All-Cause Mortality Risk in National Prostate Cancer Cohort: An Impact of Population-Based Prostate Cancer Screening

While abundant research suggests a sex-specific role of endogenous sex steroid hormones in chronic diseases, research on mortality remains inconclusive. We quantified the sex-specific associations of endogenous sex steroid hormones, including total testosterone (TT), free testosterone, bioavailable testosterone, estradiol, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS), and sex hormone-binding globulin (SHBG) with risk of all-cause and cause-specific mortality in the general population. Embase, Medline, Web of Science, and Cochrane Central were searched and population-based cohort studies investigating the association of interest were included. The risk of bias was assessed using the ROBINS-E tool. The certainty of evidence was evaluated using the GRADE framework. Pooled hazard ratios (HRs) and 95% CI were calculated using a random effects model for the top vs bottom tertile of sex hormones and risk of mortality. The systematic review included 53 publications with 359 047 participants. A significant association was observed between higher level of TT and risk of all-cause mortality (HR [95% CI]: 0.89 [0.83-0.97], n = 19 studies) in men, while no association was found in women. Dose-response analysis suggested a significant U-shaped association between TT and all-cause mortality in men and a J-shaped association in women. Higher SHBG level was significantly associated with higher risk of all-cause mortality in women (1.25 [1.13-1.39], n = 3) and no association was observed in men. Additionally, higher DHEAS levels were associated with lower risk of all-cause mortality in men (0.72 [0.57-0.91], n = 6) and no association was observed in women. This meta-analysis reveals a dose-response link between endogenous sex steroid hormones and mortality, highlighting the need for sex-specific studies on hormone modulation's impact on mortality and longevity.

Fruit, vegetable, and legume intake and the risk of all-cause, cardiovascular, and cancer mortality: A prospective study

OBJECTIVE To clarify the relationships between legume intake and the risk of major cardiovascular events and all-cause mortality. METHODS In this study, the data were from the Prospective Urban and Rural Epidemiology China (PURE-China) cohort study, which enrolled adults aged 35–70 years in 115 urban and rural areas in 12 provinces in China from 2005 to 2009 and followed them up every three years. The follow-up deadline for this analysis was 10 August 2019. Legume intake was obtained through a validated food frequency questionnaire during face-to-face interviews, and was divided into four groups: <10.0, 10.0–<72.4, 72.4–<214.7, ≥ 214.7 g/d. The Cox frailty models were used to analyze the associations between legume intake and the risk of major cardiovascular events and all-cause mortality. Restricted cubic splines analyses were used to examine the non-linear associations between legume intake and the risks of major cardiovascular events and all-cause mortality. RESULTS A total of 41,357 subjects were included in the analysis, and the median daily intake of legumes was 72.4 (29.5, 134.3) g/d. During 11.9 (9.5, 12.6) years of median follow-up, a total of 3,175 major cardiovascular events and 1,827 all-cause deaths were recorded. Legume intake was associated with the risk of major cardiovascular events (Pnon-linear <0.001). In the multivariable-adjusted model, compared with individuals who consumed legumes of <10.0 g/d, individuals who consumed legumes of 72.4–<214.7 g/d had a 17.0% lower risk of major cardiovascular events (hazard ratio (HR) = 0.83, 95% confidence interval (CI) 0.73–0.93, P = 0.002) and 24.0% lower risk of all-cause mortality (HR = 0.76, 95% CI 0.66–0.89, P = 0.001). Stratified analysis showed that in the elderly population, compared with the reference population, legume intake ranging from 72.4 to <214.7 g/d was associated with a 34.0% reduction in the risk of major cardiovascular events (HR = 0.66, 95% CI 0.50–0.86, P = 0.002). Among people with hypertension, compared with the reference population, legume intake ranging from 72.4 to <214.7 g/d was associated with an 18.0% reduction in the risk of major cardiovascular events (HR = 0.82, 95% CI 0.71–0.95, P = 0.008) and a 30.0% reduction in the risk of all-cause mortality (HR = 0.70, 95% CI 0.57–0.86, P = 0.001). In the western region, compared with the reference population, the risk of major cardiovascular events was reduced by 26.0% in the individuals with legumes intake of 72.4–<214.7 g/d (HR = 0.74, 95% CI 0.59–0.93, P = 0.008). In the eastern population, compared with the reference population, the risk of all-cause mortality was reduced by 29.0% in the individuals with legumes intake of 72.4–<214.7 g/d (HR = 0.71, 95% CI 0.57–0.89, P = 0.002). CONCLUSION There is a non-linear association between legumes intake and the risk of major cardiovascular events in the Chinese population. In the general population, elderly and hypertensive population, moderate legume intake (72.4–<214.7 g/d) is associated with lower risks of major cardiovascular events and all-cause mortality.

