Lower Risk Of Cardiovascular Disease Mortality Research Articles

Association of resting heart rate and physical activity with cardiovascular mortality: A population-based cohort study of Korean adults

ABSTRACT To examine the independent and combined association of resting heart rate (RHR) and physical activity (PA) with risk of cardiovascular disease (CVD) mortality. RHR was categorized as < 60, 60–69, 70–79, and ≥ 80 bpm. Meeting PA guidelines was defined as ≥ 150 min/week of moderate to vigorous physical activity (MVPA). Cox proportional hazard models were used to calculate hazard ratios (HRs) for CVD mortality associated with RHR and PA. Among 31,697 participants, 311 CVD deaths occurred during 9.2 years of follow-up. Compared to RHR of 60–69 bpm, the risk of CVD mortality was higher in RHR of < 60 bpm (HR, 1.48; 95% CI, 1.05–2.10) and ≥ 80 bpm (HR, 1.42; 95% CI, 1.06–1.91). Participants who met PA guidelines had a lower risk of CVD mortality (HR, 0.59; 95% CI, 0.44–0.78). Among physically inactive adults compared to participants in RHR of 60–69 bpm with meeting PA guidelines, the adjusted HR for CVD mortality was 2.41 (95% CI, 1.42–4.08) for RHR of < 60 bpm, 1.59 (95% CI, 1.01–2.49) for RHR of 60–69 bpm, 1.98 (95% CI, 1.23–3.20) for RHR of 70–79 bpm and 2.41 (95% CI, 1.50–3.89) for RHR of ≥ 80 bpm Exceeding the minimum level of PA guidelines may attenuate the risk of CVD mortality associated with RHR.

Combined association of aerobic and muscle strengthening activity with mortality in individuals with hypertension.

Evidence on the association between meeting both aerobic physical activity (PA) and muscle-strengthening activity (MSA) guidelines with mortality in individuals with hypertension is scarce. We included 34,990 adults from the 2007 to 2013 Korea National Health and Nutrition Examination Survey, linking mortality follow-up data until 2019. Adherence to PA guidelines was assessed based on the current PA guidelines using a self-reported questionnaire and categorized as follows: meeting MSA only, aerobic PA only, both MSA and aerobic PA, or neither. Associations of hypertension and adherence to PA guidelines with all-cause and cardiovascular disease (CVD) mortality were examined using Cox proportional hazard models. Over 9.2 years, 1948 participants died from any cause and 419 from CVD. Meeting both PA guidelines was associated with the lowest risk of all-cause and CVD mortalities in the total sample regardless of hypertension status. In individuals with hypertension, meeting aerobic PA guidelines only had a 24% lower risk of both all-cause and CVD mortality, and meeting both PA guidelines further reduced risks by 40% and 43%, respectively; however, meeting MSA guidelines only was not associated with either all-cause or CVD mortality. In individuals without hypertension, only meeting both MSA and aerobic PA guidelines, but not meeting either MSA or aerobic PA guidelines, showed reduced risk of CVD mortality. In Korean population, non-hypertensive individuals who met both guidelines had a lower risk of CVD mortality. However, hypertensive individuals showed a reduced risk of both all-cause and CVD mortality when meeting aerobic PA or both guidelines, but not MSA alone.

Implications of food ultra-processing on cardiovascular risk considering plant origin foods: an analysis of the UK Biobank cohort

Comprehensive research evidence is lacking on the role of ultra-processed foods (UPF) in the relationship between the consumption of plant-sourced foods and their impact on cardiovascular disease (CVD) outcomes. This study aims to assess CVD risk associated with the dietary contribution of food groups that consider both plant or animal origin and food processing categories, within a large cohort of British adults. Data from the UK Biobank participants (40-69y) who completed at least two 24-h dietary recalls between 2009 and 2012 (n=126,842; median follow-up: 9y), with subsequent data linkage to hospital and mortality records, were used. Food groups were classified as either plant-sourced or non-plant/animal-sourced foods. These groups were further divided into non-UPF and UPF, and expressed as a percentage of total energy intake. Every 10 percentage points increase in plant-sourced non-UPF consumption was associated with a 7% lower risk of CVD (95% CI 0.91-0.95) and a 13% lower risk of CVD mortality (0.80-0.94). Conversely, plant-sourced UPF consumption was associated with a 5% increased risk (1.03-1.07) and a 12% higher mortality (1.05-1.20). The contribution of all UPF was linked to higher CVD risk and mortality, and no evidence for an association between contribution of all plant-sourced foods and CVD incidence and mortality was observed. The dietary contribution of plant-sourced non-UPF inversely linked to CVD risk, while plant-sourced UPF contribution showed a positive association. Recognizing the role of food processing is crucial for favourable CVD outcomes, even in plant-sourced diets. World Cancer Research Fund.

