Risk Of Premature All-cause Mortality Research Articles

Psychotic Disorders and the Risk of Type 2 Diabetes Mellitus, Atherosclerotic Cardiovascular Diseases, and All-Cause Mortality: A Population-Based Matched Cohort Study.

The effects of psychotic disorders on cardiometabolic diseases and premature death need to be determined in Asian populations. In this population-based matched cohort study, the Korean National Health Insurance Service database (2002 to 2018) was used. The risk of type 2 diabetes mellitus (T2DM), acute myocardial infarction (AMI), ischemic stroke, composite of all cardiometabolic diseases, and all-cause death during follow-up was compared between individuals with psychotic disorders treated with antipsychotics (n=48,162) and 1:1 matched controls without psychiatric disorders among adults without cardiometabolic diseases before or within 3 months after baseline. In this cohort, 53,683 composite cases of all cardiometabolic diseases (during median 7.38 years), 899 AMI, and 1,216 ischemic stroke cases (during median 14.14 years), 7,686 T2DM cases (during median 13.26 years), and 7,092 deaths (during median 14.23 years) occurred. The risk of all outcomes was higher in subjects with psychotic disorders than matched controls (adjusted hazard ratios [95% confidence intervals]: 1.522 [1.446 to 1.602] for T2DM; 1.455 [1.251 to 1.693] for AMI; 1.568 [1.373 to 1.790] for ischemic stroke; 1.595 [1.565 to 1.626] for composite of all cardiometabolic diseases; and 2.747 [2.599 to 2.904] for all-cause mortality) during follow-up. Similar patterns of associations were maintained in subgroup analyses but more prominent in younger individuals (P for interaction <0.0001) when categorized as those aged 18-39, 40-64, or ≥65 years. Patients with psychotic disorders treated with antipsychotics were associated with increased risk of premature allcause mortality and cardiometabolic outcomes in an Asian population. This relationship was more pronounced in younger individuals, especially aged 18 to 39 years.

Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging.

Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.

Urinary Excretion of N1-Methylnicotinamide, as a Biomarker of Niacin Status, and Mortality in Renal Transplant Recipients.

Renal transplant recipients (RTR) commonly suffer from vitamin B6 deficiency and its functional consequences add to an association with poor long-term outcome. It is unknown whether niacin status is affected in RTR and, if so, whether this affects clinical outcomes, as vitamin B6 is a cofactor in nicotinamide biosynthesis. We compared 24-h urinary excretion of N1-methylnicotinamide (N1-MN) as a biomarker of niacin status in RTR with that in healthy controls, in relation to dietary intake of tryptophan and niacin as well as vitamin B6 status, and investigated whether niacin status is associated with the risk of premature all-cause mortality in RTR. In a prospective cohort of 660 stable RTR with a median follow-up of 5.4 (4.7–6.1) years and 275 healthy kidney donors, 24-h urinary excretion of N1-MN was measured with liquid chromatography-tandem mass spectrometry LC-MS/MS. Dietary intake was assessed by food frequency questionnaires. Prospective associations of N1-MN excretion with mortality were investigated by Cox regression analyses. Median N1-MN excretion was 22.0 (15.8–31.8) μmol/day in RTR, compared to 41.1 (31.6–57.2) μmol/day in healthy kidney donors (p < 0.001). This difference was independent of dietary intake of tryptophan (1059 ± 271 and 1089 ± 308 mg/day; p = 0.19), niacin (17.9 ± 5.2 and 19.2 ± 6.2 mg/day; p < 0.001), plasma vitamin B6 (29.0 (17.5–49.5), and 42.0 (29.8–60.3) nmol/L; p < 0.001), respectively. N1-MN excretion was inversely associated with the risk of all-cause mortality in RTR (HR 0.57; 95% CI 0.45–0.71; p < 0.001), independent of potential confounders. RTR excrete less N1-MN in 24-h urine than healthy controls, and our data suggest that this difference cannot be attributed to lower dietary intake of tryptophan and niacin, nor vitamin B6 status. Importantly, lower 24-h urinary excretion of N1-MN is independently associated with a higher risk of premature all-cause mortality in RTR.

