Cardiovascular Death In Men Research Articles

Beyond T-Trials, T4DM and TRAVERSE: the next large testosterone randomized controlled trial.

Lower testosterone concentrations have been associated with poorer health outcomes in ageing men, but proving causality and demonstrating potential for therapeutic benefit requires randomized clinical trials (RCTs). This review discusses recent observational findings and results of major testosterone RCTs, to explore the need for another, larger trial. Evidence of Leydig cell impairment emerges in men above the age of 70 years. Lower testosterone is associated with diabetes risk, and also risk of incident dementia. An individual participant data meta-analysis found that below thresholds of testosterone of 7.4 nmol/L and 5.3 nmol/l respectively, risks of all-cause mortality and cardiovascular deaths in men increased. Testosterone for the Prevention of Type 2 Diabetes Mellitus (T4DM), a multicentre RCT, showed that testosterone treatment prevented or reverted type 2 diabetes in men at high risk. Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE), a cardiovascular safety trial, demonstrated cardiovascular and prostate safety of testosterone treatment in men with or at risk of cardiovascular disease. T4DM confirmed findings from the Testosterone Trials (T-Trials) that testosterone improved sexual function, and bone microarchitecture and density. However, in TRAVERSE, testosterone-treated men had a higher risk of clinical bone fractures, but not major osteoporotic fractures. Men with disorders of the hypothalamic-pituitary-testicular (HPT) axis causing androgen deficiency warrant consideration for testosterone therapy. In men with an intact HPT axis, testosterone treatment is a pharmacological intervention which requires justification from high quality RCT data. Currently, there is insufficient evidence to justify wider use of testosterone for prevention of cardiometabolic disease. However, there is scope for another large testosterone RCT to investigate whether testosterone treatment might, in older men, extend disability-free survival.

Gender differences in the relationship between serum uric acid and the long-term prognosis in heart failure: a nationwide study

BackgroundSerum uric acid (SUA) is an important pathogenetic and prognostic factor for heart failure (HF). Gender differences are apparent in HF. Furthermore, gender differences also exist in the association between SUA and prognosis in various cardiovascular diseases. However, the gender difference for SUA in the prediction of long-term prognosis in HF is still ambiguous.MethodsA total of 1593 HF patients (897 men, 696 women) from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 cycle were enrolled in our final analysis. Participants were categorized according to gender-specific SUA tertile. We assessed the association between SUA and long-term prognosis of HF patients, defined as all-cause mortality and cardiovascular mortality, in different genders via Kaplan–Meier curve analysis, Cox proportional hazard model, and Fine-Gray competing risk model. The restricted cubic spline (RCS) was performed to investigate the dose-response relationship between SUA and outcomes.ResultsGender differences exist in demographic characteristics, clinical parameters, laboratory tests, and medication of HF patients. After a median follow-up of 127 months (95% CI 120–134 months), there were 853 all-cause deaths (493 events in men, 360 events in women) and 361 cardiovascular deaths (206 events in men, 155 events in women). Kaplan-Meier analysis showed that SUA had gender difference in the prediction of cardiovascular mortality (Log-rank p < 0.001, for male, Log-rank p = 0.150, for female), but not in all-cause mortality. Multivariate Cox regression analysis revealed that elevated SUA levels were associated with higher all-cause mortality and cardiovascular mortality in men (HR 1.11, 95% CI 1.05-1.18, p < 0.001, for all-cause death; HR 1.18, 95% CI 1.09-1.28, p < 0.001, for cardiovascular death), but not in women (HR 1.05, 95% CI 0.98-1.12, p = 0.186, for all-cause death; HR 1.01, 95% CI 0.91-1.12, p = 0.902, for cardiovascular death). Even using non-cardiovascular death as a competitive risk, adjusted Fine-Gray model also illustrated that SUA was an independent predictor of cardiovascular death in men (SHR 1.17, 95% CI 1.08-1.27, p < 0.001), but not in women (SHR 0.98, 95% CI 0.87 − 1.10, p = 0.690).ConclusionsGender differences in the association between SUA and long-term prognosis of HF existed. SUA was an independent prognostic predictor for long-term outcomes of HF in men, but not in women.