Obesity paradox of cardiovascular mortality in older adults in the United States: A cohort study using 1997–2018 National Health Interview Survey data linked with the National Death Index

BackgroundLarge-scale, population-based investigations primarily investigating the association between body mass index (BMI) and cardiovascular disease (CVD) mortality among older and younger adults in the United States (U.S.) are lacking. ObjectiveTo evaluate the relationship between BMI and CVD mortality in older (≥65 years) and younger (<65 years) adults and to identify the nadir for CVD mortality. DesignThis cohort study used serial cross-sectional data from the 1997 to 2018 National Health Interview Survey (NHIS) linked with the National Death Index. NHIS is an annual nationally representative household interview survey of the civilian noninstitutionalized U.S. population. SettingResidential units of the civilian noninstitutionalized population in the U.S. ParticipantsThe target population for the NHIS is the civilian noninstitutionalized U.S. population at the time of the interview. We included all adults who had BMI data collected at 18 years and older and with mortality data being available. To minimize the risk of reverse causality, we excluded adults whose survival time was ≤2 years of follow-up after their initial BMI was recorded and those with prevalent cancer and/or CVD at baseline. MethodsWe used the BMI record obtained in the year of the NHIS survey. Total CVD mortality used the NHIS data linked to the latest National Death Index data from the survey inception to December 31, 2019. We performed multivariable Cox proportional hazards regression models to estimate adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs). ResultsThe study included 425,394 adults; the mean (SD) age was 44 (16.7) years. During a median follow-up period of 11 years, 12,089 CVD-related deaths occurred. In older adults, having overweight was associated with a lower risk of CVD mortality (aHR 0.92 [95 % CI, 0.87–0.97]); having class I obesity (1.04 [0.97–1.12]) and class II obesity (1.12 [1.00–1.26]) was not significantly associated with an increased CVD mortality; and having class III obesity was associated with an increased risk of CVD mortality (1.63 [1.35–1.98]), in comparison with adults who had a normal BMI. Yet, in younger adults, having overweight, class I, II, and III obesity was associated with a progressively higher risk of CVD mortality. The nadir for CVD mortality is 28.2 kg/m2 in older adults and 23.6 kg/m2 in younger adults. ConclusionThis U.S. population-based cohort study highlights the significance of considering age as a crucial factor when providing recommendations and delivering self-care educational initiatives for weight loss to reduce CVD mortality.

Isotemporal Substitution Modeling on Sedentary Behaviors and Physical Activity With Mortality Among People With Different Diabetes Statuses: A Prospective Cohort Study From the National Health and Nutrition Examination Survey Analysis 2007-2018.

To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses. This prospective cohort study included 21,637 participants (mean age, 48.5y) from the National Health and Nutrition Examination Survey 2007-2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks. We found significant protective associations between replacing 30minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77-0.95) to 0.96 (0.94-0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70-0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80-0.94) to 0.89 (0.81-0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63-0.83) to 0.96 (0.92-0.99). Replacing sedentary behaviors with 30minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.

Association of seafood consumption with cardiovascular disease among adults in Qingdao, China

Background and aimsThe relationship between seafood consumption and cardiovascular disease (CVD) is controversial, and studies have not considered competing risk events. Our study examined the association between a full range of seafood consumption and CVD incidence and mortality based on the Qingdao Diabetes Prevention Program. Methods and resultsWe followed up 5285 participants without CVD at baseline until December 31, 2021. CVD cases and deaths were identified through record linkage with the Qingdao CVD Surveillance System and the Qingdao Death Surveillance System, respectively. Information on seafood consumption was obtained using a food frequency questionnaire. We used the Cox proportional hazard model and the competing risk model to evaluate the association between all types of seafood consumption and CVD incidence and mortality. During a median follow-up of 11.4 years, 122 CVD cases and 75 deaths occurred. After adjustment for potential confounders, compared with nonconsumers, seafood consumption of 300–500 and > 500 g/week was associated with a lower risk of CVD incidence [hazards ratio and 95 % confidence interval (CI): 0.54 (0.29–0.99) and 0.49 (0.26–0.91), respectively]. However, seafood consumption of >500 g/week had a significantly lower risk of CVD mortality [subdistribution hazard ratio and 95 % CI: 0.40 (0.17–0.95)], but it was insignificant in other groups. ConclusionSeafood consumption of 300–500 g/week and >500 g/week was associated with a lower CVD incidence and mortality. Our findings provide evidence of the recommendations of the 2022 Dietary Guidelines for Chinese residents and may guide the promotion of strategies for CVD prevention.