ObjectiveTo examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer.DesignSystematic review and...

Optimizing clinical outcomes resulting from glucose‐lowering therapies in type 2 diabetes: increased confidence about the <scp>DPP</scp>‐4 inhibitors and continued concerns regarding sulphonylureas and exogenous insulin

A high amount of red meat consumption has been associated with higher risks of coronary heart disease (CHD) and all-cause mortality in a single food-exposure model. However, this model may overlook the potentially differential influence of red meat on these outcomes depending on the foods replaced by red meat. A PRISMA-compliant meta-analysis of prospective observational studies was performed to quantify the risks of CHD and all-cause mortality associated with the replacement of total, unprocessed, or processed red meat with fish/seafood, poultry, dairy, eggs, nuts, and legumes. The PubMed and Web of Science databases were searched to identify relevant articles published in any language from database inception to October 30, 2021. The prospective observational studies were considered relevant if they reported relative risks (RRs) and 95%CIs for the associations of interest. Thirteen articles were included. A random-effects model was used to estimate the summary RRs and 95%CIs for the associations of interest. Replacing total red meat with poultry (RR, 0.88, 95%CI, 0.82-0.96; I2 = 0%), dairy (RR, 0.90, 95%CI, 0.88-0.92; I2 = 0%), eggs (RR, 0.86, 95%CI, 0.79-0.94; I2 = 7.1%), nuts (RR, 0.84, 95%CI, 0.74-0.95; I2 = 66.8%), or legumes (RR, 0.84, 95%CI, 0.74-0.95; I2 = 7.3%) was associated with a lower risk of CHD, whereas substituting fish/seafood (RR, 0.91, 95%CI, 0.79-1.04; I2 = 69.5%) for total red meat was not associated with the risk of CHD. The replacement of total red meat with fish/seafood (RR, 0.92, 95%CI, 0.89-0.96; I2 = 86.9%), poultry (RR, 0.92, 95%CI, 0.90-0.95; I2 = 61.6%), eggs (RR, 0.91, 95%CI, 0.87-0.95; I2 = 33.8%), or nuts (RR, 0.92, 95%CI, 0.87-0.97; I2 = 81.9%) was associated with a lower risk of all-cause mortality, whereas the substitution of dairy (RR, 0.97, 95%CI, 0.93-1.01; I2 = 33.9%) or legumes (RR, 0.97, 95%CI, 0.93-1.01; I2 = 53.5%) for total red meat was not associated with the risk of all-cause mortality. Lower risks of CHD and all-cause mortality were more consistently observed for processed red meat replacements than for unprocessed red meat replacements. The results did not materially change when the analyses of total, processed, and unprocessed red meat were restricted to the studies that used a uniform substitution amount per unit of 1 serving/d. Keeping red meat, particularly processed red meat, consumption to a minimum along with increasing healthier alternative protein sources to replace red meat in the diet may contribute to the prevention of CHD and premature death. PROSPERO registration no. CRD42021259446.