Hysterectomy status and all-cause mortality in a 21-year Australian population-based cohort study

Hysterectomy is a common surgical procedure, predominantly performed when women are between 30 and 50 years old. One in 3 women in Australia has had a hysterectomy by the time they are 60 years old, and 30% have both ovaries removed at the time of surgery. Given this high prevalence, it is important to understand the long-term effects of hysterectomy. In particular, women who have a hysterectomy/oophorectomy at younger ages are likely to be premenopausal or perimenopausal and may experience greater changes in hormone levels and a shortened reproductive lifespan than women who have a hysterectomy when they are older and postmenopausal. Use of menopausal hormone therapy after surgery may compensate for these hormonal changes. To inform clinical decisions about postsurgery management of women who have a hysterectomy prior to menopause (ie, average age at menopause 50 years), it is useful to compare women with a hysterectomy to women with no hysterectomy and to stratify the hysterectomy status by whether or not women have had a bilateral oophorectomy, or used menopausal hormone therapy. We sought to investigate whether women who had a hysterectomy with ovarian conservation or a hysterectomy and bilateral oophorectomy before the age of 50 years were at a higher risk of premature all-cause mortality compared to women who did not have this surgery before the age of 50 years. We also sought to explore whether use of menopausal hormone therapy modified these associations. Women from the midcohort (born 1946 through 1951) of the Australian Longitudinal Study on Women's Health were included in our study sample (n= 13,541). Women who reported a hysterectomy (with and without both ovaries removed) before the age of 50 years were considered exposure at risk and compared with women who did not report these surgeries before age 50 years. To explore effect modification by use of menopausal hormone therapy we further stratified hysterectomy status by menopausal hormone therapy use. Risk of all-cause mortality was assessed using inverse-probability weighted Cox regression models. During a median follow-up of 21.5 years, there were 901 (6.7%) deaths in our study sample. Overall, there was no difference in all-cause mortality between women who reported a hysterectomy with ovarian conservation (hazard ratio, 0.86; 95% confidence interval, 0.72-1.02) or women who reported a hysterectomy and bilateral oophorectomy (hazard ratio, 1.02; 95% confidence interval, 0.78-1.34) and women with no hysterectomy. When stratified by menopausal hormone therapy use, women with hysterectomy and ovarian conservation before the age of 50 years were not at higher risk of all-cause mortality compared to no hysterectomy, regardless of menopausal hormone therapy use status. In contrast, among nonusers of menopausal hormone therapy only, women who reported a hysterectomy-bilateral oophorectomy before the age of 50 years were at a higher risk of death compared to women with no hysterectomy (hazard ratio, 1.81; 95% confidence interval, 1.01-3.25). Hysterectomy with ovarian conservation before the age of 50 years did not increase risk of all-cause mortality. Among nonmenopausal hormone therapy users only, hysterectomy and bilateral oophorectomy before the age of 50 years was associated with a higher risk of death.

Left ventricular morphology and function in adolescents: Relations to fitness and fatness

BackgroundObesity in childhood predisposes individuals to cardiovascular disease and increased risk of premature all-cause mortality. The aim of this study was to determine differences in LV morphology and function in obese and normal-weight adolescents. Furthermore, relationships between LV outcomes, cardiorespiratory fitness (CRF) and adiposity were explored. MethodsLV morphology was assessed using magnetic resonance imaging (MRI) in 20 adolescents (11 normal-weight [BMI equivalent to 18kg/m2–25kg/m2] and 9 obese [BMI equivalent to ≥30kg/m2]); 13.3±1.1years, 45% female, Tanner puberty stage 3 [2–4]) using magnetic resonance imaging (MRI). Global longitudinal strain (GLS), strain rate (SR) and traditional echocardiographic indices were used to assess LV function. CRF (peak oxygen consumption), percent body fat (dual-energy x-ray absorptiometry), abdominal adipose tissue (MRI), and blood biochemistry markers were also evaluated. ResultsAdolescents with obesity showed significantly poorer LV function compared to normal-weight adolescents (P<0.05) indicated by higher GLS (+6.29%) and SR in systole (+0.17s−1), and lower SR in early diastole (−0.61s−1), and tissue Doppler velocities (S′ −2.7cm/s; e′ −2.3cm/s; A′ −1.1cm/s). There were no group differences in LV morphology when indexed to fat free mass (P>0.05). Moderate to strong associations between myocardial contractility and relaxation, adiposity, arterial blood pressure and cardiorespiratory fitness were noted (r=0.49–0.71, P<0.05). ConclusionObesity in adolescence is associated with altered LV systolic and diastolic function. The notable relationship between LV function, CRF and adiposity highlights the potential utility of multidisciplinary lifestyle interventions to treat diminished LV function in this population.Clinical trial registration: NCT01991106.

Meeting Sleep Guidelines Is Associated With Better Health-Related Quality of Life and Reduced Premature All-Cause Mortality Risk.

