Magnesium intake and incidence of stroke: Meta-analysis of cohort studies

Background and aimsProspective cohort studies are inconsistent regarding the association between magnesium intake and the risk of stroke. The objective was to perform a meta-analysis to summarise the relationship between magnesium intake and risk of stroke in observational studies.Methods and resultsWe searched the PubMed and EMBASE databases for studies conducted from 1966 through August 2011. Prospective studies that provided relative risk (RR) estimates with 95% confidence intervals (CIs) for the association between magnesium intake and the risk of total stroke incidence or mortality were included. Data were independently abstracted by two investigators using a standardised protocol. Study-specific risk estimates were combined by using a random effects model.A total of eight studies, with 8367 stroke cases among 304,551 participants, were included in the meta-analysis. The summary RR indicated a significant association between the highest magnesium intake and reduced risk of total stroke (summary RR: 0.89; 95% CI: 0.82, 0.97); our dose–response analysis showed a borderline inverse association between magnesium intake and total stroke risk (an increment of 100 mg day^?1; summary RR: 0.98; 95% CI: 0.95, 1.00). Subgroup analyses suggested a significant inverse association between highest magnesium intake and the risk of ischaemic stroke (summary RR: 0.88; 95% CI: 0.80, 0.98).ConclusionThe present meta-analysis of prospective cohorts suggests that higher magnesium intake is associated with reduced risk of total and ischaemic stroke. However, well-designed randomised controlled trials are needed to draw a definitive conclusion.     

Impact of Diabetes on Stroke Risk and Outcomes: Two Nationwide Retrospective Cohort Studies

Several limitations existed in previous studies which suggested that diabetic patients have increased risk of stroke. We conducted this study to better understand the stroke risk and poststroke outcomes in patients with diabetes.From the claims data of Taiwan''s National Health Insurance, we identified 24,027 adults with new-diagnosed diabetes and 96,108 adults without diabetes between 2000 and 2003 in a retrospective cohort study. Stroke events (included hemorrhage, ischemia, and other type of stroke) during the follow-up period of 2000 to 2008 were ascertained and adjusted risk of stroke associated with diabetes was calculated. A nested cohort study of 221,254 hospitalized stroke patients (included hemorrhage, ischemia, and other type of stroke) between 2000 and 2009 was conducted. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for adverse events after stroke hospitalization in patients with and without diabetes.The incidences of stroke in cohorts with and without diabetes were 10.1 and 4.5 per 1000 person-years, respectively. During the follow-up period, diabetic patients had an increased risk of stroke (adjusted hazard ratio: 1.75; 95% CI: 1.64–1.86) than those without diabetes. Associations between diabetes and stroke risk were significant in both sexes and all age groups. Previous diabetes was associated with poststroke mortality (OR: 1.33; 95% CI: 1.19–1.49), pneumonia (OR: 1.30; 95% CI: 1.20–1.42), and urinary tract infection (OR: 1.66; 95% CI: 1.55–1.77). The impact of diabetes on adverse events after stroke was investigated particularly in those with diabetes-related complications.Diabetes was associated with stroke risk, and diabetic patients had more adverse events and subsequent mortality after stroke.     

Phylloquinone intake and risk of cardiovascular diseases in men

Background and aimsDietary patterns high in fruits and vegetables have been associated with lower risk of cardiovascular diseases. It is difficult to assess whether individuals are following a dietary pattern recommended for cardiovascular disease prevention in large population based studies. Therefore, the association between phylloquinone (vitamin K₁) intake, derived mainly from green vegetables, and risk of cardiovascular diseases [total and fatal coronary heart disease (CHD), non-fatal myocardial infarction, total and ischemic stroke] was prospectively assessed.Methods and resultsThe study was conducted in 40,087 men who participated in the Health Professionals' Follow-up Study during 1986–2000. There were 1857 CHD events and 617 strokes. After adjustment for lifestyle factors, the relative risks of total CHD events in increasing quintile categories of phylloquinone intake were 1 (reference), 0.84, 0.87, 0.82 and 0.84, respectively (P for trend 0.05). However, the risk of CHD events and strokes did not remain significantly associated with phylloquinone intake after adjustment for lifestyle and other dietary factors.ConclusionThese results suggest that although not an independent risk factor, high phylloquinone intake may be a marker of dietary patterns associated with lower CHD risk and useful when used within that context.     

