Cerebrovascular Disease Mortality Research Articles

P0790RISK OF CARDIOVASCULAR DISEASE AND CHRONIC KIDNEY DISEASE ACCORDING TO BLOOD PRESSURE CATEGORIES IN DIABETIC PATIENTS : A POPULATION-BASED STUDY

Abstract Background and Aims American College of Cardiology/American Heart Association (ACC/AHA) guidelines and cardiovascular disease (CVD) and chronic kidney disease (CKD) in diabetes patients remain unclear. We aimed to examine the effects of BP categories defined by the 2017 ACC/AHA guidelines in diabetes patients on the risk of CVD and CKD. Method In this population-based cohort study we analyzed data from the National Health Information Database in Korea during 2009-2017. The BP categories were defined as per the 2017 ACC/AHA guidelines: level 1 (systolic <120 mmHg and diastolic <80 mmHg), level 2 (systolic 120-129 mmHg and diastolic <80 mmHg), level 3 (systolic 130-139 mmHg or diastolic 80-89 mmHg), and level 4 (systolic ≥140 mmHg or diastolic ≥90 mmHg). We obtained the risk of CVD, CKD, cerebrovascular disease and CVD mortality. Results Overall, 490,352 diabetes patients (men 313,752 [64·0%], women 176,599 [36·0%]) were included in the analysis. Over a mean follow-up of 5 years, 6,508 CVD events occurred. Compared to people with BP levels 1, the adjusted hazard ratios (HRs) for CVD in people with BP levels 2, 3, and 4 were 1·07 (95% confidence interval [CI], 0·98-1·16), 1·12 (95% CI, 1·04-1·20) and 1·17 (95% CI, 1·08-1·26), respectively. There were also increased risks of CKD [1·18 (95% CI, 1·12-1·24) and 1·22 (95% CI, 1·15-1·29)], cerebrovascular disease [1·21 (95% CI, 1·14-1·29) and 1·52 (95% CI, 1·42-1·63)], and CVD mortality [1·31 (95% CI, 1·09-1·56) and 1·91 (95% CI, 1·58-2·32)] among subjects with BP levels 3 and 4 compared with those with BP level 1. Moreover, among people not taking antihypertensive medications, there were higher risks of CVD, CKD, cerebrovascular disease, and CVD mortality in those with BP levels 3 and 4 than in those with BP level 1. The risks of CVD, CKD, cerebrovascular disease, and CVD mortality significantly increased in patients with a systolic BP of 130 mmHg and diastolic BP of 80 mmHg. These findings provide evidence supporting the 2017 ACC/AHA guidelines for BP targets in diabetes patients. Conclusion The risks of CVD, CKD, cerebrovascular disease, and CVD mortality significantly increased in patients with a systolic BP of 130 mmHg and diastolic BP of 80 mmHg. These findings provide evidence supporting the 2017 ACC/AHA guidelines for BP targets in diabetes patients.

PERSISTENT GENDER AND RACIAL DIFFERENCES IN MORTALITY FROM ISCHEMIC HEART DISEASE AND CEREBROVASCULAR DISEASE IN THE UNITED STATES: 1999 TO 2017

Ischemic heart disease (IHD) and cerebrovascular disease (CVD) mortality varies across USA. We describe updated IHD and CVD trends by sex and race across USA. We performed an observational analysis of the CDC WONDER database for underlying death causes between 1999 and 2017. Age-standardized death

Analyses of Mortality and Prevalence of Cerebrovascular Disease in Colombia, South America (2014-2016): A Cross-Sectional and Ecological Study