All-cause and cause-specific mortality by spirometric pattern and sex - a population-based cohort study.

Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated. To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF). Population-based prospective cohort study. Individuals with CAO [FEV1/vital capacity (VC) < 0.70], RSP [FEV1/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV1/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine-Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years. The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31-2.02 and 1.24, 1.06-1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05-6.82 and 1.40, 1.04-1.90). The hazard of respiratory death was significant in women (3.41, 1.05-11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01-2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05-6.82) but not for cardiovascular death (1.11, 0.74-1.66), with a similar pattern in both sexes. The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.

Red blood cell count and risk of adverse outcomes in patients with mildly reduced left ventricular ejection fraction.

Anemia is associated with increased rates of heart failure (HF)-related mortality and hospitalization. No studies have focused on the association between the red blood cell (RBC) count and the prognosis of patients with HF with mildly reduced left ventricular ejection fraction (HFmrEF). We retrospectively analyzed the effect of the RBC count on outcome events in patients with HFmrEF. We investigated the association of the RBC count with outcome events in 1691 patients with HFmrEF (mean age: 68 years; 35% female) in Xiangtan Central Hospital. Using Cox proportional hazards models, the RBC count was assessed as both a continuous and categorical variable. During follow-up (median: 33 months), cardiovascular death occurred in 168 patients (114 men and 54 women). After adjusting for established risk factors, each 1.0 × 1012 cell/L increase in the RBC count was associated with a 28% lower risk of cardiovascular death in men and a 43% lower risk in women. Patients with low RBC counts had a 0.5-fold higher risk of cardiovascular death than those with normal RBC counts. The hazard ratio for men was 1.42 (95% confidence interval [CI]: 1.07-1.89), and the hazard ratio for women was 1.79 (95% CI: 1.20-2.67). The RBC count was not significantly associated with the composite endpoint of cardiovascular death and HF readmission (cardiovascular events) (p > .05). A decreased RBC count is associated with increased cardiovascular mortality in patients with HFmrEF. Correcting a low RBC count might potentially reduce the risk of cardiovascular death in patients with HFmrEF.

Abstract 8912: The Ceramide- and Phosphatidylcholine- Based Coronary Event Risk Test2 (CERT2) and Cardiovascular Mortality in Men and Women with Type 2 Diabetes

Introduction: The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations. Hypothesis: We hypothesize that CERT2 hat the power to predict cardiovascular mortality in patients with type 2 diabetes (T2DM). Methods: Prospectively, out of 280 male and 121 female patients with T2DM we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively. Results: Overall, cardiovascular survival decreased with increasing CERT2 risk categories (figure 1). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39-2.37] per standard deviation; p&lt;0.001), the unadj. HR in women was 1.36 [0.83-2.22]; p=0.228). After adjustment for age, BMI, current smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use the HR in men was 1.73 [1.31-2.29]; p&lt;0.001) and in 1.40 [083-2.36]; p=0.210 women. Interaction terms CERT2 x gender were non-significant both in univariate analysis (p=0.354) and after multivariate adjustment (p=0.359). Conclusions: We conclude that sex does not significantly impact the association of CERT2 with cardiovascular mortality in patients with T2DM.