Antioxidant vitamins in the prevention of cardiovascular disease: a systematic review

Abstract. Asplund K (Umeå and Stockholm, Sweden). Antioxidant vitamins in the prevention of cardiovascular disease: a systematic review (Review). J Intern Med 2002; 251: 372–392. Do antioxidant vitamins, in regular food or as food supplements, protect against myocardial infarction and stroke? In this systematic literature review on the effects of antioxidant vitamins in the primary prevention of cardiovascular disorders, studies with ischaemic heart disease, stroke or combined cardiovascular events as end‐points have been included. Studies on the effects of antioxidant vitamins on intermediary end‐points (such as blood lipids and blood pressure) and as secondary prevention in patients with manifest cardiovascular disease are reviewed in a conventional manner. In observational studies (case–control or cohort design), people with high intake of antioxidant vitamins by regular diet or as food supplements generally have a lower risk of myocardial infarction and stroke than people who are low‐consumers of antioxidant vitamins. The associations in observation studies have been shown for carotene, ascorbic acid as well as tocopherol. In randomized controlled trials, however, antioxidant vitamins as food supplements have no beneficial effects in the primary prevention of myocardial infarction and stroke. Serious adverse events have been reported. After an initial enthusiasm for antioxidants in the secondary prevention of cardiovascular disease, recent reports from of several large randomized trials have failed to show any beneficial effects. Thus, the apparent beneficial results of high intake of antioxidant vitamins reported in observational studies have not been confirmed in large randomized trials. The discrepancy between different types of studies is probably explained by the fact that supplement use is a component in a cluster of healthy behaviour. Antioxidant vitamins as food supplements cannot be recommended in the primary or secondary prevention against cardiovascular disease.     

咖啡与脑卒中风险的剂量-反应Meta分析

目的:用Meta分析方法评估咖啡与脑卒中风险之间的关系。方法:计算机检索Pubmed、EMBASE、Cochrane图书馆、中国生物医学文献、中国知网、万方和维普数据库,收集关于咖啡与脑卒中风险关系的前瞻性队列研究,由2位研究员按纳入排除标准独立筛选文献、提取资料并用卡斯尔-渥太华量表(NOS)评价文献质量。用Stata/SE 15.0软件进行统计分析。结果:共纳入17项前瞻性队列研究、1142274例受试者,其中包括83433例脑卒中患者。Meta分析结果显示,咖啡可明显降低脑卒中风险(RR=0.80,95%CI:0.75~0.85),但并不能降低日本人群的脑卒中风险。剂量-反应Meta分析显示,咖啡摄入量与脑卒中风险之间呈非线性关系(非线性P值<0.001)。与从不喝咖啡者相比,每天喝2、4、6、8杯咖啡者的脑卒中相对风险分别为0.87(95%CI:0.82~0.92)、0.83(95%CI:0.76~0.90)、0.84(95%CI:0.74~0.95)、0.86(95%CI:0.72~1.03)。结论:咖啡摄入量与脑卒中风险呈非线性关系,适量摄入咖啡与脑卒中风险呈负相关,每天喝4~5杯咖啡时脑卒中风险最低。但现有的研究证据不能证明喝咖啡能明显降低亚洲人群的脑卒中风险。     

