Cardiovascular Mortality In Adults Research Articles

Interactive Effects of Aerobic Fitness, Strength, and Obesity on Mortality in Men.

Low aerobic fitness, low muscular strength, and obesity have been associated with premature mortality, but their interactive effects are unknown. This study examined interactions among these common, modifiable factors, to help inform more-effective preventive interventions. This national cohort study included all 1,547,478 military conscripts in Sweden during 1969-1997 (97%-98% of all men aged 18 years each year). Aerobic fitness, muscular strength, and BMI measurements were examined in relation to all-cause and cardiovascular mortality through 2012 (maximum age, 62 years). Data were collected/analyzed in 2015-2016. Low aerobic fitness, low muscular strength, and obesity at age 18 years were independently associated with higher all-cause and cardiovascular mortality in adulthood. The combination of low aerobic fitness and muscular strength (lowest versus highest tertiles) was associated with twofold all-cause mortality (adjusted hazard ratio=2.01; 95% CI=1.93, 2.08; p<0.001; mortality rates per 100,000 person years, 247.2 vs 73.8), and 2.6-fold cardiovascular mortality (2.63; 95% CI=2.38, 2.91; p<0.001; 43.9 vs 8.3). These factors also had positive additive and multiplicative interactions in relation to all-cause mortality (their combined effect exceeded the sum or product of their separate effects; p<0.001), and were associated with higher mortality even among men with normal BMI. Low aerobic fitness, low muscular strength, and obesity at age 18 years were associated with increased mortality in adulthood, with interactive effects between aerobic fitness and muscular strength. Preventive interventions should begin early in life and include both aerobic fitness and muscular strength, even among those with normal BMI.

Association between excessive BMI increase during puberty and risk of cardiovascular mortality in adult men: a population-based cohort study

Being overweight during childhood and adolescence is associated with increased risk of cardiovascular disease in adulthood, but the relative contribution of prepubertal childhood BMI and BMI change during puberty to adult mortality due to cardiovascular disease is unknown. We assessed the contribution of these two distinct developmental BMI parameters for cardiovascular mortality in adult men. As a part of the ongoing population-based BMI Epidemiology Study (BEST) in Gothenburg, Sweden, men born between 1945 and 1961 with information on both their childhood BMI at age 8 years and BMI change during puberty were included in the study and followed up until December, 2013. Participants who died or emigrated before age 20 years were excluded from the analysis. BMI was collected from paediatric growth charts and mandatory military conscription tests. Childhood overweight (BMI of ≥17·9 kg/m2) was defined according to the Centers for Disease Control and Prevention's cutoff at 8 years of age, and BMI change during puberty was defined as the difference between young adult BMI and childhood BMI (BMI at age 20 years minus BMI at age 8 years). Information on mortality was retrieved from high quality national registers with the participants' ten-digit personal identity number. We used Cox proportional hazard regression to analyse the association between exposures and mortality. The ethics committee of the University of Gothenburg, Sweden, approved the study and waived the requirement for written informed consent. We followed 37 672 Swedish men from age 20 years for a mean of 37·8 years (1 422 185 person-years follow-up). 3188 all-cause deaths and 710 cardiovascular deaths occurred during follow-up. The correlation between childhood BMI and BMI change during puberty was marginal (r=0·06). BMI change during puberty, but not childhood BMI, was independently associated with adult all-cause and cardiovascular mortality in men. Boys that became overweight during puberty (HR 2·39; 95% CI 1·86-3·09) and boys who were overweight consistently throughout childhood and puberty (1·85; 1·28-2·67), but not boys overweight in childhood that normalised during puberty (0·99, 0·65-1·50), had increased risk of cardiovascular mortality compared with participants who were not overweight in childhood or as young adults. The association between BMI change during puberty and cardiovascular mortality was non-linear with a substantial association above a threshold of 6·7 units increase in BMI. Excessive BMI increase during puberty is a risk marker of adult cardiovascular mortality. These results indicate that BMI should be monitored during puberty to identify boys with increased risk of adult cardiovascular mortality. Swedish Research Council, the Swedish Government (under the Avtal om Läkarutbildning och Medicinsk Forskning [Agreement for Medical Education and Research]), the Lundberg Foundation, the Torsten Söderberg Foundation, the Novo Nordisk Foundation, the Knut and Alice Wallenberg Foundation, and the Anna Ahrenberg Foundation.

