Association between dietary patterns and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease.

Influence of Lifestyle on Incident Cardiovascular Disease and Mortality in Patients With Diabetes Mellitus

Introduction: Colorectal cancer (CRC) is a prevalent cancer and a leading cause of cancer deaths in the US. CRC survivors have a high risk of developing cardiovascular disease (CVD), which accounts for nearly 20% of their total mortality, likely due to shared risk factors including lifestyle. Hypothesis: We hypothesized that maintaining a healthy lifestyle after a CRC diagnosis is associated with a lower risk of CVD incidence and mortality. Methods: We analyzed data from 2,737 survivors with stages I-III CRC in the Nurses’ Health Study and Health Professional Follow-up Study. A lifestyle score, ranging from 0 to 5, was calculated for participants based on diet quality, smoking status, alcohol intake, physical activity, and body mass index. We calculated cumulative averaged scores before and after CRC diagnosis and used Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD incidence and mortality. We further examined changes in pre- and post-diagnostic lifestyle in relation to CVD outcomes and assessed potential effect modification by age, tumor characteristics, and medical history. Results: Over a median follow-up of 13.3 years after CRC diagnosis, we documented 449 incident CVD cases, including 201 coronary heart disease and 104 stroke cases, and 307 CVD-specific deaths. After adjustment for demographics, medical history, tumor characteristics, and pre-diagnostic lifestyle score, one unit increase in post-diagnostic score was associated with a 13% lower CVD incidence (HR [95% CI]: 0.87 [0.77-0.98]; p-trend: 0.03) and 29% lower CVD mortality (0.71 [0.61-0.83]; <0.0001). When stratified by tumor stage, the inverse association with CVD incidence was observed for stage I (0.74 [0.60-0.92]) but not stages II-III CRC (1.12 [0.93-1.35]; p-interaction: 0.005); whereas no differential associations were found for CVD mortality. Survivors who maintained a healthy lifestyle (score ≥4) pre- and post-diagnosis had a 28% lower risk of CVD incidence (0.72 [0.57-0.92]) and a 48% lower risk of CVD mortality (0.52 [0.39-0.70]) compared to those with a constantly poor lifestyle (score <4). Conclusions: In conclusion, a healthy lifestyle after CRC diagnosis was associated with a substantially lower risk of CVD incidence and mortality, highlighting the role of a healthy lifestyle in improving survivorship. These findings offer valuable insights for integrating lifestyle interventions into CRC oncology care.

Evidence on the association between meeting both aerobic physical activity (PA) and muscle-strengthening activity (MSA) guidelines with mortality in individuals with hypertension is scarce. We included 34,990 adults from the 2007 to 2013 Korea National Health and Nutrition Examination Survey, linking mortality follow-up data until 2019. Adherence to PA guidelines was assessed based on the current PA guidelines using a self-reported questionnaire and categorized as follows: meeting MSA only, aerobic PA only, both MSA and aerobic PA, or neither. Associations of hypertension and adherence to PA guidelines with all-cause and cardiovascular disease (CVD) mortality were examined using Cox proportional hazard models. Over 9.2 years, 1948 participants died from any cause and 419 from CVD. Meeting both PA guidelines was associated with the lowest risk of all-cause and CVD mortalities in the total sample regardless of hypertension status. In individuals with hypertension, meeting aerobic PA guidelines only had a 24% lower risk of both all-cause and CVD mortality, and meeting both PA guidelines further reduced risks by 40% and 43%, respectively; however, meeting MSA guidelines only was not associated with either all-cause or CVD mortality. In individuals without hypertension, only meeting both MSA and aerobic PA guidelines, but not meeting either MSA or aerobic PA guidelines, showed reduced risk of CVD mortality. In Korean population, non-hypertensive individuals who met both guidelines had a lower risk of CVD mortality. However, hypertensive individuals showed a reduced risk of both all-cause and CVD mortality when meeting aerobic PA or both guidelines, but not MSA alone.

