Relative Risk Of Total Mortality Research Articles

Variations of PM2.5 and Health Risk Assessment in the City of Mashhad During 2010-2018

Background: Air pollution stands as a significant environmental threat impacting human health across the globe, encompassing both developed and developing nations. This study aimed to survey the temporal variations of PM2.5 and gauge its potential health effects in the city of Mashhad over the period of 2010-2018. Methods: This cross-sectional study was carried out among the residents of Mashhad city. PM2.5 concentration data spanning the years 2008-2019 were collected and subjected to analysis using Excel and AirQ software. Results: The results indicate that the highest concentration of PM2.5 was associated with the year 2010, while the lowest concentration was observed in 2015. The analytical findings demonstrated that for each 10 µg/m3 increase in PM2.5 concentrations, the relative risk for total mortality increased by 10.47%. Furthermore, based on the Air Quality Index (AQI) results, 2010 exhibited the most adverse condition in terms of PM2.5 concentrations in Mashhad city. Conclusion: In general, long-term exposure to ambient PM2.5 significantly contributed to mortality in the megacity of Mashhad. As air pollution is a modifiable risk factor, it is advisable to implement sustainable control policies to protect public health.

The impact of heat waves on mortality and years of life lost in a dry region of Iran (Kerman) during 2005-2017.

The present study was conducted to compare the impact of heat waves on mortality and years of life lost (YLL) in Kerman, Iran during the years 2005-2017. Daily mean temperature in a combination of intensity and duration were used in order to define heat waves (90, 95, and 98th percentile and ≥ 2, 3, and 4 consecutive days). YLL was calculated according to Iran's life table and by considering the discount rate. In order to investigate the impact of heat waves in different lags and its cumulative effect on mortality and YLL, Poisson and linear models within distributed lag nonlinear models were used respectively. A maximum lag of 14days was considered. The best model was selected based on AIC (Akaike Information Criteria). The model was adjusted for air pollutants, public holidays, days of the week, and humidity. The average daily mortality and YLL were 10.54 ± 4.31 deaths and 175.58 ± 91.39years respectively. They were higher in men and in heat waves matching a definition of above the 98th temperature percentile and ≥ 3days, than others. Except heat waves defined as the 98th percentile and ≥ 4days, the impact of heat waves on mortality and YLL were the highest at lag 0. The cumulative relative risk of total mortality was significantly higher in heat waves above the 95 and 98th percentiles. The cumulative effect of heat waves on total YLL was significantly higher only above the 98th percentile. Men over 65years old were the most vulnerable and had the highest mortality and YLL. Heat waves with temperatures above the 98th percentile that lasted at least 2 or 3 consecutive days had a significant effect in increasing both total YLL and mortality in Kerman, Iran.

Meta-Analysis of the Relation of Body Mass Index to All-Cause and Cardiovascular Mortality and Hospitalization in Patients With Chronic Heart Failure

Clinical studies have indicated the existence of an "obesity paradox" in patients with chronic heart failure (HF), that is, reduced mortality in patients who have elevated body mass index (BMI) scores compared with normal-weight reference groups. The aim of this study was to investigate the relation of BMI with all-cause and cardiovascular (CV) mortality and hospitalization in patients with chronic HF though a systematic review and meta-analysis of published research. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Scopus, web of science and Embase were searched for studies reporting rates of total mortality, cardiac mortality, and risk for hospitalization in patients with HF in various BMI categories (<20 kg/m(2) [low], 20 to 24.9 kg/m(2) [normal reference], 25 to 29.9 kg/m(2) [overweight], 30 to 34.9 [obese], and ≥35 kg/m(2) [severely obese]). Event rates were compared using a forest plot of relative risk (RR) using a random-effects model assuming interstudy heterogeneity. Two study investigators independently reviewed the 124 reports retrieved and identified 6 for final analyses (n = 22,807). After a mean follow-up period of 2.85 years, the risk for adverse events was highest in patients with low BMIs: total mortality RR 1.27 (95% confidence interval [CI] 1.17 to 1.37), CV mortality RR 1.20 (95% CI 1.01 to 1.43), and hospitalization RR 1.19 (95% CI 1.09 to 1.30). Risk for CV mortality and hospitalization was lowest in overweight patients (RR 0.79, 95% CI 0.70 to 0.90, and RR 0.92, 95% CI 0.86 to 0.97, respectively). Increasing degree of obesity failed to achieve a statistically significant effect on CV mortality (RR 0.82, 95% CI 0.64 to 1.05, and RR 0.71, 95% CI 0.50 to 1.01, for obese and severely obese, respectively) and on hospitalization (RR 0.99, 95% CI 0.92 to 1.07, and RR 1.28, 95% CI 0.88 to 1.87, for obese and severely obese, respectively). In conclusion, risk for total mortality and CV mortality and hospitalization was highest in patients with chronic HF who were underweight as defined by low BMI, whereas risk for CV mortality and hospitalization was lowest in overweight subjects.

