Risk Of Mortality In Men Research Articles

"My Home, my Car, my Boat" - Satisfaction with One's Own Standard of Living as a Predictor of Gender-Specific Mortality

Men have a higher risk of mortality than women and react much more sensitively to status-related stressors. The relationship between hierarchical rank and health, mediated on the HPA axis, delivers possible explanations for the more pronounced male sensitivity. In this context, the construct of status unease has attracted a lot of attention in recent years. It links social comparison with a reduced general wellbeing and considers it to be a major risk factor for various diseases. An analysis of secondary data from the Socio-Economic Panel (SOEP) was used to analyze the extent to which subjective dissatisfaction with one's own standard of living is associated with an increased gender-related mortality risk. The statistical modeling of the question was carried out by performing gender-disaggregated Cox proportional hazard models. The unbalanced sub-sample consisted of 6 454 men (685 deaths) and 6 908 women (618 deaths). Dissatisfaction with one's standard of living has a significant influence on the mortality risk of men but not women: Men with low satisfaction have nearly a twice as high risk of mortality than the reference group (HR=1,95, 95% CI 1,48-2,58), men with moderate satisfaction a 25% higher mortality risk (HR=1,26, 95% CI 1,08-1,49). Furthermore, subjective status shows stronger dose-response relationships than objective status parameters. Dissatisfaction with one's standard of living turns out to be a clear predictor for male mortality. Stress reactions due to disparaging social comparison processes triggered by the HPA-axis could be a central cause. The results indicate that the standardized inclusion of subjective status indicators should be considered in social-epidemiological analysis. The distinctive gender difference also points out that gender-sensitive epidemiological data analysis is reasonable.

Influence of Comorbidity on the Risk of Mortality in Men With Unfavorable-Risk Prostate Cancer Undergoing High-Dose Radiation Therapy Alone

Toexplore whether a subgroup of men with unfavorable-risk prostate cancer (PC) exists in whom high-dose radiation therapy (RT) alone is sufficient to avoid excess PC death due to competing risk from cardiometabolic comorbidity. This was a cohort study of 7399 men in whom comorbidity (including congestive heart failure, diabetes mellitus, or myocardial infarction) was assessed and recorded with T1-3NxM0 PC treated with brachytherapy with or without neoadjuvant RT, October 1997 to May 2013 at a single providing institution. Cox and competing risks regression analyses were used to assess whether men with unfavorable-intermediate/high-risk versus favorable-intermediate/low-risk PC were at increased risk of PC-specific, all-cause, or other-cause mortality (PCSM, ACM, OCM), adjusting for number of comorbidities, age at and year of brachytherapy, RT use, and an RT treatment propensity score. After a median follow-up of 7.7years, 935 men died: 80 of PC and 855 of other causes. Among men with no comorbidity, PCSM risk (adjusted hazard ratio [AHR] 2.74 [95% confidence interval (CI) 1.49-5.06], P=.001) and ACM risk (AHR 1.30 [95% CI 1.07-1.58], P=.007) were significantly increased in men with unfavorable-intermediate/high-risk PC versus favorable-intermediate/low-risk PC, with no difference in OCM (P=.07). Although PCSM risk was increased in men with 1 comorbidity (AHR 2.87 [95% CI 1.11-7.40], P=.029), ACM risk was not (AHR 1.03 [95% CI 0.78-1.36], P=.84). Neither PCSM risk (AHR 4.39 [95% CI 0.37-51.98], P=.24) or ACM risk (AHR 1.43 [95% CI 0.83-2.45], P=.20) was increased in men with 2 comorbidities. To minimize death from PC, high-dose RT alone may be sufficient treatment in men with 2 or more cardiometabolic comorbidities and unfavorable-intermediate- and high-risk PC.

Perceived Social Support Trajectories and the All-Cause Mortality Risk of Older Mexican American Women and Men.

