Hazard Ratios For Participants Research Articles

Lack of association between nonalcoholic fatty liver disease and intracerebral hemorrhage: A community-based cohort study

BackgroundThe association between nonalcoholic fatty liver disease (NAFLD) and intracerebral hemorrhage (ICH) remains unclear. This study aimed to investigate whether NAFLD and its severity predict incident ICH. MethodsParticipants free of other liver diseases, prior stroke, myocardial infarction, cancer, or alcohol abuse in the Kailuan cohort were enrolled in this study. Abdominal ultrasonography was used to diagnose NAFLD and assess its severity. Participants were stratified into different groups including nonfatty liver, mild, moderate and severe NAFLD. Multivariable Cox proportional hazards regression models were used to evaluate the hazard ratios (HRs) and 95% CIs of ICH events in the 11-year follow-up. ResultsA total of 77,461 participants were enrolled in our study. Among them, NAFLD was diagnosed in 23,890 (30.83 %) participants, including 15,581 (20.11 %) with mild NAFLD, 6839 (8.83 %) with moderate NAFLD and 1470 (1.90 %) with severe NAFLD. We documented 692 ICH events during 848,579 person years of follow-up. Patients with more severe NAFLD tended to be older, had higher levels of BMI, higher proportions of hypertension, diabetes and other known risk factors for cerebrovascular disease. However, there was no significant associations between NAFLD, its severity and incident ICH events. Relative to nonfatty liver participants, the HRs for participants with mild NAFLD, moderate and severe NAFLD were 0.98 (95 % CI, 0.80 to 1.20), 1.19 (95 % CI, 0.92 to 1.54) and 1.29 (95 % CI, 0.81 to 2.06), respectively. ConclusionsNAFLD and its severity did not appear to be significantly associated with ICH after adjustment for potential risk factors.

Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults.

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population. Participants with stage 1 hypertension ( n = 69,509) or normal BP ( n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis. During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13-1.25) for primary outcome, 1.24 (95% CI, 1.05-1.46) for MI, 1.45 (95% CI, 1.33-1.59) for stroke, and 1.11 (95% CI, 1.04-1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85-0.96). Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.

Low leukocyte mitochondrial DNA abundance drives atherosclerotic cardiovascular diseases: a cohort and Mendelian randomization study.

Mitochondrial DNA dysfunction has been implicated in the pathogenesis of cardiovascular diseases. We aimed to investigate the associations between leukocyte mitochondrial DNA (mtDNA) abundance, as a proxy of mitochondrial function, and coronary artery disease (CAD) and heart failure (HF) in a cohort study and approximate the causal nature of these relationships using Mendelian randomization (MR) in genetic studies. Multivariable-adjusted Cox regression analyses were conducted in 273 619 unrelated participants of European ancestry from the UK Biobank (UKB). For genetic studies, we first performed MR analyses with individual-level data from the UKB using a weighted genetic risk score (GRS); two-sample MR analyses were subsequently performed using summary-level data from the publicly available three consortia/biobank for CAD and two for HF. MR analyses were performed per database separately and results were subsequently meta-analysed using fixed-effects models. During a median follow-up of 11.8 years, restricted cubic spline Cox regression analyses showed associations between lower mtDNA abundance and higher risk of CAD and HF. Hazard ratios for participants in the lowest quintile of mtDNA abundance compared with those in the highest quintile were 1.08 (95% confidence interval: 1.03, 1.14) and 1.15 (1.05, 1.24) for CAD and HF. Genetically, no evidence was observed for a possible non-linear causal effect using individual-level weighted genetic risk scores calculated in the UKB on the study outcomes; the pooled odds ratios (95% confidence interval) from two-sample MR of genetically predicted per one-SD decrease in mtDNA abundance were 1.09 (1.03, 1.16) for CAD and 0.99 (0.92, 1.08) for HF, respectively. Our findings support a possible causal role of lower leukocyte mtDNA abundance in higher CAD risk, but not in HF.