Dietary fiber intake and total mortality: a meta-analysis of prospective cohort studies.

Greater intake of dietary fiber has been associated with lower risk of several chronic diseases. Some observational studies have examined the association between dietary fiber intake and total mortality, but the results were inconclusive. We conducted a meta-analysis of data from prospective cohort studies to quantitatively assess the association. Eligible studies were identified by searching the PubMed and Embase databases for all articles published through November 30, 2013, and by reviewing the reference lists of retrieved articles. Study-specific estimates adjusting for potential confounders were combined to calculate a pooled relative risk and 95% confidence interval using a random-effects model. Seven prospective cohort studies of dietary fiber intake and total mortality, including 62,314 deaths among 908,135 participants, were identified. The pooled adjusted relative risk of total mortality for the highest category of dietary fiber intake versus the lowest was 0.77 (95% confidence interval: 0.74, 0.80). In a dose-response meta-analysis, the pooled adjusted relative risk for a 10-g/day increment of dietary fiber intake was 0.89 (95% confidence interval: 0.85, 0 92). By source of fiber, cereal and, to a lesser extent, vegetable fiber were significantly associated with lower total mortality, while fruit fiber showed no association. In conclusion, high dietary fiber intake may reduce the risk of total mortality.

The impact of heatwaves on mortality in Australia: a multicity study

ObjectivesTo assess the heterogeneity of heatwave-related impacts on mortality across different cities.DesignA multicity time series study.Setting3 largest Australian cities: Brisbane, Melbourne and Sydney.ParticipantsAll residents living in these cities.Main outcome measuresNon-external...

Obesity, mortality, and life years lost associated with breast cancer in nonsmoking US Women, National Health Interview Survey, 1997-2000.

IntroductionThe relationship between obesity and breast cancer has been extensively investigated. However, how obesity and breast cancer interplay to affect mortality and life expectancy of women in the United States has not been well studied.MethodsWe used data from the National Health Interview Survey, 1997–2000. Our sample included nonsmoking, nonpregnant women who reported a body mass index of at least 18.5 kg/m2 and no cancer other than breast cancer at the time of the survey. A survival model with Gamma frailty and Gompertz baseline was used to estimate relative risks of total mortality and project life years lost associated with breast cancer by obesity status and age.ResultsBreast cancer increased risk of mortality depending on degree of obesity and decreased life years by 1 to 12 years depending on race, age, and obesity status. Relative risks for death increased with degree of obesity. Obese women under age 50 across all racial groups were predicted to lose the most life years; racial groups other than whites and blacks lost the most life years (11.9 y), followed by whites (9.8 y) and blacks (9.2 y).ConclusionThe number of life years lost associated with breast cancer was more marked for more obese than for less obese women and for women under age 50 and women aged 70 or older than for women aged 50 through 69. Public health initiatives should put more emphasis on the prevention and control of obesity for these target populations.