Vitamin D status and 12-year mortality risk after myocardial infarction

Abstract Introduction Vitamin D deficiency has been associated with an increased risk of cardiovascular disease (CVD) mortality in healthy populations. Whether this association is also present in patients with established CVD is not yet clear. Purpose We examined the association of serum 25-hydroxyvitamin D [25(OH)D] as an indicator of vitamin D status with 12-year risk of CVD and all-cause mortality in post-myocardial infarction (MI) patients. Methods A prospective analysis was carried out in 4,479 Dutch patients from the Alpha Omega Cohort (aged 60-80 y) who had an MI ≤10 y prior to study enrolment. Non-fasting venous blood was sampled at baseline (2002-2006) for the assessment of 25(OH)D using LC-MS/MS. Patients were followed for cause-specific mortality through December 2018. Hazard ratios (HRs) for CVD and all-cause mortality were obtained in sex-specific 25(OH)D tertiles using Cox regression models, adjusted for age, education, physical activity, smoking status, alcohol intake, adherence to dietary guidelines (i.e. 2015 Dutch Healthy Diet index [DHD15]), prevalent diabetes and kidney function (eGFR). Restricted cubic splines (RCS) analysis was performed for continuous associations, using median 25(OH)D as the reference. Results Patients were 69.0 ± 5.6 y old, 78% was male, 17% were current smokers, 18% had diabetes and 8% used vitamin-D containing supplements. A total of 2,091 deaths occurred during a median follow-up period of 12.4 y (49,529 person-years), including 924 from CVD as a primary or contributing cause. Median 25(OH)D was 21.3 ng/mL, and tertile cut-offs were 18.3 and 26.2 ng/mL for males and 15.2 and 22.0 ng/mL for females. Of the cohort, 44% were vitamin D deficient (&amp;lt;20 ng/mL). Lower risks of CVD mortality were observed in the mid tertile (HR: 0.76, 95%CI:0.65-0.88) and upper tertile (HR: 0.67, 95%CI:0.57-0.79) of 25(OH)D, compared to the lower tertile. RCS showed a roughly linear association (P-non-linearity = 0.08), with a 11% lower risk of CVD mortality per 5 ng/mL-increment in 25(OH)D (HR: 0.89, 95%CI: 0.86-0.93). Inverse associations were more pronounced in patients with a higher calcium intake (&amp;gt;845 g/d; 0.87, 95%CI:0.96-0.98; per 5 ng/mL) and in patients who were more physically active (HR: 0.88, 95%CI: 0.83-0.93; per 5 ng/mL). Exclusion of 378 vitamin D supplement users did not materially change the associations. For all-cause mortality, multivariable HRs were 0.74 (95%CI: 0.67-0.82) in the mid tertile, and 0.65 (95%CI: 0.58-0.73) in the upper tertile, compared to the lower tertile. Conclusion A low vitamin D serum concentration is related to a higher risk of recurrent CVD and all-cause mortality in patients with coronary artery disease. Causality remains to be determined preferably in a clinical trial to evaluate the effect of oral suppletion of vitamin D on recurrent CVD and mortality risk in these patients.

Diet quality and long-term cardiovascular mortality after myocardial infarction in the Alpha Omega Cohort

Abstract Introduction A healthy diet is important for the prevention and treatment of cardiovascular disease (CVD). The Dutch Health Council recently defined dietary guidelines for patients with atherosclerotic CVD (ASCVD), which we investigated in relation to long-term mortality after myocardial infarction (MI). Purpose We developed the Dutch Healthy Diet index for CVD patients (DHD-CVD index) and examined its relation with mortality in post-MI patients. Methods We included 4,365 patients of the Dutch Alpha Omega Cohort (60-80 y, 80% male) with a MI &amp;lt;10 y prior to study enrolment. Dietary intake was assessed at baseline (2002-2006), using a validated 203-item food frequency questionnaire. To create the DHD-CVD index, the existing 2015 Dutch Healthy Diet index was adapted using the 2023 Dutch dietary guidelines for ASCVD patients (scale from 0 to maximal adherence [0-150]). Patients were followed for cause-specific mortality through December 2018. Hazard Ratios (HRs) across quartiles of the DHD-CVD-index (ref = Q1, i.e. low overall diet quality) and per 1-SD increment in score were estimated using Cox proportional hazard models. Associations were adjusted for age, sex, total energy intake, smoking, education and physical activity. Results were additionally stratified for sex, obesity and diabetes. Results Of the cohort, 17% smoked, 21% had diabetes and &amp;gt;90% used statins or other CVD drugs. During a follow-up of 48,660 person-years, 2,048 deaths occurred of which 911 were due to CVD. The mean DHD-CVD score was 78.9 (SD 13) points. High diet quality (Q4) was associated with a 29% lower risk of CVD mortality compared to low diet quality (HR: 0.71, 95% CI: 0.56, 0.84), with an HR of 0.88 (95% CI: 0.82, 0.94) per 1-SD. For all-cause mortality, we observed a 14% lower risk for high vs. low diet quality (HR: 0.86, 95% CI: 0.76, 0.98), with an HR of 0.94 (95% CI: 0.90, 0.98) per 1-SD. HRs did not essentially differ between male of female patients, or between obese and non-obese patients. HRs for CVD mortality were stronger in non-diabetic patients (HR: 0.86, 95% CI: 0.79, 0.93; per 1-SD), and no longer statistically significant in patients with diabetes (HR: 0.97, 95% CI: 0.84, 1.11; per 1-SD). Conclusion A high diet quality, measured with the DHD-CVD index, was associated with a lower risk of CVD and all-cause mortality after MI in Dutch patients. Adherence to dietary guidelines for CVD patients should be considered on top of medication use.

