ORCID Profile
0000-0002-2705-6616
Current Organisations
Curtin University
,
Deakin University
,
La Trobe University
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Publisher: Wiley
Date: 17-05-2018
DOI: 10.1111/DOM.13336
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2003
DOI: 10.1161/01.STR.0000047123.14312.3E
Abstract: Background and Purpose— Although it is recognized that in heterozygous familial hypercholesterolemia, large extracranial carotid vessels are affected by atherosclerosis, the risk of fatal stroke after treatment with cholesterol-lowering therapy remains uncertain. The goal of this study was to determine the risk of fatal stroke in patients with treated familial hypercholesterolemia. Methods— A cohort of 1405 men and 1466 women with definite or possible heterozygous familial hypercholesterolemia was recruited from 21 outpatient lipid clinics in the United Kingdom. Patients were followed up prospectively from 1980 to 1998 for 22 992 person-years for a median duration of 7.9 years (interquartile range, 4.9 to 12.0 years). The mortality rate was calculated, and the standardized mortality ratio for men and women 20 to 79 years of age was derived from the ratio of the observed deaths to the number expected in the general population of England and Wales (standardized mortality ratio=100 for the standard population). Results— A total of 169 deaths occurred 9 (5.3%) were a result of stroke. The mortality rate from stroke was 0.39 per 1000 person-years (95% confidence interval, 0.18 to 0.74), and the standardized mortality ratio for fatal stroke was nonsignificantly lower than in the general population (79 95% CI, 36 to 150). Conclusions— The results suggest that patients with treated familial hypercholesterolemia are not at increased risk of fatal stroke. However, the possibility cannot be excluded that untreated in iduals are at increased risk, which would be consistent with the evidence that familial hypercholesterolemia is a panvascular disease.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.SCITOTENV.2016.11.147
Abstract: Although studies have examined the associations between fine particles (PM
Publisher: Wiley
Date: 15-10-2008
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.SCITOTENV.2019.02.066
Abstract: Previous studies have suggested a potential relationship between temperature variability (TV) and ischaemic heart disease (IHD) but the nature and strength differ between studies. We quantify the association between TV and risk of hospitalization for IHD across Brazilian regions and examine how the relationship varies across important population subgroups. Data on hospitalization for IHD and meteorological parameters were collected from 1814 cities during 2000-2015. TV was defined as the standard deviation of daily minimum and maximum temperatures during exposure days. City-specific estimates were quantified using a time-stratified case-crossover approach, and then pooled at the national level using a random-effect meta-analysis. Stratified analyses were performed by region, sex and three age-groups. There were 2,864,904 IHD hospitalizations during 2000-2015. The estimate of TV effect was strongest on 0-1 days' exposure: odds ratio was 1.019 [95% confidence interval (CI): 1.013-1.025] per 5 °C increase in TV. The relationship was stronger in men [1.025 (95%CI: 1.017-1.033)] than in women [1.011 (95%CI: 1.002-1.019)] and in successively older age groups [1.034 (95%CI: 1.018-1.050)]. Regional differences existed, with the association only apparent in the most ageing parts of Brazil. Exposure to TV is associated with increased risk of hospitalization for IHD, particularly in men and in older age groups. Our findings add to the growing evidence regarding the potential impact of climatic factors on important health outcomes.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2014
Publisher: Springer Science and Business Media LLC
Date: 27-08-2019
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.YPMED.2011.10.010
Abstract: To examine the effects of diabetes on coronary heart disease, ischemic and hemorrhagic stroke and cardiovascular disease according to category of body mass index. Data on 161,161 men and women from 31 cohorts (baseline years, 1966-99 mean follow-up, 2-24 years) from the Asia Pacific Cohort Studies Collaboration were analyzed using Cox regression, stratified by sex and study and adjusted for age, systolic blood pressure and smoking. Diabetes was self-reported in all but one study. Body mass index was ided into five categories according to the World Health Organization Asian criteria. The hazard ratio (diabetes v. not) for cardiovascular disease was 1.83 (95% confidence interval, 1.66-2.01). Across body mass index categories, this hazard ratio did not change significantly (p=0.19). Similar lack of difference across body mass index groups was found for coronary heart disease (p=0.33), ischemic stroke (p=0.97) and hemorrhagic stroke (p=0.98). Body mass index does not modify the effect of diabetes on major cardiovascular outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
DOI: 10.1161/STROKEAHA.113.001624
Abstract: Conflicting results have been reported on whether the association between increments in systolic blood pressure (SBP) and cardiovascular disease differs between men and women. We performed a systematic review with meta-analysis to compare reliably sex-specific associations between SBP and cardiovascular risk. PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and March 31, 2012. Studies were selected if they presented sex-specific estimates, with associated variability, of the relative risk for either ischemic heart disease or stroke according to SBP. The data were pooled using random effects models with inverse variance weighting, and estimates of the ratio of the relative risks per 10 mm Hg increment in SBP, comparing women with men, were derived. Data from 124 prospective cohort studies, including information on 1197 472 in iduals (44% women) and 26 176 stroke and 24 434 ischemic heart disease events, were included. Overall, there was no evidence to suggest a sex difference in the relationship between SBP and either the risk of stroke (pooled ratio of relative risks, 0.98 [95% confidence interval, 0.96 1.01] P =0.13) or ischemic heart disease (pooled ratio of relative risks, 1.00 [95% confidence interval, 0.97 1.04] P =0.85). Elevated levels of SBP are a major risk factor for stroke and ischemic heart diseases in both women and men. This study unequivocally demonstrates the broadly similar impact of SBP increments on cardiovascular outcomes in both sexes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
DOI: 10.1161/STROKEAHA.112.650317
Abstract: Elevated blood pressure and excess body mass index (BMI) are established risk factors for cardiovascular disease (CVD) but controversy exists as to whether, and how, they interact. The interactions between systolic blood pressure and BMI on coronary heart disease, ischemic and hemorrhagic stroke and CVD were examined using data from 419 448 participants (≥30 years) in the Asia-Pacific region. BMI was categorized into 5 groups, using standard criteria, and systolic blood pressure was analyzed both as a categorical and continuous variable. Cox proportional hazard models, stratified by sex and study, were used to estimate hazard ratios, adjusting for age and smoking and the interaction was assessed by likelihood ratio tests. During 2.6 million person-years of follow-up, there were 10 877 CVD events. Risks of CVD and subtypes increased monotonically with increasing systolic blood pressure in all BMI subgroups. There was some evidence of a decreasing hazard ratio, per additional 10 mm Hg systolic blood pressure, with increasing BMI, but the differences, although significant, are unlikely to be of clinical relevance. The hazard ratio for CVD was 1.34 (95% CI, 1.32–1.36) overall with in idual hazard ratios ranging between 1.28 and 1.36 across all BMI groups. For coronary heart disease, ischemic stroke, and hemorrhagic stroke, the overall hazard ratios per 10 mm Hg systolic blood pressure were 1.24, 1.46, and 1.65, respectively. Increased blood pressure is an important determinant of CVD risk irrespective of BMI. Although its effect tends to be weaker in people with relatively high BMI, the difference is not sufficiently great to warrant alterations to existing guidelines.
Publisher: Ubiquity Press, Ltd.
Date: 12-2012
DOI: 10.1016/J.GHEART.2012.10.001
Abstract: The Asia Pacific Cohort Studies Collaboration (APCSC) was established in the late 1990s when there was a distinct shortfall in evidence of the importance of risk factors for cardiovascular disease in Asia. With few exceptions, most notably from Japan, most of the published reports on cardiovascular disease in the last century were from Western countries, and there was uncertainty how far etiological associations found in the West could be assumed to prevail in the East. Against this background, APCSC was set up as a pooling project, combining in idual participant data (about 600,000 subjects) from all available leading cohort studies (36 from Asia and 8 from Australasia) in the region, to fill the knowledge gaps. In the past 10 years, APCSC has published 50 peer-reviewed publications of original epidemiological research, primarily concerned with coronary heart disease, stroke, and cancer. This work has established that Western risk factors generally act similarly in Asia and in Australasia, just as they do in other parts of the world. Consequently, strategies to reduce the prevalence of elevated blood pressure, obesity, and smoking are at least as important in Asia as elsewhere- and possibly more important when the vast size of Asia is considered. This article reviews the achievements of APCSC in the past decade, with an emphasis on coronary heart disease.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2004
DOI: 10.1161/01.STR.0000106480.76217.6F
Abstract: Background and Purpose— The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) showed that blood pressure lowering reduced stroke risk in patients with a history of cerebrovascular events. Here, we report the consistency of treatment effects across different stroke subtypes and among major clinical subgroups. Methods— PROGRESS was a randomized, double-blind trial among 6105 people with a prior history of cerebrovascular events. Participants were assigned to active treatment (perindopril for all participants and indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). Results— During a mean of 3.9 years of follow-up, active treatment reduced the absolute rates of ischemic stroke from 10% to 8% (relative risk reduction [RRR], 24% 95% confidence interval [CI], 10 to 35) and the absolute rates of intracerebral hemorrhage from 2% to 1% (RRR, 50% 95% CI, 26 to 67). The relative risk of any stroke during follow-up was reduced by 26% (95% CI, 12 to 38) among patients whose baseline cerebrovascular event was an ischemic stroke and by 49% (95% CI, 18 to 68) among those whose baseline event was an intracerebral hemorrhage. There was no evidence that treatment effects were modified by other drug therapies (antiplatelet or other antihypertensive agents), residual neurological signs, atrial fibrillation, or the time since the last cerebrovascular event. Conclusions— Beneficial effects of a perindopril-based treatment regimen were observed for all stroke types and all major clinical subgroups studied. These data suggest that effective blood pressure–lowering therapy should be routinely considered for all patients with a history of cerebrovascular events.
Publisher: Oxford University Press (OUP)
Date: 22-10-2006
DOI: 10.1093/IJE/DYL222
Publisher: Springer Science and Business Media LLC
Date: 03-05-2014
Publisher: Elsevier BV
Date: 06-2015
Publisher: BMJ
Date: 13-09-2019
DOI: 10.1136/THORAXJNL-2019-213486
Abstract: Heat exposure has been related to increased morbidity and mortality for several health outcomes. There is little evidence whether this is also true for COPD. This study quantified the relationship between ambient heat and hospitalisation for COPD in the Brazilian population. Data on hospitalisations for COPD and weather conditions were collected from 1642 cities during the 2000–2015 hot seasons. A time-stratified, case-crossover design was used for city-specific analyses, which were then pooled at the regional and national levels using random-effect meta-analyses. Stratified analyses were performed by sex, age group and early/late hot season. Annual change in the association was examined using a random-effect meta-regression model. The OR of hospitalisation was 1.05 (95% CI 1.04 to 1.06) for every 5℃ increase in daily mean temperature at the national level, with the effect estimate stronger in the late hot season compared with the early hot season. The effect was similar in women and in men but was greatest for those aged ≥75 years. The association was stronger in the central west and southeast regions and minimal in the northeast. Assuming a causal relationship, 7.2% of admissions were attributable to heat exposure. There was no significant temporal decline in the impact of ambient heat over the 16-year study period. In Brazil, exposure to ambient heat was positively associated with hospitalisation for COPD, particularly during the late hot season. These data add to the growing evidence base implicating global warming as being an important contributor to the future healthcare burden.
Publisher: American Medical Association (AMA)
Date: 14-12-2009
DOI: 10.1001/ARCHINTERNMED.2009.439
Abstract: Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes. Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009. Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders. Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.
Publisher: Wiley
Date: 26-07-2005
Publisher: Public Library of Science (PLoS)
Date: 24-08-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2008
Publisher: Elsevier BV
Date: 06-2014
Publisher: BMJ
Date: 12-2004
Publisher: BMJ
Date: 16-07-2009
Abstract: To provide the most reliable evidence as to the nature of the associations between smoking and cause-specific illness, as well as the expected benefits from quitting smoking, in studies conducted in Asia, where smoking remains popular among men. Studies published between January 1966 and October 2008, identified in the Medline search strategy with medical subject headings, in addition to studies from the Asia Pacific Cohort Studies Collaboration. Studies were considered to be relevant if they were prospective studies, in an Asian setting that reported on the association between smoking, quitting and cause-specific illness. Two reviewers independently screened all identified articles for possible inclusion and extracted data. The pooled relative risks (RRs) for incidence or mortality, comparing current to never smokers were always significantly higher than unity the highest was for lung cancer: 3.54 (95% confidence interval 3.00 to 4.17). The pooled RRs for former smokers (compared to never smokers) were also always significantly higher than unity, and were lower than in current smokers, for coronary heart disease, stroke, lung and upper aero-digestive tract cancer. Only for respiratory disease was the RR for former smokers higher than that for current smokers. This meta-analysis has shown that, despite the relative immaturity of the smoking epidemic in Asia, smoking is unquestionably a major contributor to ill health and death. However, the beneficial effects of quitting are not yet always apparent, most probably because quitting is a consequence of ill health and the relative unpopularity of smoking cessation in many Asian populations.
Publisher: Oxford University Press (OUP)
Date: 06-01-0001
DOI: 10.1093/IJE/DYL058
Abstract: Differences in cardiovascular risk factor levels have been suggested to contribute to the age-related excess risk of coronary heart disease (CHD). The aim of this study was to reliably quantify these contributions using a large prospective dataset. We carried out an in idual participant data meta-analysis of 41 cohort studies (n = 582,134) from Asia, and Australia and New Zealand. Cox models were used to estimate hazard ratios for coronary death, comparing in iduals aged 55-64, 65-74, and >or=5 yrs with those aged <55 yrs. Adjustments were made for coronary risk factors to quantify their contributions to the age differential. During 4.1 million person-years of follow-up, there were 2,915 deaths from CHD. The risk of CHD increased substantially with age in all groups, especially in women. Differences in cardiovascular risk factors explained between one-quarter to one-third of the age-related excess of CHD in men and one-half of that in women. Systolic blood pressure was the chief contributor to the excess risk in all groups. Systolic blood pressure was the most important modifiable risk factor contributing to the excess CHD risk that occurs with aging in men and women, but in comparison with the effects of age itself, the effects of blood pressure are small.
Publisher: Environmental Health Perspectives
Date: 2019
DOI: 10.1289/EHP3889
Publisher: Oxford University Press (OUP)
Date: 03-04-2014
DOI: 10.1093/AJE/KWU041
Publisher: Wiley
Date: 27-08-2009
DOI: 10.1111/J.1753-0407.2009.00028.X
Abstract: To assess whether there is a statistical interaction between smoking and diabetes that is related to the risk of cardiovascular disease (CVD) in men in the Asia Pacific region. An in idual participant data meta-analysis was conducted on 34 cohort studies, involving 16 492 participants with diabetes (47.4% smokers) and 188 897 without (47.6% smokers). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated for smoking (stratified by study and adjusted for age) for those with and without diabetes. In men with diabetes, the HR (95% CI) comparing current smokers with non-smokers was 1.42 (1.10-1.83) for coronary heart disease, 1.10 (0.88-1.37) for total stroke and 1.15 (0.98-1.35) for total CVD. The corresponding figures for men without diabetes were 1.47 (1.33-1.61), 1.27 (1.16-1.39) and 1.35 (1.27-1.44), respectively. There was no evidence of a statistical interaction between diabetes and current smoking, the number of cigarettes smoked per day or quitting smoking. Smoking cessation was associated with a 19% reduction in CVD risk, irrespective of diabetes status. The effects of cigarette smoking and smoking cessation are broadly similar in men with and without diabetes. In Asia, where there are high rates of smoking and a rapidly increasing prevalence of diabetes, strategies that encourage smokers to quit are likely to have huge benefits in terms of reducing the burden of CVD in men with diabetes.
