Incident Ischemic Heart Disease Cases Research Articles

Combined Exposure to Multiple Air Pollutants and Incident Ischemic Heart Disease in Individuals with and without Type 2 Diabetes: A Cohort Study from the UK Biobank

BackgroundAir pollution and type 2 diabetes (T2D) are both associated with an increased risk of ischemic heart disease (IHD). Little is known about the combined effects of multiple air pollutants on IHD risk, especially among individuals with T2D. We sought to assess the association of combined exposure to multiple air pollutants with incident IHD and examine the modification effect of T2D. MethodsThis study included 388780 individuals (20036 individuals with T2D) free of cardiovascular disease and cancer from the UK Biobank. The combined exposure to multiple air pollutants, including particulate matter (PM) with diameters ≤ 2.5 μm (PM2.5), PM with diameters between 2.5 and 10 µm (PMcoarse), PM with diameters≤10 μm (PM10), nitrogen dioxide (NO2), and nitrogen dioxides (NOx), was assessed by creating a weighted air pollution score (APS), with a higher APS representing a higher level of air pollution exposure. Hazard ratios (HR) and 95% confidence intervals (CI) for incident IHD were assessed by multivariable-adjusted Cox proportional hazard models. ResultsDuring a median of 12.9 years of follow-up, 27333 incident IHD cases were observed. Compared with the lowest tertile of the APS, the multivariable-adjusted HR (95% CI) of IHD risk for the highest tertile was 1.13 (1.03-1.23) among individuals with T2D, while the HR was 1.06 (1.03-1.10) among individuals without T2D. Additionally, the associations between APS and IHD incidence showed a linear relationship among individuals with T2D (nonlinearity: P = 0.37), whereas a non-linear relationship was observed among individuals without T2D (nonlinearity: P = 0.02). For the joint analysis, individuals in the highest tertile of APS and with T2D had a 54% higher risk of IHD compared to individuals in the lowest tertile of APS and without T2D, with a significant additive interaction (Pinteraction<0.01). The proportion of relative excess risk was 17% due to the interaction in categorical analyses. ConclusionsThe combined exposure to multiple air pollutants has been associated with an elevated risk of incident IHD, and the association is more pronounced among individuals with T2D.

Plasma Proteomics to Identify Drug Targets for Ischemic Heart Disease

BackgroundIntegrated analyses of plasma proteomic and genetic markers in prospective studies can clarify the causal relevance of proteins and discover novel targets for ischemic heart disease (IHD) and other diseases. ObjectivesThe purpose of this study was to examine associations of proteomics and genetics data with IHD in population studies to discover novel preventive treatments. MethodsWe conducted a nested case-cohort study in the China Kadoorie Biobank (CKB) involving 1,971 incident IHD cases and 2,001 subcohort participants who were genotyped and free of prior cardiovascular disease. We measured 1,463 proteins in the stored baseline samples using the OLINK EXPLORE panel. Cox regression yielded adjusted HRs for IHD associated with individual proteins after accounting for multiple testing. Moreover, cis-protein quantitative loci (pQTLs) identified for proteins in genome-wide association studies of CKB and of UK Biobank were used as instrumental variables in separate 2-sample Mendelian randomization (MR) studies involving global CARDIOGRAM+C4D consortium (210,842 IHD cases and 1,378,170 controls). ResultsOverall 361 proteins were significantly associated at false discovery rate <0.05 with risk of IHD (349 positively, 12 inversely) in CKB, including N-terminal prohormone of brain natriuretic peptide and proprotein convertase subtilisin/kexin type 9. Of these 361 proteins, 212 had cis-pQTLs in CKB, and MR analyses of 198 variants in CARDIOGRAM+C4D identified 13 proteins that showed potentially causal associations with IHD. Independent MR analyses of 307 cis-pQTLs identified in Europeans replicated associations for 4 proteins (FURIN, proteinase-activated receptor-1, Asialoglycoprotein receptor-1, and matrix metalloproteinase-3). Further downstream analyses showed that FURIN, which is highly expressed in endothelial cells, is a potential novel target and matrix metalloproteinase-3 a potential repurposing target for IHD. ConclusionsIntegrated analyses of proteomic and genetic data in Chinese and European adults provided causal support for FURIN and multiple other proteins as potential novel drug targets for treatment of IHD.

