P3823Body mass index or waist and hip circumference as predictors of outcome in the UK biobank

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Pellicori ◽  
B Stanley ◽  
S Iliodromiti ◽  
C A Celis-Morales ◽  
D M Lyall ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Body Fat ◽  
Uk Biobank ◽  
Anthropometric Indices ◽  
All Cause Mortality ◽  
History Of ◽  
Cv Disease ◽  
The Uk

Abstract Background Controversies exist about the relationship between body habitus and mortality, especially for patients with cardiovascular disease. Purpose We evaluated the relations between different anthropometric indices and mortality amongst participants with and without cardiovascular (CV) risk factors, or established CV disease (stroke, myocardial infarction and/or heart failure), enrolled in the UK Biobank. Methods The UK Biobank is a large prospective study which, between 2006 and 2010, enrolled 502,620 participants aged 38–73 years. Participants filled questionnaires and had a medical history recorded, physical measurements done and biological samples taken. The UK Biobank is routinely linked to national death registries and updated on a quarterly basis. Data on death were coded according to the International Classification of Diseases, 10th Revision (ICD-10). The primary end-point was all-cause mortality (ACM) across three subgroups of men and women: those with, or without, one or more CV risk factors (smoking, diabetes and/or hypertension), and those with CV disease (history of stroke, myocardial infarction and/or heart failure) at recruitment. Presence, or absence, of CV risk factors and diagnoses of CV disease were self-reported by participants at enrolment. Associations between anthropometric indices (body mass index (BMI), waist circumference (WC), waist to hip ratio (WHiR), and waist to height ratio (WHeR)) and the risk of all-cause mortality were analysed using Cox regression models. Results After excluding those with history of cancer at baseline (n=45,222), 453,046 participants were included (median age: 58 (interquartile range: 50 - 63) years; 53% women), of whom 150,732 had at least one CV risk factor, and 17,884 established CV disease. During a median follow-up of 5 years, 6,319 participants died. Baseline BMI had a U-shaped relationship with ACM, with higher nadir-values for those with CV risk factors or CV disease, for both sexes (figure). WC, WHiR and WHeR (measures of central distribution of body fat) had more linear associations with ACM, regardless of CV risk factors, CV disease and sex. Conclusions For adults with or without CV risk factors or established CV disease, measures of central distribution of body fat are more strongly and more linearly associated with ACM than BMI. WC, or WHiR, rather than BMI, appear to be more appropriate variables for risk stratification.

scholarly journals Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women

Heart ◽  
2018 ◽  
Vol 104 (18) ◽  
pp. 1536-1542 ◽  
Author(s):  
Christian Hakulinen ◽  
Laura Pulkki-Råback ◽  
Marianna Virtanen ◽  
Markus Jokela ◽  
Mika Kivimäki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Social Isolation ◽  
Uk Biobank ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
The Uk ◽  
Adjusted Model ◽  
Conventional Risk Factors

ObjectiveTo examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions.MethodsParticipants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes.ResultsOver 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.ConclusionsIsolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.

scholarly journals Is there a link between glucose levels and heart failure? An update

2010 ◽  
Vol 54 (5) ◽  
pp. 488-497 ◽  
Author(s):  
Arnaldo Schainberg ◽  
Antônio Ribeiro-Oliveira Jr. ◽  
José Marcio Ribeiro
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Epidemiological Studies ◽  
Left Ventricular ◽  
Glucose Levels ◽  
Factors Analysis ◽  
History Of ◽  
Cv Disease ◽  
The Relationship

It has been well documented that there is an increased prevalence of standard cardiovascular (CV) risk factors in association with diabetes and with diabetes-related abnormalities. Hyperglycemia, in particular, also plays an important role. Heart failure (HF) has become a frequent manifestation of cardiovascular disease (CVD) among individuals with diabetes mellitus. Epidemiological studies suggest that the effect of hyperglycemia on HF risk is independent of other known risk factors. Analysis of datasets from populations including individuals with dysglycemia suggests the pathogenic role of hyperglycemia on left ventricular function and on the natural history of HF. Despite substantial epidemiological evidence of the relationship between diabetes and HF, data from available interventional trials assessing the effect of a glucose-lowering strategy on CV outcomes are limited. To provide some insight into these issues, we describe in this review the recent important data to understand the natural course of CV disease in diabetic individuals and the role of hyperglycemia at different times in the progression of HF.