The ceramide- and phosphatidylcholine- based Coronary Event Risk Test2 (CERT2) and cardiovascular mortality in men and women with type 2 diabetes

Abstract The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations. The purpose of this study was to investigate the power of CERT2 to predict cardiovascular mortality in 280 male and 121 female patients with type 2 diabetes (T2DM). Prospectively, we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively. Overall, cardiovascular survival decreased with increasing CERT2 risk categories (figure 1). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39–2.37] per standard deviation; p&amp;lt;0.001), the unadj. HR in women was 1.36 [0.83–2.22]; p=0.228). After adjustment for age, BMI, current smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use the HR in men was 1.73 [1.31–2.29]; p&amp;lt;0.001) and 1.40 [083–2.36]; p=0.210 in women. Interaction terms CERT2 x gender were non-significant both in univariate analysis (p=0.354) and after multivariate adjustment (p=0.359). We conclude that sex does not significantly impact the association of CERT2 with cardiovascular mortality in patients with T2DM. Funding Acknowledgement Type of funding sources: None. Figure 1

Large health disparities in cardiovascular death in men and women, by ethnicity and socioeconomic status in an urban based population cohort.

BackgroundSocioeconomic status and ethnicity are not incorporated as predictors in country-level cardiovascular risk charts on mainland Europe. The aim of this study was to quantify the sex-specific cardiovascular death rates stratified by ethnicity and socioeconomic factors in an urban population in a universal healthcare system.MethodsAge-standardized death rates (ASDR) were estimated in a dynamic population, aged 45–75 in the city of The Hague, the Netherlands, over the period 2007–2018, using data of Statistics Netherlands. Results were stratified by sex, ethnicity (country of birth) and socioeconomic status (prosperity) and compared with a European cut-off for high-risk countries (ASDR men 225/100,000 and women 175/100,000).FindingsIn total, 3073 CVD deaths occurred during 1·76 million person years follow-up. Estimated ASDRs (selected countries of birth) ranged from 126 (95%CI 89–174) in Moroccan men to 379 (95%CI 272–518) in Antillean men, and from 86 (95%CI 50–138) in Moroccan women to 170 (95%CI 142–202) in Surinamese women. ASDRs in the highest and lowest prosperity quintiles were 94 (95%CI 90–98) and 343 (95%CI 334–351) for men, and 43 (95%CI 41–46) and 140 (95%CI 135–145), for women, respectively.InterpretationIn a diverse urban population, large health disparities in cardiovascular ASDRs exists across ethnic and socioeconomic subgroups. Identifying these high-risk subgroups followed by targeted preventive efforts, might provide a basis for improving cardiovascular health equity within communities. Instead of classifying countries as high-risk or low-risk, a shift towards focusing on these subgroups within countries might be needed.FundingLeiden University Medical Center and Leiden University

363-P: The Ceramide- and Phosphatidylcholine-Based Coronary Event Risk Test 2 (CERT2) and Cardiovascular Mortality in Men and Women with Type 2 Diabetes

The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations. We here aimed at investigating the power of CERT2 to predict cardiovascular mortality in 280 male and 121 female patients with type 2 diabetes (T2DM). Prospectively, we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively. Overall, cardiovascular survival decreased with increasing CERT2 risk category (Figure), and cardiovascular mortality was higher in men than in women (20.1% vs. 15.8%; p=0.321). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39-2.37] per standard deviation; p Disclosure A. Leiherer: None. M. Laaperi: None. A. Jylha: None. P. Fraunberger: None. H. Drexel: None. A. Muendlein: None. C. H. Saely: None. B. Larcher: None. A. Mader: None. M. Maechler: None. L. Sprenger: None. B. Mutschlechner: None. R. Laaksonen: None.

Cutoff value for hypertrophic heart weight in the Japanese population.