The impact of heatwaves on mortality in Australia: a multi-city study

Background: It is important to quantify the health impact of heatwaves. However, little is known about the geographic difference of the heatwave - mortality relationship in the southern hemisphere. This study assessed the impact of heatwave on mortality in three major Australian cities: Brisbane, Melbourne and Sydney. Methods: Daily data on climatic variables and mortality for these three cities during the period 1988 to 2009 were obtained from relevant government agencies. A consistent definition of a heatwave was used for these cities. Generalized additive Poisson regression models were fitted to assess the impact of heatwaves on mortality after adjustment for confounders. Results: Total mortality increased mostly within the same day (lag 0) or a lag of one day (lag 1) during almost all heatwaves in three cities. Using the 95 percentile of mean temperature for two or more consecutive days in the summer season as a consistent heatwave definition (HWD) across different cities, the relative risk for total mortality at lag 1 in Brisbane, Melbourne and Sydney was 1.13 (95% confidence interval (CI): 1.08 – 1.19), 1.10 (95% CI: 1.06 – 1.14) and 1.06 (95% CI: 1.01 – 1.10), respectively. Using the more stringent HWD, i.e. the 99 percentile of mean temperature for two or more consecutive days in the summer season, the relative risk of total mortality at the lags of 0-2 days in Brisbane and Melbourne was 1.40 (95% CI: 1.29 – 1.51) and 1.47 (95% CI: 1.36 – 1.59), respectively, indicating significant increases in mortality risk. Elderly, particularly females, were more vulnerable to the impact of heatwaves. Conclusions: A consistent and significant increase in mortality was observed during heatwaves in three major Australian cities, but the impacts of heatwave varied with age, gender, the HWD and geographic area.

Abstract MP091: Healthy Eating Index and Food Based a Priori Diet Pattern Score and Mortality in Postmenopausal Women: The Iowa Women’s Health Study

Introduction Summary measures of food quality such as the Alternative Healthy Eating Index (AHEI) predict the risk of total mortality and cardiovascular disease (CVD). Most of the scores are impractical for public use in that they are based on selected nutrients rather than foods. We have created an a priori diet pattern score which is exhaustive and food based. Hypothesis We assessed the hypothesis that food quality scores (both AHEI and a priori diet score) are associated with a reduced risk of total and disease specific mortality. Methods We analyzed data from 24,859 postmenopausal women free at baseline in 1986 of diabetes, CVD and cancer and mean age 61.4 years in the Iowa Women’s Health Study. Food intake was assessed at baseline using a validated 127-food-item Harvard food frequency questionnaire. The AHEI score was calculated based on the values of 9 components; vegetables, fruits, nuts and soy, the ratio of white (seafood and poultry) to red meat, cereal fiber, trans fatty acids, the ratio of polyunsaturated fatty acids to saturated fatty acids, the use of multivitamins, and alcohol intake. Each component could contribute 0-10 points to the total AHEI score, except multivitamin use (2.5 points for non-users or 7.5 points for users). The a priori food score was based on intake categories for 34 food groups rated by expert judgment as positive (n=17), neutral (n=7) or negative (n=10); these judgments resulted in a plant-centered diet. The total score was the sum of the category scores (0-3) for positively rated food groups plus reverse scores (3-0) for negatively rated food groups. Through December 31, 2008, 8528 total, 2982 CVD, and 2675 cancer deaths were identified through the State Health Registry of Iowa and the National Death Index. Results Mean ± SD AHEI was 35.8 ± 9.5 and a priori diet score 38.5 ± 8.2; correlation between scores was 0.6. In proportional hazard regression models adjusted for age, energy intake, marital status, education, place of residence, high blood pressure, body mass index, waist-hip-ratio, hormone replacement therapy, physical activity and smoking, relative risk (RR) was computed for highest vs. lowest quartile of the diet score. For AHEI, the multivariable adjusted RR was 0.82 (95% CI: 0.77-0.88) for total mortality. For CVD and cancer mortality the multivariable adjusted RRs for AHEI were 0.73 (95% CI: 0.65-0.82) and 0.86 (95% CI: 0.76-0.97), respectively. The a priori diet score had a multivariable adjusted RR for total mortality of 0.76 (95% CI: 0.71-0.81). For CVD and cancer mortality, the multivariable adjusted RRs for a priori diet score were 0.77 (95% CI: 0.69-0.87) and 0.83 (95% CI: 0.73-0.92), respectively. Conclusions In conclusion, both the food-based a priori diet score and the food- and nutrient-based AHEI were associated with a reduced risk of total and disease specific mortality in older women. A food-based score may be more practical for public health policy.