Urinary phthalate concentrations and mortality risk: A population-based study

Phthalates are widely used as plasticizers. Laboratory-based mechanistic and epidemiological studies suggest that phthalates are detrimental to human health. Here, we present prospective analyses on phthalate exposure and all-cause, as well as cause-specific, mortality from the National Health and Nutrition Examination Survey (NHANES), a population-based cohort. Between 1999 and 2018, urinary concentrations of 12 phthalate metabolites were measured by high-performance liquid chromatography-electrospray ionization tandem mass spectrometry in spot urine samples of 10,881 adults aged 40–85 years, of which 2382 died over a median duration of 8.9 years after sample provision. Multivariable Cox regression analyses adjusted for a wide range of lifestyle factors and comorbidities showed that higher concentrations of mono-benzyl phthalate (MBzP) and Mono-n-butyl phthalate (MnBP) were associated with increased mortality. The hazard ratios for participants in the highest quartiles of MBzP and MnBP concentrations were at 1.27 [95% confidence interval: 1.08, 1.49; p linear trend = 0.002] and 1.35 [1.13, 1.62; p linear trend = 0.005). These findings reinforce the need for monitoring of phthalate exposure in relation to health outcomes.

Patterns Of Recommended Levels Of Physical Activity And Mortality: A Prospective Cohort Study

PURPOSE: We examined the association of different patterns of recommended levels of physical activity with all-cause, cardiovascular disease (CVD), and cancer mortality. METHODS: We included 403,681 participants (≥18 years) from National Health Interview Survey (1997-2013) who were linked to the National Death Index with follow-up to date of death or Dec 31, 2015, whichever came first. Leisure-time physical activity was measured through frequency (times/week) and duration of light to moderate intensity physical activity and vigorous intensity physical activity. Cox proportional hazards regression models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CI), adjusted for potential confounders including total amount of physical activity. RESULTS: During median 10.1 years of follow-up, 36,861 deaths occurred, including 7,634 from CVD and 8,902 from cancer. Compared to participants who had not met the physical activity guidelines, those who met the recommended levels of physical activity in one or two sessions a week (aka “the weekend warriors”) had lower all-cause (HR 0.72; CI 0.66, 0.78; P < 0.01), CVD (HR 0.67; CI 0.53, 0.85; P < 0.01), and cancer mortality (HR 0.80; CI 0.67, 0.96; P < 0.01). HR for participants doing the recommended levels of physical activity in ≥3 sessions/week (regularly actives participants) were 0.64 (0.62, 0.65; P < 0.01) for all-cause mortality, 0.58 (CI 0.54, 0.62; P < 0.01) for CVD, and 0.74 (CI 0.70, 0.78; P < 0.01) for cancer mortality. Weekend warriors and regularly active participants had similar mortality, after adjusting for total physical activity. CONCLUSION: Weekend warriors had a lower mortality when compared to individuals classified as inactive. After accounting for total physical activity, weekend warriors and regularly active participants had similar mortality, suggesting that benefits of physical activity for reducing mortality can be obtained from different combination of sessions/week.

Adherence to a healthy lifestyle and all-cause and cause-specific mortality in Chinese adults: a 10-year prospective study of 0.5 million people

BackgroundAdherence to a healthy lifestyle is associated with substantially lower risks of mortality from all causes, cardiovascular diseases, and cancer in white populations. However, little is known about the health benefits among non-white populations. Also, no previous studies have focused on respiratory disease mortality in both white and non-white populations. We assessed the relationships between a combination of healthy lifestyle factors and multiple death outcomes in Chinese adults.MethodsThis study included 487,198 adults aged 30–79 years from the China Kadoorie Biobank without heart disease, stroke, and cancer at study enrolment. We defined five healthy lifestyle factors as never smoking or smoking cessation not due to illness; non-daily drinking or moderate alcohol drinking; median or higher level of physical activity; a diet rich in vegetables, fruits, legumes and fish, and limited in red meat; a body mass index of 18.5 to 27.9 kg/m2 and a waist circumference < 90 cm (men)/85 cm (women). Cox regression was used to produce adjusted hazard ratios (HRs) relating these healthy lifestyle factors to all-cause and cause-specific mortality.ResultsDuring a median follow-up of 10.2 years (IQR 9.2–11.1), we documented 37,845 deaths. After multivariable adjustment, the number of healthy lifestyle factors exhibited almost inverse linear relationships with the risks of all-cause and cause-specific mortality. Compared with participants without any healthy factors, the hazard ratio of participants with five healthy factors was 0.32 [95% confidence interval (CI): 0.28, 0.37] for all-cause mortality. The corresponding HRs in specific cause of death were 0.42 (95% CI: 0.26, 0.67) for ischaemic heart disease, 0.21 (95% CI: 0.09, 0.49) for ischaemic stroke, 0.37 (95% CI: 0.22, 0.60) for haemorrhage stroke, 0.36 (95% CI: 0.29, 0.45) for cancer, 0.26 (95% CI: 0.14, 0.48) for respiratory diseases, and 0.29 (95% CI: 0.22, 0.39) for other causes. Theoretically, 38.5% (95% CI: 33.0, 43.8%) of all-cause mortality was attributable to nonadherence to a healthy lifestyle, and the proportions of preventable deaths through lifestyle modification ranged from 26.9 to 47.9% for cause-specific mortality.ConclusionsAdherence to a healthy lifestyle was associated with substantially lower risks of all-cause, cardiovascular, respiratory, and cancer mortality in Chinese adults. Promotion of a healthy lifestyle may considerably reduce the burden of non-communicable diseases in China.