Although numerous studies of non-Hispanic Whites and Blacks show that social integration and social support tend to favor longevity, it is unclear whether this general pattern extends to the Mexican American population. Building on previous research, we employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the association between perceived social support trajectories and the all-cause mortality risk of older Mexican Americans. Growth mixture estimates revealed three latent classes of support trajectories: high, moderate, and low. Cox regression estimates indicated that older Mexican American men in the low support trajectory tend to exhibit a higher mortality risk than their counterparts in the high support trajectory. Social support trajectories were unrelated to the mortality risk of older Mexican American women. A statistically significant interaction term confirmed that social support was more strongly associated with the mortality risk of men.

Pre-existing Pulmonary Diseases and Survival in Patients With Stage-dependent Lung Adenocarcinoma: A STROBE-compliant Article.

Asthma, chronic obstructive pulmonary disease (COPD), and pulmonary tuberculosis (TB) are common lung diseases associated with lung cancer mortality. This study evaluated sex disparities in pre-existing pulmonary diseases and stage-dependent lung adenocarcinoma survival.Patients newly diagnosed with lung adenocarcinoma between 2003 and 2008 were identified using the National Health Insurance Research Database and Cancer Registry. Cases with lung adenocarcinoma were followed until the end of 2010. Survival curves were estimated by the Kaplan-Meier method. Cox proportional-hazard regression was used to calculate the hazard ratio (HR) of pre-existing asthma, COPD, and/or TB, and to estimate all-cause mortality risk in patients with different stages of lung adenocarcinoma.A total of 14,518 cases were identified with lung adenocarcinoma. Specifically, among men, the HRs for TB were 1.69 (95% confidence interval [CI], 1.10-2.58), 1.48 (95% CI, 1.14-1.93), and 1.27 (95% CI, 1.08-1.49) for individuals with stage I + II, III, and IV diseases, respectively. The HRs for asthma were 1.41 (95% CI, 1.00-1.99) in women with stage I + II and 1.14 (95% CI, 1.04-1.26) in men with stage IV disease. For pulmonary disease combinations in men, the HRs were 1.45 (95% CI, 1.12-1.89) for asthma + COPD + TB, 1.35 (95% CI, 1.12-1.63) for COPD + TB, 1.28 (95% CI, 1.01-1.63) for TB, and 1.15 (95%CI, 1.04-1.27) for asthma + COPD, respectively. For women with stage I + II disease, the HR was 6.94 (95% CI, 2.72-17.71) for asthma + COPD + TB.Coexistence of pre-existing pulmonary diseases increased mortality risk in men with adenocarcinoma. TB is at elevated risk of mortality among men with different stages of adenocarcinoma. Asthmatic women with early-stage adenocarcinoma had increased risk of mortality.

Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort

ObjectiveLarge-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study. Methods38,379 participants (62.4% women), 30–65years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders. ResultsAfter 13.6years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1=0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend=0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1=0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality. ConclusionsHPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.

The Prognostic Value of Family History for the Estimation of Cardiovascular Mortality Risk in Men: Results from a Long-Term Cohort Study in Lithuania.

AimTo evaluate the additional prognostic value of family history for the estimation of cardiovascular (CVD) mortality risk in middle-aged urban Lithuanian men.MethodsThe association between family history of CVD and the risk of CVD mortality was examined in a population-based cohort of 6,098 men enrolled during 1972–1974 and 1976–1980 in Kaunas, Lithuania. After up to 40 years of follow-up, 2,272 deaths from CVD and 1,482 deaths from coronary heart disease (CHD) were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD and CHD mortality.ResultsAfter adjustment for traditional CVD risk factors, the HR for CVD mortality was 1.24 (95% CI 1.09–1.42) and for CHD mortality 1.20 (1.02–1.42) in men with first-degree relatives having a history of myocardial infarction (MI), compared to men without positive family history. A significant effect on the risk of CVD and CHD mortality was also observed for the family history of sudden cardiac death and any CVD. Addition of family history of MI, sudden death, and any CVD to traditional CVD risk factors demonstrated modest improvement in the performance of Cox models for CVD and CHD mortality.ConclusionsFamily history of CVD is associated with a risk of CVD and CHD mortality significantly and independently of other risk factors in a middle-aged male population. Addition of family history to traditional CVD risk factors improves the prediction of CVD mortality and could be used for identification of high-risk individuals.