Pioglitazone for the Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Patients with or at High Risk of Type 2 Diabetes Mellitus: A Meta-Analysis

2019 ◽  
Vol 105 (5) ◽  
pp. 1670-1681 ◽  
Author(s):  
Yue Zhou ◽  
Yajing Huang ◽  
Xiaoyun Ji ◽  
Xiang Wang ◽  
Liyan Shen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
High Risk ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Primary And Secondary Prevention ◽  
All Cause Mortality ◽  
History Of

Abstract Context The goal of the meta-analysis was to evaluate the effect of pioglitazone on the primary and secondary prevention of cardiovascular diseases (CVDs) and renal adverse events in patients with or at high risk of type 2 diabetes mellitus (T2DM). Design Randomized controlled trials (RCTs) comparing pioglitazone with any control were identified through PubMed, Embase, and the Cochrane Library. Cardiovascular outcomes included major adverse cardiovascular events (MACEs, defined as the composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death), hospitalization for heart failure, and all-cause mortality. Renal outcomes included change in urinary albumin to creatinine ratio and 24-hour urinary protein excretion. Weighted mean difference (WMD) and risk ratio (RR) with 95% confidence intervals (CIs) were pooled. Results A total of 26 studies with 19 645 participants were enrolled. Pioglitazone reduced the risk of MACE (RR, 0.8 [95% CI, 0.7–0.9]), with benefit only seen in patients with a history of established CVDs (0.8 [0.7–0.9]) and not in those without (1.0 [0.7–1.3]). Regarding the individual components, pioglitazone reduced the risk of nonfatal myocardial infarction (0.8 [0.6–1.0]) and nonfatal stroke (0.8 [0.7–0.9]), which was confined to patients with a history of established CVDs, whereas no treatment effect was found on cardiovascular death (1.0 [0.7–1.2]) regardless of the presence of established CVDs. Pioglitazone increased the risk of hospitalization for heart failure (1.3 [1.1–1.6]) and had no treatment effect on all-cause mortality (1.0 [0.8–1.1]). Pioglitazone reduced albuminuria by 18.5% (WMD 18.5% [95% CI, 21.1-16.0]), with a similar benefit in patients with different renal function categories. Conclusions Pioglitazone should be considered in patients with or at high risk of T2DM for the prevention of cardiovascular endpoints, especially in those with a history of established CVD who might benefit the most. Robust reductions in progression of renal disease are seen regardless of baseline renal function degree.

P990Assessment of clinical risk factors for all-cause mortality among hypertrophic cardiomyopathy patients with ICDs

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mielczarek ◽  
P Syska ◽  
M Lewandowski ◽  
A Przybylski ◽  
M Sterlinski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Family History ◽  
Secondary Prevention ◽  
Positive Family History ◽  
Left Ventricular ◽  
Icd Implantation ◽  
All Cause Mortality ◽  
History Of ◽  
End Stage

Abstract Introduction According to the literature, the annual mortality rate of hypertrophic cardiomyopathy (HCM) patients is estimated to 1–2%. Sudden cardiac death (SCD), heart failure and thromboembolism are the main causes of death among this population. Patients at high risk for SCD, identified using HCM risk score, are qualified for ICD implantation. Unfortunately for clinicians, there is no validated model or statistical tool for assessment of the risk of mortality within the HCM patients with ICDs. Purpose The aim of this study was to determine the main risk factors of all- cause mortality in HCM patients with ICDs. Methods The long-term follow-up of group of 104 consecutive patients with HCM, who had the ICD implanted between 1996 and 2006 in tertiary reference clinical unit was performed. Twenty patients who died during observation were the subject of the current analysis. ICD was implanted for primary (n=16) and secondary (n=4) prevention of SCD within this subpopulation. Analysis were performed for mentioned below potential risk factors: age at the time of implantation, syncopes, family history of SCD, atrial fibrillation/supraventricular tachycardia, decreased left ventricular ejection fraction (LVEF), non-sustained ventricular tachycardia (nsVT), maximum left ventricular wall thickness, abnormal exercise blood pressure response, left ventricular outflow tract obstruction. Results The average time of survival since ICD implantation was 8,5±4,6 years. Decreased LVEF (Wald chi2 4,57; p=0,033), secondary prevention (Wald chi2 8,57; p=0,003), family history of SCD (Wald chi2 4,93; p=0,026) and episodes of nsVT (Wald chi2 3,49; p=0,062) are the clinical risk factors that significantly affect the time of survival. The probability of death, expressed as Hazard Ratio, was 27-fold higher in secondary prevention group (HR=27,18), almost 10-fold higher in patients with positive family history of SCD (HR=9,74) and 3,7-fold higher when nsVT was detected. The cause of death was established in 16/20 patients. In 15 cases, these were deaths from cardiovascular causes: end-stage heart failure (8), complications of heart transplantation or circulatory support (4), SCD (1) and other cardiovascular (2). Conclusion Secondary prevention, positive family history of SCD, nsVT and decreased LVEF seem to be the most significant risk factors associated with all- cause mortality in HCM patients with ICDs. Despite the ICD implantation, subpopulation studied had poor prognosis with high incidence of progression to end-stage heart failure. Further studies to create validated model for assessment of death risk in long-term observation of patients with HCM after ICD implantation are required.