Background: Stroke is the second cause of death and the first cause of disability worldwide. However, although numerous reports regarding stroke epidemiology in Latin America have been published, they differ widely in terms of employed methods and end points. This is the first of a series of articles that describes the epidemiology of stroke and other cerebrovascular diseases (CVD) in the nation, as well as their correlation with recognized risk factors and social variables. Methods: Descriptive analyses were performed using the Colombian vital registration system and social security information system as primary data sources. Rates and ratios were calculated, corrected for under-registration, and standardized. Secondary analyses were made using data from national surveys and government organizations on hypertension, diabetes mellitus, sedentarism, obesity, tobacco and alcohol consumption, and unsatisfied basic needs. Factorial multivariate multiple regression analyses were performed to evaluate correlations. Concentration curves and indices were calculated to evaluate for inequities in the distribution of events. Results: Global CVD had a national mortality rate and a prevalence ratio of 28 and 142 per 100,000 persons, respectively. Nontraumatic intracranial hemorrhage had the highest mortality rate (ie, 15 per 100,000), while cerebral infarction and transitory cerebral ischemia had the highest prevalence ratios (ie, 28 and 29 per 100,000, respectively). Hypertension and tobacco use were the most relevant risk factors for most of the simple and multiple models, and cerebral amyloid angiopathy and nonpyogenous intracranial venous thrombosis were the disease categories with the most socially unequal distribution of deaths and cases (ie, concentration indices of .34 and .29, respectively). Conclusions: CVDs are a cause for concern in Colombia and a marker of healthcare inequality and social vulnerability. Nationwide control of risk factors such as hypertension and tobacco use, as well as the design and conduct of public policy focused on the vulnerable and medically underserved regions and on standardizing mandatory CVD registries might ease its burden.

Trends in educational inequalities in premature mortality between 2001 and 2016: results from the Emilian Longitudinal Study

to describe changes in relative and absolute inequalities in mortality by education level between 2001 and 2016 in the Emilian longitudinal study (SLEm) and to estimate the impact of these inequalities at population level. closed cohort study based on record-linkage between municipal population registries, Census archives of 2001 and 2011, and the mortality register. 2001- and 2011-Census respondents >=30 years old residing in Bologna, Modena, or Reggio Emilia followed up to the age of 75 years, death, emigration, or end of follow-up (December 2006 or December 2016). premature mortality for all causes and for 16 groups of causes known to be associated with socioeconomic position. In order to capture various aspects of the inequalities, the association with the education level is assessed through summary regression-based indexes (Relative and Slope Index of Inequality) and the Attributable Population Fraction. premature mortality declined across all educational level between 2001-2006 and 2011-2016; declines were greater among men than women. Among men, relative inequalities in mortality slightly increased (RII from 1.86 in 2001 to 2.13 in 2011), while absolute inequalities declined (SII from 382.3 to 360.6). Among women, both relative and absolute inequalities increased (RII from 1.23 to 1.65, SII from 73.7 to 137.4). Educational inequalities in lung cancer, respiratory and cerebrovascular diseases mortality decreased among men and increased among women. The proportion of the low educated shrank over time (men: from 40% to 36%; women: from 43% to 35%); nonetheless, the fraction of the deaths attributable to educational inequalities showed an upward tendency (from 18.5% to 21.9% in men and from 9.7% to 15.6% in women); the groups of causes that contribute most to this increase were malignant cancers, especially lung cancer, diseases of the circulatory and respiratory systems, and accidents. relative inequalities slightly increased in both genders, while absolute inequalities only in women. A reduction in the population impact could be achieved by tackling educational inequalities in mortality due to lung cancer, diseases of the circulatory and respiratory systems, and accidents.

Modification effect of sex and obesity on the correlation of LEP polymorphisms with leptin levels in Taiwanese obese women.

BackgroundObesity has become the main health issue in developed countries as it impacts life expectancy and increases mortality of cerebrovascular or cardiovascular diseases. The leptin is one of the adipokines which presents in the serum in proportion to the amount of adipose tissue and is translated from LEP gene. It involves in energy homeostasis, lipid and glucose metabolisms, modulation of immune systems, and thermogenesis. Many previous studies have revealed controversial results between LEP polymorphisms and leptin levels in different ages and ethnicities. Herein, we investigated the impacts of LEP polymorphism against leptin levels in Taiwanese subjects.MethodsIn 599 Taiwanese subjects, excluding clinically overt systemic disease, age below 18 years old, and C‐reactive protein (CRP) level of above 10 mg/L, few of LEP polymorphisms were genotyped with TaqMan SNP genotyping assays, were further analyzed for association with leptin level in univariate and multivariate linear regression analyses with Bonferroni correction for multiple tests in stratified groups. The univariate and stepwise multivariate linear regression analyses were performed to determine the coefficient of determinant of LEP polymorphisms over leptin level.ResultsSignificant associations were found between LEP polymorphisms and leptin levels in obese women. Circulating leptin level was positively correlated with inflammatory, insulin resistance markers, and visceral obesity markers in all subjects. Furthermore, stratified and interaction analyses revealed that LEP polymorphisms, rs7799039 and rs2167270, were significantly associated with leptin levels in obese women—8%–10% of which could be explained by LEP polymorphisms.ConclusionThe LEP polymorphisms are independently associated with leptin levels in Taiwanese obese women. Further, the genetic determinants for leptin levels may be different between obese and nonobese, and in different sex individuals. The obesity status and female sex may exert modification effect on transcription of LEP, particularly in obese women.