Age-period-cohort effects in alcoholic liver disease mortality in France from 1968 to 2010

BackgroundPer capita alcohol consumption in France has historically been among the highest levels in Europe. In more recent history, however, consumption (mostly wine) has substantially decreased as has alcohol-related mortality. The present study characterizes age, period, and cohort (APC) trends in liver disease in France for the past four decades.MethodsData were drawn from overall French death certificates records covering the years 1968 to 2010. Liver disease mortality was defined from underlying cause ICD 8, 9, and 10 codes. We estimated age, period, and cohort effects, by sex, using Poisson modeling estimation and Clayton & Shiffler’s approach to model identification for APC modeling.ResultsLiver disease mortality exhibited significant age, period and cohort effects. The overall mortality rates were 25/100,000 for men and 9/100,000 for women over the period of data collection, with mortality increasing across age and peaking around age 70. Among males, there was no cohort effect and a clear and significant period effect; the risk of liver cirrhosis mortality in men has been steadily decreasing for all age groups across time. Conversely among women, there was a similar decreasing period effect but a strong and significant cohort effect as well. Specifically, there was a positive cohort effect for cirrhosis mortality for women born before around 1960 with the risk of liver cirrhosis for those cohorts between 4.0 and 5.0 times higher than the risks for those born after 1970, controlling for age and period effect.ConclusionLiver disease mortality has been decreasing in France for the past four decades, across all age groups and across men and women. Women born in older cohorts have much higher risks of dying from liver disease compared with women in younger cohorts, controlled for age, which may be a function of different beverage consumption patterns.

Choline and Betaine Intakes Are Not Associated with Cardiovascular Disease Mortality Risk in Japanese Men and Women1–3

Background: Dietary intakes of betaine and choline may reduce the risk of cardiovascular disease; however, epidemiologic evidence is limited. Seafood is a rich source of betaine and is a popular traditional food in Japan.Objective: We examined the associations of betaine and choline intakes with cardiovascular disease mortality in a population-based cohort study in Japan.Methods: Study subjects were 13,355 male and 15,724 female residents of Takayama City, Japan, who were aged ≥35 y and enrolled in 1992. Their diets were assessed by a validated food frequency questionnaire. Deaths from coronary heart disease and stroke were identified from death certificates over 16 y. Multivariable-adjusted HRs were computed by using Cox regression models.Results: During follow-up, we documented 308 deaths from coronary heart disease and 676 deaths from stroke (393 from ischemic and 153 from hemorrhagic strokes). Compared with the lowest quartile, the second, third, and highest quartiles of betaine intake were significantly associated with a decreased risk of mortality from coronary heart disease in men after controlling for covariates. The HRs were 0.58 (95% CI: 0.36, 0.93), 0.62 (95% CI: 0.39, 0.998), and 0.60 (95% CI: 0.37, 0.97), respectively. The trend was not statistically significant (P = 0.08). There was no significant association between betaine intake and the risk of mortality from ischemic stroke. In women, betaine intake was unrelated risk of mortality from coronary heart disease and stroke (P = 0.32 and 0.73, respectively, for interaction by sex). There was no significant association between choline intake and cardiovascular disease mortality risk in men or women.Conclusion: Overall, we found no clear evidence of significant associations between choline and betaine intakes and cardiovascular disease mortality risk in Japanese men and women.

Association between socioeconomic status and cardiovascular risk.