ASSOCIATION BETWEEN SOLAR LIGHT EXPOSURE AND TOTAL MORTALITY AMONG RENAL TRANPLANT RECIPIENTS

Background: Vitamin D deficiency is prevalent among renal transplant recipients (RTRs). Vitamin D may play a role in reducing inflammation and slowing disease progression. Solar light is an essential component in initiating events resulting in the active form of vitamin D within the human body. This study evaluated the association between solar light and survival among RTRs. Methods: This retrospective cohort study included 38,102 subjects identified through the US Renal Data System (USRDS), included adult, RTRs, transplanted between 1997-2002, and living in the continental U.S.A. Solar radiation data was obtained from the National Solar Radiation Database (NSRDB). Annual average values based on monthly concentrations of solar radiation data for the year 2000, were interpolated to ZIP code centroids according to the residence of the RTR population. Cox Proportional Hazard models used to estimate effect of solar radiation (&lt;3600 reference, 3600-&lt;4000, 4000-&lt;4400 and 4400+ Wh/m2 categories) on risk of total mortality, while adjusting for confounders. Results: The relative risk (RR) for total mortality among RTRs residing in areas with 3600-&lt;4000 Wh/m2 of solar radiation was 1.14 (95% CI, 1.01-1.28) in the multivariable adjusted model. For subjects residing in higher solar radiation areas with 4000 – &lt;4400 Wh/m2 and for areas equal to or greater than 4400 Wh/m2 the RR for total mortality was 1.08 (95% CI, 0.95 -1.24) and 1.03 (95%CI, 0.91 -1.16), respectively in the adjusted models. When excluding subjects with prevalent heart disease at time of transplant, the strongest association between solar radiation and total mortality was RR=1.21(95%CI, 1.05-1.39) and found for subjects within the lower solar radiation area of 3600-4000 Wh/m2. Conclusion: The findings indicate that for RTRs, living in areas with lower levels of solar radiation may negatively impact survival and increased solar light exposure may be warranted among RTRs in areas with less intense solar radiation.

Association between temperature and daily mortality in Guangzhou, 2006-2009: a time-series study

To study the association between temperature and daily mortality from June 1, 2006 to December 31, 2009 in Guangzhou. Time series approach was used to estimate the impact of temperature on the rates of total and cause-specific daily mortality. We fitted generalized additive Poisson regression using non-parametric smooth functions to control for the long-term time trend, day of week, air pollution and other weather variables. A slight sloping U-like relationship between the total mortality and temperature was found, with an optimum average temperature (temperature with lowest mortality risk) value of 19.7°C in Guangzhou. For temperature above the optimum value, the relative risk of total mortality increased by 3.0% (RR=1.030, 95%CI: 1.011-1.050) for each increase of degree in Celsius. For average temperature below the optimum value, the relative risk of total mortality and diseases of circulatory system had a 3.3% (RR=0.967, 95%CI: 0.936-0.997) decrease and a 3.6% (RR=0.964, 95%CI: 0.935-0.994) increase, for each degree of Celsius increase, respectively. Our findings showed that the temperature had an impact on the daily mortality in Guangzhou. Countermeasures needed to be taken to reduce the temperature related mortality.

Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials

Results of randomized controlled trials are consistent in showing reduced rates of stroke, heart failure and cardiovascular events in very old patients treated with antihypertensive drugs. However, inconsistencies exist with regard to the effect of these drugs on total mortality. We performed a meta-analysis of available data on hypertensive patients 80 years and older by selecting total mortality as the main outcome. Secondary outcomes were coronary events, stroke, cardiovascular events, heart failure and cause-specific mortality. The common relative risk (RR) of active treatment versus placebo or no treatment was assessed using a random-effect model. Linear meta-regression was performed to explore the relationship between intensity of antihypertensive therapy and blood pressure (BP) reduction and the log-transformed value of total mortality odds ratios (ORs). The overall RR for total mortality was 1.06 (95% confidence interval 0.89-1.25), with significant heterogeneity between hypertension in the very elderly trial (HYVET) and the other trials. This heterogeneity was not explained by differences in the follow-up duration between trials. The meta-regression suggested that a reduction in mortality was achieved in trials with the least BP reductions and the lowest intensity of therapy. Antihypertensive therapy significantly reduced (P < 0.001) the risk of stroke (35%), cardiovascular events (27%) and heart failure (50%). Cause-specific mortality was not different between treated and untreated patients. Treating hypertension in very old patients reduces stroke and heart failure with no effect on total mortality. The most reasonable strategy is the one associated with significant mortality reduction; thiazides as first-line drugs with a maximum of two drugs.

