Heart Disease In Men Research Articles

Population regularities of the prevalence of coronary heart disease and psychosocial risk factors in men in a medium-urbanized city of Western Siberia

Purpose of the study: to determine associations of the prevalence of coronary heart disease and some psychosocial risk factors (negative affective states) among men 25–64 years old in the open population of a mid-urban city in Western Siberia.Material and methods. A cross-sectional study with a response rate of 85.0 % was conducted on a representative sample of men 25–64 years old in the city of Tyumen (n = 1000). To determine the levels of personal anxiety, depression, hostility, vital exhaustion, and sleep quality, the standard WHO MONICA-MOPSY questionnaire was used.Results. In the open population of a mid-urban city in Western Siberia, psychosocial risk factors for CVD are significantly common in men aged 25–64 years: personal anxiety (92.4 %), depression (23.6 %), sleep disturbance (50.9 %), hostility (70.0 %), vital exhaustion (54.5 %). Frequency of detection of high gradations of psychosocial risk factors for CVD – personal anxiety (36.6 %), depression (4.6 %), sleep disorders (9.5 %), hostility (46.4 %), vital exhaustion (15.9 %) – increases with age, reaching a maximum in the sixth decade of life. In men 25–64 years old in a mid-urban city in Western Siberia with the presence of IHD, high levels of PSF are more common than in persons without IHD – personal anxiety (OR 4.07), depression (OR 21.07), sleep disorders (OR 5.05) , hostility (OR 2.71), vital exhaustion (OR 6.02); with the presence of «definite» IHD – significantly more often – personal anxiety (OR 9.51), depression (OR 39.84), sleep disturbance (OR 5.28), hostility (OR 4.65), vital exhaustion (OR 14. eleven).Conclusions. Thus, analysis of the definition of psychosocial risk factors associated with the prevalence of coronary heart disease in men 25–64 years old seems necessary to use when developing a preventive program to reduce high cardiovascular risk in the open population of a mid-urban city in Western Siberia, focused primarily on regulation of psychological parameters.

Relationship between cumulative exposure to occupational lifting throughout working life and risk of ischemic heart disease in men and women. The Copenhagen Aging and Midlife Biobank.

Ischemic heart disease (IHD) causes mortality and morbidity. High levels of occupational physical activity (OPA) increases IHD risk, and occupational lifting (OL) is suggested as a detrimental OPA exposure. This study investigated the association between accumulated OL throughout working life, and risk for IHD, and potential sex and hypertension differences. Data from Copenhagen Ageing and Midlife Biobank linked to register-based information on incident IHD during 9 years follow-up in the Danish National Patient Registry were included. The outcome was the odds of IHD from baseline (2009-2011) to end of follow-up (2018), among participants without IHD at baseline. Accumulated OL was assessed by linking occupational codes to a Job Exposure Matrix, creating a measure in ton-years (lifting 1,000 kg/day/year). Multivariable logistic regression tested associations between level of accumulated OL and IHD, among the 6,606 included individuals (68% men). During follow-up, 7.3% men and 3.6% women were hospitalized with IHD. Among all participants, the odds for IHD were 47% (OR 1.47, 95% CI 1.05-2.06) higher among those with ≥5 to <10 ton-years, 39% (OR 1.39, 95% CI 1.06-1.83) higher among those with ≥10 to <30 ton-years, and 62% (OR 1.62, 95% CI 1.18-2.22) higher among those with ≥30 ton-years, compared to no accumulated OL. However, these increased odds were in the same direction in the fully-adjusted model but statistically insignificant, ≥5 to <10 ton-years OR 1.28, 95% CI 0.88-1.88; ≥10 to <30 ton-years OR 1.20, 95% CI 0.85-1.69; and ≥30 ton-years OR 1.22, 95% CI 0.81-1.84. No statistically significant interactions, nor any associations, between OL and sex, or hypertension were seen.

Birth Weight, Childhood and Young Adult Overweight, and the Risk of Coronary Heart Disease in Men.