Abstract 14297: The Portfolio Dietary Pattern and Risk of Cardiovascular Disease Mortality During 1988-2019 in US Adults: Findings From the Third National Health and Nutrition Examination Survey

Introduction: The Portfolio Diet, a dietary pattern that combines cholesterol-lowering plant foods, reduces several cardiovascular disease (CVD) risk factors in clinical trials and has been associated with reduced CVD risk predominately in White populations. As NHANES III (1988-1994) purposely over-sampled non-Hispanic Blacks and Mexican Americans, undertaking an analysis of the Portfolio Dietary Pattern in NHANES III will expand the generalizability of previous findings. Objective: To examine the relation of the Portfolio Dietary Pattern with CVD and all-cause mortality in NHANES III. Methods: We included 14,035 adults (76% non-Hispanic White, 11% non-Hispanic Blacks, 5% Mexican Americans, 8% other) without reported CVD. Diet was assessed by a 24-hour recall and supplemented with a food frequency questionnaire using the Portfolio Diet Score (PDS), with positive points given to nuts, plant protein, viscous fibre, phytosterols and plant monosaturated fat sources, and negative points given to foods high in saturated fat and cholesterol. To identify cause of death we used the NHANES III Linked Morality File (2019). SAS PROC SURVEYPHREG was used to run Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) by tertiles of PDS for CVD and all-cause mortality with adjustment for behavioral, sociodemographic, family history, and baseline clinical and dietary characteristics. Results: During a median follow-up of 23 years, a total of 1,809 CVD deaths were documented over 321,950 person-years. After multivariable adjustment, higher PDS was associated with a lower risk of CVD mortality (HR 0.85; 95% CI: 0.73-0.99) and all-cause mortality (HR 0.86; 95% CI: 0.77-0.95) when comparing the highest to lowest tertiles of intake. A 25-percentile increase in PDS (6 points) tended towards an association with a lower risk of CVD mortality (HR: 0.88; 95% CI: 0.76-1.01) and was associated with lower risk of all-cause mortality (HR: 0.90; 95% CI: 0.85-0.96). Conclusion: Among US adults greater adherence to the Portfolio Dietary Pattern was inversely associated with CVD and all-cause mortality. These findings improve the generalizability of the Portfolio Dietary Pattern for CVD prevention in diverse populations.

Sex Differences in Cardiovascular and All-Cause Mortality in Adults with and without CKD: NHANES 1999-2018.

Key Points Women with CKD had a lower cardiovascular disease mortality risk than men.Kidney function markers (i.e., eGFR and urinary albumin-to-creatinine ratio) may influence mortality risk in women with CKD, but not in men.

Associations of composite dietary antioxidant index with cardiovascular disease mortality among patients with type 2 diabetes

To investigate the associations of composite dietary antioxidant index (CDAI) with risk of cardiovascular disease (CVD) mortality among individuals with type 2 diabetes (T2D). This prospective cohort study included 7551 patients with T2D who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2018. Death statistics were gathered by connecting the cohort database to the National Death Index through December 31, 2019. Multivariable Cox proportional hazards regression models were utilized to calculate hazard ratios and 95% CIs for the relationship of CDAI with risks of CVD and all-cause mortality. Three multivariable models were built. Restricted cubic spline analyses were utilized to explore the nonlinear association of CDAI with CVD mortality, and nonlinearity was tested by the likelihood ratio test. This cohort study included data from 7551 participants with T2D (mean [SE] age, 61.4 (0.2) years; 3811 male [weighted, 50.5%] and 3740 female [weighted, 49.5%]; median CDAI level, − 2.19 [IQR, − 2.19 ~ − 0.22]). A total of 2227 all-cause deaths and 746 CVD deaths were identified during an average of 98 months of follow-up. Nonlinear associations were observed for CDAI (P < 0.05 for nonlinearity) with risk of CVD mortality among patients with T2D. Compared with participants in the first quartile of CDAI levels (< − 2.19), the hazard ratios for CVD mortality were 0.47 (95% CI 0.30–0.75) for participants in the highest CDAI level quartile. This cohort study found that higher CDAI levels were significantly associated with lower risk of CVD mortality among individuals with T2D.