Long-Term Exposure to Transportation Noise and Ischemic Heart Disease: A Pooled Analysis of Nine Scandinavian Cohorts.

Transportation noise may induce cardiovascular disease, but the public health implications are unclear. The study aimed to assess exposure-response relationships for different transportation noise sources and ischemic heart disease (IHD), including subtypes. Pooled analyses were performed of nine cohorts from Denmark and Sweden, together including 132,801 subjects. Time-weighted long-term exposure to road, railway, and aircraft noise, as well as air pollution, was estimated based on residential histories. Hazard ratios (HRs) were calculated using Cox proportional hazards models following adjustment for lifestyle and socioeconomic risk factors. A total of 22,459 incident cases of IHD were identified during follow-up from national patient and mortality registers, including 7,682 cases of myocardial infarction. The adjusted HR for IHD was 1.03 [95% confidence interval (CI) 1.00, 1.05] per 10 dB for both road and railway noise exposure during 5 y prior to the event. Higher risks were indicated for IHD excluding angina pectoris cases, with HRs of 1.06 (95% CI: 1.03, 1.08) and 1.05 (95% CI: 1.01, 1.08) per 10 dB for road and railway noise, respectively. Corresponding HRs for myocardial infarction were 1.02 (95% CI: 0.99, 1.05) and 1.04 (95% CI: 0.99, 1.08). Increased risks were observed for aircraft noise but without clear exposure-response relations. A threshold at around 55 dB was suggested in the exposure-response relation for road traffic noise and IHD. Exposure to road, railway, and aircraft noise in the prior 5 y was associated with an increased risk of IHD, particularly after exclusion of angina pectoris cases, which are less well identified in the registries. https://doi.org/10.1289/EHP10745.

Abstract 12063: Antidepressant Use and Incident Ischemic Heart Disease in Women Veterans With Posttraumatic Stress Disorder

Introduction: Antidepressants, namely selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are efficacious in reducing posttraumatic stress disorder (PTSD) symptoms, but their implications for cardiovascular health are unclear. Although SSRI/SNRI treatment could improve PTSD—thus decreasing cardiovascular risk, antidepressant use has also predicted cardiovascular events. This study examined if antidepressant use was associated with developing ischemic heart disease (IHD) in women veterans with PTSD. Methods: The Veterans Affairs (VA) electronic health record (EHR) database was used to identify women veterans with PTSD who engaged with VA healthcare from 2000-2019. Antidepressant use (documented in the EHR) was categorized as SSRIs, SNRIs, both SSRIs/SNRIs, other, or none (ref). We used Cox regression with time-varying exposure and covariates to estimate effects of antidepressants on risk of incident IHD (angina, MI, CAD). Once a woman was exposed to antidepressants, she was considered exposed until IHD onset or censoring. Age, race, ethnicity, and a range of time-varying risk factors [traditional risk factors (e.g., hypertension), other medical risk factors (e.g., obesity), women-specific risk factors (e.g., preeclampsia), psychiatric risk factors (e.g., depression)], were covariates. Results: The analytic sample comprised 143,324 women without IHD at start of follow-up; mean age was 36.1 years ( SD =11.0). Over a median follow-up of 8.6 years, there were 6,633 incident IHD cases. When adjusting for demographics and traditional IHD risk factors, exposure to SNRIs was associated with a 33% greater rate of IHD (95% CI: 1.24-1.43), SSRIs with a 27% greater rate (95% CI: 1.20-1.34), both SSRIs/SNRIs with a 59% greater rate (95% CI: 1.01-2.49), and other antidepressants with a 24% greater rate (95% CI: 1.17-1.31). Associations with SNRIs (HR=1.21, 95% CI: 1.12-1.30), SSRIs (HR=1.15, 95% CI: 1.09-1.22), and other antidepressants (HR=1.19, 95% CI: 1.13-1.26) remained significant in fully adjusted models. Conclusions: Antidepressant use in women veterans with PTSD may exacerbate risk of IHD. Mechanism-focused research and further work in women veterans without PTSD is also needed.