Fasting Blood Glucose Predicts Incidence of Hypertension Independent of HbA1c Levels and Insulin Resistance in Middle-Aged Japanese: The Saku Study.

Relationships between blood glucose (BG) levels and insulin action, and incidence of hypertension have not been well known epidemiologically. This study aimed to investigate the association between indices of diabetes and the incidence of hypertension and compare the predictive powers of these indices in middle-aged Japanese. This 5-year cohort study included 2,210 Japanese aged 30-64 years without hypertension. Hazard ratios of high fasting blood glucose (FBG) levels, high post-loaded BG levels, high glycated hemoglobin (HbA1c) levels, insulin resistance (defined by homeostasis model assessment of insulin resistance [HOMA-IR]) and impaired insulin secretion at baseline for the incidence of hypertension were estimated using multivariable-adjusted Cox proportional hazard models. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or receiving antihypertensive treatment. During the follow-up, 456 participants developed hypertension. After adjustment for HbA1c and HOMA-IR, FBG was independently and significantly associated with hypertension. The hazard ratio of participants with FBG ≥ 7.0 mmol/l was 1.79 compared with those with FBG < 5.6 mmol/l. Even among those with HbA1c < 6.5%, HOMA-IR < 2.5, body mass index < 25 kg/m2, age < 55 years old, blood pressure < 130/80 mm Hg or non- and moderate drinking, the results were similar. High 120-minute BG level and impaired insulin secretion did not increase the risk for hypertension. FBG was a predictable index for future incidence of hypertension in middle-aged Japanese men and women. This is the first study comparing predictive powers of indices of diabetes for the incidence of hypertension.

Adherence to Healthy Lifestyle and Cardiovascular Diseases in the Chinese Population

BackgroundAdherence to a combination of healthy lifestyle factors has been related to a considerable reduction of cardiovascular risk in white populations; however, little is known whether such associations persist in nonwhite populations like the Asian population. ObjectivesThis study aimed to examine the associations of a combination of modifiable, healthy lifestyle factors with the risks of ischemic cardiovascular diseases and estimate the proportion of diseases that could potentially be prevented by adherence to these healthy lifestyle patterns. MethodsThis study examined the associations of 6 lifestyle factors with ischemic heart disease and ischemic stroke (IS) in the China Kadoorie Biobank of 461,211 participants 30 to 79 years of age who did not have cardiovascular diseases, cancer, or diabetes at baseline. Low-risk lifestyle factors were defined as nonsmoking status or having stopped smoking for reasons other than illness, alcohol consumption of <30 g/day, a median or higher level of physical activity, a diet rich in vegetables and fruits and limited in red meat, a body mass index of 18.5 to 23.9 kg/m2, and a waist-to-hip ratio <0.90 for men and <0.85 for women. ResultsDuring a median of 7.2 years (3.3 million person-years) of follow-up, this study documented 3,331 incident major coronary events (MCE) and 19,348 incident ISs. In multivariable-adjusted analyses, current nonsmoking status, light to moderate alcohol consumption, high physical activity, a diet rich in vegetables and fruits and limited in red meat, and low adiposity were independently associated with reduced risks of MCE and IS. Compared with participants without any low-risk factors, the hazard ratio for participants with ≥4 low-risk factors was 0.42 (95% confidence interval: 0.34 to 0.52) for MCE and 0.61 (95% confidence interval: 0.56 to 0.66) for IS. Approximately 67.9% (95% confidence interval: 46.5% to 81.9%) of the MCE and 39.1% (95% confidence interval: 26.4% to 50.4%) of the IS cases were attributable to poor adherence to healthy lifestyle. ConclusionsAdherence to healthy lifestyle may substantially lower the burden of cardiovascular diseases in Chinese.