Associations of short-term changes in obesity indices with cardiovascular disease and all-cause mortality among overweight and obese adults

Abstract Funding Acknowledgements Type of funding sources: None. Background Given the crucial role of obesity as a risk factor for progression of cardiovascular disease (CVD), various guidelines have emphasized the importance of its prevention 1,2. The non-linear relationships of changes in weight, body mass index (BMI), and waist circumference (WC) to all-cause deaths were observed. Evidence on the associations of changes in obesity indices with CVD mortality is scarce. Purposes This study aimed to explore the linear and non-linear relationships of 1- and 3-year changes in obesity indices (i.e., weight, BMI, WC, waist-to-hip ratio (WHR), waist-to-hip ratio (WHRtR)), respectively, to CVD and all-cause mortality. Methods We included adults aged 18 - 65 years from an on-going longitudinal cohort in Taiwan. Multivariable logistics regression models and restricted cubic splines were used to explore the linear and non-linear associations of 1- and 3-year absolute and relative changes in weight, BMI, WC, WHR, and WHtR with CVD and all-cause mortality, respectively. Results A total of 18,024 participants were included in the 1-year change study, and 1,761 and 1,038 cases of all-cause and CVD mortality were reported (follow-up: 6 (range: 2 - 21) years). The 3-year study sample consisted of 12,695 participants, and 1,025 and 931 all-cause and CVD deaths were recorded (follow-up: 6 (range: 2 - 19) years). Results from multivariable logistics regression models showed that the CVD mortality risks were significantly reduced by 1-year absolute and relative increases in weight, BMI, WC, WHR, and WHtR. However, 3-year changes in WC and WHtR did not affect the risk of CVD deaths, while both absolute and relative increases in weight, BMI, and WHR were associated with a lower risk of CVD mortality. For all-cause mortality, any increase in obesity indices was associated with a reduced risk (Table 1). Additionally, restricted cubic splines visually showed U- and L-shaped relationships of changes in obesity indices to CVD and all-cause deaths. Risks of CVD mortality decreased until around 1-year changes of 2.1 cm (2.7%) in WC and 0.01 (2.8%) in WHtR and then increased. Also, below around 3-year change of 2.2 kg (2.5%) in weight, 0.7 kg/m2 (-1.6%) in BMI, 0.03 (3.5%) in WHR, and 0.03 (6.3%) in WHtR, the risks of CVD mortality went down with increases in obesity indices. Above the cut-off points, increased WHR and WHtR were associated with greater risks of CVD mortality. Moreover, an increase was a risk factor for CVD deaths among participants with increased WC of more than approximately 5.5 cm (6.3%) within three years. Similar trends were found among the relationships between changes in obesity indices with all-cause mortality (Figure 1-16). Conclusions We found U- and L-shaped relationships between changes in obesity indices and mortality from CVD and any cause. Risks of CVD and all-cause deaths decreased until a certain value of changes in obesity indices, especially central obesity indices, and then increased.