Individual unhealthy sleep behaviours have been associated with increased risks of all-cause mortality and deaths due to cardiovascular disease (CVD) or cancer. The evidence regarding the association of sleep patterns with these risks is limited. To examine the associations of sleep patterns with all-cause, CVD and cancer mortality in a large prospective cohort. This prospective cohort study included 283,443 adults from UK Biobank without CVD and cancer at baseline. We created a healthy sleep score and sleep patterns combining five individual sleep behaviours. During a mean (standard deviation) of 8.9 (1.1) years (2.5 million person-years) of follow up, a total of 7936 all-cause deaths, 762 CVD-caused deaths, and 4540 cancer-caused deaths occurred during follow up. One point increase of the healthy sleep score was associated with a 4-11% lower risk of all-cause mortality (Hazard Ratio [HR], 0.94; 95% CI, 0.92-0.96), CVD mortality (HR, 0.89; 95% CI, 0.83-0.95) and cancer mortality (HR, 0.96; 95% CI, 0.93-0.99), with adjustment for age, sex, assessment centres, smoking status, alcohol intake status, socioeconomic status and physical activity. Compared with participants with an unfavourable sleep pattern, those with a favourable sleep pattern had 24-42% lower risks of all-cause and CVD mortality. The association with all-cause mortality tended to be stronger among underweight participants and those with insufficient physical activity. A healthy sleep pattern was associated with lower risks of all-cause mortality and mortality from CVD and cancer. Our findings highlight the importance of improving overall sleep behaviours in lowering mortality.

BackgroundA higher Life's Essential 8 (LE8)-based cardiovascular health (CVH) has been reported to be associated with a lower risk of both all-cause mortality and cardio-cerebrovascular diseases (CCVDs) related mortality in adults in the United States. At the same time, multiple studies have shown a significant negative association of CVH with the risk of stroke and CCVDs. Since no research has investigated the applicability of the LE8 in stroke patients, this study aimed to explore the association of LE8 with all-cause mortality and cardio-cerebrovascular mortality in stroke patients.MethodsData of patients were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2007–2018 in this retrospective cohort study. Weighted univariate and multivariate COX regression analyses were utilized to investigate the associations of LE8 with all-cause mortality and cardio-cerebrovascular mortality. We further explored these relationships in subgroups of age, gender, body mass index (BMI), cancer, congestive heart failure (CHF), and coronary heart disease (CHD). The evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsAmong the eligible patients, 278 died from all-cause and 89 (8.38%) of them died due to CCVDs. After adjusting for covariates, patients with LE8 score ≥ 58.75 seemed to have both lower risk of all-cause mortality (HR = 0.46, 95%CI: 0.31–0.69) and cardio-cerebrovascular mortality (HR = 0.51, 95%CI: 0.26–0.98), comparing to those with LE8 score < 48.123. Higher LE8 scores were associated with lower risk of all-cause mortality in patients aged < 65 years old, without cancer, and whatever the gender, BMI, CHF or CHD conditions (all P < 0.05). The relationships between high LE8 scores and low cardio-cerebrovascular mortality risk were only found in age < 65 years old and non-cancer subgroups (all P < 0.05).ConclusionA higher LE8 score was associated with lower risk of both all-cause mortality and cardio-cerebrovascular mortality in patients with stroke, which may provide some reference for risk management and prognosis improvement in stoke. However, more evidences are needed to verify this beneficial role of high LE8 score in stroke prognosis.

Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Background: recent dietary guidelines recommend a diet that mainly includes plant-based foods and a moderate amount of animal products. Therefore, we hypothesized that plant-based diet indices (overall plant-based diet index (oPDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI)) might be associated with risk of all-cause and cause-specific mortality. Methods: a systematic review was conducted using PubMed, Web of Science, Scopus, and Embase databases until December 2024. Meta-analysis was performed utilizing random-effects models to calculate relative risk (RR) with the corresponding 95% confidence intervals (95% CIs). Results: from 436 initial records, 25 prospective studies met the inclusion criteria. The findings of our study indicated a modest inverse association between the adherence to oPDI and risk of all-cause mortality (RR [95% CI]: 0.89 [0.83-0.94]; n = 15 studies) as well as mortality related to cardiovascular diseases, chronic heart disease, and total cancer. Also, adherence to hPDI was found to reduce risk of all-cause (RR [95% CI]: 0.86 [0.82-0.90]; n = 21 studies), cardiovascular disease, chronic heart disease, total-cancer, and prostate cancer mortality, whereas uPDI was associated with higher risk of all-cause (RR [95% CI]: 1.20 [1.13-1.27]; n = 19 studies), cardiovascular disease, chronic heart disease, and total-cancer mortality. Our dose-response meta-analysis showed a monotonic inverse association between adherence to oPDI and hPDI and a positive linear association between adherence to uPDI and risk of all-cause mortality. Conclusion: our findings highlight the importance of evaluating the quality of plant-based foods as either healthy or unhealthy in relation to the risk of all-cause and cause-specific mortality.