Publisher: Elsevier BV
Date: 08-2016
Publisher: Informa UK Limited
Date: 10-2010
DOI: 10.3109/17477166.2010.490262
Abstract: To assess temporal changes in mean body mass index (BMI) and the impact of socio-economic status on the prevalence of overweight and obesity among Chinese children and adolescents in nine provinces between 1991 and 2006. Analysis of height and weight data in children and adolescents aged 7-17 years with complete information on age, gender, region, height and weight from consecutive China Health and Nutrition Surveys (CHNS). Measurements were recorded in 1991, 1993, 1997, 2000, 2004 and 2006. Household income data in 2006 were included in the analysis of the impact of socio-economic status on the prevalence of overweight and obesity in children and adolescents. BMI cut-offs recommended by IOTF were used to define childhood overweight and obesity, as well as the Chinese cut-offs. The Cochrane-Mantel-Haenszel test for trend was used to examine the temporal trends in the prevalence of childhood overweight and obesity. Generalised estimating equations analysis was performed to assess the changes in BMI during the study period after adjusting for age, sex, region and income. In Chinese children and adolescents mean BMI steadily increased from 17.4 kg/m(2) (95% CI: 17.3-17.5) in 1991 to 18.3 kg/m(2) (95% CI: 18.1-18.5) in 2006, after adjusting for age, sex, region and income level. There was a corresponding increase in the prevalence of overweight and obesity from 5.2% in 1991 to 13.2% in 2006. The greatest increase occurred among male children and adolescents in whom the prevalence of excess body weight tripled from 4.8% in 1991 to 15.4% in 2006, compared with 5.4% and 11.0% in females over the same period. In 2006, those from higher income families tended to have the highest prevalence of overweight and obesity. The prevalence of overweight and obesity among Chinese children and adolescents has increased steadily over the past 15 years with the increase being apparent in all age, sex and income groups. However, the most noticeable increase was in children from urban areas and those from higher income backgrounds.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.SCITOTENV.2017.08.244
Abstract: The association between temperature and cardio-respiratory disease in urban areas has been widely reported but there is limited information from populations living in rural areas that may be disproportionately affected by climate change. To quantify the associations between daily temperature and clinical visits due to cardiovascular and/or respiratory disease in rural villages in the Ningxia Hui Autonomous Region, China over 2012-2015. Daily data on clinical visits and weather conditions were collated from 203 villages. A quasi-Poisson regression with distributed lag non-linear model was used to examine the associations between daily temperature and clinical visits up to 28days, after controlling for potential confounders. Over three years, 158,733 and 1,272,212 clinical visits were recorded for cardiovascular and respiratory diseases, respectively. Both low and high temperatures were associated with an increased risk of clinical visits for cardiovascular-related conditions, whereas only low temperatures were associated with increased clinical visits related to respiratory illness. The cold effect on cardiovascular visits appeared at the lag 6th day and persisted until the 22nd day, resulting in a cumulative relative risk (RR) 1.55 (95% CI: 1.26-1.92), compared with the minimum-clinical visit temperature. The cold effect on respiratory visits appeared immediately and lasted over the lag 0-28days, with a cumulative RR 2.96 (2.74-3.21). Suboptimal temperature accounted for approximately 13% and 26% of clinic visits due to cardiovascular and respiratory disorders, respectively, with the majority of cases attributable to moderate - rather than extreme - cold temperature. In rural settings, sub-optimal temperatures explained nearly one quarter of all clinical visits due to cardiovascular and respiratory diseases. Although extreme cold temperature had a stronger, more immediate, prolonged effect on respiratory disease than for cardiovascular disease, moderately cold temperatures accounted for most of the overall burden of clinical visits.
Publisher: Oxford University Press (OUP)
Date: 26-10-2012
Publisher: Oxford University Press (OUP)
Date: 10-2005
DOI: 10.1097/01.HJR.0000170264.84820.8E
Abstract: Cardiovascular disease is already the leading cause of death in many Asian populations. Relationships between vascular risk factors and cardiovascular disease may differ in Asian and western populations. Previously, a lack of prospective data has prevented the reliable quantification of such differences, which, if they were shown to exist, would suggest that novel cardiovascular prevention and treatment strategies are required for Asia. An in idual participant data meta-analysis of 32 studies from the Asia-Pacific region involving 331 100 subjects (75% from Asia 25% from the predominantly Caucasian populations of Australia and New Zealand). Outcomes were death from coronary heart disease, ischaemic and haemorrhagic stroke. Hazard ratios were estimated from Cox models for systolic blood pressure (SBP), total cholesterol, triglycerides, body mass index, diabetes and current cigarette smoking, stratified by study and sex and adjusted for age, the other risk factors and regression dilution. After an average period of follow-up of 4 years there were 2082 deaths from coronary heart disease, 600 from haemorrhagic stroke and 420 from ischaemic stroke. The direction and strength of the associations between risk factors and cardiovascular outcomes were similar in the two regions, although in two cases there were significant differences. Triglycerides were more strongly associated with coronary heart disease in Australia and New Zealand ( P = 0.03), whereas SBP showed a stronger relationship with haemorrhagic stroke in Asia ( P = 0.04). Classical vascular risk factors act similarly in Asian and Caucasian populations prevention and treatment strategies should thus be similar. Blood pressure reduction should be particularly effective in Asia.
Publisher: Cambridge University Press (CUP)
Date: 08-2000
DOI: 10.1017/S0007114500001483
Abstract: To investigate the nutritional status of the population of the UK during the Second World War, nutritional surveys were commissioned in 1941. These included surveys of two groups of pregnant women: the first comprised 120 working-class women who were studied in the spring of 1942, and a second group of 253 women in 1944. Both groups were followed up until after delivery. Detailed biochemical assessments were performed on each subject. Our statistical analysis of the haematological data showed that nearly 25 % of women from the 1942 group were deficient in protein, over 60 % were deficient in Fe and vitamin A, and over 70 % had severe vitamin C deficiency. The findings were reported to the Ministries of Health and Food who instigated a food supplementation policy at the end of 1942 that entitled pregnant women in the UK to extra rations of fruit, dairy produce and to a supply of cod-liver-oil tablets. A second group of 253 pregnant women were studied 15 months later which enabled the effects of this programme to be investigated. Supplementation reduced the proportion of women with vitamin A concentrations below the normal range from 63 % to 38 %, and vitamin C from 78 % to 20 %, but protein and Fe concentrations were not increased but actually declined. These findings continued to exert an influence over government food policy for pregnant women until the abolition of rationing in 1954.
Publisher: Informa UK Limited
Date: 23-08-2023
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.ENVINT.2018.08.021
Abstract: Extreme temperature events are known to be adversely associated with a range of health outcomes, but little is known about the effect of less extreme, but more frequent fluctuation in temperature. We examined the spatiotemporal and demographic variation in the effect of temperature variability (TV) on nationwide hospitalizations in Brazil during 2000-2015. Data on daily hospitalizations and weather variables were collected from 1814 cities, comprising 78.4% of Brazilian population. TV was defined as the standard deviation of daily minimum and maximum temperatures during exposure days. City-specific TV effect was estimated using a quasi-Poisson regression model, and then pooled at the national and regional level using meta-analysis. Stratified analyses were performed by sex, 10 age-groups, and 11 cause categories. Meta-regression was applied to city-year-specific estimates to examine the temporal change. The estimate of TV effect peaked on 0-1 days' exposure, contributing to 3.5% [95% confidence interval (CI): 3.1-3.8%] of hospitalizations nationwide, equalling 221 (95%CI: 200-242) cases per 100,000 population annually. The effect estimate varied across 11 cause categories, which was strongest for respiratory admissions. Males, particular those 10-49 year old were more affected than females but there was no sex difference for the attributable hospitalization rate. The attributable rate for the under-fives was twice as high as for the elderly, and five times higher than in adults. The majority of the most affected cities were located in the central west and the inland of northeast. The risk of hospitalization related to TV showed a significant increase over the 16-year period at the national level. In Brazil, the effect of TV on hospitalization is acute, and varies by spatial, sex, age, and cause category. Given there is no evidence regarding TV adaptation, hospitalization burden associated with TV is likely to further increase and warrants consideration when developing future public health policies in the context of climate change.
Publisher: Elsevier BV
Date: 10-2002
Publisher: Springer Science and Business Media LLC
Date: 10-05-2005
Publisher: Oxford University Press (OUP)
Date: 14-10-2007
Abstract: The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL cholesterol and stroke, particularly for stroke subtypes. Cox survival models were applied to in idual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After adjustment for age and regression dilution, hazard ratios (95% confidence intervals) for a 1 standard deviation (SD) lower level of HDL cholesterol (0.4 mmol/L) were: for CHD events, 1.39 (1.22-1.57) for ischaemic stroke, 0.90 (0.75-1.07), and for haemorrhagic stroke, 0.89 (0.74-1.07). As total cholesterol (TC) increased relative to HDL cholesterol, the risk of CHD increased, the risk of ischaemic stroke was unchanged but the risk of haemorrhagic stroke decreased. A 1 SD increase in TC/HDL cholesterol (1.63 units) was associated with a 27% decrease in the risk of haemorrhagic stroke (95% confidence interval, 7-44%). There is clear evidence of potential benefit for CHD of increases in HDL cholesterol and decreases in TC relative to HDL cholesterol, but no evidence of an association between either HDL cholesterol or TC/HDL cholesterol and ischaemic stroke. Increasing HDL cholesterol relative to TC may increase the risk of haemorrhagic stroke.
Publisher: Mary Ann Liebert Inc
Date: 11-2005
Abstract: There is much interest in promoting healthy heart awareness among women. However, little is known about the reasons behind the lower rates of heart disease among women compared with men, and why this risk difference diminishes with age. Previous comparative studies have generally had insufficient numbers of women to quantify such differences reliably. We carried out an in idual participant data meta-analysis of 39 cohort studies (32 from Asian countries and 7 from Australia and New Zealand). Cox models were used to estimate hazard ratios (HR) for coronary death, comparing men to women. Further adjustments were made for several proven coronary risk factors to quantify their contributions to the sex differential. Sex interactions were tested for the same risk factors. During 4 million person-years of follow-up, there were 1989 (926 female) deaths from coronary heart disease (CHD). The age-adjusted and study-adjusted male/female HR (95% confidence interval [95% CI]) was 2.05 (1.89-2.22). At baseline, 54% of men vs. 7% of women were current smokers hence, adjustment for smoking explained the largest component (20%) of this HR. A significant sex interaction was observed between systolic blood pressure (SBP) and CHD mortality such that a 10 mm Hg increase was associated with a 15% greater increase in the relative risk (RR) of coronary death in women compared with men (p = 0.002). Only a small amount of the sex differential in coronary death could be explained by differences in the prevalence of classic risk factors. Alternative explanations are required to explain the age-related attenuation of the sex difference in CHD risk.
Publisher: Elsevier BV
Date: 03-2010
Publisher: American Diabetes Association
Date: 12-2007
DOI: 10.2337/DC07-1455
Publisher: Wiley
Date: 17-12-2013
DOI: 10.1111/NEP.12148
Publisher: BMJ
Date: 19-02-2008
Abstract: Although the dangers of smoking, and the benefits of quitting, are well established and understood in the West, smoking remains popular among Asian men. We investigated the associations between smoking (including ex-smoking) and major causes of mortality in Asian men and women, and compared with Australians and New Zealanders (ANZ). An overview of 34 cohort studies in the Asia Pacific region involving 512 676 in iduals (81% from Asia), followed up for a median of 6.7 years (20 804 deaths). Mortality rates for cause-specific and all causes of mortality were systematically higher for current compared with never smokers. Hazard ratios (HR) for overall and cause-specific mortality comparing current-smokers with never smokers, ex- smokers with current-smokers and comparing numbers of cigarettes smoked per day, were higher for ANZ than Asia (p<0.001). For overall mortality, the HR (95% CI) comparing current-smoking with not was 1.37 (1.23 to 1.53) and 1.33 (1.26 to 1.40) in Asian men and women respectively. The corresponding figures in ANZ were 1.95 (1.81 to 2.09) and 1.85 (1.69 to 2.02). The HR for quitting in ANZ was 0.67 (0.63 to 0.71) and 0.66 (0.58 to 0.74) in men and women respectively. Quitting smoking had a significant benefit among Asian men, the HR was 0.88 (0.81 to 0.97) after ignoring the first 3 years of follow-up. There was no evidence of benefit for Asian women, for whom ex-smoking is rare. Allowing for the recent uptake of smoking in Asia, its effects are comparable to those observed in ANZ. Stringent tobacco control measures and smoking cessation strategies are urgently required in Asia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2009
DOI: 10.1161/HYPERTENSIONAHA.108.128413
Abstract: Chronic kidney disease is a major worldwide public health problem that causes substantial morbidity and mortality. Studies from the Asia-Pacific region have reported some of the highest chronic kidney disease prevalence rates in the world, but access to dialysis is limited in many countries, making it imperative to identify high-risk in iduals. We performed a participant-level data overview of prospective studies conducted in the Asia-Pacific region to quantify the magnitude and direction of the associations between putative risk factors and renal death. Age- and sex-adjusted Cox proportional hazards models were applied to pooled data from 35 studies to calculate hazard ratios (95% CIs) for renal death associated with a standardized change in risk factors. Among 560 352 participants followed for a median of 6.8 years, a total of 420 renal deaths were observed. Continuous and positive associations among systolic blood pressure, diastolic blood pressure, fasting blood glucose, and total cholesterol levels with renal death were observed, as well as a continuous but inverse association with high-density lipoprotein cholesterol. Systolic blood pressure was the strongest risk factor for renal death with each SD increase in systolic blood pressure (19 mm Hg) associated with % higher risk (hazard ratio: 1.84 95% CI: 1.60 to 2.12). Neither cigarette smoking nor excess weight was related to the risk of renal death ( P .10). The results were similar for cohorts in Asia and Australia. These results suggest that primary prevention strategies for renal disease should focus on in iduals with elevated blood pressure, diabetes mellitus, and dyslipidemia.