Eleven‐minutes of brisk walk a day shown to reduce risk of early death

Current guideline recommends at least a 150 min of moderate intensity activity a week (e.g., brisk walking, cycling or playing tennis) or 75 min of vigorous intensity activity a week, spread over 4–5 days a week to reduce risks of cardiovascular disease (CVD). Despite this modest recommendation, uptake for this level of activity remains low in the general population due to time commitments. A new study, published in the British Journal of Sports Medicine conducted by researchers from the MRC Epidemiology Unit at the University of Cambridge has set out to explore the amount of physical activity necessary to have a beneficial impact on several chronic diseases and premature death. One of the main aim is to understand the shape of the dose–response association between levels of physical activity with premature death and chronic disease outcomes. To do this, researchers performed a systematic review and meta-analysis of 196 peer-reviewed articles, covering more than 30 million participants, from 94 large study cohorts. This, according to the investigators enabled them to produce the largest analysis to date of the association between physical activity levels and risk of heart disease, cancer, and early death. From their analyses, they concluded that, apart from work-related physical activity, 2 in 3 people reported activity levels below 150 min per week of moderate-intensity activity, and fewer than 1 in 10 managed more than 300 min per week. Overall, higher activity levels of physical activities were associated with lower risks of all outcomes. Compared with inactive individuals, adults who achieved the 150 min of moderate-intensity activity had a 31% lower risk of all-cause mortality, a 29% lower risk of CVD mortality, and a 15% lower risk of cancer mortality. If all individuals accumulated at least 150 min a week, then 15.7%, 12.3%, and 7.1% of all-cause, CVD-related, and cancer-related deaths, respectively, would ‘potentially have been averted’. The researchers also calculated that if everyone in the studies had done the equivalent of at least 150 min per week of moderate-intensity activity, around 1 in 6 (15.7%) premature deaths, 1 in 9 (10.9%) cases of CVD, and 1 in 20 (5.2%) cases of cancer, would have been prevented. They also found that ‘beyond’ 150 min per week of moderate-intensity activity, the additional benefits in terms of reduced risk of disease or early death were ‘marginal’. Importantly, even reducing the amount of physical activity by half also came with significant benefits. Accumulating 75 min per week of moderate-intensity activity brought with it a 23% lower risk of early death. If everyone managed at least 75 min per week of moderate-intensity physical activity, around 1 in 10 (10%) premature deaths, 1 in 20 (5%) cases of CVD, and nearly 1 in 30 (3%) cases of cancer, would be prevented. Seventy-five minutes per week of moderate activity was also enough to reduce the risk of developing CVD by 17% and cancer by 7%. The study therefore suggests that doing some level of activity is better than doing none. This is particularly so for individuals who struggles to do the recommended 150 min of moderate-intensity physical activity a week. Thus, ‘11 min a day—75 min a week—of moderate-intensity physical activity—such as a brisk walk—would be sufficient to lower the risk of diseases such as heart disease, stroke, and a number of cancers’, according to the authors.

Association of Ultra-Processed Food Intake with Cardiovascular and Respiratory Disease Multimorbidity: AProspective Cohort Study.

Evidence suggests a positive association between ultra-processed food (UPF) consumption and the incidence of cardiovascular disease (CVD). The study aims to investigate associations between UPF intake and respiratory disease, CVD, and their multimorbidity in a large prospective cohort. Within the UK Biobank, participants who are free from respiratory disease or CVD at baseline and completed at least two times 24-h dietary records are included in this study. After adjusting for socioeconomic status and lifestyle factors, the hazard ratios (95% confidence interval) for each 10% increase in UPF are 1.06 (1.04, 1.09) for CVD, 1.04 (1.02, 1.06) for respiratory disease, 1.15 (1.08, 1.22) for CVD mortality, and 1.06 (1.01, 1.12) for their multimorbidity, respectively. In addition, replacing 20% of UPF weight in diet with an equivalent proportion of unprocessed or minimally processed foods is estimated to be associated with 11% lower risk of CVD, 7% lower risk of respiratory disease, 25% lower risk of CVD mortality, and 11% lower risk of CVD and respiratory disease multimorbidity. In this prospective cohort study, higher consumption of UPF is associated with higher risks of CVD and respiratory disease multimorbidity. Further longitudinal studies are needed to confirm these findings.

Higher dietary intake of aromatic amino acids was associated with lower risk of cardiovascular disease mortality in adult participants in NHANES III

Little is known about the associations between dietary aromatic amino acids (AAAs) intake and mortality from all causes and cardiovascular disease (CVD). Accordingly, we evaluated these associations in the adult population of the United States using data from the Third National Health and Nutrition Examination Survey. This was a cohort study. Dietary intake of AAAs (tyrosine, phenylalanine, and tryptophan) was determined from the total nutrient intake document. We hypothesized that higher dietary AAA intake would lower all-cause and CVD mortality in adults in the United States. First, we categorized participants into quintiles based on their dietary intakes of total AAAs, tyrosine, phenylalanine, and tryptophan. Then, we established 4 Cox proportional-hazards models (models 1-4) and calculated hazard ratios and 95% confidence intervals to estimate the associations between dietary intakes of total AAAs, tyrosine, phenylalanine, and tryptophan and all-cause and CVD mortality. Mortality status was primarily obtained from files linked to the National Death Index records up to December 31, 2015. After multivariate adjustment, the hazard ratios (95% confidence intervals) of CVD mortality in the highest quintiles of dietary total AAAs, tyrosine, phenylalanine, and tryptophan intake (reference: the lowest quintiles) were 0.66 (0.52-0.84), 0.65 (0.51-0.83), 0.66 (0.52-0.85) and 0.64 (0.50-0.82), respectively. In a nationally representative cohort, higher dietary intakes of total AAA and the 3 individual AAAs were independently associated with a lower risk of CVD mortality, and these associations were stronger in non-Hispanic White people than in other people.