Low birth weight is a known risk factor for adult coronary heart disease (CHD), but the additional effect of weight development during childhood and early adult life has not been studied. We included 35 659 men born 1945 to 1961 from the population-based BMI Epidemiology Study Gothenburg, with data available on birthweight, BMI in childhood (8 years), and BMI in young adulthood (20 years). Information on CHD diagnoses was retrieved from national registers. We used Cox proportional hazards regression to estimate hazard ratios and 95% CIs for the risk of early and late CHD (before and after 58.4 years of age, respectively). During follow-up, a total of 3380 cases of CHD (fatal and nonfatal) were registered. Birth weight was inversely associated with the risk of both early (hazard ratio, 0.88 per SD increase [95% CI, 0.84-0.92]) and late (hazard ratio, 0.94 per SD increase [95% CI, 0.90-0.98]) CHD, independently of BMI at 8 years and BMI change during puberty. In a model including birth weight (below or above the median) together with overweight at 8 and 20 years, only birth weight and young adult overweight, but not overweight in childhood, were significantly associated with the risk of CHD. A birth weight below the median, followed by overweight at 20 years of age was associated with a more than doubled risk of early CHD (hazard ratio, 2.29 [95% CI, 1.86-2.81]), compared with the reference (birth weight above the median and normal weight at 20 years of age). This excess risk was even more pronounced for a birthweight below 2.5 kg. We demonstrate that low birth weight and young adult overweight are important developmental markers of risk for adult CHD. These findings motivate a life course perspective for prevention and risk assessment of adult CHD.

Social Networks and Cardiovascular Disease Events in the Jackson Heart Study.

Cardiovascular disease (CVD) disproportionately affects Black adults. Greater social networks (SNs), or social connectedness, may lower the risk of CVD events. This study determined the association of SNs and incident CVD and tested mediation by depressive symptoms, hypertension control, and diabetes control. We used the Social Network Index at exam 1 (2000-2004) to develop a continuous standardized SN score and binary categories (high versus low) among participants in the Jackson Heart Study (n=4686; mean age, 54.8 years). Surveillance of coronary heart disease, stroke, and heart failure events occurred after exam 1 (2005 for HF) until 2016. Using Cox proportional hazards regression, we estimated the association of SNs and CVD events by sex and tested the mediation of depressive symptoms, hypertension control, and diabetes control. Models adjusted for age, education, health behaviors, CVD comorbidities, and depressive symptoms. Among women, the SN score was associated with a lower hazard of stroke, coronary heart disease, and heart failure after full adjustment (hazard ratio [HR], 0.78 [95% CI, 0.64-0.95]; HR, 0.79 [95% CI, 0.71-0.88]; and HR, 0.78 [95% CI, 0.66-0.92], respectively). SN scores were also associated with a lower hazard of coronary heart disease in men (HR, 0.84 [95% CI, 0.75-0.94]) after full adjustment. High versus low SNs were associated with a lower hazard of coronary heart disease and heart failure among women after full adjustment. There was no evidence of mediation by depressive symptoms, diabetes control, and hypertension control. Higher SNs may lower the risk of CVD events, especially in women.

Adenosine 5'monophosphate-activated protein kinase activation reduces the risks of psoriasis and its comorbidities: a Mendelian randomization study in the UK Biobank.

Whether metformin and its adenosine 5'monophosphate-activated protein kinase (AMPK) activation protect from psoriasis risk is unconcluded. We investigated the effect of AMPK, a pharmacological target of metformin, on the risk of psoriasis and its comorbidities and mortality among participants in the UK Biobank (UKB). To avoid immortal time biases in pharmacoepidemiologic studies, Mendelian randomization was used to infer the AMPK pathway-dependent effects. The cut-off age for distinguishing early-onset/late-onset psoriasis (EOP/LOP) was set at 60 years, based on the incident psoriasis peak in UKB. A genetic instrument comprising 44 single-nucleotide polymorphisms associated with glycated haemoglobin (HbA1c), serving as a proxy for AMPK genetic risk score (negatively associated with AMPK activation), was employed as previously reported in the literature. Log-binomial models were used to estimate the effect size of AMPK regarding relative risk (RR) and 95% CI. A total of 407 159 participants were analysed, including 9126 EOP and 3324 LOP. The AMPK genetic risk score was associated with a 12.4% increase in the risk of LOP in men (RR = 1.124, 95% CI: 1.022-1.236). This association was not significant for EOP or women. AMPK genetic risk score exhibited an elevated risk of ischemic heart disease (RR = 1.217, 95% CI 1.062-1.395) in male psoriasis patients. AMPK activation may protect against LOPs and associated ischemic heart disease in men. A sex-specific, comorbidity-targeted intervention for psoriasis is needed.