Effect of Different Obesity Phenotypes on Incidence of Chronic Kidney Disease in Tehranian Adults

Background: The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults.Study Design: A prospective cohort study, the Tehran Lipid Glucose Study (TLGS).Setting and Participants: Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD.Predictor: Obesity phenotypes.Outcome: Incidence of chronic kidney disease.Measurements: Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study.Results: CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p < 0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91–1.43) and 1.43 (95% CI, 1.09–1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93–1.62) and 1.43 (95% CI, 1.08–1.90), respectively.Conclusion: Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.

Dietary inflammatory index, cardiometabolic conditions and depression in the Seguimiento Universidad de Navarra cohort study.

Only one prospective study has analysed the relationship between the inflammatory properties of diet and risk of depression thus far. The aim of this study was to assess the association between the dietary inflammatory index (DII) and the incidence of depression. In a cohort study of 15 093 university graduates, participants completed a validated FFQ at baseline and after 10 years of follow-up. The DII was calculated based on the FFQ. Each of the twenty-eight nutrients or foods received a score based on findings from the peer-reviewed literature reporting on the relationships between diet and inflammatory biomarkers (IL-1β, IL-4, IL-6, IL-10, TNF-α and C-reactive protein). Participants were classified as having depression if they reported a new clinical diagnosis of depression by a physician, antidepressant drugs, or both. Multivariable Cox regression models were used to estimate hazard ratios (HR) of depression according to quintiles of the DII. After a median 8·5 years of follow-up, we observed 1051 incident cases of depression. The HR for participants in the highest quintile of DII (strongly pro-inflammatory) was 1·47 (95% CI 1·17, 1·85) compared with those in the bottom quintile, with a significant dose-response relationship (P trend=0·01). In the subgroup analyses, the association between DII and depression was stronger among participants >55 years and among those with cardiometabolic comorbidities (HR 2·70; 95% CI 1·22, 5·97 and HR 1·80; 95% CI 1·27, 2·57, respectively). A pro-inflammatory diet was associated with a significantly higher risk of depression in a Mediterranean population. This association was stronger among older subjects and subjects with cardiometabolic diseases.

Abstract 861: The association between cancer prevention guidelines and cancer risk in the Southern Community Cohort Study

Abstract Background: Public health and cancer prevention guidelines recommend healthy behaviors to decrease overall cancer risk. The impact of cancer prevention guidelines on cancer incidence has been rarely studied in low-income Whites and African Americans. Design: We quantified the association of meeting current American Cancer Society cancer prevention guidelines, as measured by non-smoking, none to moderate alcohol intake, higher diet quality, and regular physical activity with total and site-specific cancer incidence. Data were obtained at enrollment from 73,022 adults age 40-79, without a previous cancer diagnosis, participating in the Southern Community Cohort Study. The Southern Community Cohort Study is a prospective cohort study that enrolled participants during 2002-2009, in 12 southeastern US states via Community Health Centers (86%) or stratified random sampling of the general population (14%). Fifty-six percent of the cohort has a household income&amp;lt;$15,000. The median follow-up time for cohort members was 6 years. Exposures: We created a healthy guidelines score by counting the number of cancer prevention guidelines each participant met for tobacco smoking, alcohol intake, diet, and physical activity. Outcomes: Breast (N = 503), prostate (N = 479), lung (N = 621), colorectal (N = 333), other (N = 1374), and total cancer incidence (N = 3,310) were identified from state cancer registries through December 31, 2011. Results: Meeting fewer cancer prevention guidelines was associated with increased cancer incidence: hazard ratios (HRs) for overall cancer incidence comparing participants with four guidelines met vs three, two, one, or zero guidelines were 1.04 (95% confidence interval (CI): 0.79-1.38), 1.23 (0.94-1.61), 1.52 (1.16-1.98), and 1.86 (1.40-2.46), respectively. Tests for interactions with race and sex were not statistically significant. The association between the healthy guidelines score and total cancer incidence was most apparent in participants with normal weight (body mass index 18.5-24.9 kg/m2) (P-interaction = 0.02). The strongest association was observed for lung cancer risk largely attributable to the sizable numbers of current smokers in the cohort; the HR for participants meeting no guideline recommendations compared to participants meeting three or four healthy guidelines was 6.78 (95%CI: 4.24-10.84). Weaker and non-significant associations were observed between the healthy guidelines score and breast, colorectal, and prostate cancer risk (all P-trends&amp;gt;0.10). Conclusions: Meeting current public health guidelines is associated with substantial reductions in cancer incidence. This study provides support for individual lifestyle modification to reduce cancer incidence in this under-served population. Citation Format: Shaneda N. Warren Andersen, Jennifer Sonderman, Xiao-Ou Shu, Danxia Yu, Mark Steinwandel, Joesph K. McLaughlin, Margaret K. Hargreaves, William J. Blot, Wei Zheng. The association between cancer prevention guidelines and cancer risk in the Southern Community Cohort Study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 861. doi:10.1158/1538-7445.AM2015-861