Cardiac hypertrophy is a clinical risk factor for cardiovascular death (CVD) frequently recorded in autopsy reports, but the diagnostic criteria for the condition have not been clearly-established for autopsy. This study aimed to estimate the cutoff value for hypertrophic heart weight that can efficiently assist the postmortem diagnosis of CVD. We analyzed accumulated autopsy data from 3534 individuals aged 0-101years. We found that heart weight increased linearly with a person's age until 20years, after which it remained stable. The mean heart weight in CVD cases was 473g in men and 379g in women. The mean heart weight in non-CVD cases was 385g in men and 320g in women. Receiver operating characteristic curve analysis for CVD assessment revealed that the cutoff value of heart weight was 407g (odds ratio of 4.2) in men and 327g (2.6) in women, and that of heart weight/body height was 2.38g/cm (4.0) in men and 2.15g/cm (2.6) in women, respectively. Overall, heart weight was a more useful predictor of CVD in men than in women. In logistic regression analysis, the predictive power of heart weight for CVD was higher than that of body mass index in both sexes. Thus, the criteria for hypertrophic heart weight are practical and useful for autopsy recordings, and it can be helpful for postmortem diagnosis of CVD. Our report is the first to reveal the cutoff value for hypertrophic heart weight in the Japanese population.

Biomarkers of kidney function and prediction of death from cardiovascular and other causes in the elderly: A 9-year follow-up study

BackgroundCystatin C is claimed to be superior to creatinine-based estimates of glomerular filtration rate (eGFRcr). The purpose of the study is to analyze whether cystatin C, creatinine, and/or estimated glomerular filtration rates (eGFR) predicted cardiovascular and/or non-cardiovascular deaths among Finnish elderly. MethodsHazard ratios (HR) of cystatin C, creatinine and eGFRs for cardiovascular and non-cardiovascular deaths. ResultsDuring a 9-year follow-up, 275 died, 192 deaths were a result of cardiovascular disease. In age-adjusted analyses, cystatin C predicted the risk of non-cardiovascular and cardiovascular death in men (HR for 0.1-unit increase 1.12 [95% CI, 1.04–1.19] for non-CVD deaths and 1.18 [1.09–1.28] for CVD deaths) and women (1.14 [1.07–1.21] and 1.14 [1.06–1.22], respectively). CKD-EPIcr-cyc predicted the risk of CVD deaths in men (HR for 5-unit decrease 1.17 [1.09–1.25]) and women (1.09 [1.02–1.17]) and non-CVD deaths in women (1.07 [1.01–1.14]). Also, MDRD (HR for 5-unit decrease 1.16 [1.05–1.27]) and CKD-EPI (HR for 5-unit decrease 1.15 [1.05–1.25]) predicted CVD deaths among men. After additional adjustments, predictive value of cystatin C remained significant. Also, the predictive value of CKD-EPIcr-cys remained significant in non-CVD deaths among women. ConclusionCystatin C was clearly the best predictor for cardiovascular and non-cardiovascular deaths among Finnish elderly. Serum cystatin C is more accurate for clinical decision making than creatinine-based eGFR equations or the combined CKD-EPIcr-cys equation in persons older than 64years.

BASELINE Q WAVES AND TIME FROM SYMPTOM ONSET TO ST-ELEVATION MYOCARDIAL INFARCTOIN: DOES SEX MATTER?

BACKGROUND: Delay in time from symptom onset to first medical contact in women with ST-Elevation Myocardial Infarction (STEMI) is a well recognized impediment to their care. Given that a baseline Q wave on the presenting ECG is a known prognostic variable, we evaluated the relationship of these two metrics to one year cardiovascular death in women versus men in a large clinical trial. METHODS: Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory in 2838 STEMI patients (2163 men and 675 women) from the PLATelet inhibition and patient Outcomes trial (PLATO) who underwent PCI within 12 hours of symptom onset. Sex specific associations between baseline Q waves and time on one-year vascular mortality were examined using Cox proportional hazards regression model. RESULTS: Women were older (median 63 vs. 57 years), more likely to have diabetes (24.1% vs. 15.5%), hypertension (69.2% vs. 50.9%), higher Killip class > I (8.6% vs. 5.9%), compared to men. Whereas the frequency of baseline Q waves rose as time from symptom onset to the baseline ECG progressed, the slope of this relationship was steeper for men than women (p1⁄40.057 for slope difference). In figure 1 both baseline Q waves (HR: 2.03, 95% CI: 1.11-3.72, p1⁄40.022) and time from symptom onset to PCI (HR: 1.62, 95% CI: 0.87-3.01, p1⁄40.129) tended to be associated with a higher one year cardiovascular death in men while only baseline Q showed this trend in women (HR: 1.97, 95% CI: 0.874.51, p1⁄40.108). CONCLUSION: These differences between women and men in the predictive value of baseline Q waves versus time from symptom onset to PCI deserve recognition in future studies of STEMI.