Abstract 006: Age And Sex Differentially Regulate Epigenetic Mechanisms In The Heart

Understanding epigenetic mechanisms associated with aging might reveal potential biomarkers for aging as well as therapeutic targets for reversing or ameliorating aging pathologies, including cardiovascular disease. There is a sex difference in the age of onset of cardiovascular disease, where females are protected against age related changes, including hypertension and fibrosis, until menopause. We hypothesized that epigenetic mechanisms would be differentially regulated in a sex and age dependent manner, with changes in the older females reflecting the loss of estrogen with aging. To test this hypothesis, we examined heart tissue from 4-month (4M), 12-month (12M), and 24-month (24M)-old male and female C57BL/6JN mice (National Institute of Aging). Surprisingly histone deacetylase (HDAC) activity (ELISA) was significantly higher in all female mice than in age-matched males (4M, female 5.2 ± 0.6 vs male 2.8 vs 0.5; 12M, female 4.2 ± 0.4 vs male 1.3 ± 0.2; 24M, female 8.1 ± 0.6 vs male 2.3 ± 0.4; ng/min/mg protein; p &lt; 0.05). In females age increased HDAC activity (35% increase 24M v 4M; p &lt; 0.05). Western blot analysis revealed that expression levels of profibrotic class I HDACs were significantly higher in 12M and 24M old female mice (HDAC1, 52% and 48%, p &lt; 0.05 and HDAC2, 52% and 79%, p &lt; 0.05), respectively, as compared with age-matched males. However, histone acetyltransferase activity was comparable in all male and female groups as was histone 3 (H3) acetylation at lysine 9 and 27. Levels of circulating histones were determined in the serum. Histones are released in the extracellular space during disease state, act as damage-associated molecular pattern molecules and activate inflammatory pathways. Circulating H3 levels in serum increased significantly with age in both sexes (male 12M, 17.1 ± 1.4; and 24M, 21.4 ± 0.8 vs. 4M, 4.0 ± 0.6; ng/ml, p &lt; 0.05; female 12M, 13.8 ± 2.1 and 24M, 17.4 ± 1.4 vs. 4M, 7.2 ± 1.0 p &lt; 0.05). The data demonstrate the effect of age and sex in heart tissues with aged female mice exhibiting higher levels of profibrotic epigenetic enzymes compared to males. These findings will have important implications in age-related cardiac injury as aging is a primary risk factor for hypertension and related heart disease in men and women.

Study of Factors for Heart Disease Prediction between Men and Women based on Multiple Regression Models

Although previous studies have shown that there are differences in heart disease between men and women, the importance of some specific physical and chemical factors in the prediction of heart disease in different genders has not been clearly clarified. In this research, K-means clustering, multiple linear regression, logistic regression and random forest are adopted to analyze the UCI Heart Disease Data Set, which contains various physical and chemical indicators worth studying. The results demonstrate that exercise induced angina is more significant to the judgement of heart disease in women, while number of major vessels colored by fluoroscopy is more significant to the judgement of heart disease in men and type of chest pain is a statistically significant variable for both men and women. Thalassemia, ST depression induced by exercise relative to rest, greatest number of heartbeats per minute, age, resting blood pressure also have reference value for the judgment of heart disease. In terms of each model's fit to heart disease prediction, for women, the accuracy of random forest is the first, logistic regression is the second, and multiple linear regression is the third, while for men, the accuracy of random forest is the first, multiple linear regression is the second, and logistic regression is the third. These conclusions are an optimization of previous studies, and to a certain extent reflect that this study is of great significance to the prevention of heart disease in different groups of people.

Sex Hormone-Binding Globulin and Risk of Coronary Heart Disease in Men and Women.