Modest U-Shaped Association between Dietary Acid Load and Risk of All-Cause and Cardiovascular Mortality in Adults

Background: Conflicting evidence associates diet acidity with the incidence of chronic diseases such as hypertension, diabetes, kidney disease, and bone-mineral disorders. It is currently unknown whether dietary acidity is associated with death.Objective: We investigated the association of dietary acid load with the risk of all-cause and cardiovascular disease (CVD) mortality.Methods: We used data from 2 prospective cohorts, the Swedish Mammography Cohort and the Cohort of Swedish Men, which included 36,740 women and 44,957 men aged 45–84 y at the start of a 15-y follow-up period (1998–2012). Acid load was estimated from food-frequency questionnaires by use of the validated potential renal acid load (PRAL) algorithm. Deaths were ascertained via record linkage. Associations of PRAL with mortality were modeled by use of restricted cubic splines.Results: The median PRAL was 0.65 mEq/d (range: −109 to 81.5 mEq/d) in women and 12.3 mEq/d (−111 to 121 mEq/d) in men. During a mean of 13.5 ± 3.3 y of follow-up, there were 8576 and 13,332 deaths, of which 3203 and 5427 were attributed to cardiovascular causes in woman and men, respectively. In both sexes, a nonlinear U-shaped relation was observed, with higher mortality rates for both dietary acid and alkali excess. Compared with neutral PRAL (0 mEq/d), the HRs for all-cause mortality for the 10th and 90th percentiles of PRAL were 1.05 (95% CI: 1.01, 1.10) and 1.03 (95% CI: 0.98, 1.08), respectively, in women. The corresponding results for men were HRs 1.01 (95% CI: 1.00, 1.02) and 1.04 (95% CI: 1.00, 1.08) respectively. This relation was slightly stronger for CVD mortality.Conclusions: Excess diet alkalinity and acidity both showed weak associations with higher mortality in Swedish adults. An acid-base balanced diet was associated with the lowest mortality, but the magnitude of mortality reduction was modest. The Swedish Mammography Cohort was registered at as NCT01127698. The Cohort of Swedish Men was registered at clinicaltrials.gov as NCT01127698. The Cohort of Swedish Men was registered at clinicaltrials.gov as NCT01127711.

Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood

BackgroundIn light of the worldwide increase in childhood obesity, we examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes in adulthood.MethodsWe grouped data on BMI, as measured from 1967 through 2010 in 2.3 million Israeli adolescents (mean age, 17.3±0.4 years), according to age- and sex-specific percentiles from the U.S. Centers for Disease Control and Prevention. Primary outcomes were the number of deaths attributed to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories (total cardiovascular causes) by mid-2011. Cox proportional-hazards models were used.ResultsDuring 42,297,007 person-years of follow-up, 2918 of 32,127 deaths (9.1%) were from cardiovascular causes, including 1497 from coronary heart disease, 528 from stroke, and 893 from sudden death. On multivariable analysis, there was a graded increase in the risk of death from cardiovascular causes and all causes that started among participants in the group that was in the 50th to 74th percentiles of BMI (i.e., within the accepted normal range). Hazard ratios in the obese group (≥95th percentile for BMI), as compared with the reference group in the 5th to 24th percentiles, were 4.9 (95% confidence interval [CI], 3.9 to 6.1) for death from coronary heart disease, 2.6 (95% CI, 1.7 to 4.1) for death from stroke, 2.1 (95% CI, 1.5 to 2.9) for sudden death, and 3.5 (95% CI, 2.9 to 4.1) for death from total cardiovascular causes, after adjustment for sex, age, birth year, sociodemographic characteristics, and height. Hazard ratios for death from cardiovascular causes in the same percentile groups increased from 2.0 (95% CI, 1.1 to 3.9) during follow-up for 0 to 10 years to 4.1 (95% CI, 3.1 to 5.4) during follow-up for 30 to 40 years; during both periods, hazard ratios were consistently high for death from coronary heart disease. Findings persisted in extensive sensitivity analyses.ConclusionsA BMI in the 50th to 74th percentiles, within the accepted normal range, during adolescence was associated with increased cardiovascular and all-cause mortality during 40 years of follow-up. Overweight and obesity were strongly associated with increased cardiovascular mortality in adulthood. (Funded by the Environment and Health Fund.)

Depression and all-cause and cardiovascular mortality in patients on haemodialysis: a multinational cohort study.