ABSTRACTBackgroundThe association between short-chain fatty acid (SCFA) levels and the risk of all-cause and cardiovascular disease (CVD) mortality in patients undergoing maintenance hemodialysis (MHD) is inconclusive. Furthermore, no studies on the significance of SCFA levels in MHD patients have been conducted in China. Therefore, this association was investigated in MHD patients.MethodsIn this retrospective cohort study, 260 MHD patients were followed up at Central Hospital of Dalian University of Technology between January 2015 and December 2017. Serum SCFA levels were categorized into three tertiles, and the lowest tertile served as the reference group. Survival curves were obtained using the Kaplan–Meier method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models.ResultsThere were 141 all-cause deaths during the follow-up period of (91.00 ± 0.84) months, of which 85 were due to CVDs. Kaplan–Meier analysis revealed that the risk of CVD mortality in the highest tertile of serum butyric acid level was significantly lower than that in the lowest tertile (log-rank P < .05). The level of serum butyric acid was negatively associated with the risk of CVD mortality (HR 0.368, 95% CI 0.187–0.724) after adjusting for potential confounders, and a linear trend was evident in this association (P < .05). A linear dose–response relationship was also observed between butyric acid and CVD mortality (P nonlinearity >.05). However, none of the SCFAs was associated with the risk of all-cause mortality after adjusting for potential confounders.ConclusionSerum butyric acid level was associated with lower risk of CVD mortality among MHD patients. Further prospective large-scale studies are needed to confirm this finding.

Cardiovascular Disease in Children with Chronic Kidney Disease

Associations of Physical Activity with Long-Term Mortality Among Peripheral Artery Disease Patients: A Population-Based Cohort Study.

To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses. This prospective cohort study included 21,637 participants (mean age, 48.5y) from the National Health and Nutrition Examination Survey 2007-2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks. We found significant protective associations between replacing 30minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77-0.95) to 0.96 (0.94-0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70-0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80-0.94) to 0.89 (0.81-0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63-0.83) to 0.96 (0.92-0.99). Replacing sedentary behaviors with 30minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.

The correlations between body mass index (BMI) and risk of all-cause and cardiovascular disease (CVD) mortality in patients with type 2 diabetes mellitus (T2DM) are still controversial. To explore the correlation between BMI and the risk of all-cause and CVD mortality in patients with T2DM. The data sources China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed, Web of Science, Embase, and The Cochrane Library were searched up until May 25, 2024. After adjusting for confounding factors, the original study on the association between BMI and all-cause and CVD mortality in patients with T2DM was analyzed. Number of all-cause and CVD mortality events, BMI, and basic characteristics were extracted. Twenty-eight papers with a total of 728 321 participants were finally included. Compared to normal-weight patients with T2DM, the risk of all-cause (HR = 1.61; 95% CI [1.51, 1.72]; P = .000) and CVD (HR = 1.31; 95% CI [1.10, 1.54]; P = .002) mortality were increased in underweight patients; however, they were reduced (HR = 0.85; 95% CI [0.81, 0.89]; P = .000) and (HR = 0.86; 95% CI [0.78, 0.96]; P = .007), respectively in patients with overweight. Also, there were significant reductions in the risk of all-cause (HR = 0.85; 95% CI [0.78, 0.92]; P = .000) and CVD (HR = 0.81; 95% CI [0.74, 0.89]; P = .000] mortality in patients with mild obesity. The difference in the risk of all-cause mortality (HR = 0.98; 95% CI [0.80, 1.21]; P = .881) in patients with moderate obesity was not statistically significant. We found that there were correlations between BMI and the risk of all-cause and CVD mortality in patients with T2DM. The obesity paradox remains.

There is still debatable of the optimal standards for obesity and salt intake, particularly their potential impacts on mortality among older population. This study aimed to characterized the complex relationships among high-salt diet, obesity, and the cardiovascular disease (CVD) and all-cause mortality in US adults, with a focus on individuals aged 50 years or older. This is a retrospective cohort analysis of data from the National Health and Nutrition Examination Survey (2005-2020, n = 11,977). Data on individual body weight status and dietary sodium intake were extracted. Daily salt intake above 9g is considered a high salt consumption. Adjusted weighted multivariable logistic regression models were was used for the analysis of the association among salt intake, obesity, and CVD outcomes. Cox proportional hazards model to estimate the association between salt intake and mortality. Mediation analysis was performed to investigate whether insulin levels mediate the relationship between salt intake and obesity. Individuals with high-salt intake were more likely to exhibit both overall (OR: 1.33; 95% CI: 1.16-1.53) and central obesity (OR: 1.29; 95% CI: 1.13-1.48) after adjusting for potential confounders. Among individuals aged 50 years or older, the risks of overall obesity and central obesity were higher in those following a high-salt diet. No such relationships were observed in individuals younger than 50 years of age. High salt intake was associated with lower risks of both all-cause and CVD mortality compared to low salt intake in individuals over 50 years. In the older population with either overall (HR: 0.39, 95% CI: 0.17-0.89, P = 0.0254) or central obesity (HR: 0.40, 95% CI: 0.22-0.72, P = 0.0025), high salt intake was linked to a lower risk of CVD mortality compared to low salt intake. In individuals aged younger than 50 years and without obesity, high salt intake was associated with increased risk of CVD mortality. This study found that higher salt intake was associated with an increased risk of obesity, whereas had an inverse association with all-cause and CVD mortality in adults aged over 50 years. Caution is warranted in interpreting these findings due to potential selection bias. Further longitudinal studies incorporating objective evaluation of salt intake are necessary to establish evidence-based recommendations for healthy lifestyle practices aimed at promoting healthy aging.