The role of sex hormone-binding globulin (SHBG) levels in clinical risk stratification and intervention for coronary heart disease (CHD) remains uncertain. We aimed to examine whether circulating levels of SHBG are predictive of CHD risk in men and women. We investigated the association between SHBG and the risk of incident CHD in 128 322 men and 135 103 women free of CHD at baseline in the prospective United Kingdom Biobank (UKB) cohort. The unconfounded associations were estimated using Mendelian randomization (MR) analysis. We further conducted a meta-analysis to integrate currently available prospective evidence. CHD events included nonfatal and fatal myocardial infarction and coronary revascularization. In the UKB, during a median of 11.7 follow-up years, 10 405 men and 4512 women developed CHD. Serum levels of SHBG were monotonically associated with a decreased risk of CHD in both men (adjusted hazard ratio [HR] per log nmol/L increase in SHBG: 0.88 [0.83-0.94]) and women (HR: 0.89 [0.83-0.96]). MR-based analyses suggested causality and a dose-response relationship of SHBG with CHD risk. A cumulative meta-analysis including 216 417 men and 138 282 women from 11 studies showed that higher levels of SHBG were prospectively associated with decreased CHD risk in men comparing the highest with the lowest quartile: pooled relative risk (RR) 0.81 (0.74-0.89) and women (pooled RR: 0.86 [0.78-0.94]). Higher circulating SHBG levels were directly and independently predictive of lower CHD risk in both men and women. The utility of SHBG for CHD risk stratification and prediction warrants further study.

Mathematical Analysis of the Healthcare Treatment of 215 Patients with Coronary Heart Disease

The main risk factors for CHD and the comorbidity include hyperlipidemia (HL), hypertension, smoking, dietary factors, and genetic factors. In this work, 215 patients with coronary heart disease, including 128 males and 87 females, were analyzed for a better understanding of the related clinical pharmacology. Nonparametric test, analysis of variance, chi-square test, correlation analysis, and other methods were used to sort out the data. From the analysis, there are significant differences in age among different gender samples. The incidence of coronary heart disease in men is five years younger than that in women. The sample pairs from different regions showed differences in the presence of family history of diabetes, indicating that a series of patients in some regions concentrated on the disease status of family history of diabetes. Age has a significant positive effect on cardiac functional classification. The older you are, the larger the cardiac functional classification is and the worse the cardiac function is. Age was negatively correlated with VTE score, diastolic blood pressure, CAR, TG, neutrophil, and TC. The older you are, the lower these six values are. Samples of different types of CHD showed significant differences in the presence of comorbidity and family history of CHD. The most significant are unstable angina pectoris and ischemic cardiomyopathy. Samples of different CHD types showed significant effects on VTE score, creatine kinase, low-density lipoprotein cholesterol (LDL⁃C), and lactate dehydrogenase. The highest lactate dehydrogenase is ischemic cardiomyopathy. The highest LDL cholesterol is ST-segment elevation angina. The highest creatine kinase is ischemic cardiomyopathy. The VTE score was the highest for ischemic cardiomyopathy, followed by non-ST-segment elevation angina. Samples taken with or without lipid-lowering drugs showed significant differences in lactate dehydrogenase, creatinine, and TC. There was a significant positive correlation between VTE scores and lactate dehydrogenase, myoglobin, and creatine kinase. High VTE score indicates high lactate dehydrogenase, myoglobin, and creatine kinase. TC has a significant positive correlation with HDL⁃C and TG, respectively. Higher TC values indicate higher HDL⁃C and TG values.

Mitochondrial DNA polymorphism and myocardial ischemia: Association of haplogroup H with heart failure

