The sense of coherence, occupation and all-cause mortality in the Helsinki Heart Study

Introduction Coronary artery calcium (CAC), a measure of atherosclerosis predicts mortality in both diabetes and the general population. The incremental utility of measuring atherosclerosis across multiple vascular beds beyond CAC for the prediction of mortality has not been reported. In this study we derived a composite atherosclerosis score (CAS) from multiple vascular beds and compared it with CAC in predicting all-cause mortality. We hypothesized that this composite score will be significantly better than CAC in predicting mortality. Methods A total of 803 participants, ages 39–86, with complete data on diabetes and vascular imaging in the Diabetes Heart Study (DHS) were followed for an average of 7.4 years. Computed tomography (CT) scans were performed at baseline to obtain measures of carotid (CAAC), coronary (CAC) and abdominal aorta (AAC) Agatston scores. A principal component analysis using studentized residuals of log transformed (CAAC+1), (CAC+1), and (AAC+1) adjusting for age, race, and gender was performed. We selected the first principal component as the CAS. Seven-year risk estimates for mortality were obtained using logistic regression models. Model 1 included age, gender, smoking, systolic blood pressure, antihypertensive medication use, total and high-density lipoprotein cholesterol, and ethnicity and CAS. Model 2 included these risk factors plus CAC. We compared the estimation of mortality in Model 1 with CAS vs. Model 2 with CAC using chi-square values. Results Overall, 14% (116/803) of participants died during follow-up. CAS explained 70% of the variance, (eigenvalue of 2.1 with loading, CAAC, 0.57; CAC, 0.57; and AAC, 0.59). After adjusting for potential confounders, the odds ratio (95% CI) of all-cause mortality for 1-standard deviation (SD) increment was 2.12 (1.64–2.78) for CAS and 2.38 (1.77–3.35) for CAC. The area under the curve (chi-square value) with CAS or CAC to predict mortality was 0.76 (36) vs 0.76 (37) respectively. Conclusion Subclinical atherosclerosis, as measured by CT determined calcified plaque burden has increasing evidence supporting its role as a tool to stratify future risk for mortality. Here we demonstrated that the diagnostic accuracy between CAS and CAC are comparable and the predictive value of CAC alone for mortality is not further enhanced by inclusion of calcified plaque burden in carotid or abdominal aortic territories.

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Abstract MP65: Masked Hypertension is Associated with Cardiovascular Disease Events in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.133.suppl_1.mp65 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

John N Booth ◽

Keith M Diaz ◽

Samantha Seals ◽

Mario Sims ◽

Joseph Ravenell ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Blood Pressure Monitoring ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Cvd Risk ◽

Nocturnal Hypertension ◽

Heart Study ◽

All Cause Mortality

Introduction: Masked hypertension has been associated with increased cardiovascular disease (CVD) risk in Europeans and Asians. Hypothesis: Determine the association of masked hypertension with CVD events and all-cause mortality in African Americans (AA). Methods: The Jackson Heart Study, an exclusively AA population-based, prospective cohort study, was restricted to participants with clinic systolic/diastolic blood pressure (SBP/DBP) < 140/90 mmHg and valid ambulatory blood pressure monitoring (ABPM) at the baseline exam in 2000-2004 (n=738). Masked daytime hypertension was defined as mean ambulatory daytime (10am-8pm) SBP ≥ 135 mmHg or DBP ≥ 85 mmHg. Masked nocturnal hypertension was defined as mean ambulatory nighttime (12am-6am) SBP ≥ 120 mmHg or DBP ≥ 70 mmHg. Using all ABPM measurements, masked 24-hour hypertension was defined as mean SBP ≥ 130 mmHg or DBP ≥ 80 mmHg. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease) and all-cause mortality were identified and adjudicated through December 31, 2011. Results: Any masked hypertension (masked daytime, nocturnal or 24-hour hypertension) was present in 52.2% of participants; 28.2% had masked daytime hypertension, 48.2% had masked nocturnal hypertension and 31.7% had masked 24-hour hypertension. There were 51 CVD events and 44 deaths over a median follow up of 8.2 and 8.5 years, respectively. The CVD rate (95% CI) per 1,000 person years in participants with and without any masked hypertension were 13.5 (9.9-18.4) and 3.9 (2.2-7.1), respectively (Table). The multivariable adjusted hazard ratio (95% CI) between any masked hypertension and CVD was 2.49 (1.26-4.93). CVD rates for those with and without masked daytime, nocturnal and 24-hour hypertension, and the hazard ratios for CVD associated with masked daytime, nocturnal and 24-hour hypertension, were similar. Masked hypertension was not associated with all-cause mortality. Conclusion: Masked hypertension is common and associated with increased CVD risk in AAs.

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Medication compliance in the Helsinki Heart Study

Inpharma Weekly ◽

10.2165/00128413-199208270-00024 ◽

1992 ◽

Vol &NA; (827) ◽

pp. 16

Author(s):

&NA;

Keyword(s):

Medication Compliance ◽

Helsinki Heart Study ◽

Heart Study

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Trends in excess mortality associated with atrial fibrillation over 45 years (Framingham Heart Study): community based cohort study

BMJ ◽

10.1136/bmj.m2724 ◽

2020 ◽

pp. m2724

Author(s):

Nicklas Vinter ◽

Qiuxi Huang ◽

Morten Fenger-Grøn ◽

Lars Frost ◽

Emelia J Benjamin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Time Varying ◽

Newly Diagnosed ◽

Survival Times ◽

Community Based ◽

Period 2 ◽

Hazard Ratios ◽

Time Period ◽

Heart Study ◽

All Cause Mortality

AbstractObjectiveTo assess temporal trends in the association between newly diagnosed atrial fibrillation and death.DesignCommunity based cohort study.SettingFramingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA.ParticipantsParticipants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period.Main outcome measuresThe main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods.Results5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (Ptrend=0.70). Ten years after diagnosis of atrial fibrillation, the adjusted difference in restricted mean survival times between participants with atrial fibrillation and matched referents decreased by 31%, from −2.9 years (95% confidence interval −3.2 to −2.5) in period 1, to −2.1 years (−2.4 to −1.8) in period 2, to −2.0 years (−2.3 to −1.7) in period 3 (Ptrend=0.03).ConclusionsNo evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.

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