scholarly journals Walking pace improves all-cause and cardiovascular mortality risk prediction: A UK Biobank prognostic study

2019 ◽  
Vol 27 (10) ◽  
pp. 1036-1044 ◽  
Author(s):  
Stavroula Argyridou ◽  
Francesco Zaccardi ◽  
Melanie J Davies ◽  
Kamlesh Khunti ◽  
Thomas Yates
Keyword(s):  
Risk Factors ◽  
Risk Prediction ◽  
Cardiovascular Mortality ◽  
Smoking Status ◽  
Density Lipoprotein ◽  
Uk Biobank ◽  
All Cause Mortality ◽  
Lifestyle Measures ◽  
European Society Of Cardiology ◽  
The Uk

Aims The purpose of this study was to quantify and rank the prognostic relevance of dietary, physical activity and physical function factors in predicting all-cause and cardiovascular mortality in comparison with the established risk factors included in the European Society of Cardiology Systematic COronary Risk Evaluation (SCORE). Methods We examined the predictive discrimination of lifestyle measures using C-index and R2 in sex-stratified analyses adjusted for: model 1, age; model 2, SCORE variables (age, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol). Results The sample comprised 298,829 adults (median age, 57 years; 53.5% women) from the UK Biobank free from cancer and cardiovascular disease at baseline. Over a median follow-up of 6.9 years, there were 2174 and 3522 all–cause and 286 and 796 cardiovascular deaths in women and men, respectively. When added to model 1, self-reported walking pace improved C-index in women and men by 0.013 (99% CI: 0.007–0.020) and 0.022 (0.017–0.028) respectively for all-cause mortality; and by 0.023 (0.005–0.042) and 0.034 (0.020–0.048) respectively for cardiovascular mortality. When added to model 2, corresponding values for women and men were: 0.008 (0.003–0.012) and 0.013 (0.009–0.017) for all-cause mortality; and 0.012 (–0.001–0.025) and 0.024 (0.013–0.035) for cardiovascular mortality. Other lifestyle factors did not consistently improve discrimination across models and outcomes. The pattern of results for R2 mirrored those for C-index. Conclusion A simple self-reported measure of walking pace was the only lifestyle variable found to improve risk prediction for all-cause and cardiovascular mortality when added to established risk factors.

scholarly journals Effect of n-3 polyunsaturated fatty acids on ischemic heart disease and cardiometabolic risk factors: a two-sample Mendelian randomization study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bayi Xu ◽  
Zhixia Xu ◽  
Duanmin Xu ◽  
Xuerui Tan
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Blood Pressure ◽  
Fatty Acids ◽  
Cardiometabolic Risk ◽  
Mendelian Randomization ◽  
Meta Analysis ◽  
Cardiometabolic Risk Factors ◽  
Uk Biobank ◽  
The Uk

Abstract Background The cardioprotective ability of n-3 polyunsaturated fatty acids (PUFAs) is controversial. Most studies suggest a specific role for PUFAs in cardioprotection from ischemic heart disease (IHD). However, few studies have used genetic biomarkers of n-3 PUFAs to examine their potential relationships with IHD. This study aimed to use Mendelian randomization to evaluate whether genetically-predicted n-3 PUFAs affect IHD and cardiometabolic risk factors (CRFs). Methods Genetic variants strongly (p < 5 × 10–8) and independently (r2 > 0.1) associated with n-3 PUFAs were derived from the CHARGE Consortium (including 8,866 subjects of European ancestry) and were used as instrumental variables (IVs) for evaluating the effect of n-3 PUFAs, including α-linolenic acid (ALA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA). Data on the associations between the IVs and IHD, myocardial infarction, and CRFs (including diabetes, lipids, blood pressure, body mass index, and waist-to-hip ratio (WHR)) were obtained from the UK Biobank SOFT CAD GWAS with the CARDIoGRAMplusC4D 1000 Genomes-based GWAS (113,937 IHD cases and 339,115 controls), the Myocardial Infarction Genetics and CARDIoGRAM Exome consortia (42,335 MI cases and 78,240 controls), the DIAbetes Genetics Replication And Meta-analysis consortium (26,676 diabetes mellitus cases and 132,532 controls), the Global Lipids Genetics Consortium (n = 196,475), the International Consortium for Blood Pressure (n = 69,395), and the meta-analysis of GWAS for body fat distribution in the UK Biobank and Genetic Investigation of Anthropometric Traits (n = 694,649). Results Genetically-predicted higher ALA was associated with lower risk of IHD, type 2 diabetes (T2D), and lower serum lipids. The effect size per 0.05-unit increase (about 1 standard deviation) in plasma ALA level) was − 1.173 (95% confidence interval − 2.214 to − 0.133) for IHD. DPA and EPA had no association with IHD but were associated with a higher risk of T2D, higher levels of lipids or WHR. DHA had no association with IHD or CRFs. Conclusions Our study suggests a benefit of ALA for IHD and its main risk factors. DHA, DPA, and EPA had no association with IHD but were partly associated with increasing cardiometabolic risk factors.