The pathogenesis of atherosclerosis and ischemic heart disease is associated with oxidative stress and mitochondrial dysfunction. Mitochondrial DNA encodes subunits of mitochondrial respiratory chain and is highly polymorphic in human populations. Mitochondrial DNA can be considered a candidate genetic locus for predisposition to cardiovascular diseases.Aim. To analyze the associations of the mitochondrial genome polymorphism and chronic heart failure in ischemic heart disease.Material and Methods. The study included two groups of individuals: patients with a combination of ischemic heart disease and chronic heart failure (n = 175) and a population sample of residents of Tomsk (n = 424). Percentages of patients with chronic heart failure of NYHA classes II, III, and IV were 37%, 50%, and 13%, respectively. All patients underwent echocardiographic examination; body mass index and the lipid fractions in blood serum were determined. The average was 55.4 years in patients and 47.6 years in the population sample. Polymorphism of mtDNA was studied by sequencing the hypervariable segment of D-loop of mtDNA and subsequent classification of mtDNA haplotypes into the known haplogroups. The mtDNA haplogroup frequencies were compared between the samples using the Chi-square test. The associations of genotype with quantitative trait variability were analyzed by variance analysis.Results. Male patients showed a higher frequency of haplogroup H compared to the population (45.86% in patients and 35.4% in population) and a higher total frequency of haplogroup H subgroups except the most frequent subgroup H1 (36.94% and 25.22%, respectively). The values of significance level (p-value) and odds ratio (OR) were determined as follows: p = 0.04; odds ratio OR = 1.55 (95% confidence interval (CI) 1.02–2.34) for haplogroup H as a whole; p = 0.02; OR = 1.74 (95% CI 1.12–2.70) for haplogroup H without subgroup H1. Analysis of quantitative traits revealed the associations of the same genetic marker (mtDNA haplogroup H) with the levels of high-density lipoproteins (p = 0.03) and triglycerides (p = 0.02) in blood serum of men in the population sample.Conclusion. The obtained results suggested that the most frequent European mtDNA haplogroup H may be a risk factor for the complications of ischemic heart disease in men.

Prevalence and Risk Factors of Urinary Incontinence Among Elderly Adults in Rural China: A Cross-Sectional Survey.

The purpose of this study was to explore the prevalence of urinary incontinence (UI) and several subtypes: (stress, urge, and mixed UI) and the influence of multiple factors on the likelihood of UI. Epidemiological study based on cross-sectional data collection. The sample comprised 1279 inhabitants 65 years and older residing in 10 villages randomly selected from the Shanxi province, located in North China. The presence and types of UI were assessed using the International Consultation of Incontinence Questionnaire-Short Form. Sociodemographic parameters were also recorded, along with data on lifestyle, bowel function, and medical conditions. The Activity of Daily Living Scale and Mini-Mental State Examination instruments were used to evaluate physical and cognitive functions, respectively. A multivariate logistic regression model with the backward method was employed to identify factors associated with UI. The prevalence of any UI among the rural Chinese elderly 65 years and older was 46.8%, with a female predominance (56.3% in females vs 35.0% in males). The most common incontinence subtype in women was mixed UI (n = 170, 24.0%), followed by stress UI (n = 131, 18.5%) and urge UI (n = 97, 13.7%). The most prevalent form of UI in males was urge UI (n = 190, 33.2%), followed by stress UI (n = 5, 0.9%) and mixed UI (n = 5, 0.9%). Less than one quarter of respondents (17%, n = 102) of participants with UI had consulted a doctor. Multivariate analysis found that poorer physical function, poor quality of sleep, and fecal incontinence were common factors associated with UI in both women and men. In women, higher body mass index and constipation were also independent correlates, as were poor vision and heart disease in men. Poorer physical function was associated with all UI subtypes. For female stress UI, poorer cognitive status, tea drinking, and hypertension also emerged as independent risk factors. Heart disease was an independent risk factor in both female and male urge UI; as was consumption of a non-plant-based diet for female mixed and urge UI; nonfarmer and traumatic brain injury for female urge UI; and poor vision and fecal incontinence in male urge UI. Chinese rural citizens showed a high UI prevalence, but only a small proportion had consulted a health care provider. Physical function decline was the most important contributor to UI among participants. Individualized intervention programs targeting modifiable risk factors among high-risk populations should be developed.

Some indicators of the attitude to their health and medical care in the presence of coronary heart disease in men and women of the open population of Western Siberia

Some indicators of the attitude to their health and medical care in the presence of coronary heart disease in men and women of the open population of Western Siberia

Genetically predicted sex hormone binding globulin and ischemic heart disease in men and women: a univariable and multivariable Mendelian randomization study