To examine whether meeting sleep guidelines (7-9 hours/night) is associated with better health-related quality of life (HRQOL) and reduced all-cause mortality risk. Prospective cohort study. 2005 to 2010 National Health and Nutrition Examination Survey. A total of 13 423 adults. Sleep duration and HRQOL were assessed from self-report; covariates assessed via survey, examination, and laboratory data; and mortality assessed through 2011 via matching from the National Death Index. Cox proportional hazard regression and ordinal logistic regression. After adjusting for age, gender, race-ethnicity, body mass index, education, smoking, white blood cell level, iron level, red blood cell distribution width, mean platelet volume, blood pressure, diabetes, coronary artery disease, physical activity, and depression, those meeting sleep guidelines had an 19% reduced risk of premature all-cause mortality (hazard ratio = 0.81; 95% confidence interval [CI]: 0.67-0.99; P = .04). After adjustments, those meeting sleep guidelines had better HRQOL (β = -0.30; 95% CI: -0.38 to -0.21; P < .001). Results for the ordinal regression and Cox proportional analyses were similar in unadjusted and minimally adjusted models. Obtaining optimal levels of sleep is associated with better HRQOL and reduced premature mortality risk, independent of demographic, behavioral, and biological conditions. These findings underscore the importance of achieving optimal levels of sleep.

Dose-dependent association between muscle-strengthening activities and all-cause mortality: Prospective cohort study among a national sample of adults in the USA

We have a limited understanding of the association between behavioural participation in muscle-strengthening activities (MSA) and all-cause mortality. To determine the effect of MSA on all-cause mortality, and examine a potential dose-response relationship between the frequency with which MSA are performed and the incidence of all-cause mortality. Individuals (8772 adults aged≥20years) from the 2003-2006 National Health and Nutritional Examination Survey were evaluated for baseline characteristics, then followed for an average of 6.7years. MSA were assessed at baseline as the number of self-reported sessions completed within the past 30days. Analyses were performed in 2015. Only 18.6% of individuals met MSA guidelines (2-3 MSA sessions/week) at baseline, while those performing any form of MSA had a 23% reduced risk of all-cause mortality (hazard ratio [HR]: 0.77; 95% confidence interval: 0.60-0.98; P=0.04). Additionally, we created a five-category variable to determine whether a dose-response relationship existed between MSA and premature mortality; only individuals performing 8-14 sessions over a 30-day period (current MSA guidelines) had a reduced risk of all-cause mortality (HR: 0.70; P=0.02). Results were similar for CVD-specific mortality. The national recommendations that 2-3 MSA sessions be performed per week appear to be most effective at reducing the risk of premature all-cause mortality; however, despite these recommendations, the majority of the adult population in the USA still fails to perform any MSA. Future studies should determine strategies for increasing adherence to these established guidelines.

Determining the Importance of Meeting Muscle-Strengthening Activity Guidelines: Is the Behavior or the Outcome of the Behavior (Strength) a More Important Determinant of All-Cause Mortality?

ObjectiveTo determine whether the behavioral participation in muscle-strengthening activity (MSA) or the strength outcome produces the largest reduction in all-cause mortality risk. Patients and MethodsThe 1999-2002 National Health and Nutritional Examination Survey was used, with follow-up of up to 12.6 years (mean, 9.9 years) (N=2773 adults aged ≥50 years). Participants were placed into 4 groups based on 2 dichotomously categorized variables: lower-extremity strength (LES) of the knee extensors (top quartile) and adherence to MSA guidelines (≥2 MSA sessions per week). Approximately 21% of the population died during follow-up. ResultsCompared with individuals not meeting MSA guidelines and not in top quartile for LES, the adjusted hazard ratios (HRs) and 95% CIs were as follows: (1) meets MSA guidelines but not in top quartile for LES (HR=0.96; 95% CI, 0.63-1.45; P=.84), (2) in top quartile for LES but does not meet MSA guidelines (HR=0.54; 95% CI, 0.42-0.71; P<.001), and (3) in top quartile for LES and meets MSA guidelines (HR=0.28; 95% CI, 0.12-0.66; P=.005). Further analyses revealed that individuals in the top quartile for LES who also met MSA and moderate to vigorous physical activity guidelines were at even further reduced risk for premature all-cause mortality (HR=0.23; 95% CI, 0.08-0.61; P=.005). ConclusionThese results demonstrate that muscle strength seems to be more important than the behavioral participation in MSA for reducing the risk of premature all-cause mortality.