Cardiovascular disease (CVD) is one of the major health problems of the modern societies. Socioeconomic status (SES) is an important predictor of CVD and its risk factors. To examine whether SES is related to an increased cardiovascular (CV) risk in the population of southwestern Poland. The study population comprised 2027 subjects, including 929 (45.8%) men and 1098 (54.2%) women participating in the WOBASZ study. From this population, we selected a subgroup of 1821 subjects free from CVD, including 816 men and 1005 women, all with defined SES. Their CV risk was estimated using the SCORE risk algorithm and an analysis of the relationship between SES indicators and the SCORE risk was performed. We found a negative correlation between the SCORE risk and SES (p = 0.0005). In the overall study group and among participating women, the SCORE risk was significantly lower among subjects with high SES (SES score > 12). This relation was also noted in men and women aged 30–39 years (p = 0.02), women aged 30–39 years (p = 0.0001) and 40–49 years (p = 0.04), and in men aged 70–74 years (p = 0.046). With an increase in SES, the proportion of high CVD risk subjects decreased significantly in the overall study population and in those aged 30–39 years (p = 0.01). Similar relations were observed in women in the entire age range and those aged 30–39 years (p = 0.01). We found that SES had a significant effect on the rate of high CVD risk in all study subgroups aged 30–39 years (odds ratio 0.57, 95% CI 0.39–0.85, p = 0.005 in men and women overall; odds ratio: 0.6, 95% CI 0.37–0.99, p = 0.045 in men; and odds ratio: 0.4, 95% CI 0.16–0.99, p = 0.01 in women). Socioeconomic status was found to be a predictor of high CVD mortality risk in men and women aged 30–39 years.

RSR′ pattern and the risk of mortality in men and women free of cardiovascular disease

This study included 6,398 participants (mean age 55±0.34years; 54% female; 49% white; 22% black; 24% Mexican; 4.3% other) free of clinical cardiovascular disease (CVD) and major ECG abnormalities. Cox regression was used to examine the association between the RSR′ (incomplete right bundle branch block (RBBB) or right ventricular conduction delay) pattern and CVD and all-cause mortalities. The RSR′ pattern was not associated with an increased risk of CVD (HR=1.10; 95%CI=0.63, 1.91) mortality or all-cause (HR=0.95; 95%CI=0.66, 1.35) mortality. The results were similar when the RSR′ pattern was further separated into incomplete RBBB and right ventricular conduction delay. In conclusion, the RSR′ pattern is a benign finding in older adults free of clinical CVD.

Baseline Cataract Status and 11-year Mortality: A Population-Based Study from a Mediterranean Population

Purpose: To examine the relationship between cataract, previous cataract surgery and risk of mortality in an elderly Mediterranean population. Methods: This is a survival analysis of data from the Spanish centre of the European Eye Study (EUREYE) to examine 11-year-mortality risk among participants with previous cataract surgery or cataract compared to noncataract participants diagnosed at the start of the study. Results: After adjustment for age-related maculopathy (ARM), age, smoking, physical activity, obesity, diabetes mellitus, hypertension, previous stroke and heart attack, only the cataract no surgery group in men showed a significant elevated increased risk of mortality. The adjusted Hazard Ratio (HR) for the cataract no surgery men was, 1.96 95% CI (1.11-3.47) p=0.020 compared to non-cataract men. Conclusion: We observed an increased risk of mortality in men with cataract in this elderly population. These results might indicate a differential use of medical services by elderly men compared to women. In addition, the lack of an increased mortality risk among the cataract surgery groups might be explained by the improvement in visual function. Future studies should include information on medical care use as well as information on measurements of pre and post-operative visual acuity.