Dietary salt intake and cerebrovascular damage

AIM: Diet is a major contributor to variation in the occurrence of hypertension and cardiovascular disease, including stroke, worldwide. Dietary salt intake plays a critical role in blood pressure regulation. However the question of whether high dietary salt intake increases risk of stroke, either indirectly via effects on blood pressure or directly via alternative mechanisms has received limited attention. DATA SYNTHESIS: Narrative review of evidence linking dietary salt intake with left ventricular hypertrophy and cardiovascular disease end-points. CONCLUSIONS: There is accumulating evidence that high salt intake predicts left ventricular hypertrophy, independent of other variables including body mass index and blood pressure. Data are now available from nine different studies worldwide consistent with a significant independent effect of salt intake on left ventricular hypertrophy. There is also evidence from animal experiments and ecological studies of an independent association between salt intake and risk of stroke. However, data from prospective observational studies on the relation between sodium intake and cardiovascular endpoints (including stroke) are sparse and inconsistent. Data from Alderman et al suggesting that there may be a significant inverse association between urinary sodium excretion and risk of cardiovascular disease has attracted controversy. In a number of prospective studies no association between salt intake and cardiovascular disease end-points (including stroke) has been observed. In a recent analysis from the US NHANES follow-up study, there was evidence that high salt intake is strongly and significantly associated with risk of stroke, other cardiovascular disease and all cause mortality in overweight persons, but not in those of normal weight. These findings need to be replicated. However, current data on the association between salt intake, blood pressure and left ventricular hypertrophy support public policy recommendations on the need for a moderate reduction in dietary salt intake at the population level.     

Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: A systematic review with meta-analysis and trial sequential analysis

Background: Elderly population is known to be associated with polymedication, comorbidities and altered drug pharmacokinetics. However, the most adequate oral anticoagulant, attending to its relative efficacy and safety, remains unclear.Methods: We searched for phase III randomized controlled trials (MEDLINE, Cochrane Library, SciELO collection and Web of Science) comparing novel non-vitamin K antagonist oral anticoagulants (NOACs) with Vitamin K antagonists (VKA) in the elderly population (≥75 years-old) in atrial fibrillation (AF). Risk ratios (RR) were calculated using a random effects model. Trial sequential analysis (TSA) was performed in statistically significant results to evaluate whether cumulative sample size was powered.Results: Four trials rendered data about elderly (≥75 years-old) and younger patients (<75 years-old) with AF. NOACs demonstrated a 30% significant risk reduction (RR 0.70, 95% CI: 0.61 to 0.80) in elderly patients compared to VKA, without heterogeneity across studies (I² = 0%). The TSA showed that cumulative evidence of this subgroup exceeded the minimum information size required for the risk reduction. In younger patients, VKA and NOACs shared a similar risk of stroke and systemic embolism (RR 0.97, 95% CI: 0.79 to 1.18). Regarding major bleeding risk in the elderly, the overall comparative risk of NOACs was not different from VKA (RR 0.91, 95% CI: 0.72 to 1.16; I² = 86%).Conclusions: NOACs reduce significantly the risk of stroke and systemic embolism in elderly patients without increasing major bleeding events. The dimension of stroke risk reduction was significantly higher in the elderly than in younger adults.     

What is the role of dietary sodium and potassium in hypertension and target organ injury?

There is substantial evidence from both observational epidemiology studies and randomized controlled trials that dietary intake of sodium and potassium is important in the etiology of hypertension. However, the direct evidence for a direct link between dietary sodium and potassium and risk of cardiovascular and renovascular events is limited. Epidemiological studies should be designed to examine the relationship between dietary intake of sodium and potassium and risk of stroke, coronary heart disease, left ventricular hypertrophy, and renal disease in a prospective manner. In these studies, dietary intake of sodium and potassium should be estimated using multiple 24-hour urine collections. These studies should be focused on African Americans because they are at a disproportionately high risk of developing hypertension and blood pressure-related vascular disease. Moreover, this group has been underrepresented in most previous epidemiological studies.     

Prospective study of serum uric acid levels and stroke in a Chinese hypertensive cohort

Our aim was to investigate the association between serum uric acid (SUA) levels and the risk of first stroke in a Chinese population of hypertensive patients. This prospective study enrolled 20,577 hypertensive participants who without a history of stroke, and was conducted from May 2008 to August 2013 in Anqing and Lianyungang (China). A total of 632 (3.1%) first stroke events (510 ischemic events, 120 hemorrhagic events and 2 unspecified stroke events) were identified during a mean 4.5-year follow-up period. The risk of first stroke was not significantly associated with the increased SUA levels; this conclusion was also found after adjustment for gender and age. However, a statistically significant decreased risk of hemorrhagic stroke for the second SUA quartile (Q2) compared to the first quartile (Q1) (HR 0.56, 95%CI: 0.32–0.97, P = 0.037) was found. In addition, when grouped by tertiles of diastolic blood pressure (DBP), the results showed that high SUA lowered the risk of total stroke in participants in the third SUA quartile (Q3) (HR 0.69, 95%CI: 0.49–0.96, P = 0.028) and fourth SUA quartile (Q4) (HR 0.70, 95%CI: 0.50–0.99, P = 0.043) as compared with that in the first quartile (Q1). To sum up, no significant evidence in present study indicates that increased SUA levels are predictive of first stroke in a Chinese population of hypertensive patients.     