Men are more vulnerable to ischemic heart disease (IHD) than women, possibly due to testosterone. Correspondingly, sex hormone binding globulin (SHBG) which lowers circulating testosterone might protect men against IHD. SHBG may also affect IHD independent of testosterone, which has not previously been examined. To assess the sex-specific role of SHBG in IHD, in univariable Mendelian randomization (MR), we used sex-specific, genome-wide significant genetic variants to predict SHBG, and examined their association with IHD in the UK Biobank. We also replicated using genetic instruments from Japanese men and applied to Biobank Japan. To assess the role of SHGB independent of testosterone in men, we used multivariable MR controlling for testosterone. Genetically predicted SHBG was associated with lower IHD risk in men [odds ratio (OR) 0.78 per standard deviation, 95% confidence interval (CI) 0.70 to 0.87], and the association was less clear in women. The estimates were similar in Japanese. The inverse association remained after controlling for testosterone in men (OR 0.79, 95% CI 0.71 to 0.88). SHBG might lower the risk of IHD in men, with a role independent of testosterone. Exploring intervention strategies that increase SHBG is important for targeting IHD treatments.

Birth weight as destiny?

In 1989, Barker et al reported a correlation between lower birth weights and increased risk for death in adulthood from ischemic heart disease in men born between 1911-1930 in England (Lancet 1989;2:577-80. doi: https://doi.org/10.1016/s0140-6736(89)90710-1). Many subsequent studies have affirmed the relationship between birth weight and conditions such as diabetes, hypertension, and obesity. In this volume of The Journal of Pediatrics, Lilja et al report an association between birth weight and stroke in adulthood. The study used a large cohort of Swedish men born in 1945-1961 with recorded birth weight and body measurements until the age of young adult military conscription tests, linked to national disease and cause of death registers. The study found that lower birth weights were associated with an increased risk of stroke, regardless of body mass index in young adulthood. However, men who were overweight in young adulthood were at significantly higher risk. From a public health standpoint, it is important to learn how individuals can mitigate the risks associated with low birth weight and we need more studies such as this one that show how risk is increased or decreased along the lifespan. It is possible that birth weight is destiny, and that the baseline increase in risk incurred by the fetal environment cannot be decreased and disease risks can only be increased by postnatal health. To understand this, we need even deeper studies of how modifiable factors such as early diet and physical exercise interact with perinatal risk factors in both men and women. However, this needs to be studied prospectively with earlier outcomes, so we do not have to wait several more generations to start improving the long-term health of small newborn infants. Article page 162 ▸ Low Birth Weight as an Early-Life Risk Factor for Adult Stroke Among MenThe Journal of PediatricsVol. 237PreviewTo evaluate the association between birth weight and the risk of adult stroke in men, independent of body mass index (BMI) at young adult age. Full-Text PDF Open Access

Association of long-term inhalation of caffeine-sodium benzoate with coronary heart disease in men.

A possible correlation between caffeine and coronary heart disease (CHD) is controversial. The objective of this study was to explore the effect of long-term inhalation of caffeine-sodium benzoate (CSB) on the development of CHD in men, the severity of coronary artery lesions and the possible contributing effects of smoking. A retrospective analysis was performed on 2,001 consecutive men who underwent selective coronary angiography. These men were assigned to a CSB inhalation group (CSB; 1-6 times/d, 274-1,644mg/d, >10years; n=326) or a non-inhalation group (non-CSB; n=1,675). The two groups were compared for the prevalence, onset age, and risk factors of CHD. The men were also stratified as CSB-only, smoking-only, combined CSB+ smoking, and the control (non-CSB+non-smoking). The prevalence, onset age, risk factors of CHD, and severity of coronary artery lesions and major adverse cardiovascular events (MACE) were compared among these groups. The prevalence of CHD in the CSB group was higher compared with the non-CSB group (91.72 vs. 86.09%, p<0.01). In the CSB+smoking group, the percentages of men with CHD (93.11%) or >70% stenosis of the coronary artery lesion (64.92%) were significantly higher than that of the smoking-only group (88.19 and 54.29%, respectively) or control (83.20 and 52.90%), while the percentage with stenosis involving the anterior descending branch was lower (62.30 vs. 72.29% and 74.17%, p<0.01). Men who inhaled CSB long-term had a higher rate of CHD compared with those who did not take CSB. The combination of CSB inhalation and smoking appears to increase synergistically the risk and severity of CHD.