MULTIFACTOR PRIMARY PREVENTION OF ISCHEMIC HEART DISEASE IN MIDDLE-AGED MEN AND ITS EFFICACY (10-YEAR FOLLOW-UP)

Aim. To evaluate in a prospective 10-year follow-up study cardiovascular mortality rate in a population of middle-aged men with different levels of total cardiovascular risk, and correlation between combinations of risk factors (RF) and the extent of coronary atherosclerosis according to autopsy reports of subjects who have died of ischemic heart disease (IHD) undiagnosed during life-time. To estimate the efficacy of multifactor primary prevention. Material and methods. The analysis was based on the results of the “Multifactor ischemic heart disease prevention” prospective controlled study of two 40-59-year-old men populations (1preventive measures, 2 – a group of comparison). Standardized epidemiological examination using unified protocol was performed in the total of 6656 people. The article presents results of prospective follow-up of the two groups, participants of which did not initially have IHD clinical signs: the group 1 – n=2975, the group 2 – n=2705. Active correction of IHD RF (high blood pressure, hypercholesterolemia, overweight, smoking, low physical activity) in the group 1 lasted for 5 years; the whole period of follow-up was 15 years. At that, end points (all-cause mortality, myocardial infarction and stroke) were estimated and verified in each case. This article evaluates the 10-year follow-up period. Results. Prevention in middle-aged men population allowed significantly to reduce levels of the major RF and total cardiovascular risk by 38.1%. In the absence of preventive measures cardiovascular risk, predicted by the SCORE chart, already realizes during the first 5 years. In fact cardiovascular mortality rates during 10-year follow-up exceed the risk predicted by the SCORE chart. Active primary IHD prevention allows to reduce the risk of cardiovascular death in men with initially high risk – by 36.9% and with initially very high risk – by 43.4%. Men, who have died of IHD undiagnosed during life-time, with combination of 3 and more RF revealed coronary artery stenosis of multiple localization in 91.7%, with 2 RF – in 89.6% and with singular RF – in 78.3% of the cases. Conclusion. We proved substantiated the relevance of multifactor primary prevention of atherosclerosis-mediated cardiovascular diseases. Primary medical prevention has demonstrated its effectiveness, especially at high cardiovascular risk, and particularly evident at a long-term follow-up. For the first time ever long-term prospective follow-up study of the population with standardized assessment of health parameters revealed negative predictive value of multiple RF in respect to coronary atherosclerotic lesions estimated postmortem.