Cardiovascular and Overall Mortality Risk in Relation to Alcohol Consumption in Patients With Cardiovascular Disease

Alcohol, in striking contrast to tobacco and illicit drugs, is linked to an extensively documented J-shaped dose-effect curve, with regular moderate consumption reducing cardiovascular and overall mortality,1 whereas excessive or binge drinking has the opposite effect.1,2 Data indicative of a lower risk of cardiovascular events among moderate drinkers in apparently healthy people are extensive and consistent, whereas the role of alcohol intake among patients with cardiovascular disease (CVD) is less clear.3 Among the factors that contribute to prevention in survivors of primary cardiovascular events, lifestyle and dietary habits play a major role. However, guidelines in this area are based either on studies of apparently healthy subjects or on a few studies of cardiovascular patients.4,5 In particular, recommendations about alcohol consumption in patients with previous CVD reflect experts’ consensus rather than circumstantial evidence.3,6 The US Food and Drug Administration warns that heart disease patients should stop drinking, and people who take aspirin regularly should not drink alcohol.7 However, in the American Heart Association/American College of Cardiology guidelines for secondary prevention,5 CVD patients are encouraged to maintain a lifestyle that includes drinking alcohol in moderation. The “Diet and Lifestyle Recommendations” scientific statement from the American Heart Association Nutrition Committee8 advises, “If you consume alcohol, do so in moderation (equivalent of no more than 1 drink in women or 2 drinks in men per day).” The latter statement is largely accepted within the scientific community, definitely when referring to healthy people, although some would advise people to abstain completely rather than encouraging them to drink small amounts regularly. It has in fact been suggested that the consumption of alcohol for certain health benefits should not be encouraged, because the harm would far outweigh the gain, especially among poor populations and in low-income countries, where the …

Maximizing Survival Benefit With Primary Prevention Implantable Cardioverter-Defibrillator Therapy in a Heart Failure Population

Although implantable cardioverter-defibrillator (ICD) therapy reduces mortality in moderately symptomatic heart failure patients with an ejection fraction <or=35%, many such patients do not require ICD shocks over long-term follow-up. Using a modification of a previously validated risk prediction model based on routine clinical variables, we examined the relationship between baseline predicted mortality risk and the relative and absolute survival benefits of ICD treatment in the primary prevention Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). In the placebo arm, predicted 4-year mortality grouped into 5 equal-sized risk groups varied from 12% to 50% (c statistic=0.71), whereas the proportion of SCD in those same risk groups decreased from 52% to 24% of all deaths. ICD treatment decreased relative risk of SCD by 88% in the lowest-risk group versus 24% in the highest-risk group (P=0.009 for interaction) and decreased relative risk of total mortality by 54% in the lowest-risk group versus no benefit (2%) in the highest-risk group (P=0.014 for interaction). Absolute 4-year mortality reductions were 6.6%, 8.8%, 10.6%, 14.0%, and -4.9% across risk quintiles. In highest-risk patients (predicted annual mortality >20%), no benefit of ICD treatment was seen. Projected over each patient's predicted lifespan, ICD treatment added 6.3, 4.1, 3.0, 1.9, and 0.2 additional years of life in the lowest- to highest-risk groups, respectively. A clinical risk prediction model identified subsets of moderately symptomatic heart failure patients in SCD-HeFT in whom single-lead ICD therapy was of no benefit and other subsets in which benefit was substantial.

Absence of trends in relative risk estimates for the association between Black Smoke and daily mortality over a 34 years period in The Netherlands