Depression and early death are both common in adults with Stage 5 chronic kidney disease. Studies have shown an association between depression and total mortality, but the association between depression and cardiovascular death is less certain. We conducted a prospective multinational cohort study involving adults who were treated with long-term haemodialysis within a single dialysis network between April and November 2010. Depression was considered present when patients reported a Beck Depression Inventory (BDI) II score ≥14 at baseline. Sensitivity analyses considered a BDI II score ≥20 to identify moderate depression. Multivariable Cox proportional hazards regression was used to assess adjusted hazards for all-cause and cardiovascular mortality at 12 months. Three thousand and eighty-six participants in the network received the BDI II questionnaire, and 2278 (73%) provided complete responses to the survey questions. Among these, 1047 (46%) reported depression. During a mean follow-up of 11 (standard deviation: 2.5) months (2096 person-years), we recorded 175 deaths, of which 66 were attributable to cardiovascular causes. Depression (BDI score ≥14) was not associated with all-cause mortality [adjusted hazard ratio: 1.26 (95% confidence interval: 0.93–1.71)] or cardiovascular mortality [0.82 (0.50–1.34)]. When a higher BDI score (BDI score ≥20) was used to identify moderate depression, depression was associated with total mortality [1.40 (1.02–1.93)] but not cardiovascular mortality [1.05 (0.63–1.77)]. The association between depression and cardiovascular mortality in adults with kidney failure treated with haemodialysis is uncertain. Depression is a heterogeneous disorder and may only be a risk factor for premature death when at least of moderate severity.

Abstract 15307: Dairy Intake and Risk of Cardiovascular Mortality in Singapore Chinese Adults

Introduction: Studies have suggested that dairy foods may be associated with lower risk of metabolic syndrome, HTN, and T2D. However, the relation of dairy products with CVD risk has been less clear, with mixed findings from various epidemiological studies. So far, few reports are from Chinese populations where the consumption levels are generally low. Methods: The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998 in Singapore. A validated 165-item semi-quantitative food-frequency questionnaire was used to assess usual diet at recruitment, and mortality information was identified via registry linkage up to December 31, 2013. Cox proportional hazard models were used to calculate HRs (95% CI) with adjustment for potential confounders. Results: The median total dairy intake was 20.1 g/d (ranged 0-1084 g/d). During 981,480 person-years of follow-up, we identified 5,484 CVD deaths. After controlling for socio-demographic, lifestyle and other dietary factors, marginally inverse association was observed, and the HRs (95% CI) for CVD mortality were 1.00, 0.95 (0.88-1.02), 0.96 (0.89-1.04), and 0.91 (0.84-0.99) for increasing quartiles of total dairy intake (P-trend=0.08). No significant association was observed for CHD deaths (n=3,033), and the HR comparing extreme quartiles was 0.93 (95% CI: 0.84-1.04; P-trend=0.27). Although the trend was not significant (P-trend=0.15) for stroke mortality (n=1544), the HRs were 1.00, 0.88 (0.77-1.02), 0.88 (0.76-1.01), and 0.84 (0.72-0.98) for increasing quartiles of total dairy intake. In men, higher total dairy intake was inversely associated with risk of CVD mortality [HR comparing extreme quartiles 0.89 (0.80-0.99); P-trend=0.02] and stroke mortality [0.72 (0.58-0.89); P-trend=0.005], but no significant association was observed in women [CVD mortality 0.99 (0.88-1.12); P-trend=0.41; and stroke mortality 0.93 (0.75-1.15); P-trend=0.97]. Conclusions: In this large cohort study of Chinese adults with generally low dairy consumption, high intake of total dairy products was associated with a modestly decreased risk of total CVD mortality, and this association was mainly observed for stroke mortality and only evident in men.

Bariatric and Metabolic Surgery in Adolescents: a Path to Decrease Adult Cardiovascular Mortality

Obesity is a major health problem across all age groups and has escalated to pandemic proportions. The proportion of children with overweight or obesity has risen rapidly over recent decades, and it is recognized that most obese children become obese adults. Furthermore, BMI is the strongest CV risk factor to track from childhood into adulthood. As well as BMI, multiple CV risk factors begin in childhood and strong associations between these factors and BMI are evident. Clear evidence exists for the CV benefits of reversing obesity in adults, much of which examines the effects of bariatric surgery. The capacity of bariatric surgery to reliably achieve safe and lasting improvement in BMI is unparalleled, and the emerging evidence base in adolescent bariatric surgery has so far concurred. In the absence of effective alternatives, it appears that the increase in use of bariatric surgery in adolescents will continue.