Intake of dietary flavonoids and incidence of ischemic heart disease in the Danish Diet, Cancer, and Health cohort

Background/ObjectivesFew studies have investigated the association between dietary flavonoid intake, including all major subclasses, and the long-term risk of ischemic heart disease (IHD). We examined whether dietary flavonoid intake associated with IHD incidence, assessing the possible modifying role of sex and smoking, in participants from the Danish Diet, Cancer, and Health study.Subjects/MethodsIn a cohort study design, 54,496 adults (46.8% male), aged 50–64 years, without a history of IHD, were followed for up to 23 years. Habitual dietary flavonoid intake was estimated from food frequency questionnaires using Phenol-Explorer. Incident cases of IHD were identified within Danish nationwide health registries. Restricted cubic splines in Cox proportional hazards models were used to examine associations between flavonoid intake and IHD risk.ResultsDuring follow-up, 5560 IHD events were recorded. No overall association was seen between total flavonoid intake, nor any subclass, and IHD, following adjustment for demographics, lifestyle, and dietary confounders. Stratified by sex and smoking status, higher intakes of specific subclasses associated with lower IHD risk among ever-smokers [Q5 vs. Q1 flavonols HR (95% CI): 0.90 (0.82, 0.99); flavanol oligo+polymers: 0.88 (0.80, 0.97)], but not among never-smokers, nor either sex specifically.ConclusionsWhile we did not find clear evidence that higher habitual dietary flavonoid intake was associated with lower IHD risk, these results do not exclude the possibility that certain subclasses may have a protective role in prevention of IHD among population sub-groups; this was evident among smokers, who are at a higher risk of atherosclerosis.

Residential greenness, air pollution, and incident ischemic heart disease: A prospective cohort study in China

Background and aim: Green living environments are associated with beneficial health outcomes, whereas higher air pollution exposure might increase the risk of chronic diseases. Moreover, few studies have explored the interaction between residential greenness and air pollution on the risk of ischemic heart disease (IHD). Therefore we aimed to estimate the associations of residential greenness and air pollution with IHD and their interaction. Methods: We performed a prospective cohort study that included 29,141 adult participants recruited from Yinzhou District, Ningbo, China. Normalized Difference Vegetation Index (NDVI) around each participant’s residence was calculated to measure residential greenness exposure. Land-use regression models were conducted to estimate long-term individual exposure to air pollutants, including nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters &amp;#x2264; 2.5 &amp;#x3bc;m (PM2.5) and &amp;#x2264;10 &amp;#x3bc;m (PM10). Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association of residential greenness and air pollutants with the risk of incident IHD. Results: During 101,172.5 person-years of follow-up, 1,392 incident IHD cases were reported in the study population. Residential greenness, expressed as an interquartile range (IQR) increase in NDVI within 300m, was inversely associated with incident IHD. However, long-term air pollution exposures were associated with higher IHD incidence. Mediation analyses suggested that the beneficial effect of residential greenness on incident IHD could be partly mediated by reducing the exposure to PM2.5. Conclusion: Higher greenness was associated with decreased risk of IHD, while air pollutants were positively associated with incident IHD. Meanwhile, residential greenness may decrease the risk of IHD by reducing PM2.5 exposure. Keywords: Residential greenness; Air pollution; Ischemic heart disease; Cohort study; Effect mediation

Residential greenness, air pollution, and incident ischemic heart disease: A prospective cohort study in China.

Greener residential surroundings are associated with beneficial health outcomes, whereas higher air pollution exposure is linked with elevated risks of chronic diseases. To date, limited studies have explored the interaction between residential greenness and air pollution on the risk of ischemic heart disease (IHD). We performed a prospective cohort study that included 29,141 adult participants recruited from Yinzhou District, Ningbo, China. Normalized Difference Vegetation Index (NDVI) around each participant's residence was calculated to measure residential greenness exposure. Land-use regression models were conducted to estimate long-term individual exposure to air pollutants, including nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters ≤ 2.5 μm (PM2.5) and ≤10 μm (PM10). Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations of residential greenness and air pollutants with the risk of incident IHD. During 101,172.5 person-years of follow-up, 1392 incident IHD cases were reported in the study population. Residential greenness, expressed as an interquartile range (IQR) increase in NDVI within 250 m, was inversely associated with incident IHD (HR = 0.89, 95%CI: 0.81,0.98). However, long-term exposures to air pollution were associated with higher IHD incidence (HR = 1.21, 95%CI:1.10,1.33 per IQR increase for PM2.5; HR = 1.12, 95%CI:1.03,1.22 per IQR increase for PM10; HR = 1.09, 95%CI:1.02,1.16 per IQR increase for NO2). Mediation analyses suggested that the beneficial effect of residential greenness on incident IHD could be partly mediated by reducing the exposure to PM2.5. These findings suggested that higher greenness was associated with decreased risk of IHD, while air pollutants were positively associated with incident IHD. Meanwhile, residential greenness may decrease the risk of IHD by reducing exposure to PM2.5.