Risk of Cardiovascular Disease, Chronic Kidney Disease, Cerebrovascular Disease, and Cardiovascular Mortality According to Blood Pressure Categories in Diabetes Patients: A Population-Based Study

Background: The association between blood pressure (BP) defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines and cardiovascular disease (CVD) and chronic kidney disease in diabetes patients remains unclear. We aimed to examine the effects of BP categories defined by the 2017 ACC/AHA guidelines in diabetes patients on the risk of CVD and CKD. Methods: In this population-based cohort study we analyzed data from the National Health Information Database in Korea during 2009-2017. The BP categories were defined as per the 2017 ACC/AHA guidelines: level 1 (systolic <120 mmHg and diastolic <80 mmHg), level 2 (systolic 120-129 mmHg and diastolic <80 mmHg), level 3 (systolic 130-139 mmHg or diastolic 80-89 mmHg), and level 4 (systolic ≥140 mmHg or diastolic ≥90 mmHg). We obtained the risk of CVD, CKD, cerebrovascular disease and CVD mortality. Findings: Overall, 490,352 diabetes patients (men 313,753 [64·0%], women 176,599 [36·0%]) were included in the analysis. Over a mean follow-up of 5 years, 6,508 CVD events occurred. Compared to people with BP levels 1, the adjusted hazard ratios (HRs) for CVD in people with BP levels 2, 3, and 4 were 1·07 (95% confidence interval [CI], 0·98-1·16), 1·12 (95% CI, 1·04-1·20) and 1·17 (95% CI, 1·08-1·26), respectively. There were also increased risks of CKD [1·18 (95% CI, 1·12-1·24) and 1·22 (95% CI, 1·15-1·29)], cerebrovascular disease [1·21 (95% CI, 1·14-1·29) and 1·52 (95% CI, 1·42-1·63)], and CVD mortality [1·31 (95% CI, 1·09-1·56) and 1·91 (95% CI, 1·58-2·32)] among subjects with BP levels 3 and 4 compared with those with BP level 1. Moreover, among people not taking antihypertensive medications, there were higher risks of CVD, CKD, cerebrovascular disease, and CVD mortality in those with BP levels 3 and 4 than in those with BP level 1. Interpretation: The risks of CVD, CKD, cerebrovascular disease, and CVD mortality significantly increased in patients with a systolic BP of 130 mmHg and diastolic BP of 80 mmHg. These findings provide evidence supporting the 2017 ACC/AHA guidelines for BP targets in diabetes patients. Funding Statement: This study did not receive finding from any public or private institution. Declaration of Interests: The authors have no relevant conflicts to disclose. Ethics Approval Statement: The study was approved by the local Institutional Review Board (IRB), Yonsei University Wonju College of Medicine, Wonju, Korea (IRB number: CR 318344) and informed consent was waived because anonymous and de-identified information was used for analysis.

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis

Introduction: In patients with end-stage kidney disease (ESKD), cardiovascular diseases (CVDs) are the most common causes of hospitalization and death. Objective: We aimed to determine the association between dialysis modality and CVDs. Methods: This retrospective observational cohort study compared the emergency hospitalization and mortality of patients with CVDs who underwent peritoneal dialysis (PD) versus hemodialysis (HD). After propensity score matching, the risk factors were evaluated using Cox proportional hazards regression models. Results: A total of 260 patients were matched: 130 of 135 PD (75 men; age, 65.4 years; dialysis vintage, 3.3 years) and 130 of 706 HD (70 men [p = 0.5]; 66.6 years [p = 0.4]; dialysis vintage, 3.1 years [p = 0.5]) patients. Emergency hospitalization rates (hospitalizations/person-years) for overall CVDs (0.138 vs. 0.066, p = 0.002) and pulmonary edema (0.048 vs. 0.019, p = 0.03) were significantly higher in patients who underwent PD than those who underwent HD. The log-rank test revealed that all-cause and CVD mortalities were significantly higher in PD (both p < 0.001). Mortality rates (deaths/person-years) for overall CVDs (0.058 vs. 0.015, p < 0.002), cerebrovascular disease (0.019 vs. 0.004, p = 0.03), and ischemic heart disease (0.010 vs. 0, p = 0.02) were significantly higher in PD. The Cox proportional hazards regression model showed that PD and age were significant predictors of emergency hospitalization (hazard ratio [HR] 2.70; 95% CI 1.53–4.77; p = 0.001) and mortality (HR 4.41; 95% CI 1.66–11.72; p = 0.003) for CVDs. Conclusions: PD is a risk factor for emergency hospitalization and mortality associated with CVDs in dialysis patients with ESKD. Strict control of body fluid balance may prevent cardiovascular events in patients undergoing PD.

