase in life expectancy that will be larger than the gains in health expectancy.     

Regional variations in cardiovascular mortality in Canada

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in Canada with wide, unexplained regional variations in heart disease mortality. However, no studies to date have explored the relationship between a number of health region characteristics and regional variation in heart disease mortality rates across Canada. INTRODUCTION: We studied the contribution of various traditional cardiac risk factors, social determinants of health and other community characteristics to regional variations in heart disease mortality rates across Canada. METHODS: Cardiovascular disease and ischemic heart disease (IHD) age-standardized mortality rates were obtained from Statistics Canada for three years - 1995 to 1997. Health region characteristics were taken from the 2000/2001 Canadian Community Health Survey, and the 1996 Canadian Census and the Labour Force Survey. Linear regression analyses and analyses of variance were employed to identify relationships between these health region characteristics and CVD and IHD mortality rates. RESULTS: Significant regional variations in CVD mortality rates per 100,000 population were observed. Newfoundland and Labrador had the highest CVD and IHD mortality rates, while Nunavut and the Northwest Territories had the lowest CVD and IHD mortality rates. Health region smoking and unemployment rates were identified as the most important factors associated with CVD and IHD mortality at the health region level. CONCLUSIONS: Significant regional variations in age-standardized CVD and IHD mortality were noted both at the provincial/territorial level and the health region level. Efforts to reduce CVD and IHD mortality in Canada require attention to both traditional risk factors (eg, smoking) and broader determinants of health (eg, unemployment rates).     

Regional variation in self-reported heart disease prevalence in Canada

BACKGROUND: Cardiovascular disease is the leading cause of death in Canada. OBJECTIVE: To provide an analysis of the self-reported prevalence of heart disease and three specific cardiac conditions--myocardial infarction (MI), angina and congestive heart failure (CHF)--in subgroups of the Canadian population. METHODS: Data from the Public Use Microdata File from Statistics Canada's 2000/2001 Canadian Community Health Survey (CCHS) were used to estimate the crude self-reported prevalence of heart disease, MI, angina and CHF in Canada. The data are reported by age and sex groups, as well as by province or territory and health region. RESULTS: Based on the 2000/2001 CCHS data, it was estimated that among Canadians 12 years of age and older, 5.0% (n=1,286,000) have heart disease, 2.1% (n=537,000) have had a heart attack, 1.9% (n=483,000) have angina and 1.0% (n=264,000) have CHF. Marked variation in the prevalence of heart disease and the other specific cardiac conditions exists across age and sex groups, and across geographical regions. The prevalence of heart disease is low among those younger than 50 years; thereafter, the prevalence of heart disease increases and is more common among men than among women. By 70 years of age, at least one in four men and one in five women report having heart disease. Large differences in the burden of heart disease were observed across provinces, territories and health regions. Comparison of the highest and lowest prevalence rates among provinces and territories revealed a 1.9-fold difference for heart disease, a 2.8-fold difference for MI, a 2.3-fold difference for angina and a 3.3-fold difference for CHF. CONCLUSIONS: Large regional differences in the prevalence of heart disease and other specific cardiac conditions were observed across Canada. These data may assist health system planners to identify those regions and population subgroups most affected by heart disease, and to support the development of heart disease prevention and treatment programs.     

Risk Factor Clusters and Cardiovascular Disease in High-Risk Patients: The UCC-SMART Study