SOCIO-ECONOMIC RISK FACTORS FOR CARDIOVASCULAR DEATH: DATA FROM 12-YEAR PROSPECTIVE EPIDEMIOLOGIC STUDY

Aim. Studying of the influence of socio-economic risk factors on relative risk (RR) of death from cardiovascular diseases (CVD) in non-organized population of Tyumen city. Material and methods. The epidemiological study was performed with standard approaches on relevant selection of Tyumen citizens aged 25-64 y. During next 12 years the whole cohort (795 men, 814 women) was analyzed for the deaths from cardiovascular diseases (CVD). Multivariate regression model of proportional Kox risk used to estimate RR for cardiovascular death. RR with 95% CI calculated with added concomitant RF like: age, SBP and DBP, BMI, total cholesterol, triglycerides, HDL, smoking state, coronary heart disease anamnesis and arterial hypertension. Results. By 12 years of observation there were 85 (10,7%) cases of cardiovascular death in men and 33 (4,1%) in women. Higher risk of cardiovascular death was in men with low educational level than in those with higher education (RR: 1,94, 95% CI 1,12-3,34). In women the same (RR: 3,42, 95% CI 1,53-7,64) in comparison to more educated women. After standartization of all concomitant factors the risk of cardiovascular death was significantly higher in men and women involved in hard physical labour (RR: 2,51, 95% CI 1,03-6,08 and 5,47, 95% CI 1,69-17,74, resp.), comparing to those of higher labour qualification (RR: 4,08 (95% CI 2,12-7,8), RR 3,19 (95% CI 1,22-8,34) and RR 3,18 (95% CI 1,90-5,34), resp. In women the relation was opposite: RR for cardiovascular death was higher for married women (3,21, 95% CI 1,28-8,06; p<0,001), than for single. Conclusion. The highest risk for cardiovascular death in non-organized Tyumen citizen cohort was found for those with lower educational level, involved into hard physical labour and single, divorced or widowed men. In women, opposite, being married was associated with higher risk of death from CVD.

Cardiovascular death risk and body mass index in male and female Tumen City residents

Aim. To study the association between body mass index (BMI) and cardiovascular (CV) death risk in an open population ofTumenCity, using prospective data of the 12-year follow-up. Material and methods. In 1996, a cardiologic screening of a representative Tumen City sample (25–64 years) was performed, using standard methods and achieving a response rate of 80,4% (n=1608). Over 12 years of the prospective follow-up, 85 CV deaths in men (10,69%) and 33 CV deaths in women (4,06%) were registered. Using Cox regression models, the parameters of absolute and relative risk (AR, RR) were assessed. Survival assessment was performed using the Kaplan-Meier method. Results. In men, RR of CV death was significantly higher for the top quintile of body mass index, BMI (

Erectile Dysfunction Is Not Independently Associated with Cardiovascular Death: Data from the Vitamins and Lifestyle (VITAL) Study

Erectile dysfunction (ED) is a significant problem among aging men. ED is independently associated with cardiovascular (CV) events (angina, myocardial infarction, and stroke). We sought to determine if ED was associated with CV death. Risk of CV death in men with ED. Exactly 31,296 men in Washington aged 50-76 completed a questionnaire in 2000-2002 on supplements, diet, exercise, personal health, and ED. ED was determined by one question: "Have you experienced impotence in the last year?" We excluded patients with a history of coronary artery disease or stroke. Participants linked yearly through 2008 to the Washington State Death Certificate System. CV death was defined by death certificates listing CV-related deaths (International Classification of Diseases 10th Revision [ICD-10] codes: I00-I15, I20-I52, and I60-I99). We performed multivariate Cox proportional hazard regression adjusting for age, marital status, race, education, self-rating of health, body mass index (BMI), antihypertensive/lipid-lowering drug use, diabetes, family history of CV disease, smoking, and exercise. About 7,762 men had ED and there were 486 CV deaths over 7.8-year average follow-up. The typical man who suffered CV death was older, single, reporting poor health, taking antihypertensives, higher BMI, a smoker, a diabetic, and had a family history of CV disease. When adjusting for age, marital status, and education only, men with ED had a 23% increased risk of CV death (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01, 1.49). With further adjustment for known risk factors for CV disease (diabetes, treatment for hypertension or hyperlipidemia, family history of myocardial infarction/stroke, BMI, and exercise), ED no longer predicted CV death (HR 0.93, 95% CI 0.76, 1.15). In this community-based cohort, ED was not independently associated with an elevated risk of CV death. These data do not contradict prior data associating ED and CV events but rather suggest that ED may be a manifestation of other known risk factors for CV disease.