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Cardiovascular and cerebrovascular disease (CCDs) contribute to leading causes of morbidity and mortality in the United States of America (USA). Hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a simple and convenient indicator, could reflect the combination of inflammation and nutritional status. This study was undertaken to evaluate the associations between HALP score and risk of cardiovascular, cerebrovascular, and all-cause mortality in the general population from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. We identified 21,578 participants during the 1999-2018 cycles of the NHANES in this research. HALP score was calculated as hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). Outcomes were cerebrovascular, cardiovascular, and all-cause mortality determined by the NHANES-linked National Death Index record and followed until 31 December 2019. Survey-weighted Cox regression, restricted cubic spline analysis, and subgroup analysis were applied to investigate relationships between HALP score and risk of mortality. This cohort study comprised 49.2% male and 50.8% female, of which the median age was 47 years old. In multivariate survey-weighted Cox regression adjusting for all confounders, compared with participants with low HALP scores, participants with highest HALP score had a lower risk of all-cause mortality (adjusted HR:0.80, 95% CI: 0.73, 0.89, P < 0.0001) and cardiovascular mortality (adjusted HR:0.61, 95% CI: 0.50, 0.75, P < 0.0001), and mediate HALP score had the lowest risk of all-cause mortality (adjusted HR:0.68, 95% CI: 0.62, 0.75, P < 0.0001) and cardiovascular mortality (adjusted HR:0.60, 95% CI: 0.48, 0.75, P < 0.0001). Restricted cubic spline analysis showed a non-linear relationship between HALP score and cardiovascular and all-cause mortality (all P values <0.001). HALP score was independently associated with risk of cardiovascular and all-cause mortality, but not cerebrovascular mortality.

BackgroundEvidence on the health effects of occupational physical activity (OPA) remains inconsistent, and potential sex-based differences in physical activity outcomes are understudied. Our goal was to investigate the relationships between OPA and leisure time physical activity (LTPA), both separately and in combination, and the risk of cancer, cardiovascular disease and all-cause mortality by sex.MethodsUsing data from the NHANES 2007–2018 database, the study involved 29 404 adults aged 20 years and older with OPA. Physical activity was assessed through the Global Physical Activity Questionnaire, subjects were classified as inactive, insufficiently active, sufficiently active or highly active OPA. Mortality outcomes were determined by linking to the National Death Index records. Cox/Fine-Gray regressions were employed to investigate sex-specific multivariable-adjusted associations. Covariates including age, race, body mass index, smoking status, hypertension, diabetes mellitus, alcohol consumption, education, income to poverty ratio, marriage status, access to medical care, self-rated health, LTPA and history of diseases were adjusted in the multivariable models.ResultsOver a median follow-up of 6.7 (3.7, 9.8) years for men and 6.8 (3.8,9.8) years for women, 1560 deaths in men and 1150 deaths in women occurred. For men, highly active OPA compared with inactivity was associated with 23% lower risk of all-cause mortality. For women, sufficiently active OPA compared with inactivity was associated with 36% lower risk of all-cause mortality. According to joint analyses that used inactive LTPA and inactive OPA as reference, ≥150 min LTPA was linked to the lowest risk of all-cause mortality (HR: 0.25; 95% CI 0.12 to 0.54) and cardiovascular mortality (HR 0.27, 95% CI 0.12 to 0.64) in women when combined with ≥150 min OPA.ConclusionOPA had a beneficial association with cancer mortality in women and risk of all-cause mortality in both sexes. OPA and LTPA were jointly linked to a further decreased risk of death from all causes and cardiovascular disease in women.