Background:Clustering of vascular risk factors, i.e., the co-existence of two or more risk factors, has been associated with a higher risk of cardiovascular disease (CVD) in the general population. This study aims to firstly, examine patterns of clustering of major cardiovascular risk factors in high-risk patients and their relation with the risk of recurrent cardiovascular disease and all-cause mortality. Secondly, to assess which combinations are associated with the highest risk of CVD and all-cause mortality and to study population attributable fractions.Methods:A total of 12,616 patients from the Utrecht Cardiovascular Cohort – Second Manifestations of ARTerial diseases (UCC-SMART) study consisting of patients with or a high risk to develop cardiovascular disease were studied. We constructed sixteen clusters based on four individual modifiable risk factors (hypertension, dyslipidemia, current smoking, overweight). Patients were followed from September 1997 to March 2017. Cox proportional hazard models were used to compute adjusted hazard ratios for CVD risk and all-cause mortality and 95% confidence intervals for clusters, with patients without any risk factor as reference group. The population attributable fractions (PAFs) were calculated. Subgroup analyses were conducted by age and sex.Results:During a mean follow-up period of 8.0 years, 1836 CVD events were registered. The prevalence of patients with zero, one, two, three, and four risk factors was 1.4, 11.4, 32.0, 44.8 and 10.4%. The corresponding hazard ratios (HR) for CVD risk and all-cause mortality were 1.65 (95% CI 0.77; 3.54) for one risk factor, 2.61 (1.24; 5.50) for two, 3.25 (1.55; 6.84) for three, and 3.74 (1.77; 7.93) for four risk factors, with patients without any risk factor as reference group. The PAFs were 6.9, 34.0, 50.1 and 22.2%, respectively. The smoking-hypertension-dyslipidemia combination was associated with the highest HR: 4.06 (1.91; 8.63) and the hypertension-dyslipidemia combination with the highest PAF: 37.1%.Conclusion:Clusters including smoking and hypertension contributed to the highest risk of CVD and all-cause mortality. This study confirms that risk factor clustering is common among patients at high-risk for CVD and is associated with an increased risk of CVD and all-cause mortality.     

Smoking-attributable mortality and expected years of life lost in Canada 2002: conclusions for prevention and policy

Cigarette smoking is one of the most important risk factors for burden of disease. Our objective was to estimate the smoking-attributable deaths and the years of life lost for Canada 2002. For Canada in 2002, 37,209 of all deaths aged 0 to 80+ years were attributable to smoking, 23,766 in men and 13,443 in women. This constituted 16.6 percent of all deaths in Canada, 21 percent for men and 12.2 percent for women. Main causes of smoking-attributable death were malignant neoplasms (17,427), cardiovascular diseases (CVD) (10,275) and respiratory diseases (8,282). Lung cancer (13,401) and chronic obstructive pulmonary disease (COPD) (7,533) were the single largest disease contributors to deaths caused by smoking. 515,608 years of life were lost prematurely in Canada in that year, 316,417 years in men and 199,191 years in women. Cigarette smoking is a major contributor to mortality in Canada and its impact on Canadian society continues to be an unacceptable burden.     

Worksite Health and Wellness Programs: Canadian Achievements & Prospects

Canada has experienced a substantial reduction in mortality related to cardiovascular disease (CVD). There is a general consensus that more effective and widespread health promotion interventions may lead to further reductions in CVD risk factors and actual disease states. In this paper, we briefly outline the prevalence of selected risk factors for CVD in Canada, describe characteristics of the Canadian labor market and workforce, and depict what is known about health and wellness program delivery systems in Canadian workplaces. Our review indicates that there have been numerous and diverse relevant legislative and policy initiatives to create a context conducive to improve the healthfulness of Canadian workplaces. However, there is still a dearth of evidence on the effectiveness of the delivery system and the actual impact of workplace health and wellness programs in reducing CVD risk in Canada. Thus, while a promising model, more research is needed in this area.     

Complex Evolution of Epidemiology of Vascular Diseases,Including Increased Disease Burden: From 2000 to 2015