A major issue in air pollution epidemiology is whether the associations that are found in the statistical analyses on the health effects of air pollution reflect real causal associations of single components or mixtures thereof, or just reflect statistical associations that are mainly the result of the high correlation between the separate components, one of them being the true causal factor. In a previous analysis on the relationship between daily SO 2 levels and daily mortality in The Netherlands [Buringh, E., Fischer, P., Hoek, G., 2000. Is SO 2 a causative factor for the PM-associated mortality risks in The Netherlands? Inhal. Toxicol. 12 (Suppl. 1), 55–60.], it was shown that the statistical significant association between daily variation in SO 2 and daily mortality did not reflect a causal relation. Black Smoke levels in The Netherlands have decreased 4-fold during the 34 years in the period 1972–2006 (annual average from 27 μg m −3 to 6 μg m −3). This large decrease in concentrations enabled us to use the same approach for this component as was done earlier for SO 2 to assess whether a decreasing trend in Black Smoke levels in The Netherlands is associated with an increasing trend in mortality relative risks or not. We used daily averaged Black Smoke (BS) data from 1972 to 2006. In the first two decades (1970–1990) only sparse data were available. Based on the availability of the data, we selected data from 1972 to 1974 and from 1982 to 1984 because during these two periods continuous daily measurement series were available. For the later years (1989–2006) data covering the whole of The Netherlands were available, giving a total of 24 years of daily data. Data on daily total mortality counts (excluding external causes), cardiovascular mortality and respiratory mortality for the whole population of The Netherlands were analyzed with regard to daily Black Smoke levels using generalized additive Poisson regression models (GAM). Period specific relative risk estimates were compared and differences in estimates between periods were evaluated. We found no consistent increase in relative risks for daily total and cause-specific mortality over time, despite the decreasing trend in the Black Smoke levels in The Netherlands. Average relative risks for total mortality varied over the different periods from 0.997 per 10 μg m −3 daily Black Smoke to 1.010 per 10 μg m −3. Average relative risks for cardiovascular mortality varied from 0.988 per 10 μg m −3 to 1.010 per 10 μg m −3 and for respiratory mortality from 1.000 to 1.010 per 10 μg m −3. For weekly averaged concentrations the average relative risks for total mortality varied over the different periods from 1.004 per 10 μg m −3 Black Smoke to 1.018 per 10 μg m −3. Average relative risks for cardiovascular mortality varied from 1.003 per 10 μg m −3 to 1.016 per 10 μg m −3 and for respiratory mortality from 1.000 to 1.050 per 10 μg m −3. The result of our analyses suggests that Black Smoke cannot be excluded as a potential causal agent because relative risks over time show no increasing trend despite the decreasing trend in Black Smoke concentrations.

L’appréhension médicale des résultats de la chirurgie bariatrique: leçons de l’étude SOS

The SOS study is the first to demonstrate that intentional weight loss can improve the mortality rate and functional prognosis of people who are severely obese. Many lessons can be learned from this benchmark study. Weight change occurs in 3 phases: 1) initial weight loss during the first 12 to 18 months; 2) weight gain from the 2nd to the 6th or 7th year; 3) then the weight stabilises, remaining level after 10 years. The quality of life of patients operated on appears to correlate to corpulence; there is major improvement in psychosocial terms, but the level of improvement is rather disappointing on average in terms of mood, and even more so for anxiety levels. Cognitive and behavioural therapy would therefore appear to be useful after surgery. Indeed, some reports say that suicide rates double after bariatric surgery. The effects on diabetes (remission or incidence) are spectacular. The mortality rate was generally low in the SOS study. A 24% decrease in the relative risk of total mortality was observed in the surgery group, which corresponds to a sharp decrease in the number of cardiovascular events or fatal cancers. Age and smoking are the 2 major predictors in multivariate analysis. It should also be noted that total mortality is around 4 times higher for patients with a history of cardiovascular problems, but this is also true for the population of obese subjects not operated on.