Association between dairy consumption and ischemic heart disease among Chinese adults: a prospective study in Qingdao

BackgroundPrevious studies linking dairy consumption with ischemic heart disease (IHD) are almost from western countries, with little from China. The present study was to explore the relationship between dairy consumption and IHD among Chinese adults.MethodsThe data for the present study was from the prospective cohort study of China Kadoorie Biobank in Qingdao, a total of 33,355 participants in the present study. An interviewer-administered laptop-based questionnaire was used to collect information on the consumption frequency of dairy, incident IHD cases were identified through Disease Surveillance Point System and the new national health insurance databases. Cox regression analyses were performed to estimate adjusted hazard ratios (HRs) and confidence interval for the relationship between the incidence of IHD and dairy consumption.ResultsThe baseline survey reported that 32.4% of males and 34.6% of females consumed dairy regularly (i.e. ≥ 4 days/week). Over an average of 9.2 years follow-up, 2712 new-onset IHD were documented. Compared with participants who never or rarely consume dairy, the HR of consumed dairy regularly was 0.85(0.73–0.98) for males (P < 0.05), while no significant benefits were identified for females.ConclusionsRegular dairy consumption had an inverse association to the onset of IHD among males, with no similar findings for females.

Identification of risk factors of 30-day readmission and 180-day in-hospital mortality, and its corresponding relative importance in patients with Ischemic heart disease: a machine learning approach

ABSTRACT Background: The primary objective of this study is to identify non-laboratory predictors for 30-day hospital readmission and 180-day in-hospital mortality rates among patients hospitalized with ischemic heart disease (IHD). Research design and methods: This is a retrospective cohort study of hospitalized patients (≥ 40 years) with a primary diagnosis of IHD. Data were extracted from the Florida Agency for Health Care Administration dataset from 2006 to 2016. A machine learning approach was used to identify predictors of 30-day hospital readmission and 180-day in-hospital mortality. Results: 346,390 patient records for incident IHD cases were identified. The top two predictors of 30-day readmission were the length of stay and the Elixhauser comorbidity index for readmission [ECI] (Area Under the Curve [AUC]=88%) using decision tree algorithms. For in-hospital mortality, the top two predictors were LOS and ECI (AUC=92%) using gradient boosting regressors. The cumulative 30-day readmission and the 180-day probability of mortality rates were 9.82% and 4.6% respectively. Conclusions: Risk factors of 30-day readmission and 180-day mortality in hospitalized IHD patients identified by machine learning and their relative importance (value) will help pharmacists and other health care providers to prioritize their disease management strategies as they improve the care provided to IHD patients.

Meat consumption and risk of ischemic heart disease and stroke: results from the UK Biobank

AbstractIntroductionMeat consumption may be associated with a higher risk of cardiovascular diseases, but the evidence remains inconclusive. We prospectively examined the association between meat (total meat, red and processed meat, red meat, processed meat and poultry) intake and risk of ischemic heart disease (IHD) and stroke, including ischemic and haemorrhagic subtypes, in a large British cohort.Materials and methodsData were from UK Biobank participants who were free of IHD, stroke and cancer at recruitment (2006–2010), with available information on meat intake in the baseline touchscreen survey, and linked hospital admissions and death data for IHD, stroke, and stroke subtypes over follow-up (n = 441,700). We used multivariable Cox proportional hazards models to assess associations between meat consumption and risk of IHD, total stroke and ischemic and haemorrhagic stroke subtypes.ResultsOver a mean of 8.1 years of follow-up, 13,590 incident cases of IHD, 5,441 cases of total stroke, 2,258, cases of ischaemic stroke, and 949 cases of haemorrhagic stroke occurred. The risk of IHD was positively associated with intakes of total meat (Hazard ratio (HR) = 1.18, 95% Confidence Interval (CI) 1.09, 1.27 per 100 g/day higher intake), red and processed meat (HR = 1.15, 95% CI 1.08, 1.24 per 70 g/day higher intake), red meat (HR = 1.15, 95%, CI 1.07–1.24 per 50 g/day higher intake), processed meat (HR = 1.11, 95% CI 1.05, 1.16 per 20 g/day higher intake), and poultry (HR = 1.07, 95% CI 1.01, 1.13 per 30 g/day higher intake). The risk of total stroke was positively associated with intakes of total meat (HR = 1.15, 95% CI 1.02–1.29 per 100 g/day higher intake) and red and processed meat (HR = 1.14, 95% CI 1.03–1.27 per 70 g/day higher intake). Meat intake was not associated with ischaemic or haemorrhagic stroke.DiscussionThis large prospective study found that any meat consumption was associated with an increased risk of IHD and that red and processed meat consumption was associated with an increased risk of total stroke. Our findings for IHD and total stroke in relation to red and processed meat are in line with previous studies but our positive findings for poultry and IHD and null findings for red meat and ischaemic stroke are not, thus warranting further study.