Abstract P218: Quality of Plant-Based Diets is Differently Associated With Cardiovascular Mortality: A Longitudinal Analysis From the Moli-Sani Study

Introduction: Vegetarian diets are characterized by the absence of some animal foods (e.g. red and processed meats), and a high consumption of plant-based foods. However, plant-based foods can include foods with varying nutritional value and divergent health effects. Hypothesis: We assessed the hypothesis that three different pro-vegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG) are differently associated with the risk of cardiovascular disease (CVD) mortality in adult Italians. Established CVD risk factors ( e.g. blood lipids, inflammatory markers) were analyzed as potential biological mechanisms underpinning these associations. Methods: Longitudinal analysis on 22,895 women and men (mean age 55±12 y) from the Moli-sani Study (2005-2010). Food intake was assessed by a 188-item food frequency questionnaire. A pro-vegetarian food pattern was constructed by assigning positive scores to plant foods and reverse scores to animal foods. Both a healthful and an unhealthful pro-vegetarian food patterns, distinguishing between healthy ( e.g . fruits, vegetables, legumes) and less-healthy plant foods ( e.g . fruit juices, potatoes, sugary beverages), were built up. Cox proportional hazard regression models were used to estimate the association between dietary exposures (quarters of) and mortality. Hazard ratios (HRs) were calculated with their 95% confidence intervals (CIs) for each quarter, considering Q1 as the reference category. Results: After a median follow-up of 12.2 y (272,960 person/years), a total of 792 CVD deaths were ascertained. In multivariable-adjusted analyses controlled for common known risk factors, higher adherence to a gPVG was not associated with CVD mortality (HR=0.92; 0.75-1.13 for Q4 vs. Q1). Increasing adherence to a hPVG was linked to lower risk of CVD mortality (HR=0.78; 0.62-0.98 for Q4 vs. Q1), whereas a higher uPVG led to an increased risk (HR=1.28; 1.04-1.57). Altered levels of subclinical inflammation ( i.e. C-reactive protein) accounted for 13.4% (p=0.012) of the association of the hPVG with CVD mortality. Conclusions: In this large Italian general population, increasing adherence to a general pro-vegetarian food pattern was not associated with CVD mortality. Only participants preferring healthful vegetarian foods experienced a significant protection against CVD mortality risk, possibly through a favorable modulation of the inflammatory pathway. Consistently, a large dietary share of unhealthful vegetarian foods, mostly highly processed, was associated with increased risk of CVD mortality. We conclude that it is not sufficient to adopt a general vegetarian diet, since it is the quality of the plant food consumed that is critical to achieve vegetarian diet-related benefits on CVD mortality.

Abstract 67: Obesity Paradox of Cardiovascular Mortality in Older Adults: National Health Interview Survey 1997-2018

Background: The optimal body mass index (BMI) for cardiovascular disease (CVD) prevention in older adults remains uncertain. We aimed to evaluate the relationship between BMI and CVD mortality and identify the nadirs for CVD mortality in older (≥65 years) and younger (&lt;65 years) individuals. Methods: We used data from the 1997 to 2018 National Health Interview Survey, linked to the National Death Index (NDI). We included adults aged 18 years and older with BMI and NDI follow-up data available. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between BMI and CVD mortality. Fully adjusted models were stratified by age and controlled for baseline age, sex, race, income, education, marital status, diabetes, cancer, general health, physical activity, smoking, and alcohol status. Results: Among 490,037 adults, the mean(±SD) age was 47(18) years; 55% were female. During a median follow-up period of 11 years, 19,194 CVD deaths occurred. The associations between BMI and CVD mortality were J-shaped in adults aged ≥ 65 years and &lt; 65 years. The CVD mortality was minimized at a BMI of 26 kg/m 2 in adults aged ≥ 65 years and 22 kg/m 2 in those aged &lt; 65 years. In adults aged ≥ 65 years, being overweight was associated with a lower risk of CVD mortality (HR 0.93, [95% CI, 0.89-0.96]); having level I obesity (0.90 [0.94-1.05]) and level II obesity (1.06 [0.97-1.16]) did not increase the risk of CVD mortality; and level III obesity was associated with increased risk of CVD mortality in comparison with individuals who had a normal BMI ( Figure ). In individuals aged &lt; 65 years, being overweight, level I, II, and III obesity were associated with a progressively higher risk of CVD mortality. Conclusion: Overweight and level I obesity seem to be protective against CVD mortality in older adults. This obesity paradox suggests that the optimal BMI might be sensitive to age. Thus, weight management should be individualized.