Subclinical Myocardial Injury Identified by Cardiac Infarction/Injury Score and the Risk of Mortality in Men and Women Free of Cardiovascular Disease

Previous studies have explored the ability of the Cardiac Infarction/Injury Score (CIIS) to identify individuals who are high risk for cardiovascular disease (CVD) mortality. However, its prognostic significance among those without CVD in the United States general population has not been established. This analysis included 6,298 participants (mean age 59±13 years, 53% women, 51% nonwhites) from the Third National Health and Nutrition Examination Survey, excluding participants with a history of CVD or electrocardiographic evidence of old myocardial infarction or ischemic ST depression at baseline. Subclinical myocardial injury was defined as CIIS≥10. Mortality data were ascertained using the National Death Index. Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between subclinical myocardial injury and CVD and all-cause mortalities. Subclinical myocardial injury was detected in 1,376 participants (22%). A total of 1,928 deaths occurred during a median follow-up of 14 years of which 765 (40%) were due to CVD. In a multivariate model adjusted for demographics, traditional CVD risk factors, and other medical co-morbidities, subclinical myocardial injury was associated with an increased risk of CVD (HR 1.26, 95% CI 1.02 to 1.56) and all-cause (HR 1.42, 95% CI 1.23 to 1.63) mortalities. In conclusion, subclinical myocardial injury in those without manifestations of CVD is associated with an increased risk of CVD and all-cause mortalities. These findings highlight the important role of CIIS to identify subclinical myocardial injury and its association with mortality among men and women in the United States.

Trends in prevalence of dyslipidaemias and the risk of mortality in Lithuanian urban population aged 45-64 in relation to the presence of the dyslipidaemias and the other cardiovascular risk factors.

The aim of this study was to provide reliable information on dyslipidaemias, to estimate the trend of the prevalence of dyslipidaemias and other selected cardiovascular disease (CVD) risk factors at population level, and to evaluate the risk of all-cause and CVD mortality in relation to presence of mixed dyslipidaemias and other CVD risk factors.MethodsData from the five surveys (1983–2008) are presented. A random sample of 9,209 subjects aged 45–64 was selected for statistical analysis. During follow-up there were 1653 death cases from any cause, 864 deaths from CVD. Estimates of hazard ratios (HR) and 95% confidence intervals (CI) were based on the multivariate Cox proportional hazards regression for all-cause mortality and CVD mortality.ResultsDuring 25 year period the prevalence of normal total cholesterol level (<5.2 mmol/L) significantly increased only in women; triglycerides and high density lipoprotein (HDL) cholesterol did not change in men and women. Findings in our longitudinal study showed that in men and women mixed dyslipidaemias (HDL cholesterol <1.03 mmol/L plus triglycerides ≥1.70 mmol/L) significantly increased the risk for all-cause and CVD mortality (respectively in men HR = 1.30; HR = 1.15, in women HR = 1.83; HR = 2.13). These mixed dyslipidaemia combinations combination with the other risk factors such as arterial hypertension, high fasting glucose level increased all-cause and CVD mortality risk in men and women; while, these mixed dyslipidaemias plus smoking increased all-cause and CVD mortality risk only in men compared to never smokers without these dyslipidaemias (respectively HR = 1.89; HR = 1.92); and these dyslipidaemias plus obesity increased all-cause and CVD mortality risk in women (respectively HR = 2.25; HR = 2.39) and CVD mortality risk in men (HR = 1.72), as compared to responders without obesity and these dyslipidaemias.ConclusionMixed dyslipidaemias (reduced HDL cholesterol plus elevated triglycerides) significantly increased the risk for all-cause and CVD mortality in this Lithuanian population aged 45–64 years.