Consumption of nuts and legumes and risk of stroke: A meta-analysis of prospective cohort studies

Background and aimThe relationships between dietary nuts and legume intake and risk of stroke are inconsistent. We summarized the evidence by a meta-analysis of prospective cohort studies.Methods and resultsWe systematically searched the MEDLINE and EMBASE databases up to 31 January 2014. Random-effects models were used to calculate summary relative risks (SRRs) and 95% confidence intervals (CIs). Between-study heterogeneity was assessed using the Cochran's Q and I² statistics.Eight prospective studies with a total of 468,887 subjects and 10,493 stroke events were included in the meta-analysis. Overall, a diet containing greater amounts of legumes may be not associated with a lower risk of stroke (SRR = 0.95, 95% CI: 0.84–1.08; P_{heterogeneity} = 0.091, I² = 43.2%); however, a diet containing greater amounts of nuts may be associated with a lower risk of stroke (SRR = 0.90, 95% CI: 0.81–0.99; P_{heterogeneity} = 0.527, I² = 0). Gender significantly modified the effects of nut consumption on stroke risk, and high nut intake was associated with reduced risk of stroke in women (SRR = 0.85, 95% CI: 0.75–0.97) other than in men (SRR = 0.95, 95% CI: 0.82–1.11).ConclusionThe current meta-analysis provides some evidences for the hypothesis that high intake of dietary nut was inversely associated with stroke risk, whereas dietary legumes intake was not associated with stroke risk.     

Association between difference in blood pressure reduction and risk of cardiovascular events in a type 2 diabetes population: A meta-regression analysis

AimRecent US recommendations indicate a target blood pressure (BP) of 130/80 mmHg for patients with type 2 diabetes (T2D). Our aim was to characterize the association between risk of cardiovascular events and differences in BP decreases in randomized trials of a T2D population.MethodsA systematic search was made for randomized clinical trials assessing the effects of antihypertensive treatments in T2D patients on mortality, and fatal and non-fatal cardiovascular events, using a meta-regression technique to explore the influence of BP decreases on treatment effects.ResultsA total of 88,503 patients from 44 randomized trials were included. There was no significant association between BP decreases and risk of all-cause or cardiovascular mortality, cardiovascular events or myocardial infarction. However, stroke risk was influenced by BP decreases: compared with no reduction, a 10-mmHg reduction in systolic BP was associated with a relative odds ratio (OR) decrease of 33% (OR: 0.67, 95% CI: 0.54–0.82), and a 5-mmHg diastolic BP reduction was associated with a relative OR decrease of 38% (OR: 0.62, 95% CI: 0.50–0.76). Restricting the analysis to double-blind studies did not change the results for diastolic BP.ConclusionA reduction in BP lowers the risk of stroke, but does not appear to affect the risk of other cardiovascular events in a T2D population.     

The association between migraine and cerebral vascular events: an analytical review

This paper explores the uncertain relationship between migraine headache and thromboembolic stroke. In reviewing the literature that links migraine with thromboembolic cerebral vascular events, a distinction is made between two stroke events that occur in migraine patients: stroke associated with a migraine attack (a migrainous stroke) and stroke unrelated to a migraine attack (a non-migrainous stroke). In a recent community-based stroke register, migrainous strokes occurred at a rate of 3.4 per 100,000 per annum. Prevalence rates for migraine in young stroke populations (11-28%) are similar to those in the general population and do not support an additional long-term risk of non-migrainous stroke in migraine patients. The only study providing a controlled estimate of long-term thromboembolic stroke risk (odds ratio = 1.7; 95% CI 1.3, 2.2) included only women and has not been independently confirmed. The contribution of migraine to other known risk factors for thromboembolic stroke needs to be examined further by controlled studies.     

