Plasma C-peptide and cognitive performance in older men without diabetes.

BACKGROUND: Emerging evidence suggests that type 2 diabetes may be related to diminished cognition, but little data are available directly regarding the role of insulin levels. OBJECTIVE: The objective of this prospective cohort study was to examine the relation of insulin secretion to cognitive function among men without diabetes. SETTING: The study setting was the Physicians' Health Study-U.S. male physicians. PARTICIPANTS: Three hundred sixty-seven men who provided blood samples in 1982, when they had no lifetime history of diabetes and ranged in age from 47-65 years (mean age: 57 years). MEASUREMENTS: The authors assayed plasma C-peptide, reflecting insulin secretion, in the stored blood samples. Beginning in 2001, an average 18 years after blood collection, the authors administered telephone interviews, including tests of general cognition (Telephone Interview of Cognitive Status [TICS]), verbal memory, and category fluency. The authors used regression models to estimate mean differences in cognitive performance across levels of C-peptide controlling for a wide variety of potential confounding factors. RESULTS: On the TICS, men in the top tertile of C-peptide performed significantly worse than those in the bottom (multivariable-adjusted mean difference: -1.01 points, 95% confidence interval: -1.78 to -0.24); this apparent impact of C-peptide on cognition was equivalent to the cognitive differences the authors observed between men 6 years apart in age. Performance on the global score (combining results from all the individual tests) and verbal memory score (combining results from four tests of verbal memory) appeared lower among men in the highest C-peptide tertile, but results were not statistically significant. CONCLUSION: Higher midlife insulin secretion may be related to decreased later-life cognitive function, even among men without diabetes.     

Alcohol consumption and mortality in men with preexisting cerebrovascular disease

BACKGROUND: In counseling patients with a history of stroke, clinicians have limited information regarding the risks and benefits of alcohol consumption. OBJECTIVE: To examine the relationship between alcohol intake and risks of total and cardiovascular mortality in men with a history of stroke. METHODS: The study population consisted of 112 528 men from the enrollment cohort of the Physicians' Health Study, 1320 of whom reported a baseline history of stroke. Men provided self-reported data on alcohol consumption, which was classified into 1 of 4 categories: rarely or never drink, very light (<1 drink per week), light (1-6 drinks per week), or moderate (> or =1 drink per day). Cox proportional hazards models were used to assess the relative risks of mortality associated with alcohol consumption, after adjustment for major coronary risk factors. RESULTS: During a mean follow-up of 4(1/2) years, 369 men died, 267 of whom died of cardiovascular disease. Compared with men with a history of stroke who drank rarely or never, those with a very light to moderate alcohol intake had multivariate relative risks for total mortality of 0.88 (95% confidence interval [CI], 0.60-1.28), 0.64 (95% CI, 0.48-0.85), and 0.71 (95% CI, 0.54-0.94), respectively (P =.03 for trend); and relative risks for cardiovascular mortality of 0.89 (95% CI, 0.58-1.36), 0.56 (95% CI, 0.40-0.79), and 0.64 (95% CI, 0.46-0.88) P =.008 for trend). Compared with age-adjusted models, adjustment for major coronary risk factors did not significantly change risk estimates for total or cardiovascular mortality. CONCLUSIONS: These data indicate a possible inverse association between light to moderate alcohol intake and risks of total and cardiovascular mortality in men with a history of stroke. More data are needed to confirm or refute these results.     