BackgroundVascular diseases, encompassing coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral artery disease (PAD), are leading causes of the global mortality and morbidity burdens. Our objective was to evaluate the temporal trends in the burden of vascular diseases in the province of Quebec from 2000 to 2015.MethodsWe identified subjects aged ≥ 20 years with vascular diseases in the Quebec Integrated Chronic Disease Surveillance System (a combination of 5 provincial health administrative datasets). We identified Quebecers with CHD, CVD, or PAD by tracking codes identifying vascular diseases (and interventions for CHD) in the hospitalization datasets. We used the 2011 Quebec standard population for age standardization.ResultsIn 2015, the crude prevalence of vascular diseases was 7.3% (n = 473,305), and the all-cause crude mortality rate was 6.6% (n = 31,320). Age-standardized prevalence of vascular diseases increased relatively by 21.4% between 2000 (5.6%; 99% confidence interval [CI], 5.5-5.6) and 2015 (6.8%; 99% CI, 6.7-6.8), whereas the age-standardized incidence and mortality rates showed relative decreases of 46.2% and 32.6%, respectively. PAD and CVD had lower prevalence and incidence but higher mortality than CHD. Most patients with CHD only had this vascular disease in contrast to patients with PAD who generally had diseases involving more than 1 vascular bed. CHD only and CHD with PAD ranked first and second, respectively, in mortality burdens.ConclusionsDuring the last decade, the age-standardized incidence and mortality rate of vascular diseases declined, but their prevalence increased with the overall burden of vascular diseases remaining substantial in Quebec, Canada.     

Mortalidad atribuida al consumo de tabaco en las comunidades autónomas de España, 2017

Introduction and objectivesTo estimate smoking-attributable mortality (SAM) in the regions of Spain among people aged ≥ 35 years in 2017.MethodsSAM was estimated using a prevalence dependent method based calculating the population attributable fraction. Observed mortality was derived from the National Statistics Institute. The prevalence of smoking by age and sex was based on the Spanish National Health Survey for 2011 and 2017 and the European Survey for 2014. Relative risks were reported from the follow-up of 5 North American cohorts. SAM and population attributable fraction were estimated for each region by age group, sex, and causes of death. Cause-specific and adjusted SAM rates were estimated.ResultsSmoking caused 53 825 deaths in the population aged ≥ 35 years (12.9% of all-cause mortality). SAM ranged from 10.8% of observed mortality in La Rioja to 15.3% in the Canary Islands. The differences remained after rates were adjusted by age. The highest adjusted SAM rates were observed in Extremadura in men and in the Canary Islands in women. Adjusted SAM rates in men were inversely correlated with those in women. The percentage of total SAM represented by cardiovascular diseases in each region ranged from 21.8% in Castile-La Mancha to 30.3% in Andalusia.ConclusionsThe distribution of SAM differed among regions. Conducting a detailed region-by-region analysis provides relevant information for health policies aiming to curb the impact of smoking.Full English text available from:www.revespcardiol.org/en     

Lifestyle and cardiovascular disease in middle-aged British men: the effect of adjusting for within-person variation.

AIMS: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index (BMI) and the development of cardiovascular disease (CVD) in middle-aged British men. METHODS AND RESULTS: In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events (fatal/non-fatal myocardial infarction or stroke) and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men (18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers (> or =40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6% for each 1 kg/m(2) increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of < or =25 kg/m(2) (6% of the population), 66% of the observed major CVD events would have been prevented or postponed (63% before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality. CONCLUSION: Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.     

Canada's Contribution to Global Research in Cardiovascular Diseases

The burden of cardiovascular disease (CVD) in Canada and other developed countries is growing, in part because of the aging of the population and the alarming rise of obesity. Studying Canada's contribution to the global body of CVD research output will shed light on the effectiveness of investments in Canadian CVD research and inform if Canada has been responding to its CVD burden. Search was conducted using the Web-of-Science database for publications during 1981 through 2010 on major areas and specific interventions in CVD. Search was also conducted using Canadian and US online databases for patents issued between 1981 and 2010. Search data were used to estimate the proportions of the world's pool of research publications and of patents conducted by researchers based in Canada. The results indicate that Canada contributed 6% of global research in CVD during 1981 through 2010. Further, Canada's contribution shows a strong upward trend during the period. Based on patent data, Canada's contribution level was similar (5%-7%). Canada's contribution to the global pool of CVD research is on par with France and close to the UK, Japan, and Germany. Canada's contribution in global CVD research is higher than its average contribution in all fields of research (6% vs 3%). As the burden of chronic diseases including CVD rises with Canada's aging population, the increase in Canadian research into CVD is encouraging.     

