The association of apolipoproteins with later-life all-cause and cardiovascular mortality: a population-based study stratified by age

AbstractMidlife lipid levels are important predictors of cardiovascular diseases, yet their association with mortality in older adults is less clear. We aimed to (1) identify lipid profiles based on cholesterol, triglycerides, and apolipoproteins using cluster analysis, and (2) investigate how lipid profiles and lipid levels at different ages are associated with later-life all-cause and cardiovascular mortality. We used data from 98,270 individuals in the Swedish AMORIS cohort who had blood measurements between 1985–1996 and were followed until 2012. Over the follow-up (mean 18.0 years), 30,730 (31.3%) individuals died. Three lipid profiles were identified. Compared with reference profile, a high lipid profile (low ApoA-I and high total cholesterol (TC), triglycerides, ApoB, and ApoB/ApoA-I ratio) at ages 39–59 or 60–79 was associated with higher all-cause mortality. A high lipid profile at ≥ 80 years, however, did not confer higher mortality. For the specific markers, high TC (≥ 7.25 mmol/L) was associated with higher all-cause mortality in ages 39–59 but lower mortality in ages 60–79 and ≥ 80. Low ApoA-I (< 1.28 g/L) and high ApoB/ApoA-I ratio (≥ 1.18), on the other hand, were associated with higher cardiovascular mortality regardless of age at lipid measurement, highlighting their potential relevance for survival in both young and older individuals.

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P125 The relationship between mid-life pain and cognitive impairment: a prospective, population-based study

Rheumatology ◽

10.1093/rheumatology/keab247.120 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Eoin Kelleher ◽

Samuel Hawley ◽

Antonella Delmestri ◽

Nigel Arden ◽

Irene Tracey ◽

...

Keyword(s):

Chronic Pain ◽

Regression Analysis ◽

Cognitive Impairment ◽

Joint Pain ◽

Bodily Pain ◽

Later Life ◽

Population Based ◽

Two Dimensions ◽

All Cause Mortality

Abstract Background/Aims Population-based studies suggest an association between pain in elderly adults and cognitive impairment. However, the temporal relationship between chronic pain and cognitive decline is uncertain: most studies are cross-sectional or have short follow-up periods. Our aim was to examine the association between two pain phenotypes - bodily pain and multi-joint pain - in middle-life and cognitive impairment in later-life in a prospective cohort study with 23 years’ follow-up. We also set out to examine the association with mortality. In contrast to much previous work, this study has available a comprehensive depth of information on health and pain characteristics over a long follow-up period. Methods Bodily pain and multi-joint pain at 3 timepoints between baseline and year 10 was measured in participants from the Chingford Women’s Study. Secondary analyses were performed on the two dimensions of bodily pain, pain intensity and interference. Multivariable logistic regression analysis was used to assess the association with cognition at year 23: the primary cognitive outcome was Mini-Mental State Examination (MMSE) score ≤28, with a secondary outcome of ≤ 26. Multivariable Cox regression analysis was used to evaluate the association between each pain exposure and all-cause mortality between years 10 and 23. Analyses were adjusted for education, socio-demographic factors, and modifiable risk factors for cognitive impairment including depression and analgesia use. Results 282 (28.1%) and 276 (27.5%) women were included in analyses for cognition and bodily pain and multi-joint pain respectively. Women with severe bodily pain showed a non-significant greater odds of MMSE ≤28 compared to those with no/mild bodily pain (OR 2.56, 95%CI 0.94-6.95, P = 0.07). Those with severe bodily pain had significantly greater odds of MMSE ≤26 (OR 7.31, 95%CI 2.11-25.36, P = 0.002). However, there was no association with multi-joint pain. Secondary analysis of the two dimensions of bodily pain demonstrated that pain interference displayed a stronger relationship with both MMSE thresholds compared to pain intensity. Women with severe bodily pain and repeated multi-joint pain each had higher crude all-cause mortality, but this was not statistically significant (log-rank test for trend, P = 0.11 & 0.068, respectively). Further adjustment left the association with both pain exposures and all-cause mortality entirely attenuated. Conclusion After 13 years’ follow-up, severe bodily pain but not multi-joint pain in mid-life was associated with subsequent cognitive impairment, determined by MMSE ≤26. Women with severe bodily pain and multi-joint pain had higher crude all-cause mortality rate, but this was not statistically significant after adjustment. Pain interference displayed a stronger association with cognitive impairment; this may reflect the impact of pain on functional status. This study represents the first time the consequences of mid-life pain on later life cognition were examined. Chronic pain, which is largely untreated, may thus represent a modifiable cause of cognitive impairment. Disclosure E. Kelleher: None. S. Hawley: None. A. Delmestri: None. N. Arden: None. I. Tracey: None. A. Soni: None.

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Migraine as a predictor of mortality: The HUNT study

Cephalalgia ◽

10.1177/0333102415593090 ◽

2015 ◽

Vol 36 (4) ◽

pp. 351-357 ◽

Cited By ~ 9

Author(s):

Anders Nikolai Åsberg ◽

Lars Jacob Stovner ◽

John-Anker Zwart ◽

Bendik Slagsvold Winsvold ◽

Ingrid Heuch ◽

...