Alcohol consumption and prognosis in patients with left ventricular systolic dysfunction after a myocardial infarction

OBJECTIVES: We assessed the influence of alcohol intake on the development of symptomatic heart failure (HF) in patients with left ventricular (LV) dysfunction after a myocardial infarction (MI). BACKGROUND: In contrast to protection from coronary heart disease, alcohol consumption has been linked to cardiodepressant effects and has been considered contraindicated in patients with HF. METHODS: The Survival And Ventricular Enlargement (SAVE) trial randomized 2231 patients with a LV ejection fraction (EF) <40% following MI to an angiotensin-converting enzyme inhibitor or placebo. Patients were classified as nondrinkers, light-to-moderate drinkers (1 to 10 drinks/week), or heavy drinkers (>10 drinks/week) based on alcohol consumption reported at baseline. The primary outcome was hospitalization for HF or need for an open-label angiotensin-converting enzyme inhibitor. Analyses were repeated using alcohol consumption reported three months after MI. RESULTS: Nondrinkers were older and had more comorbidities than light-to-moderate and heavy drinkers. In univariate analyses, baseline light-to-moderate alcohol intake was associated with a lower incidence of HF compared with nondrinkers (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.57 to 0.87), whereas heavy drinking was not (HR 0.91; 95% CI 0.67 to 1.23). After adjustment for baseline differences, light-to-moderate baseline alcohol consumption no longer significantly influenced the development of HF (light-to-moderate drinkers HR 0.93; 95% CI 0.75 to 1.17; heavy drinkers HR 1.25; 95% CI 0.91 to 1.72). Alcohol consumption reported three months after the MI similarly did not modify the risk of adverse outcome. CONCLUSIONS: In patients with LV dysfunction after an MI, light-to-moderate alcohol intake either at baseline or following MI did not alter the risk for the development of HF requiring hospitalization or an open-label angiotensin-converting enzyme inhibitor.     

Aspirin in the treatment and prevention of cardiovascular disease

Randomized trials of aspirin have been conducted in three main populations: patients with evolving acute myocardial infarction (MI), patients with a history of cardiovascular disease and apparently healthy subjects. Initiating aspirin therapy within 24 h after the onset of symptoms of an acute MI results in conclusive reductions in the risk of nonfatal reinfarction, nonfatal stroke and total cardiovascular death. In a wide range of patients with prior occlusive cardiovascular disease, aspirin reduces the risks of nonfatal MI, nonfatal stroke and vascular death. In primary prevention trials, aspirin has been shown to reduce the risk of a first MI in men; limited data make it difficult to draw conclusions regarding its effect on stroke and total cardiovascular death. Randomized data from studies in women and other populations are lacking. Until more data are available, the decision to use aspirin in primary prevention should be based on the clinical judgment of the physician and it should be used as an adjunct in the management of other cardiovascular disease risk factors.     

Vitamin supplement use in a low-risk population of US male physicians and subsequent cardiovascular mortality

BACKGROUND: Although basic research suggests that vitamins may have an important role in the prevention of cardiovascular diseases (CVD), the data from cohort studies and clinical trials are inconclusive. METHODS: This prospective cohort study was conducted among 83 639 male physicians residing in the United States who had no history of CVD or cancer. At baseline, data on use of vitamin E, ascorbic acid (vitamin C), and multivitamin supplements were provided by a self-administered questionnaire. Mortality from CVD and coronary heart disease (CHD) was assessed by death certificate review. RESULTS: Use of supplements was reported by 29% of the participants. During a mean follow-up of 5.5 years, 1037 CVD deaths occurred, including 608 CHD deaths. After adjustment for several cardiovascular risk factors, supplement use was not significantly associated with total CVD or CHD mortality. For vitamin E use, the relative risks (RRs) were 0.92 (95% confidence interval [CI], 0.70-1.21) for total CVD mortality and 0.88 (95% CI, 0.61-1.27) for CHD mortality; for use of vitamin C, the RRs were 0.88 (95% CI, 0.70-1.12) for total CVD mortality and 0.86 (95% CI, 0.63-1.18) for CHD mortality; and for use of multivitamin supplements, the RRs were 1.07 (95% CI, 0.91-1.25) for total CVD mortality and 1.02 (95% CI, 0.83-1.25) for CHD mortality. CONCLUSIONS: In this large cohort of apparently healthy US male physicians, self-selected supplementation with vitamin E, vitamin C, or multivitamins was not associated with a significant decrease in total CVD or CHD mortality. Data from ongoing large randomized trials will be necessary to definitely establish small potential benefits of vitamin supplements on subsequent cardiovascular risk.     