Abstract 14635: The Fib-4 Index is a Risk Factor for Incident Cardiovascular Disease in Urban Male Residents: The Suita Study

Introduction: The fibrosis index based on four factors (FIB-4 index) is a score that predicts liver fibrosis easily, quickly, and inexpensively, but there is little evidence of its relationship with the onset of cardiovascular disease in general population in Japan. Therefore, we examined the relationship between incident cardiovascular disease (CVD) by the FIB-4 index level in urban area residents. Methods: We studied 5,333 follow-up Japanese individuals (2,478 men, 2,855 women) with no history of CVD in the Suita Study. The platelet count was measured at the time of medical examination. The FIB-4 index was calculated using age (yrs), alanine aminotransferase (ALT, IU/L), aspartate aminotransferase (AST, IU/L), and platelet count (PLT, 10^9/L) as follow: FIB-4 index = (AST x Age) / (PLT x (square root of ALT)). The primary endpoint was CVD events, including stroke or ischemic heart disease. The risk of CVD was analyzed by the FIB-4 index level using the Cox proportional hazards model adjusted by the components of the ischemic heart disease risk score in the Suita Study. Results: The percentage of the FIB-4 index ≥2.67 in the 30s to 80s at the baseline survey was 0%, 1%, 2%, 7,%, 21%, 43% for men, and 0%, 0%, 1%, 5%, 16%, 39% for women, respectively. During the mean follow-up period of 9.3 years, 195 strokes and 137 ischemic heart diseases were observed. Based on men with FIB-4 index &lt;1.30, the adjusted hazard ratio (95% confidence interval) for incident CVD in men with FIB-4 index ≥2.67 was 1.91 (1.05-3.47), those for incident ischemic heart disease in men with FIB-4 index 1.30-2.66 and ≥2.67 were 2.49 (1.33-4.64) and 3.29 (1.32-8.16), respectively. Conclusion: The FIB-4 index was considered to be useful as a predictor of ischemic heart disease in urban men in Japan.

Changes in life expectancy and contribution of causes of deaths and age groups in Belgium, 1997-2018

Abstract Background Concerns have been expressed about a recent decreasing growth of life expectancy (LE) in some developed countries. This study examines whether a slowing down in the LE increase was observed in Belgium between 1997 and 2018, and describes the contribution of causes of deaths (COD) and age groups to the 2000-2015 change in LE. Methods Changes in yearly LE increase were analyzed by linear regression and joinpoint regression analysis. The contribution of age and COD to the change in LE in Belgium was measured with the Arriaga decomposition method using 3-year moving average to reduce random fluctuations over years. Results No significant breakpoint was identified. The slope of the linear regression of annual LE changes in men was practically flat (slope = -0.0002, CI: -0.014, 0.013) and slightly, but not significantly, decreasing in women (slope = -0.002, CI: -0.019, 0.015). A larger increase in LE was observed in men compared to women and in people aged 70 years and over compared to younger ages. The COD contributing the most to the increase in LE was ischemic heart disease in men and in women. It was followed by transport accident and lung cancer in men and by cerebrovascular diseases and other circulatory diseases in women. Dementia, Alzheimer, and Parkinson contributed negatively to the LE increase in men and in women. The largest negative contributor was lung cancer in women. Conclusions In contrast to neighboring countries, no evidence for a significant stalling of life expectancy were found in Belgium between 1997 and 2018. Progress in reducing the major causes of deaths (cardiovascular diseases, some cancers, and transport accidents) have contributed to the increase of LE, but some COD are impeding further progress, particularly lung cancer in women. Key messages No evidence of stalling life expectancy in Belgium between 1997 and 2018. Monitoring causes of deaths is crucial to identify conditions impeding progress in life expectancy.

Incidence of Ischaemic Heart Disease in Men and Women With End-Stage Kidney Disease: A Cohort Study