The effects of objectively-measured, free-living daily ambulatory movement on mortality in a national sample of adults with diabetes

Previous research demonstrates that self-reported physical activity is protective against premature mortality among the general population, as well as those with diabetes. This confirmatory research study examines the relationship between physical activity and all-cause mortality risk among a national sample of diabetics while employing an objective measure of physical activity (ActiGraph 7164). Data from the 2003–2006 NHANES were employed, with follow-up through 2011.Among the 712 diabetics, 134 died during the median follow-up period of 79months. For every 60min increase in daily ambulatory movement, adults with diabetes had a 29% reduced risk of premature all-cause mortality (HRadjusted=0.71; 95% CI: 0.60–0.85). These confirmatory findings underscore the importance of physical activity promotion among adults with diabetes.

Erectile Dysfunction and Mortality in a National Prospective Cohort Study.

Emerging work has shown erectile dysfunction (ED) to be an important indicator of cardiovascular risk via its shared pathophysiology. Yet limited research has examined if a direct relationship between ED and mortality risk exists. The purpose of this brief report was to better define the relationship between ED and mortality risk. Prevalent ED was assessed with the question: "How would you describe your ability to get and keep an erection adequate for satisfactory intercourse?" Participant data from the population-based 2003-2004 National Health and Nutrition Examination Survey (NHANES) was linked to death certificates from the National Death Index for mortality assessment. Increased risk of premature all-cause mortality among those with ED (vs. those without). Of 1,790 adult men providing complete data (age range: 20-85 years; mean = 45.4 year), with 557 having ED, over a 93-month follow-up, 244 deceased over this time. After adjustments, those with ED (vs. those without) had a 70% increased risk of premature all-cause mortality (hazards ratio = 1.70; 95% confidence interval; 1.01-2.85; P = 0.04). ED is associated with increased premature mortality risk. The present findings have major public health and clinical implications in that ED is a strong indicator of premature mortality. Therefore, patients with ED should be screened and possibly treated for complications that may increase the risk of premature death.

Yoga participation and all-cause mortality: National prospective cohort study

BackgroundThe relatively few studies examining the effect of yoga participation on chronic disease come from small, short-term studies. As a result, the purpose of this study was to prospectively examine the effects of yoga participation on all-cause mortality in a large nationally representative study with a relatively long follow-up period (up to 12 year follow-up). MethodsData from the 1999–2006 National Health & Nutrition Examination Survey were used, with follow-up through 2011. Yoga participation was self-reported, with participant identification linked to death certificate data from the National Death Index to ascertain mortality status. ResultsIn the analyzed sample, which included 22,598 adult participants, 240 participants engaged in yoga and 3176 died over the follow-up period; the median follow-up period was 102 months (8.5 years). In an unadjusted Cox hazard model, those engaging in yoga, compared to those not engaging in yoga, had a 63% reduced risk of premature all-cause mortality (HR=0.37; 95% CI: 0.18–0.74; P=.006). However, after adjusting for age, the association was attenuated and no longer statistically significant (HRadjusted=0.82; 95% CI: 0.39–1.72; P=.60). ConclusionIn conclusion, yoga participation was not significantly associated with reduced all-cause mortality risk in an adjusted model.

The relation between resting heart rate and cancer incidence, cancer mortality and all-cause mortality in patients with manifest vascular disease

BackgroundPrevious studies suggest that elevated resting heart rate (RHR) is related to an increased risk of cancer mortality. The aim of this study was to evaluate the relation between RHR and cancer incidence and mortality in patients with vascular disease. MethodsPatients with manifest vascular disease (n=6007) were prospectively followed-up for cancer incidence and mortality. At baseline, RHR was obtained from an electrocardiogram. The relation between RHR and cancer incidence, cancer mortality and total mortality was assessed using competing risks models. ResultsDuring a median follow-up of 6.0 years (interquartile range: 3.1–9.3) 491 patients (8%) were diagnosed with cancer and 907 (15%) patients died, 248 (27%) died from cancer. After adjustment for potential confounders, the hazard ratio (HR) for incident cancer per 10beats/min increase in RHR was 1.00 (95% confidence interval [CI]: 0.93–1.07). There was a trend toward an increased risk of colorectal cancer in patients with higher RHR (HR 1.15, 95% CI 0.97–1.36). The risk of all-cause mortality was increased in patients in the highest quartile of RHR compared to the lowest quartile (HR 1.86, 95% CI 1.53–2.27), but no effect of RHR on cancer mortality was observed (HR 1.01, 95% CI 0.70–1.46). ConclusionsIn patients with manifest vascular disease, elevated RHR was related to a higher risk of premature all-cause mortality, but this was not due to increased cancer mortality. RHR was not related to risk of overall cancer incidence, although a relation between elevated RHR and incident colorectal cancer risk could not be ruled out.