Long-Term Exposure to Particulate Air Pollution, Black Carbon, and Their Source Components in Relation to Ischemic Heart Disease and Stroke.

Background:Long-term exposure to particulate matter (PM) in ambient air has been associated with cardiovascular mortality, but few studies have considered incident disease in relation to PM from different sources.Objectives:We aimed to study associations between long-term exposure to different types of PM and sources, and incident ischemic heart disease (IHD) and stroke in three Swedish cities.Methods:Based on detailed emission databases, monitoring data, and high-resolution dispersion models, we calculated source contributions to PM with aerodynamic diameter (), PM with aerodynamic diameter (), and black carbon (BC) from road wear, traffic exhaust, residential heating, and other sources in Gothenburg, Stockholm, and Umeå. Registry data for participants from four cohorts were used to obtain incidence of IHD and stroke for first hospitalization or death. We constructed time windows of exposure for same-year, 1- to 5-y, and 6- to 10-y averages preceding incidence from annual averages at residential addresses. Risk estimates were based on random effects meta-analyses of cohort-specific Cox proportional hazard models.Results:We observed 5,166 and 3,119 incident IHD and stroke cases, respectively, in 114,758 participants. Overall, few consistent associations were observed between the different air pollution measures and IHD or stroke incidence. However, same-year levels of ambient locally emitted BC (range: ) were associated with a 4.0% higher risk of incident stroke per interquartile range (IQR), [95% confidence interval (CI): 0.04, 7.8]. This association was primarily related to BC from traffic exhaust. (range: ) and (range: ) were not associated with stroke. Associations with incident IHD were observed only for exposure from residential heating.Discussion:Few consistent associations were observed between different particulate components and IHD or stroke. However, long-term residential exposure to locally emitted BC from traffic exhaust was associated with stroke incidence. The comparatively low exposure levels may have contributed to the paucity of associations. https://doi.org/10.1289/EHP4757

International food group–based diet quality and risk of coronary heart disease in men and women

Standard diet quality assessment tools, which measure micronutrient sufficiency and food consumption related to disease and applicable to different populations, are needed to track progress in meeting the Sustainable Development Goals related to hunger, food security, and nutrition. Diet quality scores have been constructed for high- and low-income countries, but none are simple to administer or applicable internationally. We prospectively examined the association between the Food Group Index (FGI), the Minimal Diet Diversity Score for Women (MDDW), and a new Prime Diet Quality Score (PDQS), and the risk of ischemic heart disease (IHD) in 3 US cohorts. In total, 75,045 women (baseline age 43-63 y), 43,966 men (aged 40-75 y), and 93,131 younger women (aged 27-44 y) without a history of cardiovascular disease were followed up to 28 y. Diet was assessed multiple times using food frequency questionnaires and the 3 diet quality scores were computed for each individual. The association with IHD was modeled with Cox proportional hazard models, controlling for potential confounders. During follow-up, we ascertained 2908 incident IHD cases in the Nurses' Health Study, 3722 in the Health Professionals Follow-up Study, and 505 in the Nurses' Health Study II. The FGI was not associated with total IHD in any cohort. The PDQS was significantly associated with IHD in all 3 cohorts separately and the pooled RR for each SD increase was 0.89 (95% CI: 0.87, 0.91). This was significantly different than the pooled RR of 0.93 for MDDW (95% CI: 0.90, 0.96) and the RR of 0.98 for the FGI (95% CI: 0.95, 1.01). The association did not appear to differ by age. We found that the PDQS with the most detailed differentiation of healthy and unhealthy foods was associated with a lower risk of IHD in a high-income country. On the other hand, diet quality scores that do not account for unhealthy foods had a limited association with IHD.