Publisher: Springer Science and Business Media LLC
Date: 04-10-2013
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1053/J.AJKD.2008.08.032
Abstract: The associations between decreased kidney function and cardiovascular disease recently have been established. However, there is uncertainty about the consistency between the independent associations of proteinuria as a risk factor across all cardiovascular end points. We undertook a meta-analysis of published cohort studies to provide a reliable estimate of the strength of association between proteinuria and risk of stroke. Meta-analysis of observational cohort studies. General population of participants with diabetes. Studies were excluded if participants had known glomerular disease or had undergone dialysis or transplantation. MEDLINE, EMBASE, and CINAHL databases were searched for studies that reported age- or multivariate-adjusted risk ratio with some estimate of the variance of the association between proteinuria and risk of stroke, without language restriction. Proteinuria or albuminuria. Fatal or nonfatal stroke. Data from 10 published studies involving 140,231 participants and 3,266 strokes were eligible for inclusion. Participants with proteinuria had a 71% greater risk of stroke compared with those without proteinuria (95% confidence interval, 1.39 to 2.10). There was evidence of significant quantitative heterogeneity in the magnitude of the association across studies (I(2) = 60% P for heterogeneity = 0.008), which was partially explained by differences in methods for measuring proteinuria. The risk of stroke remained significant after adjustment for other vascular risk factors. Because in idual patient data were unavailable, we were unable to fully examine the impact of adjustment for known cardiovascular risk factors on the strength of the association between proteinuria and stroke risk. It is possible that the pooled estimate was affected by regression dilution bias. These findings support the independent relationship between proteinuria and stroke. Additional studies are warranted to determine whether interventions to reduce proteinuria are effective at reducing rates of stroke.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2000
DOI: 10.1097/00004872-200018070-00002
Abstract: To conduct a systematic review in order to (i) summarize the relationship between birthweight and blood pressure, following numerous publications in the last 3 years, (ii) assess whether other measures of size at birth are related to blood pressure, and (iii) study the role of postnatal catch-up growth in predicting blood pressure. All papers published between March 1996 and March 2000 that examined the relationship between birth weight and systolic blood pressure were identified and combined with the papers examined in a previous review. More than 444,000 male and female subjects aged 0-84 years of all ages and races. Eighty studies described the relationship of blood pressure with birth weight The majority of the studies in children, adolescents and adults reported that blood pressure fell with increasing birth weight, the size of the effect being approximately 2 mmHg/kg. Head circumference was the only other birth measurement to be most consistently associated with blood pressure, the magnitude of the association being a decrease in blood pressure by approximately 0.5 mmHg/cm. Skeletal and non-skeletal postnatal catch-up growth were positively associated with blood pressure, with the highest blood pressures occurring in in iduals of low birth weight but high rates of growth subsequently. Both birth weight and head circumference at birth are inversely related to systolic blood pressure. The relationship is present in adolescence but attenuated compared to both the pre- and post-adolescence periods. Accelerated postnatal growth is also associated with raised blood pressure.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2014
DOI: 10.1007/S00125-014-3260-6
Abstract: A previous pooled analysis suggested that women with diabetes are at substantially increased risk of fatal CHD compared with affected men. Additional findings from several larger and more contemporary studies have since been published on the sex-specific associations between diabetes and incident CHD. We performed an updated systematic review with meta-analysis to provide the most reliable evidence of any sex difference in the effect of diabetes on subsequent risk of CHD. PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between 1 January 1966 and 13 February 2013. Eligible studies had to have reported sex-specific RR estimates for incident CHD associated with diabetes and its associated variability that had been adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain sex-specific RRs and the RR ratio (RRR) (women:men) for incident CHD associated with diabetes. Data from 64 cohorts, including 858,507 in iduals and 28,203 incident CHD events, were included. The RR for incident CHD associated with diabetes compared with no diabetes was 2.82 (95% CI 2.35, 3.38) in women and 2.16 (95% CI 1.82, 2.56) in men. The multiple-adjusted RRR for incident CHD was 44% greater in women with diabetes than in men with diabetes (RRR 1.44 [95% CI 1.27, 1.63]) with no significant heterogeneity between studies (I (2) = 20%). Women with diabetes have more than a 40% greater risk of incident CHD compared with men with diabetes. Sex disparities in pharmacotherapy are unlikely to explain much of the excess risk in women, but future studies are warranted to more clearly elucidate the mechanisms responsible for the substantial sex difference in diabetes-related risk of CHD.
Publisher: American Association for Cancer Research (AACR)
Date: 02-2009
DOI: 10.1158/1055-9965.EPI-08-1032
Abstract: Given the well-established links between diabetes and elevated rates of pancreatic cancer, there are reasons to anticipate that other markers of metabolic abnormality (increased body mass index, plasma cholesterol, and blood pressure) and their correlates (physical activity and socioeconomic status) may also confer increased risk. However, to date, the results of a series of population-based cohort studies are inconclusive. We examined these associations in the original Whitehall cohort study of 17,898 men. A maximum of 38 years of follow-up gave rise to 163 deaths due to carcinoma of the pancreas. Although Poisson regression analyses confirmed established risk factor–disease associations for increasing age, smoking, and type II diabetes, there was essentially no evidence that body mass index (rate ratio, 1.01 95% confidence interval per 1 SD increase, 0.86-1.18), plasma cholesterol (0.91 0.78-1.07), diastolic blood pressure (0.93 0.78-1.09), systolic blood pressure (0.98 0.83-1.15), physical activity (sedentary versus high: 1.37 0.89-2.12), or socioeconomic status [clerical (low) versus professional/executive, 0.95 0.59-1.51] offered any predictive value for pancreatic cancer mortality. These results were unchanged following control for a range of covariates. (Cancer Epidemiol Biomarkers Prev 2009 (2):673–5)
Publisher: Asian Pacific Organization for Cancer Prevention
Date: 28-02-2013
DOI: 10.7314/APJCP.2013.14.2.1083
Abstract: Colorectal cancer has several modifiable behavioural risk factors but their relationship to the risk of colon and rectum cancer separately and between countries with high and low incidence is not clear. Data from participants in the Asia Pacific Cohort Studies Collaboration (APCSC) were used to estimate mortality from colon (International Classification of Diseases, revision 9 (ICD-9) 153, ICD-10 C18) and rectum (ICD-9 154, ICD-10 C19-20) cancers. Data on age, body mass index (BMI), serum cholesterol, height, smoking, physical activity, alcohol and diabetes mellitus were entered into Cox proportional hazards models. 600,427 adults contributed 4,281,239 person-years follow-up. The mean ages (SD) for Asian and Australia/New Zealand cohorts were 44.0 (9.5) and 53.4 (14.5) years, respectively. 455 colon and 158 rectum cancer deaths were observed. Increasing age, BMI and attained adult height were associated with increased hazards of death from colorectal cancer, and physical activity was associated with a reduced hazard. After multiple adjustment, any physical activity was associated with a 28% lower hazard of colon cancer mortality (HR 0.72, 95%CI 0.53-0.96) and lower rectum cancer mortality (HR 0.75, 95%CI 0.45-1.27). A 2cm increase in height increased colon and all colorectal cancer mortality by 7% and 6% respectively. Physical inactivity and greater BMI are modifiable risk factors for colon cancer in both Western and Asian populations. Further efforts are needed to promote physical activity and reduce obesity while biological research is needed to understand the mechanisms by which they act to cause cancer mortality.
Publisher: Cambridge University Press (CUP)
Date: 03-2006
DOI: 10.1079/BJN20051609
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
Publisher: American Medical Association (AMA)
Date: 24-12-2008
Abstract: Low birth weight is implicated as a risk factor for type 2 diabetes. However, the strength, consistency, independence, and shape of the association have not been systematically examined. To conduct a quantitative systematic review examining published evidence on the association of birth weight and type 2 diabetes in adults. Relevant studies published by June 2008 were identified through literature searches using EMBASE (from 1980), MEDLINE (from 1950), and Web of Science (from 1980), with a combination of text words and Medical Subject Headings. Studies with either quantitative or qualitative estimates of the association between birth weight and type 2 diabetes were included. Estimates of association (odds ratio [OR] per kilogram of increase in birth weight) were obtained from authors or from published reports in models that allowed the effects of adjustment (for body mass index and socioeconomic status) and the effects of exclusion (for macrosomia and maternal diabetes) to be examined. Estimates were pooled using random-effects models, allowing for the possibility that true associations differed between populations. Of 327 reports identified, 31 were found to be relevant. Data were obtained from 30 of these reports (31 populations 6090 diabetes cases 152 084 in iduals). Inverse birth weight-type 2 diabetes associations were observed in 23 populations (9 of which were statistically significant) and positive associations were found in 8 (2 of which were statistically significant). Appreciable heterogeneity between populations (I(2) = 66% 95% confidence interval [CI], 51%-77%) was largely explained by positive associations in 2 native North American populations with high prevalences of maternal diabetes and in 1 other population of young adults. In the remaining 28 populations, the pooled OR of type 2 diabetes, adjusted for age and sex, was 0.75 (95% CI, 0.70-0.81) per kilogram. The shape of the birth weight-type 2 diabetes association was strongly graded, particularly at birth weights of 3 kg or less. Adjustment for current body mass index slightly strengthened the association (OR, 0.76 [95% CI, 0.70-0.82] before adjustment and 0.70 [95% CI, 0.65-0.76] after adjustment). Adjustment for socioeconomic status did not materially affect the association (OR, 0.77 [95% CI, 0.70-0.84] before adjustment and 0.78 [95% CI, 0.72-0.84] after adjustment). There was no strong evidence of publication or small study bias. In most populations studied, birth weight was inversely related to type 2 diabetes risk.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Elsevier BV
Date: 08-2010
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.ENVPOL.2017.02.010
Abstract: The association between ambient temperature and mortality has been well documented worldwide. However, limited data are available on nonfatal health outcomes, such as emergency department visits (EDVs), particularly from China. To examine the temperature-EDV association in 12 Chinese cities and to assess the modification effects by region, gender and age. Daily meteorological data and non-accidental EDVs were collected during 2011-2014. Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-EDV association in each city. The effect estimates were pooled using multivariate meta-analysis at the national and regional level. Stratified analyses were performed by gender and age-groups. Sensitivity analyses adjusting for air pollution and relative humidity were conducted. A total of 4,443,127 EDVs were collected from the 12 cities. Both cold and hot temperatures were associated with increased risk of EDVs, with minimum-mortality temperature located at 64th percentile of temperature. The effect of cold temperature appeared on day 2 and persisted until day 30, causing a cumulative relative risk (RR) of 1.80 (1.54, 2.11). The effect of hot temperature appeared immediately and lasted until day 3, with a cumulative RR of 1.15 (1.03, 1.29). The effect of temperature on EDVs was similar in male and female but was attenuated with increasing age. The effect of cold temperature on EDVs was greater in southern areas of the country whereas the hot effect was greater in northern cities. The association was robust to a large range of sensitivity analyses. In China, there is a U-shaped association between temperature and risk of EDVs that is independent of air pollution and humidity. The temperature-EDV association varies with latitude and age-groups but is not affected by gender. Forecasting models for hospital emergency departments may be improved if temperature is included as an independent predictor.
Publisher: Wiley
Date: 31-08-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2012
DOI: 10.1161/CIRCEP.111.966804
Abstract: Several cardiovascular risk factors have been associated with the risk of atrial fibrillation (AF). Limited and inconsistent evidence exists on the association of blood lipid levels and lipid-lowering medication use with AF risk. We analyzed 13 969 participants (25% African American, 45% men) free of AF at baseline from the Atherosclerosis Risk in Communities study. Fasting high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides, and total cholesterol were measured at baseline (1987–1989) and each of 3 follow-up visits. The incidence of AF was ascertained through 2007. The association of the use of statins and other lipid-lowering medications with AF was estimated in 13 044 Atherosclerosis Risk in Communities participants attending visit 2 (1990–1992), adjusting for covariates from the previous visit. During a median follow-up of 18.7 years, there were 1433 incident AF cases. Multivariable hazard ratios (HRs) and 95% CIs of AF associated with a 1-SD increase in lipid levels were as follows: HDLc, 0.97 (0.91–1.04) LDLc, 0.90 (0.85–0.96) total cholesterol, 0.89 (0.84–0.95) and triglycerides, 1.00 (0.96–1.04). Participants taking lipid-lowering medications had an adjusted HR (95% CI) of AF of 0.96 (0.82–1.13) compared with those not taking medications, whereas those taking statins had an adjusted HR of 0.91 (0.66–1.25) compared with those taking other lipid-lowering medications. Higher levels of LDLc and total cholesterol were associated with a lower incidence of AF. However, HDLc and triglycerides were not independently associated with AF incidence. No association was found between the use of lipid-lowering medications and incident AF.
Publisher: BMJ
Date: 17-03-2015
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.ENVPOL.2018.12.063
Abstract: There is growing recognition of a potential role for environmental and climatic factors in influencing cardiovascular risk. It has been speculated that temperature variability (TV) is a risk factor for cardiac arrhythmia but evidence is limited. To quantify the geographic and demographic variations in the association between TV and hospitalization for cardiac arrhythmia in Brazil during 2000-2015. Data on hospitalization for arrhythmia and weather conditions were collected from 1,814 cities. TV was calculated as the standard deviation of daily maximum and minimum temperatures during exposure days. A time-stratified case-crossover approach was applied to examine the city-specific association between TV and hospitalization for arrhythmia. City-specific estimates were pooled at the national and regional levels using a random-effect meta-analysis. Stratified analyses were conducted by sex, three age-groups (0-64, 65-74 and ≥75 years), and three arrhythmia subtypes (paroxysmal tachycardia, atrial fibrillation and flutter, and other arrhythmias). There were 447,667 arrhythmia-related hospitalizations during 2000-2015. The odds ratio of hospitalization per 1 °C increase in TV peaked on 0-1 days' exposure [1.012 (95% confidence interval: 1.010-1.015)]. There were no substantial differences in effect estimates of TV At a population-level exposure to TV was associated with increased risk of arrhythmia-related hospitalization in Brazil, with the relationship equally distributed across most residents but varied by arrhythmia subtypes. Our findings add to the accumulating evidence-base that climatic factors can influence cardiovascular outcomes in populations.
Publisher: Oxford University Press (OUP)
Date: 10-2002
Publisher: BMJ
Date: 12-2014
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1053/J.AJKD.2008.12.042
Abstract: There has been considerable interest in the hypothesis that low birth weight may be a marker of impaired nephrogenesis and that this is causally related to chronic kidney disease (CKD). Systematic review and meta-analysis of observational studies. Studies of the relationship between birth weight and CKD published before February 1, 2008, were identified by using electronic searches. All studies that had collected data for birth weight and kidney function at greater than 12 months of age were eligible for inclusion, except for studies of extremely low-birth-weight infants, very premature infants, or toxic exposure in utero. STUDY FACTOR: Birth weight. CKD defined as albuminuria, low estimated glomerular filtration rate (<60 mL/min/1.73 m(2) or < 10th centile for age/sex), or end-stage renal disease. We analyzed 31 relevant cohort or case-control studies with data for 49,376 in iduals and data for 2,183,317 in iduals from a single record-linkage study. Overall, 16 studies reported a significant association between low birth weight and risk of CKD and 16 observed a null result. The combination of weighted estimates from the 18 studies for which risk estimates were available (n = 46,249 plus 2,183,317 from the record linkage study) gave an overall odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.44 to 2.08). Combined ORs were consistent in magnitude and direction for risks of albuminuria (OR, 1.81 95% CI, 1.19 to 2.77), end-stage renal disease (OR, 1.58 95% CI, 1.33 to 1.88), or low estimated glomerular filtration rate (OR, 1.79 95% CI, 1.31 to 2.45). A reliance on published estimates and estimates provided on request rather than in idual patient data and the possibility of reporting bias. Existing data indicate that low birth weight is associated with subsequent risk of CKD, although there is scope for additional well-designed population-based studies with accurate assessment of birth weight and kidney function and consideration of important confounders, including maternal and socioeconomic factors.