Abdominal Adiposity and Mortality in Chinese Women

Increased abdominal adiposity has been linked to an increase in mortality in populations where many are overweight or obese; it is unclear whether the same is true in relatively lean populations. We examined the association between waist-hip ratio and mortality in the Shanghai Women's Health Study, a population-based, prospective cohort study of Chinese women aged 40 to 70 years enrolled from December 28, 1996, through May 23, 2000, 95% of whom had a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 30.0. Included in this analysis were 72 773 nonsmoking women who had anthropometrics taken by trained interviewers at enrollment and who were followed up through December 31, 2004. Deaths were ascertained by biennial home visits and linkage with the vital statistics registry. During a mean follow-up of 5.7 years, 1456 deaths occurred. The waist-hip ratio was positively and significantly associated with deaths from all causes, cardiovascular disease, and diabetes (P<.01 for trend). A less significant positive association was found for death from cancer. After adjustment for body mass index and other potential confounders, the relative risks of total mortality were 1 (reference group), 1.28 (95% confidence interval [CI], 1.04-1.58), 1.40 (95% CI, 1.14-1.72), 1.54 (95% CI, 1.26-1.88), and 1.95 (95% CI, 1.60-2.38) across the lowest to the highest waist-hip ratio quintiles. The positive association appeared to be more evident in women with a lower body mass index. The relative risks of total mortality comparing the extreme waist-hip ratio quintiles were 2.36 (95% CI, 1.71-3.27), 1.60 (95% CI, 1.10-2.34), and 1.46 (95% CI, 0.97-2.20) for women with a body mass index of less than 22.3, 22.3 to 25.1, and 25.2 or greater, respectively. Abdominal adiposity independently predicts mortality risk, particularly for nonobese women.

Atorvastatin Efficacy in the Prevention of Cardiovascular Events in Patients with Diabetes Mellitus and/or Metabolic Syndrome

Several large-scale clinical trials have assessed the efficacy of atorvastatin in the primary and secondary prevention of cardiovascular events in patients with diabetes mellitus and/or metabolic syndrome. In primary prevention, CARDS (Collaborative Atorvastatin Diabetes Study) showed that atorvastatin 10 mg/day (vs placebo) reduced relative risk of the composite primary endpoint (acute coronary heart disease [CHD] events, coronary revascularisation, or stroke) by 37% (p = 0.001). This decrease was similar to decreases in major cardiovascular events in the ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm) trial and HPS (Heart Protection Study). However, in CARDS, atorvastatin efficacy was evident as early as 6 months after starting treatment, whereas in HPS, simvastatin efficacy was noticeable only from about 15-18 months after starting treatment. In the ASCOT-LLA trial, in 2226 hypertensive diabetic patients without previous cardiovascular disease, atorvastatin (vs placebo) reduced the relative risk of all cardiovascular events and procedures by 25% (p = 0.038). In secondary prevention, substudies of the GREACE (GREek Atorvastatin and Coronary-heart-disease Evaluation), TNT (Treating to New Targets) and PROVE-IT (PRavastatin Or atorVastatin Evaluation and Infection Therapy) trials reported results for the approximately 15-25% of study participants who had diabetes. In the GREACE substudy, atorvastatin (vs physicians' standard care) significantly reduced the relative risk of total mortality by 52% (p = 0.049), coronary mortality by 62% (p = 0.042), coronary morbidity by 59% (p < 0.002) and stroke by 68% (p = 0.046). In the TNT substudy, incidence of the primary endpoint was significantly lower in diabetic patients treated with atorvastatin 80 mg/day rather than 10 mg/day (13.8% vs 17.9%; relative risk 0.75; p = 0.026). In the PROVE-IT substudy, a significantly lower incidence of acute cardiac events was reported for atorvastatin versus pravastatin recipients (21.1% vs 26.6%; p = 0.03) and, therefore, an absolute risk reduction of 5.5% was associated with atorvastatin therapy. ASPEN (Atorvastatin Study for Prevention of coronary heart disease Endpoints in Non-insulin-dependent diabetes mellitus) - a mixed primary and secondary prevention trial in diabetic patients - found that a 29% lower low-density lipoprotein-cholesterol level was seen with atorvastatin than placebo at endpoint (p < 0.0001); however, the reduction in composite primary endpoint of major cardiovascular events (cardiovascular mortality, nonfatal major cardiovascular event or stroke, and unstable angina requiring hospitalisation) with atorvastatin (13.7% vs 15.0% with placebo), and reduction in acute myocardial infarction relative risk of 27% with atorvastatin were not statistically significant. In CHD patients with metabolic syndrome (n = 5584) in a sub-analysis of the TNT trial, intensive versus lower-dosage atorvastatin therapy reduced the relative risk of major cardiovascular and cerebrovascular events by 29% (p < 0.0001). The analysis also revealed that CHD patients with, rather than those without, metabolic syndrome had a 44% greater level of absolute cardiovascular risk, thus clearly underscoring the clinical feasibility of administering intensive lipid-lowering therapy to CHD patients with metabolic syndrome. In summary, several patient populations, from definitive, large-scale studies, are now available to corroborate the integral place of atorvastatin--in line with various regional and internationally accepted disease management guidelines--in the primary and secondary prevention of cardiovascular events in patients with diabetes and/or metabolic syndrome.