Self-Rated Health Status and Risk of Ischemic Heart Disease in the China Kadoorie Biobank Study: A Population-Based Cohort Study.

BackgroundSelf‐rated health (SRH) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease (IHD) have not been extensively explored, especially in a Chinese population.Methods and ResultsMore than 500 000 adults from 10 cities in China were followed from baseline (2004–2008) through December 31, 2013. Global and age‐comparative SRH were reported from baseline questionnaires. Incident IHD cases were identified through links to well‐established disease registry systems and the national health insurance system. During 3 423 542 person‐years of follow‐up, we identified 24 705 incident cases of IHD. In multivariable‐adjusted models, both global and age‐comparative SRH was significantly associated with incident IHD. Compared with excellent SRH, the hazard ratios for good, fair, and poor SRH were 1.02 (95% confidence interval [CI], 0.98–1.07), 1.32 (95% CI, 1.27–1.37), and 1.76 (95% CI, 1.68–1.85), respectively. Compared with better age‐comparative SRH, the hazard ratios for same and worse age‐comparative SRH were 1.23 (95% CI, 1.19–1.27) and 1.78 (95% CI, 1.70–1.86), respectively. The associations persisted in all subgroup analyses, although they were slightly modified by study location, education, and income levels.ConclusionsA simple questionnaire for self‐assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient tool for assessing future IHD risk.

Association of Major Depression With Risk of Ischemic Heart Disease in a Mega-Cohort of Chinese Adults: The China Kadoorie Biobank Study.

BackgroundIncreasing evidence has suggested that major depression (MD) is associated with an increased risk of ischemic heart disease (IHD). We examined this association in Chinese adults using data from the China Kadoorie Biobank study.Methods and ResultsOver 0.5 million adults aged 30 to 79 years were followed from baseline interview (2004–2008) until December 31, 2013. Past year MD was measured with the modified Chinese version of Composite International Diagnostic Interview‐Short Form at baseline. Incident IHD cases were identified through linkage to related medical databases, and defined as having International Statistical Classification of Diseases and Related Health Problems 10th Revision codes of I20 to I25. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs for the MD‐IHD association with adjustment for sociodemographic variables and established cardiovascular risk factors. During 3 423 542 person‐years of follow‐up, 24 705 incident IHD cases were documented. Higher IHD incidence was observed in participants with MD compared with those without (8.76 versus 7.21 per 1000 person‐years), and the multivariable‐adjusted hazard ratio was 1.32 (95% CI 1.15–1.53). Geographic location modified the association (P for interaction=0.005), and a positive association was observed in urban residents (hazard ratio 1.72; 95% CI 1.39–2.14) but not rural residents (1.13; 0.93–1.37). Compared with participants without depressive symptoms, the hazard ratio (95% CI) of IHD was 1.13 (1.04–1.23) for those with depressive symptoms only and 1.33 (1.15–1.53) for those with MD.ConclusionsPast year major depression was associated with an increased risk of IHD in Chinese adults, independent of other major cardiovascular risk factors.

Gallstone Disease and the Risk of Ischemic Heart Disease.

Gallstone disease (GSD) is related to multiple cardiovascular risk factors; the present study was to prospectively examine the association between GSD and ischemic heart disease (IHD). We examined the association of GSD with IHD among 199 292 men and 288 081 women aged 30-79 years in the China Kadoorie Biobank study. Participants with cancer, heart disease, and stroke at baseline were excluded. Cox proportional hazards regression model was used to estimate the association of GSD with IHD. The prevalence of self-reported GSD was 3.7% in men and 7.3% in women at baseline. During 3 431 124 person-years of follow-up between 2004 and 2013 (median, 7.2 years), we documented 10 245 incident IHD cases in men and 14 714 in women. As compared with men without GSD at baseline, the multivariate-adjusted hazard ratio for IHD was 1.11 (95% confidence interval, 1.02-1.22) for men with GSD; the respective hazard ratio was 1.27 (95% confidence interval, 1.20-1.34) in women and 1.23 (95% confidence interval, 1.17-1.28) in the whole cohort. The sex difference in IHD risk associated with GSD was statistically significant (P=0.009 for interaction with sex). In addition, we found that the association between GSD and IHD was stronger in nonhypertensive than in hypertensive women (P<0.001 for interaction). In this large prospective study, the presence of GSD was associated with an increased risk of incident IHD, independent of other risk factors of cardiovascular disease. Our findings suggest novel prevention strategy to mitigate heart disease through improvement of gastrointestinal health.