Association Between Glycosylated Hemoglobin and Cardiovascular Events and Mortality in Older Adults without Diabetes Mellitus in the General Population: The Leiden 85-Plus Study.

To examine the association between glycosylated hemoglobin (HbA1c) and incident cardiovascular disease and mortality in 85-year-old individuals without diabetes mellitus from the general population. Population-based prospective follow-up study. General population. Individuals without known diabetes mellitus (N=445, n=291 female). HbA1c levels were categorized into three groups (<5.0% (31mmol/mol), 5.0-5.7% (31-39mmol/mol; reference), 5.7-6.5% (39-48mmol/mol)). At baseline, a history of myocardial infarction (MI) was more prevalent in subjects in the highest HbA1c group (18%) than in the reference group (7%) (P=.001). Prospectively, those with the highest level of HbA1c at baseline had a risk of incident MI during the 5-year follow-up that was 3.6 (95% confidence interval=1.5-8.3) times as great as that of the reference group. No association was found between HbA1c level and incident stroke, cardiovascular mortality, or all-cause mortality. In individuals aged 85 and older without diabetes mellitus, higher HbA1c is associated with greater risk of MI but not with stroke and mortality.

Phenotype of Children with QT Prolongation Identified Using an Institution-Wide QT Alert System.

QT prolongation is an independent risk factor for cardiovascular mortality in adults. However, there is little information available on pediatric patients with QT prolongation and their outcomes. Herein, we evaluated the prevalence of QT prolongation in pediatric patients identified by an institution-wide QT alert system, and the spectrum of their phenotype. Patients with documented QT prolongation on an ECG obtained between November 2010 and June 2011 were included. There were 1303 pediatric ECGs, and 68 children had electrographically isolated QT prolongation. Comprehensive review of medical records was performed with particular attention to QT-prolonging clinical, laboratory, and medication data, which were summarized into a pro-QTc score. Overall, 68 (5 %) pediatric patients had isolated QT prolongation. The mean age of this pediatric cohort was 9 ± 6 years, and the average QTc was 494 ± 42 ms. All children had 1 or more QT-prolonging risk factor(s), most commonly QT-prolonging medications. One patient was identified with congenital long QT syndrome (LQTS), which was not previously diagnosed. In one-year follow-up, only one pediatric death (non-cardiac) occurred (1.5 %). Potentially QT-offending/pro-arrhythmic medications were changed in 80 % of pediatric patients after the physician received the QT alert. Children with QT prolongation had very low mortality and minimal polypharmacy. Still, medications and other modifiable conditions were the most common causes of QT prolongation. Children with a prolonged QTc should be evaluated for modifiable QT-prolonging factors. However, if no risk factors are present or the QTc does not attenuate after risk factor modification/removal, the child should be evaluated for congenital LQTS.

Statistical Issues in the Evaluation of Clustering of Metabolic Syndrome in Spousal Pairs

Background: The metabolic syndrome is intimately linked hypertension, impaired glucose tolerance, dyslipidemia, and abdominal obesity and is associated with an increased risk of total and cardiovascular mortality in adults. Genetics as well as environmental influences have been implicated in obesity and several cardiovascular risk factors. Because Family is one of the most important factors affecting metabolic risk factors, studying co-aggregation of the components of the syndrome among family members, and in particular spousal pairs, is of interest to genetic epidemiologists and community health researchers. Methods: Based on the clinical definition of the syndrome, we introduce three statistical models to estimate the prime parameter of interest which measure the degree of clustering of the disease among spousal pairs. Since the focus in this paper is on the methodological approach to estimate the between pairs clustering parameters, we shall use Monte-Carlo simulated data for demonstration purposes, with values of the input parameters for each component taken from a well-known Korean study. We develop two models, the Bivariate Truncated Poisson Model (BTPM), which models the counts, and the Bivariate Dirichlet Multinomial Model (BDMM), which models the frequency of counts, and discuss the relative merits of each model. The two models are qualitatively different but quantitatively interrelated. Since the clinical definition of the metabolic syndrome requires that at least three of its components, co-exist within a subject, we show that adhering to this definition requires certain specifications that should be satisfied in any of the adopted models. We estimated the clustering parameters under the specified models. A comparison between the models was based on the internal consistency of each model. What we mean by that is the degree of closeness of the estimated distribution to the observed data. The BDMM fitted the data much closer than the BTPM. Interpretation: In a sample of randomly selected spousal pairs; and according to the clinical definition, the number of components of the metabolic syndrome can in an individual be 0, 1, 2, 3, 4, or 5. Estimation of the clustering parameter of the counts is equivalent to the estimation of the intraclass correlation coefficient (ICCC) between pairs. Assessing the goodness of fit of the proposed models, it is more statistically sound to estimate the degree of clustering of the components of the syndrome in spousal pairs under the BDMM.