Insulin resistance/hyperinsulinemia and cancer mortality: the Cremona study at the 15th year of follow-up

Type 2 diabetes is associated with risk of cancer. Hyperinsulinemia and insulin resistance may be the link with cancer, but whether this is independent of the diabetes status, obesity/visceral obesity and metabolic syndrome is uncertain and the present study wanted to address this issue. Fifteen-year all-cause, CVD and cancer mortality data were obtained through the Regional Health Registry in 2,011 out of 2,074 Caucasian middle-aged individuals of the Cremona Study, a population study on the prevalence of diabetes mellitus in Italy in which anthropometric and metabolic characteristics were collected. During the 15-year observation period, 495 deaths were registered: 221 CVD related and 180 cancer related. Age and sex were independently associated with all-cause, cancer and CVD mortality rates. Age- and sex-adjusted analysis showed that HOMA-IR, cigarette smoking and diabetes were independently associated with all-cause mortality; HOMA-IR, systolic blood pressure and fibrinogen were independently associated with CVD mortality; HOMA-IR and smoking habit were independently associated with cancer mortality. Individuals in the highest quintile of serum insulin had a 62% higher risk of cancer mortality (HR?=?1.62 95% CI: 1.19?C2.20; P?<?0.0022) and 161% higher risk of gastrointestinal cancer mortality (HR?=?2.61 95% CI: 1.73?C3.94; P?<?0.0001). Age- and sex-adjusted analysis showed that hyperinsulinemia/insulin resistance is associated with cancer mortality independently of diabetes, obesity/visceral obesity and the metabolic syndrome.     

Joint impact of smoking and hypertension on cardiovascular disease and all-cause mortality in Japan: NIPPON DATA80, a 19-year follow-up.

Hypertension and smoking are major risk factors for death due to cardiovascular disease (CVD). These attributions for CVD mortality should be higher in the countries where obesity-related conditions are uncommon. However, the joint effect of these risk factors on CVD and all-cause mortality have not been described. We followed a representative 8,912 Japanese men and women without a history of stroke and heart disease. Participants were categorized into 4 groups as follows: a group of individuals who neither smoked nor had hypertension (HT), a group of current smokers, a group with HT, and a group of current smokers with HT. We further calculated population-attributable fractions (PAF) of CVD and all-cause mortality based on relative hazards assessed by proportional hazard regression models. After 19 years of follow-up, we observed 313 and 291 CVD and 948 and 766 all-cause deaths for men and women, respectively. The PAF of CVD mortality due to smoking or HT were 35.1% for men and 22.1% for women. The PAF of CVD mortality was higher in participants <60 years of age (57.4% for men and 40.7% for women) vs. those who were older (26.3% for men and 18.1% for women). Aggressive attempts to discourage smoking and to curb HT could yield large health benefits in Japan and throughout Asia, particularly for those aged <60 years. Efforts to warn about the adverse consequence of HT and smoking during adolescence and youth could yield the greatest health benefits, since positive behaviors adopted early are more easily continued into middle adulthood and later life.     

Ankle-brachial index as a predictor of all-cause and cardiovascular disease mortality in 3733 Chinese patients with high cardiovascular risk

Objective To assess the association between 1-year risk of all-cause and cardiovascular disease （CVD） mortality and ankle-brachial index （ABI） in Chinese patients who were at high CVD risk. Methods Totally 3733 patients with high CV risk had bilateral ABI measurements at baseline and were followed up for 1-1.5 years. Patients were divided to four groups： 1） coronary heart disease （CHD）; 2） ischemic stroke （IS）; 3） diabetes mellitus （DM）; 4） very high risk group（VHR）, low ABI was defined as 〈0.9. Results A total of 3179 patients were analyzed. The prevalence of low ABI was 28.1%. At 1 year, all-cause mortality was 8.7%, and 27.6% was attributable to CVD; mortality due to CV events was 4.8% and 1.5%. After adjusting other risk factors the hazard ratio of low ABI was 1.623 for all-cause mortality and 2.304 for CVD mortality. Similar in patient with and without low ABI, respectively were found in four groups.Conclusion ABI is a strong and independent predictor ofrnortality. Patients with a low ABI have a substantially increased risk of all-cause mortality and CVD mortality （J Geriatr Cardio12010; 7：17-20）.     