Subclinical thyroid dysfunction and the risk for fractures: a systematic review and meta-analysis.

Data on the association between subclinical thyroid dysfunction and fractures conflict. To assess the risk for hip and nonspine fractures associated with subclinical thyroid dysfunction among prospective cohorts. Search of MEDLINE and EMBASE (1946 to 16 March 2014) and reference lists of retrieved articles without language restriction. Two physicians screened and identified prospective cohorts that measured thyroid function and followed participants to assess fracture outcomes. One reviewer extracted data using a standardized protocol, and another verified data. Both reviewers independently assessed methodological quality of the studies. The 7 population-based cohorts of heterogeneous quality included 50,245 participants with 1966 hip and 3281 nonspine fractures. In random-effects models that included the 5 higher-quality studies, the pooled adjusted hazard ratios (HRs) of participants with subclinical hyperthyroidism versus euthyrodism were 1.38 (95% CI, 0.92 to 2.07) for hip fractures and 1.20 (CI, 0.83 to 1.72) for nonspine fractures without statistical heterogeneity (P = 0.82 and 0.52, respectively; I2= 0%). Pooled estimates for the 7 cohorts were 1.26 (CI, 0.96 to 1.65) for hip fractures and 1.16 (CI, 0.95 to 1.42) for nonspine fractures. When thyroxine recipients were excluded, the HRs for participants with subclinical hyperthyroidism were 2.16 (CI, 0.87 to 5.37) for hip fractures and 1.43 (CI, 0.73 to 2.78) for nonspine fractures. For participants with subclinical hypothyroidism, HRs from higher-quality studies were 1.12 (CI, 0.83 to 1.51) for hip fractures and 1.04 (CI, 0.76 to 1.42) for nonspine fractures (P for heterogeneity = 0.69 and 0.88, respectively; I2 = 0%). Selective reporting cannot be excluded. Adjustment for potential common confounders varied and was not adequately done across all studies. Subclinical hyperthyroidism might be associated with an increased risk for hip and nonspine fractures, but additional large, high-quality studies are needed. Swiss National Science Foundation.

HbA1c and the Risks for All-Cause and Cardiovascular Mortality in the General Japanese Population

OBJECTIVEAssociations between HbA1c and cardiovascular diseases (CVD) have been reported mainly in Western countries. It is not clear whether HbA1c measurements are useful for assessing CVD mortality risk in East Asian populations.RESEARCH DESIGN AND METHODSThe risk for cardiovascular death was evaluated in a large cohort of participants selected randomly from the overall Japanese population. A total of 7,120 participants (2,962 men and 4,158 women; mean age 52.3 years) free of previous CVD were followed for 15 years. Adjusted hazard ratios (HRs) and 95% CIs among categories of HbA1c (<5.0%, 5.0–5.4%, 5.5–5.9%, 6.0–6.4%, and ≥6.5%) for participants without treatment for diabetes and HRs for participants with diabetes were calculated using a Cox proportional hazards model.RESULTSDuring the study, there were 1,104 deaths, including 304 from CVD, 61 from coronary heart disease, and 127 from stroke (78 from cerebral infarction, 25 from cerebral hemorrhage, and 24 from unclassified stroke). Relations to HbA1c with all-cause mortality and CVD death were graded and continuous, and multivariate-adjusted HRs for CVD death in participants with HbA1c 6.0–6.4% and ≥6.5% were 2.18 (95% CI 1.22–3.87) and 2.75 (1.43–5.28), respectively, compared with participants with HbA1c <5.0%. Similar associations were observed between HbA1c and death from coronary heart disease and death from cerebral infarction.CONCLUSIONSHigh HbA1c levels were associated with increased risk for all-cause mortality and death from CVD, coronary heart disease, and cerebral infarction in general East Asian populations, as in Western populations.