This study aimed to assess all-cause and cause-specific standardized mortality ratios (SMRs) in patients with systemic lupus erythematosus (SLE). We surveyed studies examining all-cause and/or cause-specific SMR in patients with SLE compared to the general population using PUBMED, EMBASE and Cochrane databases and manual searches. We performed a meta-analysis of all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in SLE patients. Fifteen reports including 26,101 patients with SLE with 4640 deaths met the inclusion criteria. Compared to the general population, all-cause SMR was significantly increased 2.6-fold in patients with SLE (SMR 2.663, 95% CI 2.090-3.393, p < 1.0 × 10(-8)). Stratification by ethnicity showed that all-cause SMR was 2.721 (95% CI 1.867-3.966, p = 1.9 × 10(-6)) in Caucasians and 2.587 (95% CI 1.475-4.535, p = 0.001) in Asians. Sex-specific meta-analysis revealed that all-cause SMR was 3.141 (95% CI 2.351-4.198, p < 1.0 × 10(-8)) for women and 3.516 (95% CI 2.928-4.221, p < 1.0 × 10(-8)) for men. The risk of mortality was significantly increased for mortality due to renal disease (SMR 4.689, 95% CI 2.357-9.330, p = 1.10 × 10(-5)), cardiovascular disease (CVD) (SMR 2.253, 95% CI 1.304-3.892, p = 0.004), and infection (SMR 4.980, 95% CI 3.876-6.398, p < 1.0 × 10(-8)), although there was no significant increase in SMR for mortality due to cancer (SMR 1.163, 95% CI 0.572-2.363, p = 0.676). Patients with SLE had higher rates of death from all causes, regardless of sex, ethnicity, renal disease, CVD or infection. However, the risk of death due to malignancy was not increased.

Context and Objective: Although prostate cancer is the 2nd leading cause of cancer death in the US, few studies have evaluated the effect of diet after diagnosis on prostate cancer progression and all-cause mortality. We examined fat intake after prostate cancer diagnosis in relation to risk of lethal prostate cancer and all-cause mortality. Methods: This was a prospective study of 1,019 men diagnosed with prostate cancer between 1982 and 2000 in the Physicians’ Health Study. Men completed a dietary food frequency questionnaire a median of 5.1 years after diagnosis. We examined post-diagnostic intake of saturated, monounsaturated, polyunsaturated, and trans fats, as well as animal and vegetable fats. Cases were confirmed by medical record review. The main outcomes were lethal prostate cancer, defined as prostate cancer-specific death or metastasis to bone, and all-cause mortality. Multivariate Cox proportional hazards regression was used to estimate the relative risk of lethal prostate cancer and all-cause mortality. Models were adjusted for age at diagnosis, time since diagnosis, clinical T-stage, Gleason Score, prostate cancer treatment, BMI, smoking status, intake of alcohol and protein, total calories, and other fats. Results: We observed 87 lethal prostate cancer events and 395 total deaths over a median follow-up after diagnosis of 13.9 years. There was a suggestion of a positive relation between saturated fat intake and lethal prostate cancer that failed to reach statistical significance. The hazard ratio (HR) for lethal prostate cancer associated with a 5% increase in energy from saturated fat was 1.97 (0.89, 4.36; p=0.10). In addition, saturated fat intake after diagnosis was associated with increased risk of all-cause mortality (HR per 5% energy: 1.49; 95%CI: 1.02, 2.16; p=0.04) while vegetable fat was associated with reduced risk of all-cause mortality (HR per 10% energy: 0.63; 95%CI; 0.46, 0.88; p=0.007). Conclusions: Among men diagnosed with prostate cancer, replacing calories from carbohydrates with saturated fat after diagnosis may increase risk of all-cause mortality, while replacing calories from carbohydrates with vegetable fat may reduce risk of all-cause mortality. Citation Format: Stacey A. Kenfield, Erin L. Richman, Howard D. Sesso, Jing Ma, Meir J. Stampfer, Jorge E. Chavarro. Fat intake after prostate cancer diagnosis and risk of lethal prostate cancer and total mortality. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3617. doi:10.1158/1538-7445.AM2013-3617