Depression and cardiovascular sequelae in postmenopausal women. The Women's Health Initiative (WHI)

BACKGROUND: Subclinical depression, often clinically unrecognized, may pose increased risk of cardiovascular disease. Few studies have prospectively investigated cardiovascular events related to depression in older women. We describe prevalence, cardiovascular correlates, and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women. METHODS: The Women's Health Initiative Observational Study followed up 93 676 women for an average of 4.1 years. Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale. Risks of cardiovascular disease (CVD) events were estimated from Cox proportional hazards models adjusting for multiple demographic, clinical, and risk factor covariates. RESULTS: Current depressive symptoms above the screening cutoff point were reported by 15.8% of women. Depression was significantly related to CVD risk and comorbidity (odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina). Among women with no history of CVD, depression was an independent predictor of CVD death (relative risk, 1.50) and all-cause mortality (relative risk, 1.32) after adjustment for age, race, education, income, diabetes, hypertension, smoking, high cholesterol level requiring medication, body mass index, and physical activity. Taking antidepressant medications did not alter the depression-associated risks associated. CONCLUSIONS: A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality, even after controlling for established CVD risk factors. Whether early recognition and treatment of subclinical depression will lower CVD risk remains to be determined in clinical trials.     

Impact of diabetes/metabolic syndrome in patients with established cardiovascular disease

The significance of the metabolic syndrome (MetS) resides either in its ability to identify individuals at high risk of future disease and disability or in its ability to identify individuals in need of a specific treatment. We have previously shown that in the general population the ability of the MetS to identify individuals at increased risk of diabetes or cardiovascular disease (CVD) is inferior to the ability of established predicting models for these conditions. Although it may someday become routine to recommend treatment with insulin-sensitising agents for non-diabetic individuals with the MetS, most of whom are insulin resistant, there are no clinical trial data to support such a recommendation at the present time. Currently, the treatment of the MetS is based on treatment of its component parts. In the present paper, we examine the role of the MetS as defined by the National Cholesterol Education Program (NCEP) criteria in predicting all-cause and CVD mortality in patients with prevalent CVD from the San Antonio Heart Study (SAHS). This population contains a high proportion of Mexican Americans, who are at high risk of developing type 2 diabetes. After adjusting for age and gender, the MetS is moderately predictive of all-cause and CVD mortality. After further adjustment for diabetes, however, the effect of the MetS becomes non-significant in this population. Moreover, among non-diabetics with prevalent CVD, the MetS was not associated with either all-cause or CVD mortality. Thus, this study indicates that the effect of the MetS on these endpoints is primarily driven by the inclusion in the NCEP definition of diabetes, itself a well-established, potent CVD risk factor. In fact, the prevalence of diabetes in SAHS patients with CVD and the MetS was 42% compared with only 9% in patients with CVD, but without the MetS. This excess prevalence of diabetes appears to account for the enhanced all-cause and CVD mortality in subjects with the MetS. However, these results will need to be confirmed in other populations.     

Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population.