Publisher: Elsevier BV
Date: 11-2010
Publisher: American Medical Association (AMA)
Date: 08-02-2019
Publisher: Elsevier BV
Date: 03-2012
Publisher: Portland Press Ltd.
Date: 02-2004
DOI: 10.1042/CS20030369
Abstract: Early-life nutrition has been suggested to influence the progression of chronic disease. In this issue of Clinical Science, Ozanne and colleagues argue that the pre- and post-natal diet can have a significant impact on the risk of becoming overweight in later life. Although an intriguing finding that warrants further investigation, it is most likely that the key to stemming the obesity pandemic will depend chiefly on the implementation of effective population-wide strategies that focus on lifestyle modification, both in childhood and in adult life.
Publisher: Elsevier BV
Date: 12-2009
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-021611
Abstract: To investigate the sex-specific association between smoking and lung cancer. Systematic review and meta-analysis. We searched PubMed and EMBASE from 1 January 1999 to 15 April 2016 for cohort studies. Cohort studies before 1 January 1999 were retrieved from a previous meta-analysis. In idual participant data from three sources were also available to supplement analyses of published literature. Cohort studies reporting the sex-specific relative risk (RR) of lung cancer associated with smoking. Data from 29 studies representing 99 cohort studies, 7 million in iduals and 000 incident lung cancer cases were included. The sex-specific RRs and their ratio comparing women with men were pooled using random-effects meta-analysis with inverse-variance weighting. The pooled multiple-adjusted lung cancer RR was 6.99 (95% Confidence Interval (CI) 5.09 to 9.59) in women and 7.33 (95% CI 4.90 to 10.96) in men. The pooled ratio of the RRs was 0.92 (95% CI 0.72 to 1.16 I 2 =89% p .001), with no evidence of publication bias or differences across major pre-defined participant and study subtypes. The women-to-men ratio of RRs was 0.99 (95% CI 0.65 to 1.52), 1.11 (95% CI 0.75 to 1.64) and 0.94 (95% CI 0.69 to 1.30), for light, moderate and heavy smoking, respectively. Smoking yields similar risks of lung cancer in women compared with men. However, these data may underestimate the true risks of lung cancer among women, as the smoking epidemic has not yet reached full maturity in women. Continued efforts to measure the sex-specific association of smoking and lung cancer are required.
Publisher: SAGE Publications
Date: 22-10-2013
DOI: 10.1111/IJS.12166
Abstract: The risk of stroke is high in men among both Asian and non-Asian populations, despite differences in risk factor profiles whether risk factors act similarly in these populations is unknown. To study the associations between five major risk factors and stroke risk, comparing Asian with non-Asian men. We obtained data from the Asia Pacific Cohort Studies Collaboration, a pooled analysis of in idual participant data from 44 studies involving 386 411 men with 9·4 years follow-up. Using cohorts from Asia and Australia/New Zealand Cox models were fitted to estimate risk factor associations for ischemic and haemorrhagic stroke. We identified significant, positive associations between all five risk factors and risk of ischemic stroke. The associations between body mass index, smoking, and diabetes with ischemic stroke were comparable for men from Asia and Australia/New Zealand. The association between systolic blood pressure and ischemic stroke was stronger for Asian than Australia/New Zealand cohorts, whereas the reverse was true for total cholesterol. For haemorrhagic stroke, only systolic blood pressure and smoking were associated with increased risk, although the relationship with systolic blood pressure was significantly stronger for men from Asia than Australia/New Zealand ( P interaction = 0·03), whereas the reverse was true for smoking ( P interaction = 0·001). There was an inverse trend of total cholesterol with haemorrhagic stroke, significant only for Asian men. Men from the Asia-Pacific region share common risk factors for stroke. Strategies aimed at lowering population levels of systolic blood pressure, total cholesterol, body mass index, smoking, and diabetes are likely to be beneficial in reducing stroke risk, particularly for ischemic stroke, across the region.
Publisher: BMJ
Date: 21-12-2005
Publisher: Informa UK Limited
Date: 21-11-2013
Publisher: Public Library of Science (PLoS)
Date: 21-03-2008
Publisher: Japan Epidemiological Association
Date: 2016
Publisher: Oxford University Press (OUP)
Date: 06-03-2012
DOI: 10.1093/AJE/KWR391
Publisher: Environmental Health Perspectives
Date: 05-04-2018
DOI: 10.1289/EHP3062
Publisher: Springer Science and Business Media LLC
Date: 31-03-2015
Publisher: Wiley
Date: 28-02-2008
Publisher: Cambridge University Press (CUP)
Date: 12-2006
DOI: 10.1017/BJN20061888
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2008
DOI: 10.1161/STROKEAHA.107.496752
Abstract: Background and Purpose— Smoking and increased levels of blood pressure (BP) substantially increase the risk of cardiovascular diseases (CVD). If these 2 risk factors have a synergistic impact on cardiovascular events, lowering BP and quitting smoking will contribute more to reducing CVD than would be expected from ignoring their interaction. Methods— In idual participant data were combined from 41 cohorts, involving 563 144 participants (82% Asian). During a median of 6.8 years follow-up, 4344 coronary heart disease (CHD) and 5906 stroke events were recorded. Repeat measures of systolic blood pressure (SBP) were used to adjust for regression dilution bias. Hazard ratios (HRs) and 95% confidence intervals (CIs) for SBP by cigarette smoking status were estimated from Cox proportional hazard models adjusted for age and stratified by study and sex. Results— Data suggested a log-linear relationship between SBP and all subtypes of CVD. The HRs relating SBP to both CHD and ischemic stroke were broadly similar irrespective of smoking status ( P ≥0.1). For hemorrhagic stroke (intracerebral hemorrhage), the HRs (95% CIs) for an additional 10 mm Hg increment in SBP were 1.81 (1.73 to 1.90) for present smokers and 1.66 (1.59 to 1.73) for nonsmokers ( P =0.003). For every subtype of cardiovascular events, similar results were found for analyses involving only fatal events. Conclusions— Smoking exacerbated the impact of SBP on the risk of hemorrhagic stroke. Although quitting smoking and lowering BP are both crucial for prevention of CVD, combining the 2 could be expected to have extra beneficial effect on preventing hemorrhagic stroke.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2012
Publisher: Elsevier BV
Date: 03-2011
Publisher: BMJ
Date: 19-09-2011
Publisher: Oxford University Press (OUP)
Date: 02-04-2007
DOI: 10.1093/AJE/KWM002
Abstract: Cigarette smoking is becoming increasingly common in Asia while quitting remains rare, in part because of a lack of knowledge about the risks of smoking. This study compared the risk of death from lung cancer associated with smoking habits in Australia and New Zealand and in Asia by using data from the Asia Pacific Cohort Studies Collaboration: 31 studies involving 480,125 in iduals. Cox regression models were used. The hazard ratios for lung cancer mortality associated with current smoking were, for men, 2.48 (95% confidence interval (CI): 1.99, 3.11) in Asia versus 9.87 (95% CI: 6.04, 16.12) in Australia and New Zealand p for homogeneity <0.0001. For women, the corresponding estimates were 2.35 (95% CI: 1.29, 4.28) in Asia versus 19.33 (95% CI: 10.0, 37.3) in Australia and New Zealand p for homogeneity <0.0001. Quitting was beneficial in both regions the hazard ratios for former compared with current smokers were 0.69 (95% CI: 0.53, 0.92) in Asia and 0.30 (95% CI: 0.22, 0.41) in Australia and New Zealand. The lesser effect in Asia was partly explained by the fewer number of cigarettes smoked and the shorter duration of follow-up in Asian studies. These results suggest that tobacco control policies in Asia should not solely concentrate on preventing the uptake of smoking but also attend to cessation.
Publisher: BMJ
Date: 04-2004
Publisher: BMJ
Date: 16-11-2010
DOI: 10.1136/EBM1143
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2007
Publisher: BMJ
Date: 12-2015
Publisher: BMJ
Date: 2016
Publisher: Oxford University Press (OUP)
Date: 28-01-2011
Publisher: Elsevier BV
Date: 03-2014
Publisher: MDPI AG
Date: 22-09-2019
Abstract: Background: A growing body of epidemiological and clinical evidence has implicated air pollution as an emerging risk factor for cardiometabolic disease. Whilst in iduals spend up to two-thirds of daily time in their domestic residential environment, very few studies have been designed to objectively measure the sub-clinical markers of cardiometabolic risk with exposure to domestic indoor air pollutants. This cross-sectional study aims to investigate associations between the components of domestic indoor air quality and selected sub-clinical cardiometabolic risk factors in a cohort of healthy adults living in Perth, Western Australia. Methods: One hundred and eleven non-smoking adults (65% female) living in non-smoking households who were aged between 35–69 years were recruited for the project. Study subjects were invited to participate in all sections of the study, which included: Domestic indoor air monitoring along with the concurrent 24 h ambulatory monitoring of peripheral and central blood pressure and measures of central hemodynamic indices, standardized questionnaires on aspects relating to current health status and the domestic environment, a 24 h time-activity diary during the monitoring period, and clinic-based health assessment involving collection of blood and urine biomarkers for lipid and glucose profiles, as well as measures of renal function and an analysis of central pulse wave and pulse wave velocity. Results: This study provides a standardized approach to the study of sub-clinical cardiometabolic health effects that are related to the exposure to indoor air pollution. Conclusion: The findings of this study may provide direction for future research that will further contribute to our understanding of the relationship that exists between indoor air pollution and sub-clinical markers of cardiometabolic risk.
Publisher: Elsevier BV
Date: 2012
Publisher: Elsevier BV
Date: 08-2002
Publisher: Springer Science and Business Media LLC
Date: 24-12-2015
DOI: 10.1038/IJO.2015.254
Abstract: To conduct a comprehensive examination of the association between women's reproductive health factors and measures of body adiposity in a contemporary Western population. A cross-sectional analysis of 502 664 in iduals from the UK Biobank was conducted. Multivariable linear regression models were used to examine the association of age at menarche, age at first birth, parity and age at menopause with measures of general and central body adiposity, adjusted for age, smoking and socioeconomic status. The association between number of children and body adiposity in men was also assessed. Age at menarche was inversely associated with body mass index (BMI) adjusted mean BMI was 29.0 kg m(-2) in women with menarche before the age of 12 years, compared with 26.5 kg m(-2) in those who had menarche after 14 years of age. Age at first birth was linearly and inversely associated with BMI: 0.16 kg m(-2) lower BMI per year increase in age of first birth. Each additional live birth or child fathered was associated with a 0.22 kg m(-2) higher BMI in women and a 0.14 kg m(-2) higher BMI in men. There was no evidence for an association between age at menopause and BMI. Corresponding associations for other markers of general or abdominal adiposity were similar to those for BMI. Findings were broadly similar in analyses stratified by age, smoking status, socioeconomic status, ethnic background, and history of diabetes or cardiovascular disease. In women from a contemporary Western population, earlier age at menarche and age at first birth, and higher number of total live births were associated with higher levels of body adiposity. Prospective evaluations of the association between reproductive health factors, adiposity and the onset of cardiometabolic diseases are needed to assess causality, and to explore the mechanisms involved.
Publisher: Springer Science and Business Media LLC
Date: 09-10-2013
Publisher: Elsevier BV
Date: 12-2002
Publisher: Wiley
Date: 28-02-2008
Publisher: Oxford University Press (OUP)
Date: 20-06-2012
Abstract: Multiple studies have examined the relationship between heart rate and mortality however, there are discrepancies in results. Our aim was to describe the relationship between resting heart rate (RHR) and both major cardiovascular (CV) outcomes, as well as all-cause mortality in the Asia-Pacific region. In idual data from 112,680 subjects in 12 cohort studies were pooled and analysed using Cox models, stratified by study and sex, and adjusted for age and systolic blood pressure. During a mean 7.4 years follow-up, 6086 deaths and 2726 fatal or nonfatal CV events were recorded. There was a continuous, increasing association between having a RHR above approximately 65 beats/min and the risk of both CV and all-cause mortality, yet there was no evidence of associations below this threshold. The hazard ratio (95% CI) comparing the extreme quarters of RHR (80+ v <65 beats/min) was 1.44 (1.29-1.60) for CV and 1.54 (1.43-1.66) for total mortality. These associations were not materially changed by adjustment for other risk factors and exclusion of the first 2 years of follow-up. Hazard ratios of a similar magnitude were found for ischemic and hemorrhagic stroke, but the hazard ratio for heart failure was higher (2.08, 95% CI 1.07-4.06) and for Coronary Heart Disease (CHD) was lower (1.11, 95% CI 0.93-1.31) than for stroke. RHR of above 65 beats/min has a strong independent effect on premature mortality and stroke, but a lesser effect on CHD. Lifestyle and pharmaceutical regimens to reduce RHR may be beneficial for people with moderate to high levels of RHR.
Publisher: Springer Science and Business Media LLC
Date: 09-09-2009
Publisher: American Diabetes Association
Date: 12-2008
DOI: 10.2337/DC08-1038
Abstract: OBJECTIVE—Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for the development of type 2 diabetes in the mother and is responsible for morbidity in the child. To better identify women at risk of developing GDM we examined sociodemographic correlates and changes in the prevalence of GDM among all births between 1995 and 2005 in Australia's largest state. RESEARCH DESIGN AND METHODS—A computerized database of all births (n = 956,738) between 1995 and 2005 in New South Wales, Australia, was used in a multivariate logistic regression that examined the association between sociodemographic characteristics and the occurrence of GDM. RESULTS—Between 1995 and 2005, the prevalence of GDM increased by 45%, from 3.0 to 4.4%. Women born in South Asia had the highest adjusted odds ratio (OR) of any region (4.33 [95% CI 4.12–4.55]) relative to women born in Australia. Women living in the three lowest socioeconomic quartiles had higher adjusted ORs for GDM relative to women in the highest quartile (1.54 [1.50–1.59], 1.74 [1.69–1.8], and 1.65 [1.60–1.70] for decreasing socioeconomic status quartiles). Increasing age was strongly associated with GDM, with women aged & years having an adjusted OR of 6.13 (95% CI 5.79–6.49) relative to women in their early 20s. Parity was associated with a small reduced risk. There was no association between smoking and GDM. CONCLUSIONS—Maternal age, socioeconomic position, and ethnicity are important correlates of GDM. Future culturally specific interventions should target prevention of GDM in these high-risk groups.
Publisher: Wiley
Date: 06-04-2015
DOI: 10.1002/IJC.29529
Abstract: Obesity is a risk factor for cancer. However, it is not known if general adiposity, as measured by body mass index (BMI) or central adiposity [e.g., waist circumference (WC)] have stronger associations with cancer, or which anthropometric measure best predicts cancer risk. We included 79,458 men and women from the Australian and New Zealand Diabetes and Cancer Collaboration with complete data on anthropometry [BMI, WC, Hip Circumference (HC), WHR, waist to height ratio (WtHR), A Body Shape Index (ABSI)], linked to the Australian Cancer Database. Cox proportional hazards models assessed the association between each anthropometric marker, per standard deviation and the risk of overall, colorectal, post-menopausal (PM) breast, prostate and obesity-related cancers. We assessed the discriminative ability of models using Harrell's c-statistic. All anthropometric markers were associated with overall, colorectal and obesity-related cancers. BMI, WC and HC were associated with PM breast cancer and no significant associations were seen for prostate cancer. Strongest associations were observed for WC across all outcomes, excluding PM breast cancer for which HC was strongest. WC had greater discrimination compared to BMI for overall and colorectal cancer in men and women with c-statistics ranging from 0.70 to 0.71. We show all anthropometric measures are associated with the overall, colorectal, PM breast and obesity-related cancer in men and women, but not prostate cancer. WC discriminated marginally better than BMI. However, all anthropometric measures were similarly moderately predictive of cancer risk. We do not recommend one anthropometric marker over another for assessing an in iduals' risk of cancer.