Gender-specific influencing factors on incidence, risk factors and outcome of carcinoma of the liver, gallbladder, extrahepatic bile duct and pancreas

This overview comments on gender-specific differences in incidence, risk factors and prognosis in patients with carcinoma of the liver, gallbladder, extrahepatic bile duct and pancreas. For the literature review, the MEDLINE database (PubMed) was searched under the key words "liver cancer", "gallbladder cancer", "extrahepatic bile duct carcinoma", "pancreatic cancer" AND "gender". There were significant gender differences in the epidemiology of the analysed carcinomas. The incidence of hepatocellular carcinoma (HCC) is much higher in men than in women, one of 86 men, but only 1 out of 200 women develop a malignant primary liver tumour in Germany in the course of their life. The lifetime risk for carcinomas of the gallbladder and extrahepatic bile ducts in Germany amounts to about 0.6 % for women and 0.5 % for men, specifically gallbladder carcinomas are observed more frequently in women than in men. For pancreatic cancer, no clear gender preference exists in Germany, although the mortality risk for men is higher than that for women (age-adjusted standardised death rate in men 12.8/100, 000 persons, in women 9.5). Remarkable is furthermore the shift of the tumour incidence in the last decades. Liver cancer has increased among men in Germany by about 50 % in the last 30 years, the incidence of gallbladder carcinoma has inversely dropped. The prognosis of these cancers across all tumour stages is uniformly bad in an unselected patient population. This is probably the main reason why only little - if any - gender differences in survival are described. In addition to avoiding the known risk factors such as hepatitis B and C virus infection, alcohol abuse, and smoking, the avoidance of overweight and obesity plays an increasingly important role in the prevention of these cancers.

Mortality of urinary tract cancer in Inner Mongolia 2008- 2012.

The aim of this study was to determine the mortality rate and burden of urinary tract cancers among residents of Inner Mongolia. We analyzed mortality data reported by the Death Registry System from 2008 to 2012. The rate of mortality due to urinary tract cancer was 2.04 per 100,000 person-years for the total population, 2.91 for men, and 1.11 for women. Therefore, the mortality rate for men was 2.62-fold the mortality rate for women, constituting a statistically significant difference (p<0.001). Over the period 2008 through 2012, the total potential years of life lost was 1388.1 person-years for men and 777.1 person-years for women, and the average years of life lost were 7.71 years per male decedent and 12.0 years per female decedent. Mortality due to urinary tract cancers is substantially greater among the elderly population. Further, the mortality rate associated with urinary tract cancers is greater for elderly men than it is for elderly women. Therefore, in Inner Mongolia, urinary tract cancers appear to pose a greater mortality risk for men than they do for women.

Abstract MP27: Effects of Healthy Lifestyle Behaviors on Lifetime Risk of Chronic Disease Mortality and Life Expectancy in Men and Women

The impact of healthy lifestyle behaviors on lifetime risk of chronic disease mortality and life expectancy in U.S. population remains less explored. Purpose: We investigated the combined effects of lifestyle factors on lifetime risk of chronic disease mortality and life expectancy in US men and women at 40 years of age. Methods: Lifetime risks of chronic disease mortality to 80 years of age were estimated for men and women, with death free of chronic diseases as a competing event. We followed 7848 men and women, aged 40 to 80 years, who participated in the Third National Health and Nutrition Examination Survey. All participants completed baseline lifestyle behavior questionnaires. A healthy lifestyle profile was defined as physically active, never smoking, and a healthy diet defined by the American Heart Association Strategic Committee. They were further categorized as having 0, 1, 2, or 3 combined healthy lifestyle factors. Results: During an average of 13.2 years of follow-up (103,851 person years), there were a total of 1645 chronic disease deaths (915 CVD, 546 cancer, 281 respiratory disease, 98 diabetes mellitus). The lifetime risks of chronic disease mortality (at 40 years of age) were 38.1% (95% CI: 35.7 to 40.5) and 30.7% (95% CI: 28.5 to 33.0) in men and women, respectively. Men and women who were physically active, never smoked, and had a healthy diet had a substantially lower lifetime risk of chronic disease mortality. The lifetime risks of chronic disease mortality across 0, 1, 2, and 3 combined healthy lifestyle factors were 47.2%, 33.0%, 21.2%, and 16.2%, respectively. After adjustment for multiple risk factors, men and women with all 3 healthy lifestyle factors had a 36% (95% CI: 28% to 42%) lower risk of chronic disease mortality compared with men and women with zero healthy lifestyle factors. Persons with 0 compared with 3 healthy lifestyle factors had a shorter life expectancy by 10 years (95% CI: 7.8 to 12.1 years). Approximately 30% (95% CI: 14% to 43%) of chronic disease deaths might have been avoided if men and women had maintained all 3 healthy lifestyle factors. Conclusion: Maintaining a healthy lifestyle is associated with lower risk of chronic disease mortality in men and women. Nationwide primordial and primary prevention efforts are needed to support the attainment of healthy lifestyles for the lifetime.