Health economic assessment of a shift to active transport

Active transportation (walking or cycling) as a substitute for car trips still represents a small percentage of all daily travels in many European cities. This study aimed to estimate the health and economic co-benefits for the adult population of modal shift from driving to active travel in urban environments. Three scenarios were modelled for the case study, the city of Porto, Portugal, by comparing travel patterns of 2013 to hypothetical scenarios of modal shifts from driving to active transport, namely: i) SC1 - conservative scenario, with a change of 5% from driving to cycling and 10% from driving to walking; ii) SC2 - moderate scenario, with a shift of 10% and 15%, respectively; and iii) SC3 - optimistic scenario, with a shift of 15% and 20%, respectively. The mortality risk reduction for five health outcomes (colon and breast cancers, diabetes, ischemic heart disease, cerebrovascular disease) was assessed, including an estimation of traffic injury and air pollution exposure risks. Results were presented in Disability-Adjusted Life Years (DALYs) avoided. Economic valuation for each scenario was performed using a Willingness-to-Pay approach for morbimortality and a Cost of Illness approach for 2013 hospitalizations and work absenteeism. Significant health benefits were found in all modelled scenarios, ranging from 1657 (16%) to 2881 (28%) DALYs avoided. Total costs averted ranged from €3894 to €6769 million through the scenarios. Cardio and cerebrovascular diseases mortality presented the largest benefit, accounting for about 3/4 of all avoidable DALYs in all scenarios. Reductions in CO2 and PM10 emissions were calculated, showing a decrease from 31.6 to 73.7 kt of CO2 and 7 to 16 t for PM10, respectively. A modal shift towards active transportation could lead to significant health and economic benefits, indicating that the evaluation of health impacts should be included in the analysis of active transport interventions.

Trends in Peripheral Arterial Disease Incidence and Mortality in EU15+ Countries 1990-2017

Introduction: Ischaemic heart disease and cerebrovascular disease mortality rates have reduced over recent decades in Europe and the United States. We assessed whether mortality rates from peripheral arterial disease (PAD) - the third leading cause of atherosclerotic cardiovascular morbidity - showed similar trends. Methods: PAD age-standardised mortality and incidence rates were extracted from the Global Burden of Disease Study database for European Union(EU)15+ countries for the years 1990-2017. Annual mortality-to-incidence indices were calculated for each EU15+ country to provide a population based indicator of changes in disease burden. Results: Between 1990 and 2017, the incidence of PAD was observed to be down-trending in all 19 EU15+ countries for females, and in 18 of 19 countries for males: Increasing PAD incidence was observed only for males in the United States (+1.4%) (Figure 1). In 2017, the highest incidence rates were observed in Denmark and the United States for males (213.6 and 202.3 per 100,000, respectively) and in the United States and Canada for females (194.8 and 171.1 per 100,000, respectively). There was a concomitant overall trend for increasing age-standardised mortality rates in all EU15+ countries for females, and in 16 of 19 EU15+ countries for males over the same time period (Figure 2). Italy (-25.1%), Portugal (-1.9%) and Sweden (-0.6%) were the only countries with reducing mortality rates in males. The largest increases in mortality rates were observed in the United Kingdom (males +140.4%, females +158.0%) and the United States (males +125.7%, females +131.2%). We observed an overall upward trend for mortality-to-incidence indices between 1990-2017 in all EU15+ countries for females, and in 18 of 19 EU15+ countries for males. The mortality-to-incidence trend was reducing only for males in Italy. Conclusion: We identify shifting burden of PAD in EU15+ countries, with increasing mortality rates despite reducing incidence over the past 27-years. Strong evidence supports goal-directed medical therapy in reducing PAD mortality, however inadequate compliance with medical therapy has been reported: population-wide strategies to improve compliance are called for. [Trends in PAD incidence. Squares indicate males; and circles, females] [Trends in PAD mortality. Squares indicate males; and circles, females] Disclosure: Nothing to disclose