Abstract 19269: Relations and Predictive Value of Post-load and Fasting Glucose for Incident Cardiovascular Disease and Mortality in Older Adults: the Cardiovascular Health Study

Introduction: Elders have a high prevalence of post-load hyperglycemia, which may go undetected with standard screening. Post-load glucose has shown more robust associations with cardiovascular disease (CVD) and death than fasting glucose, but data in advanced old age are sparse. Whether post-load glucose improves risk prediction for CVD and death after accounting for fasting glucose has not been examined. Methods: Fasting and 2-hour post-load glucose were measured at baseline (1989) and follow-up (1996) visits in a prospective study of community-dwelling adults initially ≥65 years old (Cardiovascular Health Study). To evaluate if previously reported associations of fasting and post-load glucose with incident CVD from the baseline visit persist later in life, and apply to mortality, we focused on the 1996 visit (n=2394). To determine the incremental value of post-load glucose for risk prediction, we examined whether it could significantly reclassify baseline (1989) participants (≤75 years) into cholesterol treatment categories based on recent guidelines (n=2542). Results: Among participants in the 1996 visit (mean age 77), there were 543 incident CVD events and 1698 deaths during median follow-up of 11.2 years. In fully adjusted models, both fasting and 2-hour glucose were associated with CVD (HR per SD, 1.13 [1.03-1.25] and 1.17 [1.07-1.28], respectively) and mortality (HR per SD, 1.12 [1.07-1.18] and 1.14 [1.08-1.20]). After mutual adjustment, however, the associations for fasting glucose with either outcome were abolished, but those for post-load glucose remained unchanged. Among subjects ≤75 years old in 1989, there were 416 CVD events and 740 deaths at 10-year follow-up. Post-load glucose did not enhance reclassification using the 7.5% 10-year risk threshold, nor did it improve the C-statistic. Conclusion: In adults surviving to advanced old age, post-load glucose was associated with CVD and mortality independently of fasting glucose, but not vice versa, although there was no associated improvement in risk prediction. These findings affirm the robust association of post-load glucose with CVD and death late in life, but do not support the value of routine oral glucose tolerance testing for prediction of these outcomes in older adults.

Permanent cardiac sarcomere changes in a rabbit model of intrauterine growth restriction.

BackgroundIntrauterine growth restriction (IUGR) induces fetal cardiac remodelling and dysfunction, which persists postnatally and may explain the link between low birth weight and increased cardiovascular mortality in adulthood. However, the cellular and molecular bases for these changes are still not well understood. We tested the hypothesis that IUGR is associated with structural and functional gene expression changes in the fetal sarcomere cytoarchitecture, which remain present in adulthood.Methods and ResultsIUGR was induced in New Zealand pregnant rabbits by selective ligation of the utero-placental vessels. Fetal echocardiography demonstrated more globular hearts and signs of cardiac dysfunction in IUGR. Second harmonic generation microscopy (SHGM) showed shorter sarcomere length and shorter A-band and thick-thin filament interaction lengths, that were already present in utero and persisted at 70 postnatal days (adulthood). Sarcomeric M-band (GO: 0031430) functional term was over-represented in IUGR fetal hearts.ConclusionThe results suggest that IUGR induces cardiac dysfunction and permanent changes on the sarcomere.