scholarly journals Risk Factors, Clinical Features of the Course of Myocardial Infarction and Treatment of Young Patients Based on Two Hospital Registries

2020 ◽  
Vol 16 (2) ◽  
pp. 250-257
Author(s):  
O. L. Barbarash ◽  
D. Yu. Sedykh ◽  
I. S. Bykova ◽  
V. V. Kashtalap ◽  
A. D. Erlich
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Chronic Heart Failure ◽  
Ace Inhibitors ◽  
Young Patients ◽  
High Density Lipoproteins ◽  
History Of ◽  
One Year

Aim. To identify specific risk factors and features of the course of myocardial infarction (MI) in young patients.Material and methods. The study design is based on a comparison of observation data for patients of different ages from the Russian RECORD-3 registry (n=2359) and the registry of acute coronary syndrome of the Kemerovo city in 2015 (n=1343). The clinical and anamnestic portrait was determined, the frequency of hospital complications and the “hard” endpoints were evaluated.Results. Young patients with myocardial infarction (MI) according to RECORD-3 are more often male smokers (p=0.001) with a heredity in cardiovascular pathology (p=0.034), who have an uncomplicated STEMI upon admission to the hospital, and are sent for coronary angiography with stenting (p=0.001), without prescribing statins in the primary and secondary prevention (p=0.050 and p=0.016, respectively). There were no differences with other age groups by endpoints a year later; during the current hospitalization, young patients less often died (p=0.001) or had a relapse of MI (p=0.011). Young patients with MI from Kemerovo were also mostly male smokers (p=0.001), who more often had a history of chronic kidney disease, chronic heart failure, and lipid metabolism disorders (p=0.001), who admitted to the hospital with uncomplicated STEMI, actively undergoing thrombolytic therapy and endovascular diagnosis and treatment (p=0.001). However, it should be noted that these patients were less likely to receive aspirin (p=0.015), dual antiplatelet therapy (p=0.003), angiotensin converting enzyme (ACE) inhibitors (p=0.040) and statins (p=0.001). Moreover, in young patients with MI, deficiency of high density lipoproteins (p=0.005) was more often found in the absence of very high values of low density lipoproteins (p=0.001). Among the complications of inpatient treatment, it should be noted a tendency to bleeding (p=0.001). One year after referent MI a high proportion of repeated non-fatal MI (p=0.005) and deaths (p=0.001) were observed. A comparison of the registries showed that young patients from Kemerovo were more likely to have STEMI (p=0.032), they were more likely to have stenting (p=0.004), they were more often diagnosed with chronic renal and heart failure (p=0.001), and more often ACE inhibitors was prescribed (p=0.017), and MI during hospitalization was more often complicated by bleeding (p=0.003).Conclusion. From 1.7 to 2.4% of all MI occurs in young patients. The most frequent version of the debut is STEMI. The leading factors of cardiovascular risk in such patients are the male gender, active smoking, a hereditary history of cardiovascular diseases, low cholesterol of high density lipoproteins with insufficient statins prevention. In young patients of the Kemerovo registry, chronic heart failure and chronic kidney disease were more often observed, and ACE inhibitors were prescribed, hospitalization was often accompanied by bleeding. In a young age differences in the frequency and structure of outcomes in one year after referent MI were not found when comparing registries.

scholarly journals Comparison of accelerometer-derived physical activity levels between individuals with and without cancer: a UK Biobank study

2019 ◽  
Vol 15 (33) ◽  
pp. 3763-3774 ◽  
Author(s):  
Laura McDonald ◽  
Mustafa Oguz ◽  
Robert Carroll ◽  
Pratik Thakkar ◽  
Fei Yang ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cox Regression ◽  
Activity Levels ◽  
Uk Biobank ◽  
Cancer Group ◽  
All Cause Mortality ◽  
History Of ◽  
The Difference ◽  
The Uk ◽  
History Of Cancer

Aim: To identify the difference in physical activity (PA) levels between individuals with and without cancer, and to estimate all-cause mortality associated with this difference. Methods: Current cancer, cancer survivor and cancer-free groups were identified from the UK Biobank. We used multivariate and Cox regression to estimate PA differences and association of PA with all-cause mortality. Results: Compared with the cancer-free individuals, participants in the two cancer groups had fewer minutes in moderate-to-vigorous PA per day in adjusted analyses. The PA difference was associated with higher mortality in the current cancer group. Conclusion: Patients with a history of cancer were less active than those without cancer, and PA is associated with increased mortality. PA improvement strategies in cancer patients must be explored.

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