Mortality from cardiovascular disease in a cohort of Swedish seafarers

PurposeThe aim of this study was to investigate whether Swedish seafarers have increased mortality from cardiovascular disease compared with the general population.MethodsRegister-based longitudinal cohort study of 85,169 Swedish seafarers where all subjects with a minimum of 30 days service registered in the Seafarers’ Register 1985–2013 were included. Mortality from coronary heart disease, cerebrovascular disease and total mortality for comparison were analysed by calculating standardised mortality ratios (SMRs), with 95% confidence intervals (CIs). Mortality was further analysed by gender, duty on board, type of vessel, and over time.ResultsThere was no increase in either mortality from cardiovascular disease or total mortality for seafarers, who had worked solely on passenger ferries. Mortality from coronary heart disease and cerebrovascular disease was increased for male seafarers < 46 years old who had worked on different types of vessels, SMR 1.48 (95% CI 1.06–2.01) and SMR 1.93 (95% CI 1.16–3.02), respectively. Analysing the seafarers by duty showed significantly increased SMRs from coronary heart disease in males aged < 46 of the categories “deck crew” and “engine officer/crew (ever)”. The total mortality for seafarers who had worked on different types of vessels was increased; males SMR 1.05 (95% CI 1.02–1.09) and females SMR 1.17 (95% CI 1.04–1.30), but decreased over time.ConclusionsNo increased mortality on passenger ferries but younger male seafarers on different types of vessels had increased mortality from cardiovascular disease. Reduction of hazardous occupational exposures onboard is important, such as shift work, stress and noise.

Interplay of Objective Sleep Duration and Cardiovascular and Cerebrovascular Diseases on Cause-Specific Mortality.

BackgroundCardiovascular and cerebrovascular diseases (CBVDs) and cancer are leading causes of death. Short sleep is a potential contributor to health; however, its role in predicting mortality associated with cardiometabolic risk factors (CMRs) and CBVD remains poorly understood. We tested whether objective short sleep duration increases the risk of mortality associated with CMRs and CBVD.Methods and ResultsA total of 1654 adults (aged 20–74 years) from the Penn State Adult Cohort (47.5 years, 52.5% women, and 89.8% white) whose cause of death was determined after 19.2 years (5.2 years). CMR was defined as stage 2 hypertension and/or type 2 diabetes mellitus on the basis of blood pressure and glucose levels or a report of diagnosis or treatment for these conditions. CBVD was defined as a report of diagnosis or treatment for heart disease and/or stroke. Objective short sleep duration was defined as polysomnographic total sleep time <6 hours. Cox proportional hazard models estimated multivariable‐adjusted hazard ratios (HRs) and 95% CIs. Risk of all‐cause mortality associated with CMR or CBVD was significantly modified by objective sleep duration (P<0.05), and it was significantly higher in subjects who slept <6 hours (HR, 2.14 [95% CI, 1.52–3.02] and HR, 3.17 [95% CI=2.16–4.65], respectively). In subjects who slept <6 hours, CMR was associated with a 1.83 higher (95% CI, 1.07–3.13) risk of CBVD mortality and CBVD with a 2.92 higher (95% CI, 1.28–6.65) risk of cancer mortality. In subjects who slept ≥6 hours, CMR was not significantly associated with CBVD mortality (HR, 1.35; 95% CI, 0.70–2.63) nor was CBVD significantly associated with cancer mortality (HR, 0.55; 95% CI, 0.18–1.64).ConclusionsObjective short sleep duration predicts the all‐cause mortality prognosis of middle‐aged adults with CMR and the cancer‐specific mortality prognosis of those with CBVD.

Do age, period or cohort effects explain circulatory disease mortality trends, Scotland 1974–2015?

ObjectiveWe aimed to explore whether age, period or cohort effects explain the trends and inequalities in ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) mortality in Scotland.MethodsWe analysed IHD and...

Progress in reducing inequalities in cardiovascular disease mortality in Europe

ObjectiveTo assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe.MethodsIn this prospective...