Keyword(s):

Cohort Study ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Population Based ◽

Risk Of Death ◽

Hazard Ratios ◽

All Cause Mortality ◽

Large Prospective Cohort Study ◽

Migrainous Headache

Background There is conflicting evidence for the association between migraine and increased mortality risk. The aim of this study was to investigate the relationship between migraine and non-migrainous headache, and all-cause mortality and cardiovascular mortality. Methods In this prospective population-based cohort study from Norway, we used baseline data from the second Nord-Trøndelag Health Survey (HUNT2), performed between 1995 and 1997 in the County of Nord-Trøndelag. These data were linked with a comprehensive mortality database with follow-up through the year 2011. A total of 51,853 (56% of invited) people were categorized based on their answers to the headache questions in HUNT2 (headache free, migraine or non-migrainous headache). Hazard ratios (HRs) of mortality during a mean of 14.1 years of follow-up were estimated using Cox regression. Results During the follow-up period 9408 died, 4321 of these from cardiovascular causes. There was no difference in all-cause mortality between individuals with migraine and non-migrainous headache compared to those without headache or between headache status and mortality by cardiovascular disease. There was, however, among men with migraine without aura a reduced risk of death by cardiovascular diseases (HR 0.72, 95% confidence interval 0.56–0.93). This relationship was not evident in women. Conclusion In this large, prospective cohort study there was no evidence for a higher all-cause mortality or cardiovascular mortality among individuals with migraine.

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Claudication, in contrast to angina pectoris, independently predicts mortality risk in the general population

VASA ◽

10.1024/0301-1526/a000172 ◽

2012 ◽

Vol 41 (2) ◽

pp. 105-113 ◽

Cited By ~ 5

Author(s):

G. Kieback ◽

Lorbeer ◽

Wallaschofski ◽

Ittermann ◽

Völzke ◽

...

Keyword(s):

Angina Pectoris ◽

Mortality Rate ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Kaplan Meier ◽

All Cause Mortality ◽

Study Population

Background: The aim of our analyses was to investigate whether claudication and angina pectoris, each defined and based on the answer to a single question, are predictive of future mortality. Probands and methods: The study population consisted of 3995 subjects selected from the population-based Study of Health In Pomerania (SHIP). Kaplan-Meier analysis and multivariable Cox proportional hazards regression analysis were used to analyze the association of angina pectoris and claudication with all-cause and cardiovascular mortality adjusted for major cardiovascular risk factors. Results: At baseline, 417 individuals had symptoms of angina pectoris, and 323 had symptoms of claudication. During a median follow-up of 8.5 years, 277 individuals died. Individuals with claudication had a higher fully-adjusted all-cause mortality rate (Hazard Ratio (HR) 1.79; 95 % CI 1.34, 2.39, p < 0.001) and a higher sex- and age-adjusted cardiovascular mortality rate (HR 1.76; 95 % CI 1.03, 2.99, p = 0.038) compared to subjects without claudication. In contrast, subjects with angina pectoris had neither an elevated fully-adjusted all-cause mortality rate (HR 1.15; 95 % CI 0.82, 1.61, p = 0.413) nor sex- and age-adjusted cardiovascular mortality rate (HR 0.71; 95 % CI 0.34, 1.48, p = 0.363) compared to those without this symptom. Conclusions: Claudication, in contrast to angina pectoris, is a strong, independent predictor of all-cause mortality.

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Gestational lipid profile as an early marker of metabolic syndrome in later life: a population-based prospective cohort study

BMC Medicine ◽

10.1186/s12916-020-01868-4 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Maria C. Adank ◽

Laura Benschop ◽

Sophia P. van Streun ◽

Anna M. Smak Gregoor ◽

Monique T. Mulder ◽

...

Keyword(s):

Metabolic Syndrome ◽

Cardiovascular Risk ◽

Lipid Profile ◽

Density Lipoprotein ◽

Later Life ◽

Population Based ◽

Risk Profile ◽

Cardiovascular Risk Profile ◽

Lipid Levels ◽

Remnant Cholesterol

Abstract Background In pregnancy lipid levels increase with gestation resembling an atherogenic lipid profile. Currently it is unclear whether gestational lipid levels are associated with an adverse cardiovascular risk profile later in life. The aim of this study is to assess the association between gestational lipid levels and lipid levels and prevalence of the metabolic syndrome (MS) six years after pregnancy. Methods In plasma of 3510 women from the Generation R Study; a prospective population-based cohort, we measured lipid levels (total cholesterol, triglycerides and high-density lipoprotein cholesterol [HDL-c]), and low-density lipoprotein cholesterol (LDL-c), remnant cholesterol and non-HDL-c were calculated in early pregnancy (median 13.2 weeks, 90% range [10.5 to 17.1]) and six years after pregnancy (median 6.5 years, 90% range [6.2 to 7.8]). MS was assessed six years after pregnancy according to the NCEP/ATP3 criteria. We also examined the influence of pregnancy complications on these associations. Results Gestational lipid levels were positively associated with corresponding lipid levels six years after pregnancy, independent of pregnancy complications. Six years after pregnancy the prevalence of MS was 10.0%; the prevalence was higher for women with a previous placental syndrome (13.5%). Gestational triglycerides and remnant cholesterol in the highest quartile and HDL-c in the lowest quartile were associated with the highest risk for future MS, independent of smoking and body mass index. Conclusions Gestational lipid levels provide an insight in the future cardiovascular risk profile of women in later life. Monitoring and lifestyle intervention could be indicated in women with an unfavorable gestational lipid profile to optimize timely cardiovascular risk prevention.