Alcohol intake and risk of stroke: A dose–response meta-analysis of prospective studies

Background

Alcohol intake is inconsistently associated with the risk of stroke morbidity and mortality. The purpose of this study was to summarize the evidence regarding this relationship by using a dose–response meta-analytic approach.

Methods

We performed electronic searches of PubMed, EMBASE, and the Cochrane Library to identify relevant prospective studies. Only prospective studies that reported effect estimates with 95% confidence intervals (CIs) of stroke morbidity and mortality for more than 2 categories of alcohol intake were included.

Results

We included 27 prospective studies reporting data on 1,425,513 individuals. Low alcohol intake was associated with a reduced risk of total stroke (risk ratio [RR], 0.85; 95% CI: 0.75–0.95; P = 0.005), ischemic stroke (RR, 0.81; 95% CI: 0.74–0.90; P < 0.001), and stroke mortality (RR, 0.67; 95% CI: 0.53–0.85; P = 0.001), but it had no significant effect on hemorrhagic stroke. Moderate alcohol intake had little or no effect on the risks of total stroke, hemorrhagic stroke, ischemic stroke, and stroke mortality. Heavy alcohol intake was associated with an increased risk of total stroke (RR, 1.20; 95% CI: 1.01–1.43; P = 0.034), but it had no significant effect on hemorrhagic stroke, ischemic stroke, and stroke mortality.

Conclusions

Low alcohol intake is associated with a reduced risk of stroke morbidity and mortality, whereas heavy alcohol intake is associated with an increased risk of total stroke. The association between alcohol intake and stroke morbidity and mortality is J-shaped.     

Blood pressure parameters and risk of fatal stroke, NHANES II mortality study

BACKGROUND: Recent studies have suggested that systolic blood pressure (BP) is a better predictor of stroke than diastolic BP in apparently healthy white men. Whether these relationships are similar for women and African Americans remains unclear. METHODS: We used data from 6667 (3205 men; 3462 women) adults from the Second National Health and Nutrition Examination Survey Mortality Study to examine whether the relative risk of fatal stroke was associated with a 10 mm Hg increase in BP parameters (systolic BP, diastolic BP, pulse pressure, and mean arterial pressure). RESULTS: During a median of nearly 15 years of follow-up, 113 fatal strokes (62 men; 51 women) occurred. Systolic BP was associated with an increased risk of fatal stroke for men (relative risk [RR] = 1.19), women (RR = 1.15), whites (RR = 1.17), and African Americans (RR = 1.28) after multivariable adjustment (all, P 相似文献   

Dietary protein intake and risk of stroke in women

BackgroundA high protein intake may reduce the risk of stroke but epidemiologic data on protein intake in relation to stroke risk are limited and inconsistent. Our objective was to test the hypothesis that protein intake would be inversely associated with risk of stroke.Methods and resultsWe conducted a population-based prospective cohort study consisting of 34,670 Swedish women who were free of cardiovascular disease and cancer in 1997. Diet was assessed with a food-frequency questionnaire. Incident cases of stroke were ascertained from the Swedish Hospital Discharge Registry. We estimated relative risks (RR) with 95% confidence intervals (CI) using Cox proportional hazard regression model. During 10.4 years of follow-up, 1680 stroke events were identified, including 1310 cerebral infarctions, 154 intracerebral hemorrhages, 79 subarachnoid hemorrhages, and 137 unspecified strokes. Intake of total and animal protein, but not vegetable protein, was statistically significantly inversely associated with risk of total stroke and cerebral infarction after adjustment for other risk factors for stroke. The multivariable RRs of total stroke for the highest versus lowest quintile of intake were 0.74 (95% CI: 0.61, 0.91; P for trend = 0.006) for total protein and 0.71 (95% CI: 0.57, 0.88; P for trend = 0.01) for animal protein. The associations were stronger in women with a history of hypertension (RR of total stroke = 0.56; 95% CI: 0.40, 0.78 for highest versus lowest quintile of total protein).ConclusionThese findings suggest that dietary protein intake is inversely associated with risk of stroke in women with hypertension.     