Publisher: Japanese Circulation Society
Date: 2013
Publisher: Public Library of Science (PLoS)
Date: 15-03-2013
Publisher: Wiley
Date: 29-07-2009
DOI: 10.1002/MSJ.20125
Abstract: Smoking and alcohol are major causal factors for upper aerodigestive tract cancer, but reliable quantification of the combined impact of smoking and alcohol on this cancer and its major subtypes has not been performed. A meta-analysis of studies that had published quantitative estimates of smoking and upper aerodigestive tract cancer by January 2007 was performed. Pooled estimates of relative risks were obtained. Publication bias was investigated through funnel plots and corrected if found to be present. Overall, 85 studies with information on 53,940 in iduals with upper aerodigestive tract cancer were included. The pooled estimate for the association between smoking and the risk of this cancer was 3.47 (95% confidence interval, 3.06-3.92). The risk remained elevated for a decade after smoking cessation but declined thereafter. In iduals who both smoked and consumed alcohol had double the risk of upper aerodigestive tract cancer in comparison with those who only smoked: the relative risk was 6.93 (95% confidence interval, 4.99-9.62) for the former and 2.56 (95% confidence interval, 2.20-2.97) for the latter (P < 0.001). Public health interventions that simultaneously discourage smoking and heavy drinking would have greater benefits than would be expected from those that target only one of these risk factors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
DOI: 10.1161/STROKEAHA.111.000173
Abstract: Increased levels of plasma troponins and natriuretic peptides are associated with increased risk of cardiovascular disease, but only limited information exists on these biomarkers and stroke occurrence. In a prospective epidemiological study, we tested the hypothesis that high-sensitivity troponin T (TnT) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) are associated positively with incidence of stroke. The Atherosclerosis Risk in Communities (ARIC) Study measured plasma TnT and NT-proBNP in 10 902 men or women initially free of stroke and followed them for a mean of 11.3 years for stroke occurrence (n=507). Both biomarkers were associated positively with total stroke, nonlacunar ischemic, and especially cardioembolic stroke, but not with lacunar or hemorrhagic stroke. For ex le, after adjustment for prevalent risk factors and cardiac diseases, the hazard ratios (95% CIs) for jointly high values of TnT and NT-proBNP (versus neither biomarker high) were 2.70 (1.92–3.79) for total stroke and 6.26 (3.40–11.5) for cardioembolic stroke. Associations with stroke appeared somewhat stronger for NT-proBNP than TnT. Strikingly, ≈58% of cardioembolic strokes occurred in the highest quintile of prestroke NT-proBNP, and 32% of cardioembolic strokes occurred in participants who had both NT-proBNP in the highest quintile and were known by ARIC to have atrial fibrillation sometime before their cardioembolic stroke occurrence. In the general population, elevated plasma TnT and NT-proBNP concentrations are associated with increased risk of cardioembolic and other nonlacunar ischemic strokes.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.EHB.2009.06.004
Abstract: This overview, based on a literature review and new data from the three cohorts (Whitehall Studies I and II, and the Vietnam Experience Study), has four objectives: (a) to outline the major determinants of height, so providing an indication as to what exposures this characteristic may capture (b) to summarise, by reviewing reports from large scale studies, the relation between adult height and a range of disease outcomes--both somatic and psychiatric--with particular emphasis on coronary heart disease (CHD) and stroke (c) to discuss why these relationships may exist, in particular, the role, if any, of socioeconomic position in explaining the apparent associations and, finally (d) to outline future research directions in this field. The large majority of evidence for predictors of height, and its health consequences, comes from observational studies. While genetic predisposition is a major determinant of height, secular rises in childhood and adult stature across successive birth cohorts suggest that early life environment also has an important impact. Plausible non-genetic determinants of height include nutrition, illness, socioeconomic status, and psychosocial stress. Evidence for an association between height and a series of health endpoints is accumulating. Thus, shorter people appear to experience increased risk of CHD, and these associations appear to be independent of socioeconomic position and other potentially confounding variables. For stroke, and its sub-types, findings are less clear. In contrast to CHD, some cancers, such as carcinoma of the colorectum, prostate, breast (in women), central nervous system, skin, endometrium, thyroid and blood (haematopoietic) are more common in taller people. While height may be negatively related to the risk of completed suicide, conclusions about the links between stature and other health endpoints is problematic given the paucity of evidence, which should be addressed. Ultimately, for want of better data, investigators in this area have used height as a proxy for a range of pre-adult exposures. In future, research should aim to explore the predictive capacity of direct measures of diet, psychosocial stress, childhood chronic illness and so on, rather than focus on height or its components. The problem is that extended follow-up of child cohorts with such data are required, and studies which hold these data are not currently available, although several are either maturing to the point where they offer sufficient clinical outcomes to facilitate analyses or are in the advanced planning stage.
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.DIABRES.2008.05.011
Abstract: To compare the prevalence of metabolic syndrome (MetS) by combinations of MetS components derived from the National Cholesterol Education Program Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) definitions. Four studies with ethnically distinct populations from the Asia-Pacific region were selected from the DETECT-2 study database. The prevalences of combinations of MetS components using the modified ATPIII (modATPIII) and IDF MetS definitions were compared between sexes and across populations. A total of 22,952 participants from Australia, Japan, Korea and Samoa were included. The age-adjusted prevalence of modATPIII MetS varied from 9.4 to 35.8% in men and 10.3 to 57.2% in women results for IDF were generally higher. Prevalences of the 16 possible MetS component combinations from the modATPIII definition that result in a diagnosis of MetS ranged from 0 to 12.7%. Of those with IDF-defined abdominal obesity, the prevalences of the 11 IDF-defined MetS component combinations ranged from 0.2 to 18.3%. The large variation in the prevalence of possible MetS component combinations to diagnose MetS may explain the different risk of cardiovascular outcomes associated with MetS in different populations, especially since particular combinations of MetS components are associated with different risk of cardiovascular disease.
Publisher: Japanese Circulation Society
Date: 2015
Publisher: American Medical Association (AMA)
Date: 08-12-2004
Abstract: Inverse associations between birth weight and subsequent blood cholesterol levels have been used to support the "fetal origins" hypothesis of the relevance of fetal nutrition to adult disease. To perform a systematic review of the association between birth weight and total blood cholesterol levels, and to explore the impact of including unpublished results, adjusting for potential confounders. Relevant studies published by September 30, 2004, were identified through literature searches using EMBASE and MEDLINE and MeSH heading search strategy (using terms such as birth weight, intrauterine growth retardation, fetal growth retardation and cholesterol, lipoprotein, lipid). Studies that reported qualitative or quantitative estimates of the association between birth weight and total blood cholesterol, or had recorded both measures but not reported on their associations, were included. A total of 79 relevant studies involving a total of 74,122 in iduals were identified 65 had reported on the direction of the association between birth weight and total blood cholesterol. Although regression coefficients were published for only 11 studies and other quantitative estimates for 3 other studies, regression coefficients (published or unpublished) were obtained for 58 studies among 68,974 in iduals. Inverse associations were observed in 11 of 14 studies that had previously published quantitative estimates but in only 18 of the remaining 51 that had reported on the direction of this association (heterogeneity P = .004). Similarly, the weighted estimate for the 11 studies was -1.89 mg/dL (-0.049 mmol/L) total cholesterol per kilogram birth weight compared with -0.69 mg/dL (-0.018 mmol/L) per kilogram for 47 studies that provided unpublished regression coefficients (heterogeneity P = .009). Overall, the weighted estimate from the 58 contributing studies was -1.39 mg/dL (-0.036 mmol/L) per kilogram (95% confidence interval, -1.81 to -0.97 mg/dL [-0.047 to -0.025 mmol/L]), but there was significant heterogeneity between their separate results (P<.001). Part of this heterogeneity appears to reflect stronger associations reported from smaller studies and studies of cholesterol levels in infants. These findings suggest that impaired fetal growth does not have effects on blood cholesterol levels that would have a material impact on vascular disease risk.
Publisher: Elsevier BV
Date: 10-2011
Publisher: Cambridge University Press (CUP)
Date: 03-2004
DOI: 10.1079/BJN20031052
Abstract: The fetal-origins hypothesis suggests that maternal and fetal nutrition can have a profound and sustained impact on the health of the offspring in adult life. Although there is abundant literature reporting on the associations between birth weight and disease risk factors, only a handful of studies have been able to examine the relationship between maternal nutrition in pregnancy with the health of offspring in adult life directly. Between 1942 and 1944, nearly 400 pregnant women were recruited into a dietary study to determine whether the wartime dietary rations were sufficient to prevent nutritional deficiencies. Detailed biochemical and clinical assessments were conducted for each of the women, who were followed-up until after delivery. More than 50 years later, approximately one-quarter of the adult offspring were recruited into a study to explore the possible impact of maternal nutrition in pregnancy on CHD risk factors, including glucose tolerance, blood pressure and components of the lipid profile. Results from the present study provide no evidence to support the hypothesis that birth weight or maternal nutrition in pregnancy are associated with CHD risk factors in adult life.
Publisher: Elsevier BV
Date: 02-2017
Publisher: Springer Science and Business Media LLC
Date: 02-10-2013
Publisher: BMJ
Date: 23-07-2019
DOI: 10.1136/HEARTJNL-2019-315134
Abstract: To determine whether sex differences exist in the management of patients with a history of coronary heart disease (CHD) in primary care. General practice records of patients aged ≥18 years with a history of CHD in a large general practice dataset in Australia, MedicineInsight, were analysed. Sex-specific, age-standardised proportions of patients prescribed with recommended medications assessed for cardiovascular risk factors and achieved treatment targets according to the General Practice Management Plan were reported. Records of 130 926 patients (47% women) from 438 sites were available from 2014 to 2018. Women were less likely to be prescribed with recommended medications (prescribed ≥3 medications: women 44%, men 61% p .001). Younger patients, especially women aged years, were substantially underprescribed (aged years prescribed ≥3 medications: women 2%, men 8% p .001). Lower proportions of women were assessed for cardiovascular risk factors (blood test for lipids: women 70%–76%, men 77%–81% p .001). Body size was not commonly assessed (body mass index: women 59%, men 62% p .001 waist: women 23%, men 25% p .001). Higher proportions of women than men achieved targets for most risk factors (achieved ≥4 targets in patients assessed for all risk factors: women 82%, men 76%). Gaps in preventative management including prescription of indicated medications and risk factor monitoring have been reported from the late 1990s and this large-scale general practice data analysis indicate they still persist. Moreover, the gap is larger in women compared to men. We need new ways to address these gaps and the sex inequity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-02-2015
Publisher: BMJ
Date: 2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
Publisher: Wiley
Date: 27-03-2009
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.ATHEROSCLEROSIS.2016.03.016
Abstract: Raised total cholesterol is a strong risk factor for cardiovascular disease (CVD). It remains unknown whether sex differences exist in the relationship between total cholesterol and CVD outcomes. PubMed was searched in December 2014 for cohort studies reporting on the relationship between total cholesterol and coronary heart disease (CHD) and total stroke, separately in men and women. Random effects meta-analyses with inverse variance weighting were used to obtain adjusted pooled sex-specific relative risks (RR) and women-to-men ratio of RRs (RRRs). Data from 97 cohorts, 1,022,276 in iduals, and 20,176 CHD and 13,067 stroke cases were included. The pooled RR (95% confidence interval) for CHD associated with a 1-mmol/L increase in total cholesterol was 1.20 (1.16 1.24) in women and 1.24 (1.20 1.28) in men, resulting in a RRR of 0.96 (0.93 0.99). Corresponding RRs for the risk of total stroke were 1.01 (0.98 1.05) in women, and 1.03 (1.00 1.05) in men, with a pooled RRR of 0.99 (0.93 1.04). Pooled RRRs (95% CI) comparing in iduals in the highest TC category to those in the lowest, such as the highest versus lowest third, were 0.87 (0.79 0.96) for CHD and 0.86 (0.76 0.97) for total stroke. Raised total cholesterol is a strong risk factor for CHD, with evidence of a small, but significantly stronger, effect in men compared to women. Raised total cholesterol had little effect on the risk of total stroke in both sexes.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.ENVRES.2015.11.004
Abstract: China is experiencing more and more days of serious air pollution recently, and has the highest lung cancer burden in the world. To examine the associations between lung cancer incidence and fine particles (PM2.5) and ozone in China. We used 75 communities' data of lung cancer incidence from the National Cancer Registration of China from 1990 to 2009. The annual concentrations of fine particles (PM2.5) and ozone at 0.1°×0.1° spatial resolution were generated by combing remote sensing, global chemical transport models, and improvements in coverage of surface measurements. A spatial age-period-cohort model was used to examine the relative risks of lung cancer incidence associated with the air pollutants, after adjusting for impacts of age, period, and birth cohort, sex, and community type (rural and urban) as well as the spatial variation on lung cancer incidence. The relative risks of lung cancer incidence related to a 10 µg/m(3) increase in 2-year average PM2.5 were 1.055 (95% confidence interval (CI): 1.038, 1.072) for men, 1.149 (1.120, 1.178) for women, 1.060 (1.044, 1.075) for an urban communities, 1.037 (0.998, 1.078) for a rural population, 1.074 (1.052, 1.096) for people aged 30-65 years, and 1.111 (1.077, 1.146) for those aged over 75 years. Ozone also had a significant association with lung cancer incidence. The increased risks of lung cancer incidence were associated with PM2.5 and ozone air pollution. Control measures to reduce air pollution would likely lower the future incidence of lung cancer.
Publisher: Elsevier BV
Date: 03-2015
Publisher: American Diabetes Association
Date: 12-06-2015
DOI: 10.2337/DC14-2820
Abstract: To investigate infection-related mortality in in iduals with type 1 and type 2 diabetes. A total of 1,108,982 in iduals with diabetes who were registered with the Australian Diabetes register between 2000 and 2010 were linked to the National Death Index. Mortality outcomes were defined as infection-relatedA-B death (ICD codes A99–B99), pneumonia (J12–J189), septicemia (A40 and A41), and osteomyelitis (M86). During a median follow-up of 6.7 years, there were 2,891, 2,158, 1,248, and 147 deaths from infection-relatedA-B causes, pneumonia, septicemia, or osteomyelitis, respectively. Crude mortality rates from infectionsA-B were 0.147 and 0.431 per 1,000 person-years in type 1 and type 2 diabetes, respectively. Standardized mortality ratios (SMRs) were higher in type 1 and type 2 diabetes for all outcomes after adjustment for age and sex. For infection-relatedA-B mortality, SMRs were 4.42 (95% CI 3.68–5.34) and 1.47 (1.42–1.53) for type 1 and type 2 diabetes (P & 0.001), respectively. For pneumonia in type 1 diabetes, SMRs were approximately 5 and 6 in males and females, respectively, while the excess risk was ∼20% for type 2 (both sexes). For septicemia, SMRs were approximately 10 and 2 for type 1 and type 2 diabetes, respectively, and similar by sex. For osteomyelitis in type 1 diabetes, SMRs were 16 and 58 in males and females, respectively, and ∼3 for type 2 diabetes (both sexes). Although death owing to infection is rare, we confirm that patients with diabetes have an increased mortality from a range of infections, compared with the general population, and that the increased risk appears to be greater for type 1 than type 2 diabetes.