Association of milk consumption with all-cause mortality and cardiovascular outcomes: a UK Biobank based large population cohort study

BackgroundThe association of milk consumption with mortality and cardiovascular disease (CVD) outcomes was unclear.ObjectiveThe present study was performed to reveal the association of full cream, semi-skimmed, skimmed, soy, and other milk with all-cause mortality and CVD outcomes.MethodsA prospective cohort study was performed using data from the UK Biobank. This study recruited 450,507 participants without CVD at baseline between 2006 and 2010 from UK Biobank and followed them up through 2021. Cox proportional hazard models were adopted to calculate the hazard ratios (HRs) and 95% confidence interval (CI) to understand the correlation between milk consumption and clinical outcomes. Subgroup and sensitivity analyses were further conducted.ResultsAmong the participants, 435,486 (96.7%) were milk consumers. Multivariable model indicated that the adjusted HR of association between milk consumption and all-cause mortality was 0.84 (95% CI 0.79 to 0.91; P = 0.000) for semi-skimmed milk; 0.82 (0.76 to 0.88; P = 0.000) for skimmed milk and 0.83 (0.75 to 0.93; P = 0.001) for soy milk. Semi-skimmed, skimmed, and soy milk use were significantly related to lower risks of CVD mortality, CVD event, and stroke.ConclusionCompared with non-milk users, semi-skimmed milk, skimmed milk, and soy milk consumption were related to a lower risk of all-cause mortality and CVD outcomes. Among them, skim milk consumption was more beneficial for all-cause mortality, while soy milk consumption was more beneficial for CVD outcomes.

Life's Essential 8 and the risk of cardiovascular disease death and all-cause mortality in Finnish men.

The aim of the study was to examine the association between Life's Essential 8 (LE8) and the risk of cardiovascular and all-cause mortality. The LE8 was computed for 1662 men, aged 42-60 years, without pre-existing history of cardiovascular disease (CVD) at baseline in the Kuopio Ischaemic Heart Disease study. The LE8 factors include diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose, and lipids. Each LE8 factor was scored between 0 and 100 points. The summation of all points generated the total LE8 score, which was categorized into quartiles ≤-420, >420-485, >485-550, and >550. Multivariable Cox regression models were used to estimate hazard ratios and 95% confidence intervals of LE8 scores for the outcomes. During a median follow-up of 30 years, 402 and 987 men died from CVD and any cause, respectively. The total LE8 score among participants ranged from 185 to 750. The higher the LE8 scores, the lower the risk of dying from CVD and all-cause. Following adjustment for age, alcohol consumption, and socio-economic status, every 50-unit increase in LE8 score was associated with 17% and 14% lower risk of CVD and all-cause deaths, respectively. Men within LE8 top quartile had 60% lower risk of CVD mortality when compared with those within the bottom quartile. Life's Essential 8 was strongly and inversely associated with the risk of CVD death and all-cause mortality among ageing men. Measures that promote optimal LE8 scores should be encouraged among the general population.

Edible mushroom intake and risk of all-cause and cause-specific mortality: results from the Korean Genome and Epidemiology Study (KoGES) Cohort.

Mushroom is rich in protein, fiber, vitamins, and essential amino acids. A relationship between mushroom consumption and a lower all-cause mortality risk has been reported. This study aimed to examine the association of mushroom consumption with all-cause and cause-specific mortality. Data were extracted from the Korean Genome and Epidemiology Study cohort. Mortality outcomes were confirmed from 2001-2020 death records provided by the Korea National Statistical Office. Mushroom intake was assessed using food frequency questionnaires and categorized into four groups: none, <1 serving per week, 1-3 servings per week, and ≥3 servings per week. Cox proportional hazard regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. The 152 828 participants ≥40 years had a mean age of 53.7 years. Over a mean 11.6-year follow-up, 7085 deaths were recorded. In men, consuming <1 and 1-3 servings per week of mushroom was associated with lower risks of all-cause (HR = 0.858, 95% CI = 0.793-0.929; HR = 0.902, 95% CI = 0.819-0.993) and cardiovascular disease (CVD) (HR = 0.767, 95% CI = 0.632-0.930; HR = 0.762, 95% CI = 0.601-0.967) mortality than non-consumption. In women, consuming <1 and 1-3 servings per week of mushrooms was associated with a lower risk of all-cause mortality (HR = 0.864, 95% CI = 0.784-0.952; HR = 0.869, 95% CI = 0.771-0.980) than non-consumption. This prospective cohort study demonstrated that low and medium mushroom consumption is associated with a lower risk of all-cause mortality in men and women. However, only men who consumed <1 and 1-3 servings per week of mushrooms exhibited a lower risk of CVD mortality.