Is Obstructive Sleep Apnea Associated with Cardiovascular Mortality in Women

Obstructive sleep apnea (OSA) is a recognized risk factor for cardiovascular death in men but hasn't been well studied in women. To find out more,

Cardiovascular Mortality in Women With Obstructive Sleep Apnea With or Without Continuous Positive Airway Pressure Treatment

Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in men, but whether it is also a risk factor in women is unknown. To investigate whether OSA is a risk factor for cardiovascular death in women and assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk. Prospective, observational cohort study. 2 sleep clinics in Spain. All women consecutively referred for suspected OSA between 1998 and 2007. Every woman had a diagnostic sleep study. Women with an apnea-hypopnea index (AHI) less than 10 were the control group. Obstructive sleep apnea was diagnosed when the AHI was 10 or higher (classified as mild to moderate [AHI of 10 to 29] or severe [AHI ≥30]). Patients with OSA were classified as CPAP-treated (adherence ≥4 hours per day) or untreated (adherence <4 hours per day or not prescribed). Participants were followed until December 2009. The end point was cardiovascular death. 1116 women were studied (median follow-up, 72 months [interquartile range, 52 to 88 months]). The control group had a lower cardiovascular mortality rate (0.28 per 100 person-years [95% CI, 0.10 to 0.91]) than the untreated groups with mild to moderate OSA (0.94 per 100 person-years [CI, 0.10 to 2.40]; P = 0.034) or severe OSA (3.71 per 100 person-years [CI, 0.09 to 7.50]; P < 0.001). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 3.50 (CI, 1.23 to 9.98) for the untreated, severe OSA group; 0.55 (CI, 0.17 to 1.74) for the CPAP-treated, severe OSA group; 1.60 (CI, 0.52 to 4.90) for the untreated, mild to moderate OSA group; and 0.19 (CI, 0.02 to 1.67) for the CPAP-treated, mild to moderate OSA group. The study was observational and not randomized, and OSA was diagnosed by 2 different methods. Severe OSA is associated with cardiovascular death in women, and adequate CPAP treatment may reduce this risk. None.

Relation of Serum ^|^alpha;- and ^|^gamma;-Tocopherol Levels to Cardiovascular Disease-Related Mortality Among Japanese Men and Women

BackgroundThere is limited evidence regarding the relationship between serum tocopherol levels and cardiovascular disease.MethodsWe conducted a nested case-control study as part of the Japan Collaborative Cohort Study for evaluation of cancer risk (JACC Study). Baseline serum samples were collected from 39 242 participants (age range, 40–79 years) between 1988 and 1990. During the 13-year follow-up, there were 530 stroke deaths (302 ischemic strokes and 210 hemorrhagic strokes) and 211 deaths from coronary heart disease. Controls were matched for sex, age, and area of residence.ResultsSerum α-tocopherol level was not associated with any type of cardiovascular death in men; however, in women, it was inversely associated with total stroke mortality and hemorrhagic stroke mortality. The multivariate odds ratio (95% CI) for the highest versus the lowest quintile of serum α-tocopherol levels among women was 0.35 (0.16–0.77; P for trend = 0.009) for total stroke and 0.26 (0.07–0.97; P for trend = 0.048) for hemorrhagic stroke. Serum γ-tocopherol was inversely associated with ischemic stroke mortality in men but positively associated with hemorrhagic stroke mortality in women. The respective multivariate odds ratios (95% CI) for the highest versus the lowest quintile and for a 1-standard deviation increment in γ-tocopherol level were 0.48 (0.22–1.06; P for trend = 0.07) and 0.77 (0.58–1.02), respectively, for ischemic stroke in men and 3.10 (0.95–10.12; P for trend = 0.052) and 1.49 (1.04–2.13) for hemorrhagic stroke in women.ConclusionsAmong women, hemorrhagic stroke mortality was inversely associated with serum α-tocopherol and positively associated with serum γ-tocopherol. These findings are due in part to the antioxidative and antithrombotic activities of these tocopherols.