Publisher: BMJ
Date: 12-2019
DOI: 10.1136/BMJDRC-2019-000794
Abstract: There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful. We conducted an in idual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell’s C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points. Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79–0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol). In terms of identifying in iduals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying in iduals at risk of diabetes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-04-2011
DOI: 10.1161/CIRCULATIONAHA.110.009035
Abstract: Atrial fibrillation (AF) is an important risk factor for stroke and overall mortality, but information about the preventable burden of AF is lacking. The aim of this study was to determine what proportion of the burden of AF in blacks and whites could theoretically be avoided by the maintenance of an optimal risk profile. This study included 14 598 middle-aged Atherosclerosis Risk in Communities (ARIC) Study cohort members. Previously established AF risk factors, namely high blood pressure, elevated body mass index, diabetes mellitus, cigarette smoking, and prior cardiac disease, were categorized into optimal, borderline, and elevated levels. On the basis of their risk factor levels, in iduals were classified into 1 of these 3 groups. The population-attributable fraction of AF resulting from having a nonoptimal risk profile was estimated separately for black and white men and women. During a mean follow-up of 17.1 years, 1520 cases of incident AF were identified. The age-adjusted incidence rates were highest in white men and lowest in black women (7.45 and 3.67 per 1000 person-years, respectively). The overall prevalence of an optimal risk profile was 5.4% but varied according to race and gender: 10% in white women versus 1.6% in black men. Overall, 56.5% of AF cases could be explained by having ≥1 borderline or elevated risk factors, of which elevated blood pressure was the most important contributor. As with other forms of cardiovascular disease, more than half of the AF burden is potentially avoidable through the optimization of cardiovascular risk factors levels.
Publisher: Elsevier BV
Date: 08-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2014
DOI: 10.1161/CIRCEP.113.001244
Abstract: Physical activity (PA) has previously been suggested to attenuate the risk of atrial fibrillation (AF) conferred by excess body weight and weight gain. We prospectively examined the relationship between body size, weight change, and level of PA in a biracial cohort of middle-aged men and women. Baseline characteristics on risk factor levels were obtained on 14 219 participants from the Atherosclerosis Risk in Communities Study. AF incidence was ascertained from 1987 to 2009. Adjusted Cox proportional hazards models were used to estimate the associations between body mass index, waist circumference, relative weight change, and PA level with incident AF. During follow-up, there were 1775 cases of incident AF. Body mass index and waist circumference were positively associated with AF as was weight loss/gain of % initial body weight. An ideal level of PA had a small protective effect on AF risk and partially attenuated the risk of AF associated with excess weight in men but not women: compared with men with a normal body mass index, the risk of AF in obese men with an ideal, intermediate, and poor level of PA at baseline was increased by 37%, 129%, and 156% ( P interaction =0.04). During follow-up, PA did not modify the association between weight gain and risk of AF. Obesity and extreme weight change are risk factors for incident AF, whereas being physically active is associated with a small reduction in risk. In men only, being physically active offset some, but not all, of the risk incurred with excess body weight.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2009
DOI: 10.1161/HYPERTENSIONAHA.109.133041
Abstract: The relative importance of various blood pressure indices on cardiovascular risk in people with type 2 diabetes mellitus has not been established. This study compares the strengths of the associations between different baseline blood pressure variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], and mean arterial pressure) and the 4.3-year risk of major cardiovascular events in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation Study. Mean (SD) age for the 11 140 participants was 65.8 years (6.4 years). During follow-up, 1000 major cardiovascular events, 559 major coronary events, and 468 cardiovascular deaths were recorded. After adjustment for age, sex, and treatment allocation, the hazard ratios (95% CIs) associated with 1 increment in SD for the risk of major cardiovascular events were 1.17 (1.10 to 1.24) for SBP 1.20 (1.13 to 1.28) for PP 1.12 (1.05 to 1.19) for mean arterial pressure and 1.04 (0.98 to 1.11) for DBP. The areas under the receiver operating characteristic curve were slightly higher for SBP and PP compared with mean arterial pressure and DBP for major cardiovascular and coronary events. Using achieved instead of baseline blood pressure values marginally improved the effect estimates for SBP, DBP, and mean arterial pressure, with no significant differences in the areas under the receiver operating characteristic curve between models with SBP and those with PP. In conclusion, SBP and PP are the 2 best and DBP is the least effective determinant of the risk of major cardiovascular outcomes in the relatively old patients with type 2 diabetes mellitus participating in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation Study. However, SBP may be the simplest and most useful predictor across a wider range of age groups and populations.
Publisher: Elsevier BV
Date: 03-2013
Publisher: MDPI AG
Date: 03-04-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
DOI: 10.1161/STROKEAHA.113.002342
Abstract: It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men. PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled. Data from 81 prospective cohort studies that included 3 980 359 in iduals and 42 401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99–1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02–1.18)] but not in Asian (RRR, 0.97 [0.87–1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99–1.22]). Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.
Publisher: American Association for Cancer Research (AACR)
Date: 12-2006
DOI: 10.1158/1055-9965.EPI-06-0368
Abstract: Background: Pancreatic cancer accounts for about 220,000 deaths each year. Known risk factors are smoking and type 2 diabetes. It remains to be seen whether these risk factors are equally important in Asia and whether other modifiable risk factors have important associations with pancreatic cancer. Methods: An in idual participant data analysis of 30 cohort studies was carried out, involving 420,310 Asian participants (33% female) and 99,333 from Australia/New Zealand (45% female). Cox proportional hazard models, stratified by study and sex and adjusted for age, were used to quantify risk factors for death from pancreatic cancer. Results: During 3,558,733 person-years of follow-up, there were 324 deaths from pancreatic cancer (54% Asia and 33% female). Mortality rates (per 100,000 person-years) from pancreatic cancer were 10 for men and 8 for women. The following are age-adjusted hazard ratios (95% confidence interval) for death from pancreatic cancer: for current smoking, 1.61 (1.12-2.32) for diabetes, 1.76 (1.15-2.69) for a 2-cm increase in waist circumference, 1.08 (1.02-1.14). All three relationships remained significant (P & 0.05) after adjustment for other risk factors. There was no evidence of heterogeneity in the strength of these associations between either cohorts from Asia and Australia/New Zealand or between the sexes. In men, the combination of cigarette smoking and diabetes more than doubled the likelihood of pancreatic cancer (2.47 95% confidence interval, 1.17-5.21) in both regions. Conclusions: Smoking, obesity, and diabetes are important and are potentially modifiable risk factors for pancreatic cancer in populations of the Asia-Pacific region. Activities to prevent them can be expected to lead to a major reduction in the number of deaths from this cancer, particularly in Asia with its enormous population. (Cancer Epidemiol Biomarkers Prev 2006 (12):2435–40)
Publisher: Springer Science and Business Media LLC
Date: 24-07-2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2000
DOI: 10.1016/S0029-7844(99)00662-6
Abstract: Nausea and emesis in early pregnancy is a common phenomenon affecting between 50% and 70% of pregnant women, but little is known about the etiology and possible function of this common and often incapacitating condition. Morning sickness has been reported to have a positive effect on pregnancy outcome and is associated with a decreased risk of miscarriage, preterm birth, low birth weight (LBW), and perinatal death. Both human and animal studies have shown that reduced energy intakes in early pregnancy are associated with increased placental weight. Based on evidence from the literature, a hypothesis is proposed that suggests a functional role for the nausea and emesis of pregnancy in stimulating early placental growth. It is suggested that morning sickness, resulting from secretion of hCG and thyroxine, reduces maternal energy intake. As a result, maternal levels of the anabolic hormones, insulin, and insulin growth factor-1 (IGF-1) are lowered. By suppressing maternal tissue synthesis in early pregnancy, we propose that nausea and vomiting in pregnancy helps ensure that nutrient partitioning favors the developing placenta. Evidence is also presented that suggests there may be a positive relationship between morning sickness and preconceptional body mass index (BMI), such that women who are underweight will experience less severe symptoms of morning sickness compared with women with normal preconceptional BMIs.
Publisher: American Diabetes Association
Date: 17-12-2015
DOI: 10.2337/DC15-1588
Abstract: Type 2 diabetes confers a greater excess risk of cardiovascular disease in women than in men. Diabetes is also a risk factor for dementia, but whether the association is similar in women and men remains unknown. We performed a meta-analysis of unpublished data to estimate the sex-specific relationship between women and men with diabetes with incident dementia. A systematic search identified studies published prior to November 2014 that had reported on the prospective association between diabetes and dementia. Study authors contributed unpublished sex-specific relative risks (RRs) and 95% CIs on the association between diabetes and all dementia and its subtypes. Sex-specific RRs and the women-to-men ratio of RRs (RRRs) were pooled using random-effects meta-analyses. Study-level data from 14 studies, 2,310,330 in iduals, and 102,174 dementia case patients were included. In multiple-adjusted analyses, diabetes was associated with a 60% increased risk of any dementia in both sexes (women: pooled RR 1.62 [95% CI 1.45–1.80] men: pooled RR 1.58 [95% CI 1.38–1.81]). The diabetes-associated RRs for vascular dementia were 2.34 (95% CI 1.86–2.94) in women and 1.73 (95% CI 1.61–1.85) in men, and for nonvascular dementia, the RRs were 1.53 (95% CI 1.35–1.73) in women and 1.49 (95% CI 1.31–1.69) in men. Overall, women with diabetes had a 19% greater risk for the development of vascular dementia than men (multiple-adjusted RRR 1.19 [95% CI 1.08–1.30] P & 0.001). In iduals with type 2 diabetes are at ∼60% greater risk for the development of dementia compared with those without diabetes. For vascular dementia, but not for nonvascular dementia, the additional risk is greater in women.
Publisher: Wiley
Date: 18-06-2021
DOI: 10.1111/DME.14611
Abstract: To examine psychosocial and behavioural impacts of the novel coronavirus disease 2019 (COVID‐19) pandemic and lockdown restrictions among adults with type 2 diabetes. Participants enrolled in the PRogrEssion of DIabetic ComplicaTions (PREDICT) cohort study in Melbourne, Australia ( n = 489 with a baseline assessment pre‐2020) were invited to complete a phone/online follow‐up assessment in mid‐2020 (i.e., amidst COVID‐19 lockdown restrictions). Repeated assessments that were compared with pre‐COVID‐19 baseline levels included anxiety symptoms (7‐item Generalised Anxiety Disorder scale [GAD‐7]), depressive symptoms (8‐item Patient Health Questionnaire [PHQ‐8]), diabetes distress (Problem Areas in Diabetes scale [PAID]), physical activity/sedentary behaviour, alcohol consumption and diabetes self‐management behaviours. Additional once‐off measures at follow‐up included COVID‐19‐specific worry, quality of life (QoL), and healthcare appointment changes (telehealth engagement and appointment cancellations/avoidance). Among 470 respondents (96% aged 66 ± 9 years, 69% men), at least ‘moderate’ worry about COVID‐19 infection was reported by 31%, and 29%–73% reported negative impacts on QoL dimensions (greatest for: leisure activities, feelings about the future, emotional well‐being). Younger participants reported more negative impacts ( p 0.05). Overall, anxiety/depressive symptoms were similar at follow‐up compared with pre‐COVID‐19, but diabetes distress reduced ( p 0.001). Worse trajectories of anxiety/depressive symptoms were observed among those who reported COVID‐19‐specific worry or negative QoL impacts ( p 0.05). Physical activity trended lower (~10%), but sitting time, alcohol consumption and glucose‐monitoring frequency remained unchanged. 73% of participants used telehealth, but 43% cancelled a healthcare appointment and 39% avoided new appointments despite perceived need. COVID‐19 lockdown restrictions negatively impacted QoL, some behavioural risk factors and healthcare utilisation in adults with type 2 diabetes. However, generalised anxiety and depressive symptoms remained relatively stable.
Publisher: Elsevier BV
Date: 06-2014
Publisher: BMJ
Date: 14-08-2018
Publisher: Springer Science and Business Media LLC
Date: 16-09-2008
DOI: 10.1038/IJO.2008.162
Abstract: Obesity has been implicated in the aetiology of liver disease. However, to date, evidence is largely drawn from cross-sectional studies, where interpretation is h ered by reverse causality, and from studies on clinical populations that have limited generalisability. In this prospective cohort study, data on body mass index (BMI) and covariates were collected at baseline on 18 863 male government employees (aged 40-69 years). Respondents were then followed up for a maximum of 38 years of age. Mortality surveillance gave rise to 13 129 deaths, 122 of which were due to liver disease (57 cancers 65 non-cancers). In age-adjusted analyses, BMI was positively related to total liver disease mortality (hazards ratio per 1 s.d. increase in BMI 95% confidence interval (CI): 1.36 1.14, 1.62) in a graded fashion across the weight categories (P-value for trend: 0.01). The magnitude of this association was somewhat stronger for non-cancer liver disease deaths (1.47 1.16, 1.86) than for cancer liver disease deaths (1.25 0.96, 1.62). Excluding deaths in the first 10 years of follow-up somewhat strengthened the BMI-non-cancer liver disease association. Adjustment for socioeconomic position, other candidate confounders and mediating factors led to the modest attenuation of these associations. Further investigation in prospective cohort studies with more detailed data on liver disease, for instance using biochemical tests of liver function or hepatic ultrasonography, is warranted.
Publisher: Wiley
Date: 06-04-2009
DOI: 10.1002/IJC.24343
Abstract: Colorectal cancer is a major cause of cancer mortality and is considered to be largely attributable to inappropriate lifestyle and behavior patterns. The purpose of this review was to undertake a comparison of the strength of the associations between known and putative risk factors for colorectal cancer by conducting 10 independent meta-analyses of prospective cohort studies. Studies published between 1966 and January 2008 were identified through EMBASE and MEDLINE, using a combined text word and MESH heading search strategy. Studies were eligible if they reported estimates of the relative risk for colorectal cancer with any of the following: alcohol, smoking, diabetes, physical activity, meat, fish, poultry, fruits and vegetables. Studies were excluded if the estimates were not adjusted at least for age. Overall, data from 103 cohort studies were included. The risk of colorectal cancer was significantly associated with alcohol: in iduals consuming the most alcohol had 60% greater risk of colorectal cancer compared with non- or light drinkers (relative risk 1.56, 95% CI 1.42-1.70). Smoking, diabetes, obesity and high meat intakes were each associated with a significant 20% increased risk of colorectal cancer (compared with in iduals in the lowest categories for each) with little evidence of between-study heterogeneity or publication bias. Physical activity was protective against colorectal cancer. Public-health strategies that promote modest alcohol consumption, smoking cessation, weight loss, increased physical activity and moderate consumption of red and processed meat are likely to have significant benefits at the population level for reducing the incidence of colorectal cancer.