The relationship between transportation noise exposure and ischemic heart disease: A meta-analysis

BackgroundThere is a growing body of evidence that exposure to transportation related noise can adversely affect health and wellbeing. More recently, research on cardiovascular disease has specifically explored the hypothesis that exposure to transportation noise increases the risk for ischemic heart disease (IHD). Our objective was to review and conduct a meta-analysis to obtain an overall exposure–response association. Methods and resultsWe conducted a systematic review and retained published studies on incident cases of IHD using sources of transportation noise as exposure. Study-specific results were transformed into risk estimates per 10dB increase in exposure. Subsequently we conducted a random effects meta-analysis to pool the estimates. We identified 10 studies on road and aircraft noise exposure conducted since the mid-1990s, providing a total of 12 risk estimates. Pooled relative risk for IHD was 1.06 (1.03–1.09) per 10dB increase in noise exposure with the linear exposure–response starting at 50dB. Based on a small number of studies, subgroup analyses were suggestive of higher risk for IHD for males compared to females (p=0.14), and for persons over 65 years of age compared to under (p=0.22). Air pollution adjustment, explored only in a subset of four studies, did not substantially attenuate the association between noise exposure and IHD. ConclusionsThe evidence for an effect of transportation noise with IHD necessitates further research into the threshold and the shape of the exposure–response association, potential sources of heterogeneity and effect modification. Research in different cultural contexts is also important to derive regional and local estimates for the contribution of transportation noise to the global burden of disease.

Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study

Few previous prospective studies have examined differences in incident ischemic heart disease (IHD) risk between vegetarians and nonvegetarians. The objective was to examine the association of a vegetarian diet with risk of incident (nonfatal and fatal) IHD. A total of 44,561 men and women living in England and Scotland who were enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, of whom 34% consumed a vegetarian diet at baseline, were part of the analysis. Incident cases of IHD were identified through linkage with hospital records and death certificates. Serum lipids and blood pressure measurements were available for 1519 non cases, who were matched to IHD cases by sex and age. IHD risk by vegetarian status was estimated by using multivariate Cox proportional hazards models. After an average follow-up of 11.6 y, there were 1235 IHD cases (1066 hospital admissions and 169 deaths). Compared with nonvegetarians, vegetarians had a lower mean BMI [in kg/m(2); -1.2 (95% CI: -1.3, -1.1)], non-HDL-cholesterol concentration [-0.45 (95% CI: -0.60, -0.30) mmol/L], and systolic blood pressure [-3.3 (95% CI: -5.9, -0.7) mm Hg]. Vegetarians had a 32% lower risk (HR: 0.68; 95% CI: 0.58, 0.81) of IHD than did nonvegetarians, which was only slightly attenuated after adjustment for BMI and did not differ materially by sex, age, BMI, smoking, or the presence of IHD risk factors. Consuming a vegetarian diet was associated with lower IHD risk, a finding that is probably mediated by differences in non-HDL cholesterol, and systolic blood pressure.

Major Depression, C-Reactive Protein, and Incident Ischemic Heart Disease in Healthy Men and Women

To investigate how C-reactive protein (CRP) and major depressive disorder (MDD) relate to each other and to incident ischemic heart disease (IHD). Studies have shown that both depression and raised CRP concentration predict IHD and that elevated CRP is linked with increased risk of depression. A prospective case-control study of healthy men and women, aged 45 to 79 years, was undertaken within the United Kingdom European Prospective Investigation into Cancer (EPIC)-Norfolk study. CRP concentration was measured for 726 (fatal or nonfatal) IHD cases and 1688 matched controls who completed a baseline MDD self-assessment, defined by restricted Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnostic criteria. Past-year MDD was associated with increased CRP concentration levels (4.31 mg/L for participants who reported episodes of MDD in the past year versus 3.65 mg/L for those who did not; p = .003), and the odds ratio for incident IHD associated with higher CRP concentration was 2.02 (comparing the top versus bottom quartile of CRP; 95% Confidence Interval (CI) = 1.52-2.68), adjusted for cigarette smoking, diabetes, systolic blood pressure, body mass index, and cholesterol. The association between past-year MDD and IHD was independent of CRP (odds ratio = 1.55; 95% CI = 1.01-2.37, with adjustments as above, and additionally for CRP). Evidence from this study is supportive of an association between MDD and CRP although it suggests that CRP does not account for the association between MDD and future IHD.