Meta-analysis of the relationship between alcohol consumption and coronary heart disease and mortality in type 2 diabetic patients

This systematic review examines the relationship between alcohol consumption and long-term complications of type 2 diabetes. Meta-analyses could only be performed for total mortality, mortality from CHD, and CHD incidence, because the availability of articles on other complications was too limited. A PubMed search through to September 2005 was performed and the reference lists of relevant articles examined. Among the relevant articles there were six cohort studies reporting on the risk of total mortality and/or fatal and/or incident CHD in alcohol non-consumers and in at least two groups of alcohol consumers. Statistical pooling showed lower risks in alcohol consumers than in non-consumers (the reference category). The relative risk (RR) of total mortality was 0.64 (95% CI 0.49-0.82) in the <6 g/day category. In the higher alcohol consumption categories (6 to <18, and > or =18 g/day), the RRs of total mortality were not significant. Risks of fatal and total CHD were significantly lower in all three categories of alcohol consumers (<6, 6 to <18 and > or =18 g/day) than in non-consumers, with RRs ranging from 0.34 to 0.75. This meta-analysis shows that, as with findings in the general population, moderate alcohol consumption is associated with a lower risk of mortality and CHD in type 2 diabetic populations.

Hospitalization for Pneumonia in the Cardiovascular Health Study: Incidence, Mortality, and Influence on Longer‐Term Survival

To estimate the rate of hospitalization for pneumonia in community-dwelling older adults and to assess its risk factors and contribution to mortality. Prospective observational study. The Cardiovascular Health Study (CHS) in four U.S. communities. Five thousand eight hundred eighty-eight men and women aged 65 and older who were followed for a median 10.7 years. Participants were interviewed about medical history and demographics; evaluated for lung, physical, and cognitive function; and followed for hospitalizations, cardiovascular disease, and death. Nearly 10% of the cohort was hospitalized for pneumonia, for a rate of 11.1 per 1,000 person-years (95% confidence interval (CI)=10.2-12.0). Risk factors included older age, male sex, current and past smoking, poor physical and lung function, and history of cardiovascular disease and chronic obstructive pulmonary disease. Ten percent of participants died during their incident pneumonia hospitalization, and death rates were high in those who survived to discharge. Compared with participants who had not been hospitalized for pneumonia, the relative risk of total mortality was 4.9 (95% CI=4.1-6.0) during the first year after hospitalization and 2.6 (95% CI=2.2-3.1) thereafter, adjusted for age, sex, and race. The respective relative risks were 3.9 (95% CI=3.1-4.8) and 2.0 (95% CI=1.6-2.4) after further adjustment for baseline history of cardiovascular disease; diabetes mellitus; smoking; and measures of lung, physical, and cognitive function. In older people, hospitalization for pneumonia is common and is associated with an elevated risk of death, as shown in this population-based, prospective cohort.

The impact of occupation and family status on overall mortality in a cohort of male members of a health insurance fund in Germany

The aim of the study was to evaluate the impact of occupation, family status, and smoking on overall mortality in males in Germany. This study used data from a longitudinal register of the “Gmuender Ersatzkasse” (GEK), a German health insurance fund, for the time period between January 1989 and December 2000. Included in the analysis were male members of the GEK who were employed on 1 January 1989 and who were born between 1935 and 1950. Only those occupations were considered for which the frequency exceeded 1,000 cases. Thus, 17 occupations comprising 80,716 individuals were included. The statistical analysis was performed utilizing the software package “Transitional Data Analysis” (TDA) and employing the Kaplan-Meier life-table approach and a multivariate survival analysis applying the Cox regression method. Statistically increased relative risks for total mortality were observed for non-married persons, for the four main occupational groups with a lower status, for 13 occupations with medium or lower status, and for occupations yielding a smoking prevalence rate of 40% and more. Longitudinal data from health insurance funds in Germany provide a valuable resource for social epidemiological investigations. The findings suggest that the occupational setting has a strong impact on overall mortality experience in Germany.