Abstract 58: Age-specific Exercise Capacity Threshold for All-cause Mortality Risk in Men

Introduction: Exercise capacity is inversely associated with mortality risk. However, there is no age-specific standardized exercise capacity threshold to guide clinical assessment of mortality risk. Hypothesis: We assessed the hypothesis that an age-specific standardized threshold can be defined based on maximal exercise capacity (METs) to assess mortality risk across age groups. Methods: Peak exercise capacity was assessed in 18,102 men (mean age: 58±11) at DC and Palo Alto CA VA Medical Centers. We stratified the cohort into four age-groups (&lt;50; 50-59; 60-69; and ≥70 yrs of age). We applied Cox proportional hazards models with spline function of MET to define the MET level associated with no increase in mortality risk (hazard ratio (HR)=1.0). We formed five additional age-specific fitness categories based on METs achieved above and below this threshold (T1; n=3,705): T2=T1-2 METs (n=4,884); T3; T1-&gt;2 METs (n=1,692); T4=T1+2 METs (n=4,646); T5=T1+2-4 METs (n=1,874) and T6=T1+&gt;4 METs (n=1,301). Results: The MET thresholds for the aforementioned age groups were identified as 8; 7; 6; and 5 METs, respectively. There were 5,103 deaths (median follow-up=10.8 yrs; 208,108 person-yrs). Cox proportional hazards analysis adjusted for age, cardiac risk factors, medications and muscle-wasting disease revealed 19% (HR=1.19; CI: 1.10-1.28) and 46% (HR=1.46; CI:1.33-1.60) higher all-cause mortality risk for those with exercise capacity 2 and &gt;4 METs below the threshold, respectively. For those with an exercise capacity 2; 4 and &gt;4 METs above the threshold, mortality risk was lower by 27% (HR= 0.73; CI:0.66-0.79), 35% (HR= 0.65; CI: 0.58-0.74), and 48% (HR=0.52; CI:0.45-0.62), respectively (p&lt;0.001 for all comparisons). The trends for mortality risk were similar for each age category (Table). Conclusions: We identified an age-specific MET threshold for fitness-related clinical assessment of mortality risk in men.

Coronary Heart Disease Risks Associated with High Levels of HDL Cholesterol

BackgroundThe association between high‐density lipoprotein cholesterol (HDL‐C) and coronary heart disease (CHD) events is not well described in individuals with very high levels of HDL‐C (>80 mg/dL).Methods and ResultsUsing pooled data from 6 community‐based cohorts we examined CHD and total mortality risks across a broad range of HDL‐C, including values in excess of 80 mg/dL. We used Cox proportional hazards models with penalized splines to assess multivariable, adjusted, sex‐stratified associations of HDL‐C with the hazard for CHD events and total mortality, using HDL‐C 45 mg/dL and 55 mg/dL as the referent in men and women, respectively. Analyses included 11 515 men and 12 925 women yielding 307 245 person‐years of follow‐up. In men, the association between HDL‐C and CHD events was inverse and linear across most HDL‐C values; however at HDL‐C values >90 mg/dL there was a plateau effect in the pattern of association. In women, the association between HDL‐C and CHD events was inverse and linear across lower values of HDL‐C, however at HDL‐C values >75 mg/dL there were no further reductions in the hazard ratio point estimates for CHD. In unadjusted models there were increased total mortality risks in men with very high HDL‐C, however mortality risks observed in participants with very high HDL‐C were attenuated after adjustment for traditional risk factors.ConclusionsWe did not observe further reductions in CHD risk with HDL‐C values higher than 90 mg/dL in men and 75 mg/dL in women.