Subclinical Hypothyroidism and Risk for Incident Myocardial Infarction Among Postmenopausal Women

Subclinical hypothyroidism (SCH) has been associated with an increased risk for cardiovascular disease. However, few studies have specifically examined the association between SCH and myocardial infarction (MI), and the relationship is poorly understood. The purpose of this study was to evaluate incident MI risk in relation to SCH and severities of SCH among postmenopausal women. We used a population-based nested case-cohort design within the Women's Health Initiative observational study to examine the association between SCH and incident first-time MI risk among postmenopausal women in the United States. SCH was assessed using blood specimens collected at baseline. Participants presenting with normal free T4 levels and with thyrotropin levels of greater than 4.68-6.99 mU/L or 7.00 mU/L or greater were defined as having mild SCH or moderate/severe SCH, respectively. MI cases were centrally adjudicated by trained Women's Health Initiative staff. The primary analysis included 736 incident MI cases and 2927 randomly selected subcohort members. Multivariable adjusted Cox-proportional hazard models were used to assess MI risk in relation to SCH. Compared with euthyroid participants, the multivariable adjusted hazard ratio (HR) for participants with any SCH was 1.05 [95% confidence interval (CI) 0.77-1.44]. HRs for participants with mild SCH, moderate/severe SCH, and moderate/severe SCH and the presence of antithyroid peroxidase antibodies (TPOAb) were 0.99 (95% CI 0.67-1.46), 1.19 (95% CI 0.72-1.96), and 0.90 (95% CI 0.47-1.74), respectively. We did not find evidence to suggest that SCH is associated with increased MI risk among a population of predominantly older postmenopausal women with no prior history of MI.

ASSOCIATIONS BETWEEN TRAFFIC AND CARDIOVASCULAR MORTALITY IN A COHORT OF CALIFORNIA WOMEN

Background and Aim: Several studies have reported associations between exposure to traffic and cardiovascular events and mortality. We examined relationships between exposures to traffic and various measures of mortality and morbidity in a cohort of over 65,000 residentially stable female teachers and administrators participating in the California Teachers Study, who were followed from 1996 though 2005. Mean age of the cohort at inception was 54; the baseline active smoking rate was 5%, and participants had similar occupational exposures. Methods: Participants’ geocoded addresses were linked with cross-sectional measures of traffic intensity from the year 2000. We developed three measures of traffic exposure: (1) traffic density (estimated number of vehicle miles traveled within 150 m of a participant’s residence; (2) proximity to a highway within versus beyond 150 m; and (3) vehicle density (number of vehicles registered in each participant’s Census block group, divided by the block group area). Using Cox proportional hazards models, we examined associations between these metrics and several measures of mortality, as well as incident myocardial infarction and stroke. Results: We observed several associations between traffic density and elevated risks of all-cause, cardiopulmonary, and cardiovascular mortality, with statistically significant risk gradients with increasing vehicle density. For example, the hazard ratio for participants in the 90th percentile of traffic density in relation to those below the 50th percentile was 1.20 (95% CI = 1.03, 1.39) for cardiovascular mortality. Associations were not observed between traffic density and incident myocardial infarction or stroke, or for any of the other traffic metrics. Conclusion: This study provides additional evidence that exposure to traffic is associated with mortality from heart disease in a cohort of middle-aged and older women.

Abstract LB-395: Alcohol intake and risk of non-Hodgkin's lymphoma: The Multiethnic Cohort