Green tea consumption and mortality in Japanese men and women: a pooled analysis of eight population-based cohort studies in Japan.

The aim of our study was to assess the association between green tea consumption and all-cause and cause-specific mortality in a pooled analysis of eight Japanese population-based cohort studies. Pooled hazard ratios (HR) and 95% confidence intervals (CI), derived from random effects models, were used to evaluate the associations between green tea consumption, based on self-report at baseline, and risk of all-cause and cause-specific mortality. During a mean follow-up of 17.3years, among 313,381 persons, 52,943 deaths occurred. Compared with individuals who consumed < 1 cup/day, those in the highest consumption category (≥ 5 cups/day) had a decreased risk of all-cause mortality [the multivariate-adjusted HR was 0.90 (95% CI 0.87-0.94) for men and 0.82 (0.74-0.90) for women]. A similar inverse association was observed for heart disease mortality [HR 0.82 (0.75-0.90) for men, and 0.75 (0.68-0.84) for women], and cerebrovascular disease mortality [HR 0.76 (0.68-0.85) for men, and 0.78 (0.68-0.89) for women]. Among women, green tea consumption was associated with decreased risk of total cancer mortality: 0.89 (0.83-0.96) for the 1-2 cups/day category and 0.91 (0.85-0.98) for the 3-4 cups/day category. Results for respiratory disease mortality were [HR 0.75 (0.61-0.94)] among 3-4 cup daily consumers and [HR 0.66 (0.55-0.79)] for ≥ 5 cups/day. Higher consumption of green tea is associated with lower risk for all-cause mortality in Japanese, especially for heart and cerebrovascular disease. Moderate consumption decreased the risk of total cancer and respiratory disease mortality in women.

Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study

BackgroundTobacco smoking is a leading cause of cardiovascular disease (CVD) morbidity and mortality. Evidence on the relation of smoking to different subtypes of CVD, across fatal and non-fatal outcomes, is limited.MethodsA prospective study of 188,167 CVD- and cancer-free individuals aged ≥ 45 years from the Australian general population joining the 45 and Up Study from 2006 to 2009, with linked questionnaire, hospitalisation and death data up to the end of 2015. Hazard ratios (HRs) for hospitalisation with or mortality from CVD among current and past versus never smokers were estimated, including according to intensity and recency of smoking, using Cox regression, adjusting for age, sex, urban/rural residence, alcohol consumption, income and education. Population-attributable fractions were estimated.ResultsDuring a mean 7.2 years follow-up (1.35 million person-years), 27,511 (crude rate 20.4/1000 person-years) incident fatal and non-fatal major CVD events occurred, including 4548 (3.2) acute myocardial infarction (AMI), 3991 (2.8) cerebrovascular disease, 3874 (2.7) heart failure and 2311 (1.6) peripheral arterial disease (PAD) events. At baseline, 8% of participants were current and 34% were past smokers. Of the 36 most common specific CVD subtypes, event rates for 29 were increased significantly in current smokers. Adjusted HRs in current versus never smokers were as follows: 1.63 (95%CI 1.56–1.71) for any major CVD, 2.45 (2.22–2.70) for AMI, 2.16 (1.93–2.42) for cerebrovascular disease, 2.23 (1.96–2.53) for heart failure, 5.06 (4.47–5.74) for PAD, 1.50 (1.24–1.80) for paroxysmal tachycardia, 1.31 (1.20–1.44) for atrial fibrillation/flutter, 1.41 (1.17–1.70) for pulmonary embolism, 2.79 (2.04–3.80) for AMI mortality, 2.26 (1.65–3.10) for cerebrovascular disease mortality and 2.75 (2.37–3.19) for total CVD mortality. CVD risks were elevated at almost all levels of current smoking intensity examined and increased with smoking intensity, with HRs for total CVD mortality in current versus never smokers of 1.92 (1.11–3.32) and 4.90 (3.79–6.34) for 4–6 and ≥ 25 cigarettes/day, respectively. Risks diminished with quitting, with excess risks largely avoided by quitting before age 45. Over one third of CVD deaths and one quarter of acute coronary syndrome hospitalisations in Australia aged < 65 can be attributed to smoking.ConclusionsCurrent smoking increases the risk of virtually all CVD subtypes, at least doubling the risk of many, including AMI, cerebrovascular disease and heart failure. Paroxysmal tachycardia is a newly identified smoking-related risk. Where comparisons are possible, smoking-associated relative risks for fatal and non-fatal outcomes are similar. Quitting reduces the risk substantially. In an established smoking epidemic, with declining and low current smoking prevalence, smoking accounts for a substantial proportion of premature CVD events.