The Triglyceride/High-Density Lipoprotein Cholesterol Ratio, the Small Dense Low-Density Lipoprotein Phenotype, and Ischemic Heart Disease Risk

This study investigated the relevance of using the plasma triglyceride to high-density lipoprotein cholesterol ratio (Log TG/HDL-C) for the prediction of the small dense lowdensity lipoprotein (LDL) phenotype and the risk of ischemic heart disease (IHD). Analyses were based on data from the Quebec Cardiovascular Study in a cohort of 2072 men free of IHD at baseline, among whom 262 had a first IHD event (coronary death, non fatal myocardial infarction and unstable angina) during a 13-year follow-up period. LDL particle size phenotype was characterized using 2-16% polyacrylamide gradient gel electrophoresis (PAGGE) of whole plasma. There were significant associations between the Log TG/HDL-C ratio and features of LDL size phenotype such as the proportion of LDL with a diameter <255A (r = 0.43, p < 0.001) and LDL peak particle size (r = -20.55, p < 0.001). However, the Log TG/HDL-C ratio brought no additional value (p â yen 0.1) in predicting the small dense LDL phenotype (area under the receiver operating curve (AUROC = 71.9%) compared to TG alone (AUROC = 71.2%) or to a combination of Log TG and HDL-C (AUROC = 72.4%) after multivariate adjustment for non lipid risk factors. Finally, elevations in the Log TG/HDL-C ratio did not improve the discrimination of incident IHD cases from non IHD cases compared to the use of plasma TG levels alone (p = 0.5) or a combination of the individual TG and HDL-C values (p = 0.5). The Log TG/HDL-C ratio does not improve our ability to identify individuals with the small dense LDL phenotype compared to plasma TG levels alone. The Log TG/HDLC is also not superior to plasma TG levels alone in predicting IHD risk in men of the QuA(c)bec Cardiovascular Study.

The Triglyceride/High-Density Lipoprotein Cholesterol Ratio, the Small Dense Low-Density Lipoprotein Phenotype, and Ischemic Heart Disease Risk

This study investigated the relevance of using the plasma triglyceride to high-density lipoprotein cholesterol ratio (Log TG/HDL-C) for the prediction of the small dense lowdensity lipoprotein (LDL) phenotype and the risk of ischemic heart disease (IHD). Analyses were based on data from the Quebec Cardiovascular Study in a cohort of 2072 men free of IHD at baseline, among whom 262 had a first IHD event (coronary death, non fatal myocardial infarction and unstable angina) during a 13-year follow-up period. LDL particle size phenotype was characterized using 2–16% polyacrylamide gradient gel electrophoresis (PAGGE) of whole plasma. There were significant associations between the Log TG/HDL-C ratio and features of LDL size phenotype such as the proportion of LDL with a diameter <255Å (r = 0.43, p < 0.001) and LDL peak particle size (r = -20.55, p < 0.001). However, the Log TG/HDL-C ratio brought no additional value (p ≥ 0.1) in predicting the small dense LDL phenotype (area under the receiver operating curve (AUROC = 71.9%) compared to TG alone (AUROC = 71.2%) or to a combination of Log TG and HDL-C (AUROC = 72.4%) after multivariate adjustment for non lipid risk factors. Finally, elevations in the Log TG/HDL-C ratio did not improve the discrimination of incident IHD cases from non IHD cases compared to the use of plasma TG levels alone (p = 0.5) or a combination of the individual TG and HDL-C values (p = 0.5). The Log TG/HDL-C ratio does not improve our ability to identify individuals with the small dense LDL phenotype compared to plasma TG levels alone. The Log TG/HDLC is also not superior to plasma TG levels alone in predicting IHD risk in men of the Québec Cardiovascular Study.