Whole grain intake and cardiovascular disease: a meta-analysis

Background and aimsWhole grain food sources have been associated with lowered risk of cardiovascular disease (CVD). Studies in recent years have strengthened this observation and elucidated potential mechanisms for this association. This study sought to quantitate the available observational evidence on whole grain intake and clinical cardiovascular events.Methods and resultsSeven prospective cohort studies with quantitative measures of dietary whole grains and clinical cardiovascular outcomes were identified from MEDLINE searches and a review of the literature. Based on event estimates adjusted for cardiovascular risk factors, greater whole grain intake (pooled average 2.5 servings/d vs. 0.2 servings/d) was associated with a 21% lower risk of CVD events [OR 0.79 (95% CI: 0.73–0.85)]. Similar estimates were noted for different CVD outcomes (heart disease, stroke, fatal CVD) and in sex-specific analyses. Conversely, refined grain intake was not associated with incident CVD events [1.07 (0.94–1.22)].ConclusionsThere is a consistent, inverse association between dietary whole grains and incident cardiovascular disease in epidemiological cohort studies. In light of this evidence, policy-makers, scientists, and clinicians should redouble efforts to incorporate clear messages on the beneficial effects of whole grains into public health and clinical practice endeavors.     

中国11省市队列人群危险因素与不同类型心血管病发病危险的比较

目的描述在中国35—64岁人群中,不同类型心血管病（包括急性冠心病事件、急性缺血性脑卒中和出血性脑卒中事件）发病的特点。比较传统心血管病危险因素与冠心病和脑卒中（急性缺血性脑卒中和出血性脑卒中事件）发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,该队列由1992年建立的11省市35～64岁27249人和1996年到1999年又加入的3129人所组成,共30378人。本研究基线危险因素水平和1992--2003年期间发生的心血管病（包括冠心病和脑卒中）事件的关系进行分析。结果（1）急性冠心病事件、急性缺血性脑卒中事件和急性出血性脑卒中事件的累积人年发病率分别为114／100000、209／100000和73／100000。（2）随访期间发生心血管病的亚组人群基线时有84％～89％的人伴有1个或1个以上的心血管病危险因素,高于无心血管病的亚组人群（64．7％,P〈0．01）。（3）危险因素对不同类型心血管病发病的影响及作用强度有所差别：对冠心病发病危险的影响因素根据强度依次为高血压、吸烟、高胆固醇血症和低高密度脂蛋白胆固醇血症;对缺血性脑卒中发病危险的影响因素依次为高血压、糖尿病、低高密度脂蛋白胆固醇血症、吸烟和肥胖;对出血性脑卒中发病危险的独立影响因素只有高血压。结论在心血管病的主要危险因素中,不同的危险因素对不同类型的心血管病发病危险的作用存在差别。我国人群不同危险因素的变化趋势将影响不同类型心血管。     

Risk of mortality and cardiovascular disease associated with the ankle-brachial index: Systematic review

OBJECTIVE: To determine the strength and consistency with which a low ankle brachial pressure index (ABI), measured in the general population, is associated with an increased risk of subsequent death and/or cardiovascular events. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, reference lists and grey literature were searched; studies known to experts were also retrieved. MAIN OUTCOME MEASURES: All cause mortality, fatal and non-fatal coronary heart disease and stroke. REVIEW METHODS: Longitudinal studies in which participants were representative of the general population (all ages, either sex) and which used any standard method for measurement and calculation of the ABI. Studies in which participants were selected according to presence of pre-existing disease or were post intervention (e.g. angioplasty or peripheral arterial grafting) were excluded. RESULTS: 11 studies comprising 44,590 subjects from six different countries were included. Despite clinical heterogeneity between studies, the findings were remarkably consistent in demonstrating an increased risk of clinical cardiovascular disease associated with a low ABI. A low ABI (<0.9) was associated with an increased risk of subsequent all cause mortality (pooled RR 1.60, 95% CI 1.32-1.95), cardiovascular mortality (pooled RR 1.96, 95% CI 1.46-2.64), coronary heart disease (pooled RR 1.45, 95% CI 1.08-1.93) and stroke (pooled RR 1.35, 95% CI 1.10-1.65) after adjustment for age, sex, conventional cardiovascular risk factors and prevalent cardiovascular disease. CONCLUSIONS: The ABI may help to identify asymptomatic individuals in the general population who are at increased risk of subsequent cardiovascular events. Evaluation is now required of the potential of incorporating ABI measurement into cardiovascular prevention programmes.     