Publisher: Springer Science and Business Media LLC
Date: 12-10-2023
DOI: 10.1007/S11869-022-01270-4
Abstract: Despite that large percentages of in idual daily time is spent in the home, few studies have examined the relationship between indoor particulate matter (PM) exposure in residential settings with subclinical indicators of cardiovascular risk. This cross-sectional study investigated associations between exposure to fine (PM 2.5 ) and ultrafine (UFP) PM in domestic indoor environments, with central blood pressure (BP) and component BP measures (pulse pressure, augmented pressure [AP], augmentation index [AIx], mean arterial pressure, pulse wave velocity [PWV]) in 40 non-smoking, otherwise healthy adults (58% women) living in Perth, Western Australia. Overall, in adjusted models, an interquartile range (IQR) increase in PM 2.5 was associated with a 3.2 mmHg (95% confidence interval [CI]: 0.99, 5.45) higher diastolic BP, and a 1.8 mmHg lower AP (95%CI: − 3.63, − 0.01) and 0.4 m/s PWV (95%CI: − 0.80, − 0.08), respectively. For the UFP fraction, an IQR increase was associated with a 5.2% higher AIx (95%CI: 0.51, 9.97) and a 0.6 m/s lower PWV (95%CI: − 1.00, − 0.11). When stratified by sex, higher UFP concentrations were associated with higher DBP and lower PWV among women. Among men, higher UFP concentrations were associated with lower AP. Exposure to domestic indoor fine and ultrafine PM was associated with preclinical indicators of cardiovascular risk and some of these relationships were affected by sex. These findings contribute important evidence linking low-level residential indoor PM exposure with measurable impacts on cardiovascular physiology and may inform preventative recommendations as part of risk profiles for susceptible in iduals.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Publisher: Public Library of Science (PLoS)
Date: 22-02-2019
Publisher: Oxford University Press (OUP)
Date: 08-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Abstract: It is unclear whether ideal cardiovascular health ( CVH ), and particularly cumulative exposure to ideal CVH (cum CVH ), is associated with incident diabetes. We aimed to fill this research gap. The Kailuan Study is a prospective cohort of 101 510 adults aged 18 to 98 years recruited in 2006–2007 and who were subsequently followed up at 2‐ (Exam 2), 4‐ (Exam 3), and 6 (Exam 4)‐year intervals after baseline. The main analysis is restricted to those in iduals with complete follow‐up at all 4 examinations and who had no history of diabetes until Exam 3. Cumulative exposure to ideal CVH (cum CVH ) was calculated as the summed CVH score for each examination multiplied by the time between the 2 examinations (score×year). Logistic regression models were used to assess the association between cum CVH and incident diabetes. In fully adjusted models, compared with the lowest quintile of cum CVH , in iduals in the highest quintile had ~68% (95% confidence interval [ CI ] 60‐75) lower risk for incident diabetes (compared with 61% [95% CI 52‐69] lower risk when using baseline CVH ). Every additional year lived with a 1‐unit increase in ideal CVH was associated with a 24% (95% CI 21‐28) reduction in incident diabetes. Ideal CVH is associated with a reduced incidence of diabetes, but the association is likely to be underestimated if baseline measures of CVH exposure are used. Measures of cumulative exposure to ideal CVH are more likely to reflect lifetime risk of diabetes and possibly other health outcomes. URL : www.chictr.org . Unique identifier: Chi CTRTNC ‐11001489.
Publisher: Oxford University Press (OUP)
Date: 04-11-2015
DOI: 10.1093/JAC/DKV346
Abstract: This systematic review and meta-analysis compared effects of different antibiotics on mortality in patients with bloodstream infections caused by Enterobacteriaceae with chromosomal AmpC β-lactamase. Databases were systematically searched for studies reporting mortality in patients with bloodstream infections caused by AmpC producers treated with carbapenems, broad-spectrum β-lactam/β-lactamase inhibitors (BLBLIs), quinolones or cefepime. Pooled ORs for mortality were calculated for cases that received monotherapy with these agents versus carbapenems. PROSPERO international prospective register of systematic reviews (CRD42014014992 18 November 2014). Eleven observational studies were included. Random-effects meta-analysis was performed on studies reporting empirical and definitive monotherapy. In unadjusted analyses, no significant difference in mortality was found between BLBLIs versus carbapenems used for definitive therapy (OR 0.87, 95% CI 0.32-2.36) or empirical therapy (OR 0.48 95% CI 0.14-1.60) or cefepime versus carbapenems as definitive therapy (OR 0.61 95% CI 0.27-1.38) or empirical therapy (0.60 95% CI 0.17-2.20). Use of a fluoroquinolone as definitive therapy was associated with a lower risk of mortality compared with carbapenems (OR 0.39 95% CI 0.19-0.78). Three studies with patient-level data were used to adjust for potential confounders. The non-significant trends favouring non-carbapenem options in these studies were diminished after adjustment for age, sex and illness severity scores, suggestive of residual confounding. Despite limitations of available data, there was no strong evidence to suggest that BLBLIs, quinolones or cefepime were inferior to carbapenems. The reduced risk of mortality observed with quinolone use may reflect less serious illness in patients, rather than superiority over carbapenems.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
DOI: 10.1161/HYPERTENSIONAHA.109.140624
Abstract: There is considerable uncertainty regarding the efficacy of blood pressure–lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure–lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE: 0.5/0.3 mm Hg), with no difference by body mass index quarters ( .1, 23.1 to 25.3, 25.4 to 27.8, and ≥27.9 kg/m 2 ). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs): 0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84 P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity ≥0.07) or with the standard definitions of overweight and obesity ( , 25 to 29, and ≥30 kg/m 2 all P for heterogeneity ≥0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure–lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
Publisher: MDPI AG
Date: 17-09-2018
Abstract: Background: Indoor air pollution is still considered one of the leading causes of morbidity and mortality worldwide. We aimed to investigate the potential association between indoor particulate matter (PM) and fasting clinic blood pressure in adult Australians. Methods: Sixty-three participants residing within the Perth metropolitan area were studied. Participants were aged between 18 and 65 years and free of major medical conditions. We conducted 24-h monitoring of residential PM concentrations, including the size fractions PM1, PM2.5, PM4, and PM10. All participants attended a clinical assessment at Curtin University following a 10–12 h overnight fast. Results: In this study we found that PM1 and PM2.5 were significantly associated with heart rate: a one interquartile range (IQR) increase in PM1 or PM2.5 was associated with a 4–6 beats per minute (bpm) increase in heart rate. Both PM10 and total PM exposure had a significant impact on systolic blood pressure (SBP): a one IQR increase in PM10 and total PM were associated with a 10 mmHg (95% CI: 0.77–20.05) and 12 mmHg (2.28–22.43 mmHg) increase in SBP, respectively. Conclusion: The study findings provide additional support to the thesis that indoor air pollution is an important modifiable factor in the risk of hypertension.
Publisher: Oxford University Press (OUP)
Date: 27-03-2013
Abstract: Ischemic heart disease (IHD) is the leading cause of death and disability worldwide, with higher rates among men than women. Relatively few studies on risk factor associations are available from the Asia-Pacific region, especially with regard to sex differences. Our objective was to compare the relationships between modifiable risk factors and IHD in men and women from the Asia-Pacific region. Data from 600,445 in iduals from 44 studies from the Asia Pacific Cohort Studies Collaboration, an in idual patient data overview, were used. Cox models were used to evaluate the effects of risk factors on fatal and non-fatal IHD separately in men and women from Australia and New Zealand (ANZ) and Asia. Over a median follow-up of 6.7 years, 5695 IHD events were documented. The hazard ratio for IHD, comparing men with women, was 2.14 (95% CI 1.97-2.33) in ANZ and 1.88 (95% CI 1.54-2.29) in Asia. The age-adjusted prevalence of major risk factors was generally higher in men than women, especially in ANZ. Risk factors acted broadly similarly between men and women in both Asia and ANZ, with any indications of differences tending to favor men, rather than women. The excess risk of IHD observed in men compared with women in both Asia and ANZ may be, at least in part, a result of a more hazardous risk profile in men compared with women. The contribution of sex differences in the magnitude of the risk factor-disease associations is unlikely to be a contributing factor.
Publisher: BMJ
Date: 05-02-2009
Abstract: To explore whether an interaction between smoking and serum total cholesterol (TC) and/or decreased levels of serum high-density lipoprotein cholesterol (HDLC) exists for any major subtype of cardiovascular disease. An in idual participant overview of 34 cohort studies. The Asia-Pacific region. People aged >or=20 years without a particular condition or risk factor. Hazard ratios (HRs) and 95% confidence intervals (CIs) for both TC and HDLC by smoking status were estimated using Cox proportional hazard models adjusted for age and systolic blood pressure and stratified by study and sex. During follow-up (median 4.0 years), 3298 coronary heart disease (CHD) and 4318 stroke events were recorded. For CHD, the HR (95% CI) for an additional 1.06 mmol/l increment in TC was greater in current smokers than in non-smokers: 1.54 (1.43 to 1.66) versus 1.38 (1.30 to 1.47) p = 0.02. Similarly, the HR (95% CI) for an additional 0.40 mmol/l decrement in HDLC was greater in current smokers than in non-smokers: 1.67 (1.35 to 2.07) versus 1.28 (1.10 to 1.49) p = 0.04. The positive association of TC with ischaemic stroke, and the negative association of TC with haemorrhagic stroke, were broadly similar for current smokers and non-smokers. Similarly, the risks of both the subtypes of stroke remained broadly unchanged as HDLC decreased in both current smokers and non-smokers. Smoking exacerbated the effects of both TC and HDLC on CHD, although no interaction between smoking and TC or HDLC existed for either of the subtypes of stroke.
Publisher: Elsevier BV
Date: 2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Elsevier BV
Date: 07-2011
Publisher: Elsevier BV
Date: 03-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2007
Publisher: Elsevier BV
Date: 09-2003
DOI: 10.1016/S0021-9150(03)00233-8
Abstract: A clinical diagnosis of familial hypercholesterolaemia (FH) is often made in the absence of tendon xanthomata (TX), which are not usually present before the fourth decade of life. The prognosis of treated non-xanthomatous (TX-) FH is uncertain and the objective of this study was to compare mortality from coronary heart disease (CHD) in patients with treated TX+ (definite) and TX- (possible) heterozygous FH. A diagnosis of definite or possible FH was based on raised cholesterol levels (>7.5 mmol/l) and a family history of premature CHD or hypercholesterolaemia. Patients were recruited from 21 outpatient lipid clinics in the UK from 1980 to 1998. The cohort of 1569 patients with TX+ FH were followed for 12754 person years and the cohort of 1302 patients with TX- FH for 10238 person years. The standardised mortality ratio (SMR) was calculated from the ratio of the number of deaths observed to the number expected in the general population of England and Wales (SMR=100 for reference population). CHD accounted for 64 (63%) of the 102 deaths in the TX+ cohort and 38 (57%) of the 67 deaths in the TX- cohort with the SMR for a fatal coronary event being, respectively, 294 (95% confidence interval 228, 380, P<0.00001) and 205 (95% CI 145, 282, P=0.0001). The similarly elevated CHD mortality risk suggests that, in adulthood, both groups of patients should be treated equally aggressively with HMG Co A reductase inhibitors (statins).
Publisher: Informa UK Limited
Date: 06-2010
DOI: 10.2217/CLP.10.24
Publisher: American Medical Association (AMA)
Date: 26-04-2010
DOI: 10.1001/ARCHINTERNMED.2010.76
Abstract: Physical activity, diet, smoking, and alcohol consumption have been shown to be related to mortality. We examined prospectively the in idual and combined influence of these risk factors on total and cause-specific mortality. The prospective cohort study included 4886 in iduals at least 18 years old from a United Kingdom-wide population in 1984 to 1985. A health behavior score was calculated, allocating 1 point for each poor behavior: smoking fruits and vegetables consumed less than 3 times daily less than 2 hours physical activity per week and weekly consumption of more than 14 units of alcohol (in women) and more than 21 units (in men) (range of points, 0-4). We examined the relationship between health behaviors and mortality using Cox models and compared it with the mortality risk associated with aging. During a mean follow-up period of 20 years, 1080 participants died, 431 from cardiovascular diseases, 318 from cancer, and 331 from other causes. Adjusted hazard ratios and 95% confidence intervals (CIs) for total mortality associated with 1, 2, 3, and 4 poor health behaviors compared with those with none were 1.85 (95% CI, 1.28-2.68), 2.23 (95% CI, 1.55-3.20), 2.76 (95% CI, 1.91-3.99), and 3.49 (95% CI, 2.31-5.26), respectively (P value for trend, <.001). The effect of combined health behaviors was strongest for other deaths and weakest for cancer mortality. Those with 4 compared with those with no poor health behaviors had an all-cause mortality risk equivalent to being 12 years older. The combined effect of poor health behaviors on mortality was substantial, indicating that modest, but sustained, improvements to diet and lifestyle could have significant public health benefits.
Publisher: BMJ
Date: 06-2006
Publisher: Springer Science and Business Media LLC
Date: 26-05-2015
Publisher: Ubiquity Press, Ltd.
Date: 2009
Publisher: Oxford University Press (OUP)
Date: 06-03-2009
DOI: 10.1093/IJE/DYP150
Abstract: In Caucasian populations, adult height is inversely associated with cardiovascular disease (CVD) risk and positively related to some cancers. However, there are few data from Asian populations and from women. We sought to determine the sex- and region-specific associations between height and cardiovascular outcomes, and deaths due to cancer, respiratory and injury in populations from the Asia-Pacific region. Thirty-nine studies from the Asia Pacific Cohort Studies Collaboration database were included. We used Cox proportional hazard regression models to estimate the associations between height and pre-specified outcomes. A total of 510,800 participants with 21,623 deaths were included. Amongst men, inverse linear associations were observed between height and coronary heart disease (CHD), stroke, CVD, injury and total mortality. The hazard ratios [95% confidence intervals, (CI)] for a 1-SD (= 6 cm) increment in height ranged from 0.85 (0.80-0.91) for injury to 0.97 (0.95-0.98) for total mortality. Similar trends were found between height and CHD, haemorrhagic stroke and CVD in women. A positive linear association was observed between height and cancer mortality. For each standard deviation greater height, the risk of cancer was increased by 5% (2-8%) and 9% (5-14%) in men and women, respectively. No regional difference was observed between Asian and Australasian cohorts. Adjusting for markers of education did not alter the results. The opposing relationships of height with CVD and cancer suggest that care is required in setting national policies on childhood nutrition lest they have unintended consequences on the incidence of major non-communicable diseases.
Publisher: Cambridge University Press (CUP)
Date: 02-10-2011
DOI: 10.1016/J.EURPSY.2011.07.005
Abstract: Examine the association of oral disease with future dementia/cognitive decline in a cohort of people with type 2 diabetes. A total of 11,140 men and women aged 55–88 years at study induction with type 2 diabetes participated in a baseline medical examination when they reported the number of natural teeth and days of bleeding gums. Dementia and cognitive decline were ascertained periodically during a 5-year follow-up. Relative to the group with the greatest number of teeth (more than or equal to 22), having no teeth was associated with the highest risk of both dementia (hazard ratio 95% confidence interval: 1.48 1.24, 1.78) and cognitive decline (1.39 1.21, 1.59). Number of days of bleeding gums was unrelated to these outcomes. Tooth loss was associated with an increased risk of both dementia and cognitive decline.