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Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999–2015

International Journal of Epidemiology ◽

10.1093/ije/dyaa263 ◽

2020 ◽

Author(s):

Kosuke Inoue ◽

Roch Nianogo ◽

Donatello Telesca ◽

Atsushi Goto ◽

Vahe Khachadourian ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Regression Models ◽

Machine Learning Algorithms ◽

Logistic Regression Models ◽

Health And Nutrition ◽

Increased Risk ◽

The Us ◽

All Cause Mortality ◽

Hba1c Levels

Abstract Objective It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. Methods This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999–2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to <5.0%; mid-level, 5.0 to <5.7%; prediabetes, 5.7 to <6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. Results Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. Conclusions Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.

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P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

European Heart Journal ◽

10.1093/eurheartj/ehz748.0570 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O L Rueda Ochoa ◽

L R Bons ◽

S Rohde ◽

K E L Ghoud ◽

R Budde ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Mortality ◽

Total Mortality ◽

Population Based ◽

Cardiovascular Outcomes ◽

Increased Risk ◽

Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

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The effect of BCG revaccination on all-cause mortality beyond infancy: 30-year follow-up of a population-based, double-blind, randomised placebo-controlled trial in Malawi

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(20)30994-4 ◽

2021 ◽

Author(s):

Judith R Glynn ◽

Albert Dube ◽

Katherine Fielding ◽

Amelia C Crampin ◽

Chifundo Kanjala ◽

...

Keyword(s):

Controlled Trial ◽

Population Based ◽

Double Blind ◽

All Cause Mortality

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Multi-trajectories of lipid indices with incident cardiovascular disease, heart failure, and all-cause mortality: 23 years follow-up of two US cohort studies

Journal of Translational Medicine ◽

10.1186/s12967-021-02966-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Fatemeh Koohi ◽

Davood Khalili ◽

Mohammad Ali Mansournia ◽

Farzad Hadaegh ◽

Hamid Soori

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Cohort Studies ◽

Significant Risk ◽

Density Lipoprotein ◽

Lipid Levels ◽

Cvd Risk ◽

All Cause Mortality ◽

Over Time

Abstract Background Understanding the distinct patterns (trajectories) of variation in blood lipid levels before diagnosing cardiovascular disease (CVD) might carry important implications for improving disease prevention or treatment. Methods We investigated 14,373 participants (45.5% men) aged 45–84 from two large US prospective cohort studies with a median of 23 years follow-up. First, we jointly estimated developmental trajectories of lipid indices, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations using group-based multi-trajectory modeling. Then, the association of identified multi-trajectories with incident CVD, heart failure, and all-cause mortality were examined using Cox proportional hazard model. Results Seven distinct multi-trajectories were identified. The majority of participants (approximately 80%) exhibited decreasing LDL-C but rising TG levels and relatively stable HDL-C levels. Compared to the individuals with healthy and stable LDL-C, HDL-C, and TG levels, those in other groups were at significant risk of incident CVD after adjusting for other conventional risk factors. Individuals with the highest but decreasing LDL-C and borderline high and rising TG levels over time were at the highest risk than those in other groups with a 2.22-fold risk of CVD. Also, those with the highest and increased triglyceride levels over time, over optimal and decreasing LDL-C levels, and the lowest HDL-C profile had a nearly 1.84 times CVD risk. Even individuals in the multi-trajectory group with the highest HDL-C, optimal LDL-C, and optimal TG levels had a significant risk (HR, 1.45; 95% CI 1.02–2.08). Furthermore, only those with the highest HDL-C profile increased the risk of heart failure by 1.5-fold (95% CI 1.07–2.06). Conclusions The trajectories and risk of CVD identified in this study demonstrated that despite a decline in LDL-C over time, a significant amount of residual risk for CVD remains. These findings suggest the impact of the increasing trend of TG on CVD risk and emphasize the importance of assessing the lipid levels at each visit and undertaking potential interventions that lower triglyceride concentrations to reduce the residual risk of CVD, even among those with the optimal LDL-C level.

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Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-16-0576 ◽

2017 ◽

Vol 176 (1) ◽

pp. 1-9 ◽

Cited By ~ 19

Author(s):

Olaf M Dekkers ◽

Erzsébet Horváth-Puhó ◽

Suzanne C Cannegieter ◽

Jan P Vandenbroucke ◽

Henrik Toft Sørensen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Cardiovascular Events ◽

Population Based ◽

Arterial Embolism ◽

Registration System ◽

Increased Risk ◽

All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

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