Greenness and Health: Using Linked Data to Disentangle Effects from Spatially Crrelated Built Environment Factors

Greenness and Health: Using Linked Data to Disentangle Effects from Spatially Crrelated Built Environment FactorsAbstract Number:2915 Michael Brauer* and Perry Hystad * Michael Brauer* The University of British Columbia, Canada, E-mail Address: [email protected] Search for more papers by this author and Perry Hystad * Oregon State University, United States, E-mail Address: [email protected] Search for more papers by this author AbstractBuilt environment features including greenness have been associated with improvements in a diverse range of health outcomes, including birth outcomes and adult chronic diseases; however, it is important to differentiate the effects of greenness from otherspatially correlated exposures related to the built environment which may also impact health. We examined associations between residential greenness (satellite-derived normalized difference vegetation index (NDVI) within 100 meters of study participants’ homes), birth outcomes and adult cardiovascular disease in two linked population-based administrative data cohorts in Vancouver, British Columbia, Canada: a cohort of 64,705 singleton births and a cohort of 467,994 adults aged 45-85 years. We evaluatedassociations between greenness with birth outcomes and with cardiovascular mortality and hospitalization as well as their sensitivity to spatially correlated built environmental factors also associated with health, including exposure to air pollution and noise, neighborhood walkability and distance to the nearest park. An interquartile range increase in greenness [0.1 NDVI] was associated with an increase in term birth weight of 20.6 grams (95% CI: 16.5-24.7) as well as decreases in likelihood of being small for gestational age, and very (<30 weeks) and moderately (30-36 weeks) preterm birth. The greenness-birth outcome associations were robust to adjustment for air pollution and noise exposure, neighborhood walkability, and park proximity.Results for adult cardiovascular mortality and hospitalization will also be presented. Increased residential greenness was associated with beneficial birth outcomes in this population-based cohort. These associations did not change after adjusting for other spatially correlated built environment factors ? suggesting that alternative pathways (e.g. psychosocial and psychological mechanisms) may underlie associations between residential greenness and birth outcomes.

Usefulness of the Electrocardiogram in Predicting Cardiovascular Mortality in Asymptomatic Adults With Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis Study)

Hypertension and coronary heart disease are common in aortic stenosis (AS) and may impair prognosis for similar AS severity. Different changes in the electrocardiogram may be reflective of the separate impacts of AS, hypertension, and coronary heart disease, which could lead to enhanced risk stratification in AS. The aim of this study was therefore to examine if combining prognostically relevant electrocardiographic (ECG) findings improves prediction of cardiovascular mortality in asymptomatic AS. All patients with baseline electrocardiograms in the SEAS study were included. The primary end point was cardiovascular death. Backward elimination (p >0.01) identified heart rate, Q waves, and Cornell voltage-duration product as independently associated with cardiovascular death. Multivariate logistic and Cox regression models were used to evaluate if these 3 ECG variables improved prediction of cardiovascular death. In 1,473 patients followed for a mean of 4.3years (6,362 patient-years of follow-up), 70 cardiovascular deaths (5%) occurred. In multivariate analysis, heart rate (hazard ratio [HR] 1.5 per 11.2minute(-1) [1 SD], 95% confidence interval [CI] 1.2 to 1.8), sum of Q-wave amplitude (HR 1.3 per 2.0mm [1 SD], 95% CI 1.1 to 1.6), and Cornell voltage-duration product (HR 1.4 per 763mm× ms [1 SD], 95% CI 1.2 to 1.7) remained independently associated with cardiovascular death. Combining the prognostic information contained in each of the 3 ECG variables improved integrated discrimination for prediction of cardiovascular death by 2.5%, net reclassification by 14.3%, and area under the curve by 0.06 (all p ≤0.04) beyond other important risk factors. ECG findings add incremental predictive information for cardiovascular mortality in asymptomatic patients with AS.

Self-Reported Health Status Predicts Physical Activity in Adults with Intellectual and Developmental Disabilities

Background: Health promotion and maintenance require behavior such as regular physical activity. Inactivity has been associated with morbidity and mortality in persons with intellectual and/or developmental disability (I/DD). Selfreported health has been shown to influence health behavior and has consistently predicted overall mortality and cardiovascular mortality in adults with I/DD. Precise physical activity measurement and knowledge of correlates of physical activity among persons with I/DD are limited. This study aims to continuously measure physical activity over a two week period in persons with I/DD while wearing Personal Activity Monitor (PAM) and determine if self-report health status influences physical activity. Methods: Seventeen (10 male/7 female) participants with I/DD aged 18 to 59 years of age continuously wore PAM 24 hours a day for 14 days providing subject-specific individualized motion classification. Baseline assessment of factors associated with physical activity included assorted tools designed for persons with I/DD. Results: Findings indicate that higher ratings of self-reported health status predicted greater physical activity in adults with I/DD. Those self-reporting their health as excellent/very good or good demonstrated significantly greater physical activity measured by PAM than those self-reporting their health as good or fair. Time spent in physical activity was below the recommended guidelines for health benefits. Neither age nor body mass index correlated with activity values. Conclusions: Evaluation of self-reported health in persons with I/DD should be part of primary prevention strategies. Understanding the impact of self-reported health in this often under-served population can lead to focused interventions to improve fitness and well-being.