Abstract Evidence from case-control studies suggests an inverse association between alcohol intake and risk of non-Hodgkin's lymphoma (NHL), which might be due to immunemodulatory effects of alcohol. Results from prospective studies are sparse and less consistent. Therefore, we examined the relationship between intake of alcohol and NHL risk within the prospective Multiethnic Cohort (MEC). Between 1993 and 1996, residents of Hawaii and the county of Los Angeles, aged 45-75 years, entered the cohort by completing a questionnaire on demographics, lifestyle and diet. Portion size and consumption frequency of beer, wine, and liquor was assessed. The study population comprised 193,041 participants of Caucasian, African American, Japanese American, Latino and Native Hawaiian ancestry. NHL cases were identified via record linkage with cancer registries. Hazard ratios (HR) and 95% confidence intervals (CI) of NHL or subtypes associated with alcohol intake were calculated using Cox regression with age as underlying time metric. Models were adjusted for age at baseline, sex, ethnicity, body mass index and education. Furthermore, we tested for effect modification by sex, ethnicity, and smoking status. During a mean follow-up time of 9.1 years, 939 incident cases of NHL occurred, including 311 cases of diffuse large B-cell lymphoma (DLBCL), 152 of follicular lymphoma (FL), and 198 of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL). Overall, 39% of men and 62% of women were classified as non-drinkers, while 30% of men and 10% of women reported &amp;gt; 1 drink/day. We found no association between alcohol intake and overall risk of NHL. As compared to non-drinkers, the respective HRs for participants with ≤ 1 and &amp;gt; 1 drink/day were 1.02 (95% CI 0.88-1.19) and 1.03 (95% CI 0.86-1.24) in multivariate adjusted models. We found no interaction between alcohol intake and sex (pinteraction = 0.63) or smoking (pinteraction = 0.40). Stratified by ethnicity, HRs tend to increase with alcohol intake in Caucasians, while in Latinos those with &amp;gt; 1 drink/day had a lower risk of NHL than non-drinkers, but the test for interaction of alcohol intake and ethnicity was not significant (pinteraction = 0.14). However, among NHL subtypes, participants with &amp;gt; 1 drink/day had a HR of 0.69 (95% CI 0.49-0.98) for DLBCL, of 1.93 (95% CI 1.24-3.00) for FL, and of 0.86 (95% CI 0.59-1.26) for SLL/CLL as compared to non-drinkers. Our findings regarding DLBCL support previous studies reporting an inverse association between alcohol intake and NHL risk, but the absence of an overall effect and the positive association with FL disagree with published evidence. The small number of NHL cases per subtype, the ethnic heterogeneity of our study population, and the large proportion of non-drinkers should be kept in mind when interpreting these findings. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-395.

Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension

Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce. To assess whether alcohol consumption is inversely associated with CVD among men with hypertension. Prospective cohort study. United States. 11,711 men with hypertension from the Health Professionals Follow-Up Study. Alcohol consumption was assessed every 4 years by using a food-frequency questionnaire. Incident cases of nonfatal myocardial infarction (MI), fatal coronary heart disease, and stroke were documented from 1986 to 2002. During follow-up, 653 patients with MI were documented. Compared with patients abstaining from alcohol, the hazard ratio for participants with MI consuming 0.1 to 4.9 grams of alcohol per day was 1.09 (95% CI, 0.86 to 1.37); consuming 5 to 9.9 grams of alcohol per day was 0.81 (CI, 0.60 to 1.08 g/d); consuming 10 to 14.9 grams of alcohol per day was 0.68 (CI, 0.51 to 0.91 g/d); consuming 15 to 29.9 grams of alcohol per day was 0.72 (CI, 0.54 to 0.97 g/d); consuming 30 to 49.9 grams of alcohol per day was 0.67 (CI, 0.48 to 0.94 g/d); and consuming 50 or more grams of alcohol per day was 0.41 (CI, 0.22 to 0.77 g/d) (P < 0.001 for trend). Associations were similar for fatal and nonfatal MI. Alcohol consumption was not associated with total death or death due to CVD. Risks for total and ischemic stroke for patients consuming 10 to 29.9 g of alcohol per day were 1.40 (CI, 0.93 to 2.12) and 1.55 (CI, 0.90 to 2.68) compared with that of abstainers. When corrected for measurement error in alcohol consumption, dietary variables, and body mass index, the hazard ratio for participants with MI per 12.5 grams per day increment of alcohol intake was 0.68 (CI, 0.46 to 1.00). Hypertension, alcohol consumption, and CVD risk factors were assessed by self-report. Available data used to correct for measurement error were primarily restricted to dietary variables. In this population of men with hypertension, moderate alcohol consumption was associated with a decreased risk for MI but not with risks for total death or death due to CVD. As in the general population, men with hypertension who drink moderately and safely may not need to change their drinking habits.