Usefulness of desirable lifestyle factors to attenuate the risk of heart failure among offspring whose parents had myocardial infarction before age 55 years

Heart failure (HF) is one of the leading causes of hospitalization and death in the United States and throughout Europe. Although a higher risk for HF with antecedent myocardial infarction (MI) has been reported in offspring whose parents had MIs before age 55 years, it is unclear whether adherence to healthful behaviors can mitigate that risk. The aim of the present study was therefore to prospectively examine if adherence to healthy weight, regular exercise, moderate alcohol consumption, and abstinence from smoking can attenuate such increased HF risk. Information on parental history of MI and lifestyle factors was collected using questionnaires. Subjects adhering to ≥3 healthy lifestyle factors were classified as having good versus poor lifestyle scores. Incident HF was assessed via yearly follow-up questionnaires and validated in a subsample. During an average follow up of 21.7 ± 6.5 years, 1,323 new HF cases (6.6%), of which 190 (14.4%) were preceded by MI, occurred. Compared to subjects with good lifestyle scores and no parental histories of premature MI, multivariate adjusted hazard ratios for incident HF with antecedent MI were 3.21 (95% confidence interval 1.74 to 5.91) for subjects with good lifestyle score and parental histories of premature MI, 1.52 (95% confidence interval 1.12 to 2.07) for those with poor lifestyle score and no parental histories of premature MI, and 4.60 (95% confidence interval 2.55 to 8.30) for those with poor lifestyle scores and parental histories of premature MI. In conclusion, our data suggest that even in subjects at higher risk for HF because of genetic predisposition, adherence to healthful lifestyle factors may attenuate such an elevated HF risk.     

Alcohol consumption and cardiovascular disease mortality in hypertensive men

BACKGROUND: Heavy alcohol drinking is associated with a dose-dependent increase in blood pressure, but data on the relation between alcohol consumption and mortality in hypertensive patients are sparse. OBJECTIVE: To assess the relation between light to moderate alcohol consumption and total mortality from cardiovascular disease (CVD) among men with hypertension. PARTICIPANTS AND DESIGN: From the Physicians' Health Study enrollment cohort of 88,882 men who provided self-reported information on alcohol intake, we identified a group of 14,125 men with a history of current or past treatment for hypertension who were free of myocardial infarction, stroke, cancer, or liver disease at baseline.Main Outcome Measure Comparison of total and CVD mortality among men with hypertension who had reported to be either nondrinkers or rare drinkers, or light to moderate drinkers. RESULTS: During 75,710 person-years of follow-up, there were 1018 deaths, including 579 from CVD. Compared with individuals who rarely or never drank alcoholic beverages, those who reported monthly, weekly, and daily alcohol consumption, respectively, had multivariate adjusted relative risks (RRs) for CVD mortality of 0.83 (95% confidence interval [CI], 0.62-1.13), 0.61 (CI, 0.49-0.77), and 0.56 (CI, 0.44-0.71) (P<.001 for linear trend). In the same groups, RRs for total mortality were respectively 0.86 (CI, 0.67-1.10), 0.72 (CI, 0.60-0.86), and 0.73 (CI, 0.61-0.87) (P<.001 for linear trend). Among men with a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher, the RRs for CVD mortality were, respectively, 1.00 (referent), 0.82 (CI, 0.56-1.21), 0.64 (CI, 0.48-0.85), and 0.56 (CI, 0.42-0.75) (P<.001 for linear trend). On the other hand, we found no significant association between moderate alcohol consumption and cancer mortality (P =.8 for linear trend). CONCLUSION: These results, which require confirmation in other large-scale studies, suggest that light to moderate alcohol consumption is associated with a reduction in risk of total and CVD mortality in hypertensive men.