Trait anxiety and somatic concerns associate with increased mortality risk: a 23-year follow-up in aging men

PurposeWe aimed to examine the impact of anxiety and somatic concerns on the mortality risk during a 23-year follow-up of a representative sample of men. MethodsFinnish men aged 42–61 years (n = 2388) were followed up for a median of 23.4 years. Anxiety was assessed using baseline scores for the Minnesota Multiphasic Personality Inventory Psychasthenia subscale and somatic concerns were measured with the Hypochondriasis subscale. Mortality data were obtained from the National Population Register. ResultsAll-cause, injury, disease, cardiovascular, and cancer mortalities were examined as endpoints. Adjustments were performed for age, smoking, alcohol consumption, physical activity, low- and high-density lipoprotein cholesterol, body mass index, systolic blood pressure, a history of cardiovascular disease, marital status, socioeconomic status, the Framingham Type A Behavior Pattern Scale, and life events during the 12 months before the baseline examination. Anxiety and somatic concerns predicted the all-cause mortality risk after full adjustments for sociodemographic background, lifestyle factors, and descriptors of somatic health. Regarding other forms of mortality, the risk ratios were significant after full adjustments in anxiety for injury and in somatic concerns for disease death. ConclusionsThis study supported previous findings of anxiety predicting the all-cause mortality risk in men. Somatic concerns are a novel factor that needs to be taken into account while examining associations between personality and the risk of increased mortality.

Long-term exposure to fine particulate matter: association with nonaccidental and cardiovascular mortality in the agricultural health study cohort.

Background: Few studies have examined the relationship between long-term exposure to ambient fine particulate matter (PM2.5) and nonaccidental mortality in rural populations.Objective: We examined the relationship between PM2.5 and nonaccidental and cardiovascular mortality in the U.S. Agricultural Health Study cohort.Methods: The cohort (n = 83,378) included farmers, their spouses, and commercial pesticide applicators residing primarily in Iowa and North Carolina. Deaths occurring between enrollment (1993–1997) and 30 December 2009 were identified by record linkage. Six-year average (2001–2006) remote-sensing derived estimates of PM2.5 were assigned to participants’ residences at enrollment, and Cox proportional hazards models were used to estimate hazard ratios (HR) in relation to a 10-μg/m3 increase in PM2.5 adjusted for individual-level covariates.Results: In total, 5,931 nonaccidental and 1,967 cardiovascular deaths occurred over a median follow-up time of 13.9 years. PM2.5 was not associated with nonaccidental mortality in the cohort as a whole (HR = 0.95; 95% CI: 0.76, 1.20), but consistent inverse relationships were observed among women. Positive associations were observed between ambient PM2.5 and cardiovascular mortality among men, and these associations were strongest among men who did not move from their enrollment address (HR = 1.63; 95% 0.94, 2.84). In particular, cardiovascular mortality risk in men was significantly increased when analyses were limited to nonmoving participants with the most precise exposure geocoding (HR = 1.87; 95% CI: 1.04, 3.36).Conclusions: Rural PM2.5 may be associated with cardiovascular mortality in men; however, similar associations were not observed among women. Further evaluation is required to explore these sex differences.Citation: Weichenthal S, Villeneuve PJ, Burnett RT, van Donkelaar A, Martin RV, Jones RR, DellaValle CT, Sandler DP, Ward MH, Hoppin JA. 2014. Long-term exposure to fine particulate matter: association with nonaccidental and cardiovascular mortality in the Agricultural Health Study Cohort. Environ Health Perspect 122:609–615; http://dx.doi.org/10.1289/ehp.1307277