The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study

The prospective associations between the metabolic syndrome as defined by the National Cholesterol Education Program (NCEP/ATP III) expert panel and mortality from cardiovascular disease and all-causes has not been extensively examined. Using data from the National Health and Nutrition Examination Survey II Mortality Study (1976–1992), the author examined the association between the metabolic syndrome and mortality from all-causes and cardiovascular disease among 2431 US adults aged 30–75 years. The NCEP/ATP III criteria were modified to substitute body mass index ≥25 kg/m 2 for waist circumference for women and ≥30 kg/m 2 for men. After multiple-adjustment, the hazard ratios for participants with the metabolic syndrome were 1.37 (95% confidence interval (CI): 1.02, 1.85) for mortality from cardiovascular disease, 1.29 (95% CI: 0.92, 1.82) for mortality from coronary heart disease, 1.68 (95% CI: 0.86, 3.27) for mortality from stroke, 1.23 (95% CI: 0.95, 1.59) for mortality from diseases of the circulatory system, and 1.15 (95% CI: 0.92, 1.45) for all-cause mortality compared with participants without the syndrome. The association between the number of metabolic syndrome criteria and mortality from cardiovascular disease was near linear ( P=0.007). Three criteria of the syndrome—excess weight, hypertriglyceridemia, and low high-density lipoprotein cholesterol concentration—were not independently associated with any of the outcomes. Additional prospective studies are needed to examine the association between the metabolic syndrome and the incidence of cardiovascular disease and mortality from cardiovascular disease and all-causes.

The ankle brachial index and change in lower extremity functioning over time: the Women's Health and Aging Study.

To define the association between baseline ankle brachial index (ABI) level and subsequent onset of severe disability. Prospective cohort study. Baltimore community. Eight hundred forty-seven disabled women aged 65 and older participating in the Women's Health and Aging Study. At baseline, participants underwent measurement of ABI and lower extremity functioning. Measures of lower extremity functioning included patient's report of their ability to walk one-quarter of a mile, number of city blocks walked last week, number of stair flights climbed last week, and performance-based measures including walking speed over 4 meters, five repeated chair stands, and a summary performance score. Functioning was remeasured every 6 months for 3 years. Definitions of severe disability were developed a priori, and participants who met these definitions at baseline were excluded from subsequent analyses. Participants with an ABI of less than 0.60 at baseline had significantly higher cumulative probabilities of developing severe disability than participants with a baseline ABI of 0.90 to 1.50 for walking-specific outcomes (ability to walk a quarter of a mile, number of city blocks walked last week, and walking velocity) but not for the remaining functional outcomes. In age-adjusted Cox proportional hazards analyses, hazard ratios for participants with a baseline ABI of less than 0.60 were 1.63 for becoming unable to walk a quarter of a mile (P = .044), 2.00 for developing severe disability in the number of blocks walked last week (P = .004), and 1.61 for developing severe disability in walking speed (P = .041), compared with participants with a baseline ABI of 0.90 to 1.50. Adjusting for age, race, baseline performance, and comorbidities, an ABI of less than 0.60 remained associated with becoming severely disabled in the number of blocks walked last week (hazard ratio = 1.97, P = .009) and nearly significantly associated with becoming unable to walk a quarter of a mile (hazard ratio = 1.54, P = .09). In fully adjusted random effects models, a baseline ABI of less than 0.60 was associated with significantly greater decline in walking speed per year (P = .019) and nearly significantly greater decline in number of blocks walked last week per year (P = .053) compared with a baseline ABI of 0.90 to 1.50. In community-dwelling disabled older women, a low ABI is associated with a greater incidence of severe disability in walking-specific but not other lower extremity functional outcomes, compared with persons with a normal ABI over 3 years.

Vitamin supplement use and diabetes mellitus incidence among adults in the United States.

In some studies, use of vitamin supplements has been inversely associated with the risk of several chronic diseases, but little is known about whether vitamin use affects the risk of diabetes mellitus. Using data from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study, the author examined whether vitamin use was related to diabetes incidence in a cohort of United States adults aged 25--74 years. In the analytic sample of 9,573 participants, 1,010 participants developed diabetes mellitus during about 20 years of follow-up. A smaller percentage of participants with incident diabetes (21.4%) reported using vitamins during the previous month at baseline compared with participants who remained free of this disease (33.5%) (p < 0.001). After multiple adjustment, the hazard ratios for participants using vitamin supplements were 0.76 (95% confidence interval (CI): 0.63, 0.93) for all participants, 0.70 (95% CI: 0.54, 0.92) for men, and 0.84 (95% CI: 0.64, 1.11) for women. Sex did not modify the association between vitamin use and diabetes incidence. Whether specific vitamins or other factors closely correlated with vitamin use account for this observation is unclear.