Uric Acid for Prediction of Cardiovascular Mortality in Older Adults

Uric Acid for Prediction of Cardiovascular Mortality in Older Adults

Community-based incidence rate of cardiovascular disease and mortality in 50–75-year-old adults

Abstract Backgrounds and objectives Updated information on the incidence of the principal cardiovascular diseases (CVDs) and cardiovascular mortality is not available in Spain. We have studied the density of the incidence of new cases of myocardial infarction, heart failure, stroke and cardiovascular mortality in adults from a population in Sanlucar de Barrameda (Spain). Materials and methods A community-based prospective follow-up study was conducted. The study enrolled 858 participants aged 50–75 years who were randomly selected from the population and followed-up for 5 years. Age and gender-adjusted incidence rates of cardiovascular disease and cardiovascular mortality were calculated, obtaining complete information for 855 participants. Prognostic risk factors of new cases of cardiovascular disease were obtained using Cox proportional hazard modeling. Results The community-based incidence rate of heart failure was 455/100,000 persons-year. The incidence of myocardial infarction, stroke and cardiovascular mortality (506, 216 and 225/100,000 persons-year, respectively) was also very elevated. Male gender, family history of early cardiovascular disease, diabetes, hypertension and sedentary life style were independent risk factors of cardiovascular disease. Conclusions The incidence of myocardial infarction in Sanlucar de Barrameda (Spain) is very high. It is the first study reported in Spain. The incidence of myocardial infarction is among the highest in Spain.

Early Growth Patterns Associated with Cardiovascular Disease

Clearly, the development of cardiovascular disease in adulthood is influenced by growth very early in life, even prior to birth. Substantial evidence indicates that impaired fetal growth and subsequent low birth weight are associated with adult cardiovascular disease and related mortality, and there is emerging evidence that elevated birth weight has similar associations. Patterns of rapid and slow infant growth are each associated with multiple cardiovascular disease processes, and rapid growth during childhood is also predictive of adult cardiovascular disease. Additionally, early adiposity rebound is linked to obesity and diabetes mellitus later in life.

Soluble CD14: Genomewide Association Analysis and Relationship to Cardiovascular Risk and Mortality in Older Adults

Soluble CD14: Genomewide Association Analysis and Relationship to Cardiovascular Risk and Mortality in Older Adults

Serum γ-Glutamyltranspeptidase Predicts All-cause, Cardiovascular and Liver Mortality in Older Adults

Serum γ-glutamyltranspeptidase (GGT), a marker of fatty liver disease (FLD), predicts mortality in young adults. However, the association between serum GGT and mortality in older adults is unclear. To examine if elevated serum GGT predicts all-cause, cardiovascular (CVD), and liver mortality in community-dwelling older adults. A prospective cohort study including 2364 participants (mean-age 70 yr, BMI-24.5 kg/m2, 54% women) from the Rancho Bernardo Study who attended a research visit in 1984-87 when multiple metabolic covariates were ascertained including serum GGT. They were followed for a mean (± standard deviation) of 13.7 (±6.2) years. Multivariable-adjusted Cox-proportional hazards analyses were conducted to examine the association between elevated serum GGT (>51 U/L in men and > 33 U/L in women) and all-cause, CVD, and liver mortality. In these older men and women, cumulative mortality was 56.2% (n=1329) with CVD and liver mortality accounting for 49.4% and 2.3% of all deaths, respectively, over 32,387 person-years of follow-up. In multivariate analyses (adjusted for age, sex, alcohol use, body-mass-index, total cholesterol, HDL cholesterol, serum triglyceride, smoking status, systolic blood pressure, diabetes mellitus, serum interleukin-6, and c-reactive protein), serum GGT elevation was significantly associated with all-cause (HR, 1.55, 95% CI, 1.21-1.98), CVD (HR, 1.51, 95% CI, 1.04-2.17), and liver mortality (HR, 9.10, 95% CI, 3.42-24.26). In community-dwelling older adults, serum GGT is an independent predictor of all-cause, CVD, and liver mortality.