Association of Androgen Deprivation Therapy With Cardiovascular Death in Patients With Prostate Cancer

Whether androgen deprivation therapy (ADT) causes excess cardiovascular deaths in men with prostate cancer is highly controversial and was the subject of a joint statement by multiple medical societies and a US Food and Drug Administration safety warning. To perform a systematic review and meta-analysis of randomized trials to determine whether ADT is associated with cardiovascular mortality, prostate cancer-specific mortality (PCSM), and all-cause mortality in men with unfavorable-risk, nonmetastatic prostate cancer. A search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant randomized controlled trials in English between January 1, 1966, and April 11, 2011. Inclusion required nonmetastatic disease, intervention group with gonadotropin-releasing hormone agonist-based ADT, control group with no immediate ADT, complete information on cardiovascular deaths, and median follow-up of more than 1 year. Extraction was by 2 independent reviewers. Summary incidence, relative risk (RR), and CIs were calculated using random-effects or fixed-effects models. Among 4141 patients from 8 randomized trials, cardiovascular death in patients receiving ADT vs control was not significantly different (255/2200 vs 252/1941 events; incidence, 11.0%; 95% CI, 8.3%-14.5%; vs 11.2%; 95% CI, 8.3%-15.0%; RR, 0.93; 95% CI, 0.79-1.10; P = .41). ADT was not associated with excess cardiovascular death in trials of at least 3 years (long duration) of ADT (11.5%; 95% CI, 8.1%-16.0%; vs 11.5%; 95% CI, 7.5%-17.3%; RR, 0.91; 95% CI, 0.75-1.10; P = .34) or in trials of 6 months or less (short duration) of ADT (10.5%; 95% CI, 6.3%-17.0%; vs 10.3%; 95% CI, 8.2%-13.0%; RR, 1.00; 95% CI, 0.73-1.37; P = .99). Among 4805 patients from 11 trials with overall death data, ADT was associated with lower PCSM (443/2527 vs 552/2278 events; 13.5%; 95% CI, 8.8%-20.3%; vs 22.1%; 95% CI, 15.1%-31.1%; RR, 0.69; 95% CI, 0.56-0.84; P < .001) and lower all-cause mortality (1140/2527 vs 1213/2278 events; 37.7%; 95% CI, 27.3%-49.4%; vs 44.4%; 95% CI, 32.5%-57.0%; RR, 0.86; 95% CI, 0.80-0.93; P < .001). In a pooled analysis of randomized trials in unfavorable-risk prostate cancer, ADT use was not associated with an increased risk of cardiovascular death but was associated with a lower risk of PCSM and all-cause mortality.

Cardiovascular Mortality in Men with Erectile Dysfunction: Increased Risk But Not Inevitable

It is unclear whether men with erectile dysfunction (ED) ultimately die of cardiovascular (CV) causes. This study examined the causes of death in men with ED and their risk of CV death. Based on statutory death registrations and hospital morbidity data, the risk of CV death in men with ED in a linked-data study was assessed against the CV mortality risk in a reference male population. Deaths from CV causes as proportions of all deaths. Age-specific rate, mortality rate ratio (MRR), standardized mortality rate ratio (SMRR), and adjusted hazard ratio (HR). CV mortality was 4.0%. Compared with the reference population, the risk of CV death was higher in men with ED (SMRR 2.2; 95% confidence interval [CI] 1.6, 3.0). Risk of CV mortality was higher in men with CV disease prior to ED (adjusted HR 1.7; 95% CI 1.1, 2.6) or with history of hospital admissions for CV events (adjusted HR 2.2; 95% CI 1.3, 3.8), compared with those without the respective history. MRR was significantly increased in the 40-69 years age group (MRR 4.1; 95% CI 3.2, 5.2). The median time interval between manifestation of ED and CV death was 10.0 years. A greater proportion of deaths from oncological than from CV causes (25.0% vs. 10.8%) occurred within the first 5 years of the manifestation of ED. Although the risk of CV mortality is greater in men with ED, almost as many men die of oncological as of CV causes, with a higher proportion of oncological deaths occurring sooner subsequent to the first manifestation of ED.