The incidence of ischaemic heart disease (IHD) has fallen consistently in the general population; attributed to effective primary prevention strategies. Differences in incidence have been demonstrated by sex. Whether this fall in incidence and sex differences is mirrored in people with end-stage kidney disease (ESKD) is unclear. We aimed to establish the relative risk of IHD events in the ESKD population. We performed a retrospective cohort study from 2000 to 2010 in people with ESKD in New South Wales. We performed data linkage of the Australia and New Zealand Dialysis and Transplant Registry and state wide hospital admission and death registry data and compared this to general population data. The primary outcome was the incidence rate, incidence rate ratio (IRR), and time-trend for any IHD event. We calculated these using indirect standardisation by IHD event. 10,766 participants, contributed 44,149 years of observation time. Incidence rates were substantially higher than the general population for all IHD events (any IHD event: IRR 1.8, 95% confidence interval [CI] 1.7-1.9 for men, IRR 3.4, 95% CI 3.1-3.6 for women). Excess risk was higher in younger people (age 30-49 IRR 4.8, 95% CI 4.2-5.4), and in women with a three-fold increase risk overall and nearly a 10-fold increase in risk in young women (female age 30-49 years: IRR 9.8 95% CI 7.7-12.3), results were similar for angina and acute myocardial infarction. Ischaemic heart disease rates showed some decline for men over time, (ratio of IRR 0.93, 95% CI 0.90-0.95) but were stable for women (ratio of IRR 0.97, 95% CI 0.94-1.01). People with ESKD have substantially higher rates of IHD than the general population, especially women, in whom no improvement appears evident over the past 10 years.

Changes in causes and age of death in an eastern German county over a period of 14 years. Comparison of rural and urban populations. Focus on COPD and ischemic heart disease

We aimed to determine whether the causes of death, age of death and burden of disease have changed in the last years and whether there are differences between males and females as well as urban and rural populations. We investigated the causes of death, comorbidities and age of death as a cross-sectional study of an entire Thuringian county (approximately 100,000 inhabitants; 5 small cities with a total of 63,050 inhabitants and about 36,950 inhabitants in the countryside) for a 14-year period. All death certificates that were issued between 2002 and 2015 were reviewed for a total of 18,868 cases. The data were checked, and causes of death were coded by ICD-10 code. Because traditionally most corpses are cremated in Germany, in 79.68% of all cases a second inspection of the corpse by a pathologist, forensic pathologist or coroner was carried out for clarification of the cause of death according to the Thuringian laws. During the 14-year period, the age of death increased from 70.61 years to 74.49 years for males and from 78.94 years to 82.44 years for females. While in most of the investigated diseases the age of death also increased in parallel to the average age of death, an antiparallel development was found for COPD: the age of death for males with COPD was reduced by 0.045 years and for females by 0.15 years during the observation period. The burden of disease as measured by disability-adjusted life years (DALY) also steadily increased for COPD in both genders. The highest number of lost years of life was found for lung/bronchial cancer in both genders and for breast cancer. The highest burden of disease was calculated for ischemic heart disease in men and breast cancer in women. In general, the age of death in rural areas was nearly the same as in urban areas. Only for death from ischemic heart disease was there an increase in the age of death for men living in rural areas after the opening of a local cardiac catheterization laboratory in 2008. In all cases men exhibited an earlier age of death than women. While in all other investigated diseases the age of death increased, it dropped for COPD. COPD seems to have become a more frequent cause of death in recent years.

Adipose Tissue Gene Expression Associations Reveal Hundreds of Candidate Genes for Cardiometabolic Traits

Genome-wide association studies (GWASs) have identified thousands of genetic loci associated with cardiometabolic traits including type 2 diabetes (T2D), lipid levels, body fat distribution, and adiposity, although most causal genes remain unknown. We used subcutaneous adipose tissue RNA-seq data from 434 Finnish men from the METSIM study to identify 9,687 primary and 2,785 secondary cis-expression quantitative trait loci (eQTL; <1 Mb from TSS, FDR < 1%). Compared to primary eQTL signals, secondary eQTL signals were located further from transcription start sites, had smaller effect sizes, and were less enriched in adipose tissue regulatory elements compared to primary signals. Among 2,843 cardiometabolic GWAS signals, 262 colocalized by LD and conditional analysis with 318 transcripts as primary and conditionally distinct secondary cis-eQTLs, including some across ancestries. Of cardiometabolic traits examined for adipose tissue eQTL colocalizations, waist-hip ratio (WHR) and circulating lipid traits had the highest percentage of colocalized eQTLs (15% and 14%, respectively). Among alleles associated with increased cardiometabolic GWAS risk, approximately half (53%) were associated with decreased gene expression level. Mediation analyses of colocalized genes and cardiometabolic traits within the 434 individuals provided further evidence that gene expression influences variant-trait associations. These results identify hundreds of candidate genes that may act in adipose tissue to influence cardiometabolic traits.