Plasma procalcitonin and the risk of cardiovascular events and death: a prospective population‐based study

Abstract. Schiopu A, Hedblad B, Engström G, Struck J, Morgenthaler NG, Melander O (Lund University, Skåne University Hospital Malmö, Malmö, Sweden; BRAHMS GmbH/Thermo Fisher Scientific, Hennigsdorf, Germany). Plasma procalcitonin and the risk of cardiovascular events and death: a prospective population‐based study. J Intern Med 2012; 272: 484–491. Objectives: A number of inflammatory biomarkers such as C‐reactive protein (CRP) are independent predictors of cardiovascular risk. The inflammatory biomarker procalcitonin (PCT) has previously been shown to be associated with coronary atherosclerosis and the metabolic syndrome. We evaluated the ability of PCT to predict future cardiovascular events in a population of apparently healthy individuals. Design: We measured plasma PCT levels in 3713 subjects with no previous history of cardiovascular disease, randomly selected from the Malmö Diet and Cancer cohort. The correlation between PCT concentration and the incidence of coronary events, stroke and cardiovascular death over a median follow‐up period of 13.7 years was studied using a Cox regression analysis corrected for age, sex, CRP level, traditional risk factors and renal function. Results: Age and sex were strong determinants of PCT; the concentration of PCT was significantly higher in men than in women. PCT was associated with several of the established cardiovascular risk factors (CRP, hypertension, diabetes and renal function) as determined by multivariate linear regression. Of note, PCT was inversely correlated with HDL and smoking. We found significant correlations between PCT levels, coronary events and cardiovascular death. However, these relationships lost statistical significance when the analysis was corrected for CRP and the traditional risk factors. Conclusions: This is the largest population‐based prospective study to demonstrate a positive association between plasma PCT levels and cardiovascular risk in subjects with no previous history of acute cardiovascular events. However, the high degree of covariation between PCT and other cardiovascular risk factors limits the value of PCT as an independent cardiovascular risk predictor.     

Intake of legumes and cardiovascular disease: A systematic review and dose–response meta-analysis

AimsTo summarize the evidence on the association between the intake of legumes and the risk of cardiovascular disease (CVD) overall, coronary heart disease (CHD) and stroke, and to identify optimal intake levels for reduced disease risk through a systematic review and dose–response meta-analysis.Data synthesisWe have systematically searched PubMed, Scopus and Web of Science up to March, 2022 for the retrieval of intervention and observational studies (PROSPERO Reg. number: CRD42021247565). Pooled relative risks (RRs) comparing extreme categories of intake were computed using random-effects models. One-stage dose–response meta-analyses were also performed using random-effects models. 22 831 articles were screened resulting in 26 eligible observational studies (21 prospective cohort and 5 case–control studies). When comparing extreme categories of intake, the consumption of legumes was inversely associated with CVD (n = 25: RR = 0.94; 95%CI:0.89,0.99) and CHD (n = 16: RR = 0.90; 95%CI:0.85,0.96), but not with stroke (n = 9: RR = 1.00; 95%CI:0.93,1.08). We further found evidence for an inverse dose–response association with CHD, increasing in magnitude up to an intake of 400 g/week, after which the benefit seems to level-off.ConclusionsThe intake of legumes was associated with a reduced risk of CVD and CHD, but not with stroke, among individuals with the highest consumption levels. An intake level of 400 g/week seemed to provide the optimal cardiovascular benefit. Further research is needed to better understand the role of legumes in stroke subtypes.