THE EVALUATION OF INDICES OF MORBIDITY AND MORTALITY OF VARIOUS TYPES OF STROKE IN COHORT OF WORKERS UNDERWENT OCCUPATIONAL IRRADIATION

The purpose of study. To evaluate indices of morbidity and mortality of various types of strokes in the cohort of workers of the nuclear industry enterprise of the Ural Federal Okrug exposed to occupational prolonged irradiation. Materials and methods. The study was carried out in the cohort of 22,337 workers (25% of females) of the production association "Mayak" hired in 1948-1982 on the basis of medical dosimetry data base "Klinika" and data base "The Dosimetry System for Workers of the Production Association "Mayak" - 2008" The intensive (crude) indices and standardized indices of morbidity and mortality per 1,000 man-years were calculated. Results. The number of cases and deaths included in analysis made up to 2533 and 797 correspondingly. The most frequently occurring type of stroke is brain infarction. The largest number of cases and deaths of stroke (69% and 81% correspondingly) was registered in individuals aged older than 60 years. The results of implemented study demonstrated that morbidity and mortality of stroke in the analyzed cohort of workers depended on gender, age and calendar period. Conclusions. Because cerebrovascular diseases are one of the main causes of mortality and permanent disability of population of Russia, the results of study of unique cohort will input into analysis of epidemiology of cerebrovascular diseases. Alongside with the results of other large studies they can become a basis of development of preventive programs targeted to decreasing of morbidity and mortality of cerebrovascular diseases, including contingents working in contact with sources of ionizing radiation.

Household dietary salt consumption and mortality from cardiovascular diseases: an ecological panel analysis in Japan.

BackgroundEpidemiological evidence has shown that lower salt intake reduces hypertension-related disease mortality. Japan has experienced a drastic decrease in cardiovascular mortality, although this varies across regions. This regional variation does not necessarily match the local patterns of reported average salt intake. In this study, we examined population-level risk factors for hypertension-related disease mortality, focussing on the average household dietary consumption of salt intake sources.MethodsWe prepared an ecological panel dataset, with prefecture as the unit of analysis, by referring to public statistics and market research data from 2012 to 2015. We collected prefectural averages of household dietary consumption related to salt intake and other nutrients that may affect hypertension control. We used demographic characteristics, medical care availability and local economy indices as covariates. Panel data analysis with fixed-effects modelling was performed, regressing prefectural-level mortality from ischaemic heart diseases, subarachnoid and intracerebral haemorrhage and cerebral infarction on dietary consumption and the selected covariates.ResultsWe confirmed the average household consumption of salt equivalents of discretional salt intake sources to be positively but only weakly associated with mortality from ischaemic heart diseases and cerebral infarction. Household expenditure on processed foods was positively associated with ischaemic heart disease mortality.ConclusionsThese findings may suggest that the reduction of salt in processed foods, in addition to individual behavioural change, could be useful for decreasing mortality from ischaemic heart diseases in the Japanese population. Ecological factors related to decreasing cerebrovascular disease mortality in the context of the ageing Japanese population require further investigation.

Circulating endostatin as a risk factor for cardiovascular events in patients with stable coronary heart disease: A CLARICOR trial sub-study

Background and aimsRaised levels of serum endostatin, a biologically active fragment of collagen XVIII, have been observed in patients with ischemic heart disease but association with incident cardiovascular events in patients with stable coronary heart disease is uncertain. MethodsThe CLARICOR-trial is a randomized, placebo-controlled trial of stable coronary heart disease patients evaluating 14-day treatment with clarithromycin. The primary outcome was a composite of acute myocardial infarction, unstable angina pectoris, cerebrovascular disease or all-cause mortality. In the present sub-study using 10-year follow-up data, we investigated associations between serum endostatin at entry (randomization) and the composite outcome and its components during follow-up. The placebo group was used as discovery sample (1204 events, n = 1998) and the clarithromycin-treated group as replication sample (1220 events, n = 1979). ResultsIn Cox regression models adjusting for cardiovascular risk factors, glomerular filtration rate, and current pharmacological treatment, higher serum endostatin was associated with an increased risk of the composite outcome in the discovery sample (hazard ratio per standard deviation increase 1.11, 95% CI 1.03–1.19, p = 0.004), but slightly weaker and not statistically significant in the replication sample (hazard ratio 1.06, 95% CI 1.00–1.14, p = 0.06). In contrast, strong and consistent associations were found between endostatin and cardiovascular and all-cause mortality in all multivariable models and sub-samples. Addition of endostatin to a model with established cardiovascular risk factors provided no substantial improvement of risk prediction (<1%). ConclusionsRaised levels of serum endostatin might be associated with cardiovascular events in patients with stable coronary heart disease. The clinical utility of endostatin measurements remains to be established.