AIMS: Chronic kidney disease (CKD) was found to be an independent risk factor for all-cause mortality as well as adverse cardiovascular disease (CVD) events in high-risk populations. Findings from population-based studies are scarce and inconsistent. We investigated the gender-specific association of CKD with all-cause mortality, cardiovascular mortality, and incident myocardial infarction (MI) in a population-based cohort. METHODS AND RESULTS: The study was based on 3860 men and 3674 women (aged 45-74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. CKD was defined by an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m(2). Hazard ratios (HRs) were estimated from Cox proportional hazard models. In this study, 890 total deaths, 400 CVD deaths, and 321 incident MIs occurred in men up to 31 December 2002; the corresponding numbers in women were 442, 187, and 102. In multivariable analyses, the HR for women with CKD compared to women with preserved renal function was significant for incident MI [HR 1.67; 95% confidence interval (CI) 1.07-2.61] and CVD mortality (HR 1.60; 95% CI 1.17-2.18). In men, CKD was also significantly associated with incident MI (HR 1.51; 95% CI 1.09-2.10) and CVD mortality (HR 1.48; 95% CI 1.15-1.92) after adjustment for common CVD risk factors. In contrast, men and women with CKD had no significant increased risk of all-cause mortality. CONCLUSION: CKD was strongly associated with an increased risk of incident MI and CVD mortality independent from common cardiovascular risk factors in men and women from the general population.     

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.     

Prospective cohort study of hostility and the risk of cardiovascular disease mortality

BACKGROUND: Recent literature reviews have questioned hostility as a risk factor for heart disease. However, controversy persists due to the rarity of large-scale prospective cohort studies of initially healthy populations. METHODS: We prospectively investigated the association between hostility and cardiovascular (and all-cause) mortality among 20,550 men and women, 41-80 years of age, participating in the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk), United Kingdom study. Participants were recruited by post from general practice age-sex registers and subsequently attended health checks that included the assessment of coronary disease risk factors. Hostility assessment was completed by postal questionnaire. RESULTS: During mean follow-up of 6 years, 1284 deaths were recorded including 481 from cardiovascular disease (CVD). Hostility was not associated with CVD mortality, after adjustment for age and prevalent disease, in either men (rate ratio for a 1 SD decrease in hostility score, representing increased hostility, 1.09; 95% confidence interval 0.98-1.22) or in women (rate ratio 1.00; 95% confidence interval 0.86-1.26). Subgroup analysis suggested hostility may be associated with CVD mortality (independent of age, prevalent disease and cigarette smoking) for participants reporting very high hostility and for those aged less than 60 years. CONCLUSIONS: Hostility was not associated with an increased risk of cardiovascular mortality in this population study of older adults.     

Mortalidad atribuible al consumo de tabaco en España 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, or current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiovascular diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

Trends in self-reported multiple cardiovascular disease risk factors among adults in the United States, 1991-1999

BACKGROUND: There are few national- and state-level data on multiple cardiovascular disease (CVD) risk factor status and trends over time. We examined the prevalence of self-reported multiple CVD risk factors from 1991 through 1999. METHODS: The Behavioral Risk Factor Surveillance System is a state-based telephone survey of adults 18 years or older. Surveys in 1991, 1993, 1995, 1997, and 1999 ascertained reported high blood pressure, high blood cholesterol level, diabetes, obesity, and current smoking status. Trends in the prevalence of persons with each risk factor and of having 2 or more risk factors were calculated. Data were age standardized to the 2000 US population. RESULTS: From 1991 to 1999, the prevalence of reported high blood pressure increased from 23.8% to 25.4%, high cholesterol levels increased from 24.9% to 27.7%, diabetes increased from 5.5% to 7.1%, obesity increased from 13.5% to 20.3%, and smoking remained at approximately 21%. The prevalence of adults with 2 or more risk factors increased from 23.6% in 1991 to 27.9% in 1999 and significantly increased for both men and women and for all race or ethnic, age, and education groups. Among states, the prevalence of multiple risk factors ranged from 15.0% to 29.9% in 1991 and from 18.7% to 37.1% in 1999. From 1991 to 1999, the prevalence of multiple risk factors increased by 10% or more in 36 states. CONCLUSIONS: The substantial proportion of persons with known multiple risk factors (25% of the population) suggests that increased CVD prevention and risk factor reduction efforts should focus on comprehensive risk reduction strategies.