Publisher: BMJ
Date: 19-11-2014
Publisher: Mary Ann Liebert Inc
Date: 03-1100
Abstract: To compare the prevalence of metabolic syndrome (MetS) by four MetS definitions in four Asia-Pacific populations, and to compare the prevalence of in idual metabolic components. Population-based cross-sectional studies from Australia, Japan, Korea, and Samoa were used to assess the World Health Organization (WHO), European Group for the Study of Insulin Resistance (EGIR), modified National Cholesterol Education Program Adult Treatment Panel III (modATPIII), and International Diabetes Federation (IDF) MetS definitions. Age-adjusted MetS prevalences were compared within and between countries and kappa statistics were used to determine the agreement between IDF and the other three definitions. Japanese people had the lowest prevalence of MetS regardless of definition, and Samoans generally the highest prevalence. Age-adjusted prevalences for the four definitions ranged from 16% to 42% in Australia, 3% to 11% in Japan, 7% to 29% in Korea and 17% to 60% in Samoa. With the exceptions of Korean and Japanese males, the highest prevalence of MetS was obtained with the IDF definition. The best overall agreement with IDF MetS definition was for modATPIII, and the worst for EGIR. There were marked differences in the prevalence of MetS between the sexes, with no systematic pattern, and between the prevalences of in idual metabolic components. Differences in the prevalence of MetS and its components, using the various definitions, both within and between populations, indicate that caution is required when comparing studies from different countries. Determining the clinical significance of these differences will require prospective outcome studies.
Publisher: Wiley
Date: 12-01-2007
Publisher: Elsevier BV
Date: 04-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-12-2008
DOI: 10.1161/CIRCULATIONAHA.108.788166
Abstract: Background— The present article aims to provide accurate estimates of the prevalence, awareness, treatment, and control of hypertension in adults in China. Methods and Results— Data were obtained from sphygmomanometer measurements and an administered questionnaire from 141 892 Chinese adults ≥18 years of age who participated in the 2002 China National Nutrition and Health Survey. In 2002, ≈153 million Chinese adults were hypertensive. The prevalence was higher among men than women (20% versus 17% P .001) and was higher in successive age groups. Overall, the prevalence of hypertension was higher in urban compared with rural areas in men (23% versus 18% P .01) and women (18% versus 16% P .001). Of the 24% affected in iduals who were aware of their condition, 78% were treated and 19% were adequately controlled. Despite evidence to suggest improved levels of treatment in in iduals with hypertension over the past decade, compared with estimates from 1991, the ratio of controlled to treated hypertension has remained largely unchanged at 1:4. Conclusions— One in 6 Chinese adults is hypertensive, but only one quarter are aware of their condition. Despite increased rates of blood pressure–lowering treatment, few have their hypertension effectively controlled. National hypertension programs must focus on improving awareness in the wider community, as well as treatment and control, to prevent many tens of thousands of cardiovascular-related deaths.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2009
DOI: 10.1038/EJCN.2009.68
Abstract: Overweight and obesity have become a major public health problem in both developing and developed countries as they are causally related to a wide spectrum of chronic diseases including type II diabetes, cardiovascular diseases and cancer. However, uncertainty regarding the most appropriate means by which to define excess body weight remains. Traditionally, body mass index (BMI) has been the most widely used method by which to determine the prevalence of overweight in, and across, populations as well as an in idual's level of risk. However, in recent years, measures of central obesity, principally waist circumference and the waist:hip ratio and to a lesser extent the waist:height ratio, which more accurately describe the distribution of body fat compared with BMI, have been suggested to be more closely associated with subsequent morbidity and mortality. There is also uncertainty about how these measures perform across erse ethnic groups earlier, most of the evidence regarding the relationships between excess weight and risk has been derived chiefly from Caucasian populations, and hence, it remains unclear whether the relationships are consistent in non-Caucasian populations. The purpose of this review, therefore, is to provide an overview of the current evidence-base focusing predominantly on three main questions: (1) Which, if any, of the commonly used anthropometric measures to define excess weight is more strongly associated with cardiovascular risk? (2) Which of the anthropometric measures is a better discriminator of risk? and (3) Are there any notable differences in the strength and nature of these associations across erse ethnic groups?
Publisher: American Association for Cancer Research (AACR)
Date: 12-2007
DOI: 10.1158/1055-9965.EPI-07-0708
Abstract: Background: Colorectal cancer is the second most common cause of death and illness in developed countries. Previous reviews have suggested that obesity may be associated with 30% to 60% greater risk of colorectal cancer, but little consideration was given to the possible effect of publication bias on the reported association. Methods: Relevant studies were identified through EMBASE and MEDLINE. Studies were included if they had published quantitative estimates of the association between general obesity [defined here as body mass index (BMI) ≥30 kg/m2] and central obesity (measured using waist circumference) and colorectal cancer. Random-effects meta-analyses were done, involving 70,000 cases of incident colorectal cancer from 31 studies, of which 23 were cohort studies and 8 were case-control studies. Results: After pooling and correcting for publication bias, the estimated relative risk of colorectal cancer was 1.19 [95% confidence interval (95% CI), 1.11-1.29], comparing obese (BMI ≥30 kg/m2) with normal weight (BMI & kg/m2) people and 1.45 (95% CI, 1.31-1.61), comparing those with the highest, to the lowest, level of central obesity. After correcting for publication bias, the risk of colorectal cancer was 1.41 (95% CI, 1.30-1.54) in men compared with 1.08 (95% CI, 0.98-1.18) for women (Pheterogeneity & .001). There was evidence of a dose-response relationship between BMI and colorectal cancer: for a 2 kg/m2 increase in BMI, the risk of colorectal cancer increased by 7% (4-10%). For a 2-cm increase in waist circumference, the risk increased by 4% (2-5%). Conclusions: Obesity has a direct and independent relationship with colorectal cancer, although the strength of the association with general obesity is smaller than previously reported. (Cancer Epidemiol Biomarkers Prev 2007 (12):2533–47)
Publisher: Elsevier BV
Date: 07-2018
Publisher: Springer Science and Business Media LLC
Date: 19-04-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-11-2011
DOI: 10.1161/CIRCULATIONAHA.111.028373
Abstract: Previous studies have suggested that there is a novel dyslipidemic profile consisting of isolated low high-density lipoprotein cholesterol (HDL-C) level that is associated with increased risk of coronary heart disease, and that this trait may be especially prevalent in Asian populations. In idual participant data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region were included. Low HDL-C (HDL .03 mmol/L in men and .30 mmol/L in women) was seen among 33.1% (95% confidence interval [CI], 32.9–33.3) of Asians versus 27.0% (95% CI, 26.5–27.5) of non-Asians ( P .001). The prevalence of low HDL-C in the absence of other lipid abnormalities (isolated low HDL-C) was higher in Asians compared with non-Asians: 22.4% (95% CI, 22.2–22.5) versus 14.5% (95% CI, 14.1–14.9), respectively ( P .001). During 6.8 years of follow-up, there were 574 coronary heart disease and 739 stroke events. There was an inverse relationship between low HDL-C with coronary heart disease in all in iduals (hazard ratio, 1.57 95% CI, 1.31–1.87). In Asians, isolated low levels of HDL-C were as strongly associated with coronary heart disease risk as low levels of HDL-C combined with other lipid abnormalities (hazard ratio, 1.67 [95% CI, 1.27–2.19] versus 1.63 [95% CI, 1.24–2.15], respectively). There was no association between low HDL-C and stroke risk in this population (hazard ratio, 0.95 [95% CI, 0.78 to 1.17] with nonisolated low HDL-C and 0.81 [95% CI, 0.67–1.00] with isolated low HDL-C). Isolated low HDL-C is a novel lipid phenotype that appears to be more prevalent among Asian populations, in whom it is associated with increased coronary risk. Further investigation into this type of dyslipidemia is warranted.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-04-2011
Abstract: To further clarify the relationship between total cholesterol and cancer, which remains unclear. We prospectively examined the association between total cholesterol and site-specific and all-cancer incidence among 1,189,719 Korean adults enrolled in the National Health Insurance Corporation who underwent a standardized biennial medical examination in 1992 to 1995 and were observed for 14 years until cancer diagnosis or death. Over follow-up, 53,944 men and 24,475 women were diagnosed with a primary cancer. Compared with levels less than 160 mg/dL, high total cholesterol (≥ 240 mg/dL) was positively associated with prostate cancer (hazard ratio [HR], 1.24 95% CI, 1.07 to 1.44 P trend = .001) and colon cancer (HR, 1.12 95% CI, 1.00 to 1.25 P trend = .05) in men and breast cancer in women (HR, 1.17 95% CI, 1.03 to 1.33 P trend = .03). Higher total cholesterol was associated with a lower incidence of liver cancer (men: HR, 0.42 95% CI, 0.38 to 0.45 P trend .001 women: HR, 0.32 95% CI, 0.27 to 0.39 P trend .001), stomach cancer (men: HR, 0.87 95% CI, 0.82 to 0.93 P trend ≤ .001 women: HR, 0.86 95% CI, 0.77 to 0.97 P trend = .06), and, in men, lung cancer (HR, 0.89 95% CI, 0.82 to 0.96 P trend .001). Results for liver cancer were slightly attenuated after additional adjustment for liver enzyme levels and hepatitis B surface antigen status (men: HR, 0.60 P trend .001 women: HR, 0.46 P trend = .003) and exclusion of the first 10 years of follow-up (men: HR, 0.59 P trend .001 women: HR, 0.44 P trend .001). Total cholesterol was inversely associated with all-cancer incidence in both men (HR, 0.84 95% CI, 0.81 to 0.86 P trend .001) and women (HR, 0.91 95% CI, 0.87 to 0.95 P trend .001), but these associations were attenuated after excluding incident liver cancers (men: HR, 0.95 P trend .001 women: HR, 0.98 P trend = .32). In this large prospective study, we found that total cholesterol was associated with the risk of several different cancers, although these relationships differed markedly by cancer site.
Publisher: Springer Science and Business Media LLC
Date: 25-10-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-09-2014
Abstract: Dyslipidemia is a major contributor to the development of atherosclerosis and coronary disease. Its role in the etiology of atrial fibrillation ( AF ) is uncertain. We studied 7142 men and women from the Multi‐Ethnic Study of Atherosclerosis (MESA) and the Framingham Heart Study who did not have prevalent AF at baseline and were not on lipid‐lowering medications. Total cholesterol, high‐density lipoprotein and low‐density lipoprotein cholesterol, and triglycerides were measured using standard procedures. Incident AF during follow‐up was identified from hospital discharge codes review of medical charts study electrocardiograms and, in MESA only, Medicare claims. Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals of AF by clinical categories of blood lipids in each cohort. Study‐specific results were meta‐analyzed using inverse of variance weighting. During 9.6 years of mean follow‐up, 480 AF cases were identified. In a combined analysis of multivariable‐adjusted results from both cohorts, high levels of high‐density lipoprotein cholesterol were associated with lower AF risk (hazard ratio 0.64, 95% CI 0.48 to 0.87 in those with levels ≥60 mg/dL versus mg/dL), whereas high triglycerides were associated with higher risk of AF (hazard ratio 1.60, 95% CI 1.25 to 2.05 in those with levels ≥200 mg/dL versus mg/dL). Total cholesterol and low‐density lipoprotein cholesterol were not associated with the risk of AF. In these 2 community‐based cohorts, high‐density lipoprotein cholesterol and triglycerides but not low‐density lipoprotein cholesterol or total cholesterol were associated with the risk of AF, accounting for other cardiometabolic risk factors.
Publisher: Elsevier BV
Date: 2015
Publisher: Wiley
Date: 17-01-2010
Publisher: Wiley
Date: 17-01-2010
Publisher: BMJ
Date: 14-12-2016
Abstract: Low socioeconomic status (SES) is a known risk factor for cardiovascular disease (CVD) but whether its effects are comparable in women and men is unknown. PubMed MEDLINE was systematically searched. Studies that reported sex-specific estimates, and associated variability, of the relative risk (RR) for coronary heart disease (CHD), stroke or CVD according to a marker of SES (education, occupation, income or area of residence), for women and men were included. RRs were combined with those derived from cohort studies using in idual participant data. Data were pooled using random effects meta-analyses with inverse variance weighting. Estimates of the ratio of the RRs (RRR), comparing women with men, were computed. Data from 116 cohorts, over 22 million in iduals, and over 1 million CVD events, suggest that lower SES is associated with increased risk of CHD, stroke and CVD in women and men. For CHD, there was a significantly greater excess risk associated with lower educational attainment in women compared with men comparing lowest with highest levels, the age-adjusted RRR was 1.24 (95% CI 1.09 to 1.41) and the multiple-adjusted RRR was 1.34 (1.09 to 1.63). For stroke, the age-adjusted RRR was 0.93 (0.72 to 1.18), and the multiple-adjusted was RRR 0.79 (0.53 to 1.19). Corresponding results for CVD were 1.18 (1.03 to 1.36), 1.23 (1.03 to 1.48), respectively. Similar results were observed for other markers of SES for all three outcomes. Reduction of socioeconomic inequalities in CHD and CVD outcomes might require different approaches for men and women.
Publisher: SAGE Publications
Date: 11-2015
DOI: 10.2217/WHE.15.67
Abstract: We have produced compelling evidence that women are subject to a higher relative increase in their risk of coronary heart disease and stroke following a diagnosis of Type 2 diabetes. Thus, in terms of vascular risk, diabetes confers a female disadvantage. This excess risk could be due to three main factors. First, it is conceivable that this is merely a mathematical artifact caused by the relatively low background rate for cardiovascular diseases among women, compared with men. Second, it could be due to women receiving poorer care following their diagnosis of diabetes than men for instance, due to physician bias. Third, certain underlying biological differences in women and men, most likely related to the distribution of body fat, could explain this female disadvantage.
Publisher: Elsevier BV
Date: 05-2015
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1016/J.JCLINEPI.2007.08.012
Abstract: To determine which simple index of overweight and obesity is the best discriminator of cardiovascular risk factors. This is a meta-analysis of published literature. MEDLINE was searched. Studies that used receiver-operating characteristics (ROC) curve analysis and published area under the ROC curves (AUC) for overweight and obesity indices with hypertension, type-2 diabetes, and/or dyslipidemia were included. The AUC for each of the four indices, with each risk factor, was pooled using a random-effects model male and female data were analyzed separately. Ten studies met the inclusion criteria. Body mass index (BMI) was the poorest discriminator for cardiovascular risk factors. Waist-to-height ratio (WHtR) was the best discriminator for hypertension, diabetes, and dyslipidemia in both sexes its pooled AUC (95% confidence intervals) ranged from 0.67 (0.64, 0.69) to 0.73 (0.70, 0.75) and from 0.68 (0.63, 0.72) to 0.76 (0.70, 0.81) in males and females, respectively. Statistical evidence supports the superiority of measures of centralized obesity, especially WHtR, over BMI, for detecting cardiovascular risk factors in both men and women.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Rachel Huxley.