Correction: A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study

[This corrects the article DOI: 10.1371/journal.pmed.1002718.].

Abstract PD8-10: No increased cardiovascular mortality after twenty years in a randomized trial of radiotherapy after breast conserving surgery, SweBCG 91RT, from the Swedish breast cancer group

Abstract Introduction Breast conserving surgery (BCS) with postoperative radiotherapy (RT) is recommended for the majority of patients with early breast cancer. Meta-analyses of randomized trials have shown reduction of breast cancer and overall mortality after RT but increased cardiovascular mortality Aim To evaluate side effects of RT after BCS Patients and Methods Trial SweBCG 91RT randomized 1187 women with stage 1-IIA breast cancer after BCS to RT or to no further treatment. RT was administered as tangential opposing beams to the breast to a target dose of 48-54 Gy. Three-dimensional dose planning on multiple CT slices 10 mm apartwas used for 69% of the patients and for the remainder two-dimensional planning. All hospital records and radiotherapy charts were monitored. Update of mortality, cause of death and morbidity was made using the Swedish personal identification numbers and the following Swedish national registers: the Cancer Register, the Population Register, the Cause of Death Register, the Inpatient and the SWEDEHEART registers. For analyses the diagnoses were grouped as follows: breast cancer, cardiovascular disease, cerebrovascular disease, lung cancer and benign pulmonary disease Statistics Overall mortality was calculated using the Kaplan-Meier method, whereas cumulative incidence functions with other causes of death as competing events were used for cause-specific mortality and morbidities. For all outcomes, log-rank tests were used to compare between treatment groups up to 20 years. We studied two populations: 1) patients according to intention to treat for overall and breast cancer mortality and 2) patients treated per protocol for side effects. Cause-specific death was allocated to a certain group when either the underlying or a contributing cause belonged to the disease group Results After 20 years, overall mortality was 42.9% after BCS and 42.5% after BCS+RT (p=0.8), and breast cancer mortality was 18.0% vs 15.8% (p=0.3). The cumulative incidence of mortality from heart disease was 12.4% after BCS and 13.0% after BCS+RT (p=0.8) with no difference for left or right side. Ischemic heart disease and congestive heart failure were the most common cardiac diagnoses. The cumulative incidence of cerebrovascular mortality was 3.4% among controls and 6.7% after RT (p=0.016). Of the patients with cerebrovascular death, 50% also had a cardiac cause of death. Other cause-specific mortalities investigated were similar regardless of RT: lung cancer 1.7% vs 1.9% (p=1.0), benign pulmonary disease 7.1% vs 6.4% (p=0.5) Morbidity Morbidity outcomes were also similar in control and irradiated patients: the cumulative incidence of hospital admissions with cardiac diagnoses 29.7% vs 31.0% (p=0.7), and for cerebrovascular morbidity 11.6% vs 13.7% (p= 0.33) respectively Radiation exposure The original dose plans were retrieved from 125 patients. Doses to organs at risk were recalculated. Median of mean heart dose was 3.0 Gy (1.1-8.2) for left and 1.0 Gy (0.5-2.5) for right-sided RT Conclusions After 20 years tangential RT in a randomized trial was not associated with increased cardiac mortality. A minor increase in cerebrovascular mortality was seen, but the causality is unclear. Citation Format: Malmström P, Karlsson P, Holmberg E, Lundstedt D, Holmberg L, Werner-Hartman L, Koul S, Kjellén E, Killander F. No increased cardiovascular mortality after twenty years in a randomized trial of radiotherapy after breast conserving surgery, SweBCG 91RT, from the Swedish breast cancer group [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-10.