Background Cardiovascular disease (CVD) is an important cause of death among breast cancer survivors. The relationship between pre- and post-diagnostic healthy lifestyle and CVD risk among breast cancer survivors is unknown. Objectives To examine the associations of pre- and post-diagnostic healthy lifestyle score (HLS), defined by diet, alcohol consumption, smoking status, physical activity and body mass index, with the risk of CVD incidence and mortality among breast cancer survivors. Methods We prospectively followed for CVD incidence and mortality among 11,448 participants with confirmed diagnosis of invasive breast cancer enrolled in the Nurses’ Health Study (NHS) (1984-2020) and NHSII (1991-2019) who were free of CVD before breast cancer diagnosis. Diet and lifestyle factors before and after breast cancer diagnosis were repeatedly assessed nearly every 2 to 4 years. Results Over 124,687 person-years of follow-up, we documented 872 new-onset CVD events and 3675 overall deaths, of which 488 (13.3%) were specifically due to CVD and 1,310 (35.6%) were due to breast cancer. After multivariable adjustment, both higher pre- and post-diagnostic HLS were associated with a lower risk of CVD-specific incidence and mortality. Compared with women with the lowest cumulative average post-diagnostic HLS (0-2), the multivariable-adjusted hazard ratios (HRs) for participants with the highest score of 5 were 0.56 (95% CI: 0.32-1.00) for CVD incidence, and 0.66 (95% CI: 0.45-0.97) for CVD mortality (all p trend&amp;lt;0.0001). Participants who had an unhealthy pre-diagnostic lifestyle but improved to an HLS (3-5) after breast cancer diagnosis had a lower risk of both CVD incidence (HR: 0.69, 95% CI: 0.52-0.92) and CVD mortality (HR: 0.75, 95% CI: 0.53-1.07) compared with those continuing an unhealthy lifestyle during both periods. Participants maintaining a healthy lifestyle during both pre- and post-diagnostic periods showed the strongest inverse association, with HR of 0.57 (95% CI: 0.46-0.69) for CVD incidence and 0.50 (95% CI: 0.38-0.65) for CVD mortality. Each point increment of post-diagnostic HLS was associated with a 14% lower risk of CVD incidence (p=0.007), and a 14% lower risk of CVD mortality (p=0.01). Conclusions and relevance Independent of pre-diagnostic lifestyle, a post-diagnostic healthy lifestyle was associated with a substantial, graded lower risk of CVD-specific incidence and mortality among breast cancer survivors. These findings underscore the clinical importance for health care practitioners managing breast cancer survivors to consistently promote adherence to healthy lifestyle behaviors, highlighting the opportunity to leverage the changeable moment even for those with an unhealthy lifestyle before cancer diagnosis. Citation Format: Qiang Liu, Tengteng Wang, Qiaoli Wang, Yujia Lu, Mengxi Du, Jae H. Kang, Molin Wang, Eric B Rimm, Stephanie A. Smith-Warner, Michelle D Holmes, A.Heather Eliassen, Jing Wang, Mingyang Song, Edward Giovannucci. Pre- and post-diagnostic healthy lifestyle and cardiovascular disease among breast cancer survivors [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-03-08.

Nonexercise Estimated Cardiorespiratory Fitness and Mortality Due to All Causes and Cardiovascular Disease

Introduction: Vegetarian diets are characterized by the absence of some animal foods (e.g. red and processed meats), and a high consumption of plant-based foods. However, plant-based foods can include foods with varying nutritional value and divergent health effects. Hypothesis: We assessed the hypothesis that three different pro-vegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG) are differently associated with the risk of cardiovascular disease (CVD) mortality in adult Italians. Established CVD risk factors ( e.g. blood lipids, inflammatory markers) were analyzed as potential biological mechanisms underpinning these associations. Methods: Longitudinal analysis on 22,895 women and men (mean age 55±12 y) from the Moli-sani Study (2005-2010). Food intake was assessed by a 188-item food frequency questionnaire. A pro-vegetarian food pattern was constructed by assigning positive scores to plant foods and reverse scores to animal foods. Both a healthful and an unhealthful pro-vegetarian food patterns, distinguishing between healthy ( e.g . fruits, vegetables, legumes) and less-healthy plant foods ( e.g . fruit juices, potatoes, sugary beverages), were built up. Cox proportional hazard regression models were used to estimate the association between dietary exposures (quarters of) and mortality. Hazard ratios (HRs) were calculated with their 95% confidence intervals (CIs) for each quarter, considering Q1 as the reference category. Results: After a median follow-up of 12.2 y (272,960 person/years), a total of 792 CVD deaths were ascertained. In multivariable-adjusted analyses controlled for common known risk factors, higher adherence to a gPVG was not associated with CVD mortality (HR=0.92; 0.75-1.13 for Q4 vs. Q1). Increasing adherence to a hPVG was linked to lower risk of CVD mortality (HR=0.78; 0.62-0.98 for Q4 vs. Q1), whereas a higher uPVG led to an increased risk (HR=1.28; 1.04-1.57). Altered levels of subclinical inflammation ( i.e. C-reactive protein) accounted for 13.4% (p=0.012) of the association of the hPVG with CVD mortality. Conclusions: In this large Italian general population, increasing adherence to a general pro-vegetarian food pattern was not associated with CVD mortality. Only participants preferring healthful vegetarian foods experienced a significant protection against CVD mortality risk, possibly through a favorable modulation of the inflammatory pathway. Consistently, a large dietary share of unhealthful vegetarian foods, mostly highly processed, was associated with increased risk of CVD mortality. We conclude that it is not sufficient to adopt a general vegetarian diet, since it is the quality of the plant food consumed that is critical to achieve vegetarian diet-related benefits on CVD mortality.

Pre-diagnosis Diet and Physical Activity and Risk of Cardiovascular Disease Mortality Among Female Cancer Survivors

Simple SummaryThe number of cancer survivors is increasing; however, cancer survivors are at an increased risk of cardiovascular diseases (CVD) and CVD mortality. Therefore, it is pertinent to understand how lifestyle choices such as dietary patterns and physical activity are associated with this risk. Little is known about the relationship of pre-cancer diagnosis diet quality and physical activity (PA) with CVD among cancer survivors. Most studies have focused on post-cancer diagnosis risk factors, without accounting for their status in the pre-diagnosis period or interaction on CVD mortality. We examined pre-cancer diagnosis diet quality and physical activity in relation with CVD mortality risk in female cancer survivors from the California Teachers Study cohort. We hypothesized that higher diet quality scores and higher physical activity levels prior to cancer diagnosis would be associated with lower risk of CVD mortality in female cancer survivors.Sub-optimal diet and physical activity (PA) levels have been associated with increased risk of cardiovascular disease (CVD) mortality. The relationship between pre-cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure-time PA and their interaction on CVD mortality in cancer survivors. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure-time PA was converted to a metabolic equivalent of task hours per week (MET-h/wk). During a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED score was not associated with CVD mortality. PA level was inversely associated with CVD mortality (HRQ1-Q4 = 0.74; 95% CI: 0.61–0.88; Ptrend = 0.0014). Compared to cancer survivors with the lowest pre-diagnosis aMED score and PA level, cancer survivors with higher aMED scores and higher MET-hrs/wk were at a 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87). Overall, this study shows PA to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in lowering CVD mortality risk.

Objective This study investigated the association between several dietary quality scores—including the healthy eating index-2015(HEI-2015), dietary inflammatory index (DII), and dietary approaches to stop hypertension (DASH)—and the risk of cardiovascular disease(CVD) mortality in hypertension treatment group. Methods Data were obtained from 11,310 participants in the the U.S. Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (1999-2016). Diet quality scores were calculated based on the type and quantity of food and beverages consumed by participants in the past 24 h. CVD mortality was defined as deaths from heart or cerebrovascular disease (ICD-10). We used cox proportional hazards regression to assess the association between diet quality scores and CVD mortality. Results During an average follow-up period of 109 months, 1324 deaths from CVD were confirmed. HEI−2015 and DII showed statistically significant negative association (HR, 0.9404 (95% CI = 0.8846, 0.9998), p = 0.0491) and positive correlation (HR, 1.0514 (95% CI = 1.0055, 1.0995), p = 0.0278) with CVD mortality. DASH showed no statistically significant negative correlation with CVD mortality (HR, 0.9639 (95% CI = 0.9215, 1.0083), p = 0.1096). However, trend tests for all three diet quality scores were significant (p < 0.05). Conclusion The HEI-2015 and DASH dietary patterns reduce the risk of CVD mortality in the hypertension treatment group. In contrast, the DII dietary pattern increases the risk of CVD mortality in such patients.