Combined healthy lifestyle factors and risk of all-cause and cardiovascular first hospitalization

Abstract Background We aimed to explore the association of combined healthy lifestyles with risk of first hospitalization for all-cause, cardiovascular disease (CVD), ischemic heart disease (IHD) and stroke in a southern Italian population-based cohort. We also investigated several biological mechanisms possibly on the pathway between lifestyles and health outcomes. Methods Longitudinal analysis on 23,161 men and women (aged≥35 y) recruited in the Moli-sani Study (2005-2010). We defined 4 healthy lifestyle factors as abstention from smoking; high adherence to Mediterranean diet; physical activity; absence of abdominal obesity. First hospital admissions for any and CVD-related causes were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow up of 7.2 y, we ascertained a total of 9,482 hospitalizations, 3,556 CVD, 939 IHD and 589 stroke-related hospital admissions. Adherence to all four healthy lifestyles, compared with none or 1, was associated with lower risk of hospitalization for any cause (HR = 0.82; 0.74-0.90), CVD (HR = 0.81;0.69-0.95) and IHD (HR = 0.63; 0.44-0.90) and, to a less extent, with stroke hospitalizations. Inflammatory biomarkers (e.g. C-reactive protein) were likely to partly explain the association between lifestyles and all-cause (14%) or CVD (15%) hospitalizations, while inflammation played a leading role towards risk of IHD (30%) and stroke-related hospital admissions (21%). Conclusions The impact of combined 4 healthy lifestyles on first hospitalization risk was considerable. Inflammatory biomarkers explained a large proportion of this association. Key messages Improvements to lifestyle reduce the risk of hospitalizations in a general adult population. Achieving a greater number of healthy behaviours has the potential to reduce the burden of hospitalizations and the associated healthcare costs.

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Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study

BMC Medicine ◽

10.1186/s12916-019-1474-7 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 6

Author(s):

Heinz Freisling ◽

Vivian Viallon ◽

Hannah Lennon ◽

Vincenzo Bagnardi ◽

Cristian Ricci ◽

...

Keyword(s):

Cohort Study ◽

Cox Regression ◽

Healthy Lifestyle ◽

Smoking Status ◽

Lifestyle Factors ◽

Healthy Lifestyles ◽

Men And Women ◽

Cardiometabolic Diseases ◽

Hazard Ratios ◽

Risk Of Cancer

Abstract Background Although lifestyle factors have been studied in relation to individual non-communicable diseases (NCDs), their association with development of a subsequent NCD, defined as multimorbidity, has been scarcely investigated. The aim of this study was to investigate associations between five lifestyle factors and incident multimorbidity of cancer and cardiometabolic diseases. Methods In this prospective cohort study, 291,778 participants (64% women) from seven European countries, mostly aged 43 to 58 years and free of cancer, cardiovascular disease (CVD), and type 2 diabetes (T2D) at recruitment, were included. Incident multimorbidity of cancer and cardiometabolic diseases was defined as developing subsequently two diseases including first cancer at any site, CVD, and T2D in an individual. Multi-state modelling based on Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) of developing cancer, CVD, or T2D, and subsequent transitions to multimorbidity, in relation to body mass index (BMI), smoking status, alcohol intake, physical activity, adherence to the Mediterranean diet, and their combination as a healthy lifestyle index (HLI) score. Cumulative incidence functions (CIFs) were estimated to compute 10-year absolute risks for transitions from healthy to cancer at any site, CVD (both fatal and non-fatal), or T2D, and to subsequent multimorbidity after each of the three NCDs. Results During a median follow-up of 11 years, 1910 men and 1334 women developed multimorbidity of cancer and cardiometabolic diseases. A higher HLI, reflecting healthy lifestyles, was strongly inversely associated with multimorbidity, with hazard ratios per 3-unit increment of 0.75 (95% CI, 0.71 to 0.81), 0.84 (0.79 to 0.90), and 0.82 (0.77 to 0.88) after cancer, CVD, and T2D, respectively. After T2D, the 10-year absolute risks of multimorbidity were 40% and 25% for men and women, respectively, with unhealthy lifestyle, and 30% and 18% for men and women with healthy lifestyles. Conclusion Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.

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Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽

10.1136/heartjnl-2017-311857 ◽

2017 ◽

Vol 104 (6) ◽

pp. 487-493 ◽

Cited By ~ 14

Author(s):

Ekrem Yasa ◽

Fabrizio Ricci ◽

Martin Magnusson ◽

Richard Sutton ◽

Sabina Gallina ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Orthostatic Hypotension ◽

Cardiovascular Events ◽

Hospital Admissions ◽

Cox Regression ◽

All Cause Mortality ◽

Unexplained Syncope ◽

The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

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Health promotion in the context of behavioral economics: gender aspects

POPULATION ◽

10.19181/population.2020.23.2.10 ◽

2020 ◽

Vol 23 (2) ◽

pp. 112-124

Author(s):

Natalia S. Grigorieva ◽

Tatiana V. Сhubarova

Keyword(s):

Health Promotion ◽

Behavioral Economics ◽

Gender Stereotypes ◽

Healthy Lifestyle ◽

Modern Society ◽

Healthy Lifestyles ◽

Active Involvement ◽

Interdisciplinary Approaches ◽

Gender Aspects ◽

The Impact

The article discusses the gender aspects of health, proceeding from the assumption that taking them into account is likely to increase the effectiveness of motivational measures in the field of forming healthy lifestyles. The methodological basis of this paper is the concept of health promotion supported by WHO that is based on intersectoral and interdisciplinary approaches. It incorporates both a certain system of values, primarily active involvement of people in maintaining their health, and a set of state activities, among which motivating people to healthy lifestyles is important. Behavioral economics as an area of an interdisciplinary research on decision-making substantiates the mechanisms that should be used, among other things, to achieve the goals of healthcare policy, and to solve such problems of modern society as lack of physical activity, tobacco and alcohol abuse, and unhealthy diet.Gender approach that includes gender aspects in the process of analyzing the situation and making political decisions aimed at improving population health becomes a precondition for increasing the effectiveness of motivational measures taken in the interests of promoting the health of citizens. The results of the surveys on the impact of behavioral factors on the health status of the population of Russia conducted by the Russian statistical agency (Rosstat) in 2013 and 2018 were used as a source of empirical data. They made it possible to identify both the differences and the similarities of women and men with regard to behavior motives concerning certain parameters of a healthy lifestyle, namely physical activities and diet. The authors conclude that, despite the importance of using measures aimed at changing behavior, sustainable overcoming of gender stereotypes depends on the intersection of behavioral and socio-economic determinants of health and healthy behavior.

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P0211GLOMERULAR HYPERFILTRATION AND CANCER: A NATIONWIDE POPULATION-BASED STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0211 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yaerim Kim ◽

Jeongsoo Yoon ◽

Jin Hyuk Paek ◽

Woo Yeong Park ◽

Kyubok Jin ◽

...

Keyword(s):

National Health ◽

Malignant Disease ◽

Cox Regression ◽

Asian Population ◽

Population Based ◽

Glomerular Hyperfiltration ◽

Outcome Variable ◽

Cox Regression Analysis ◽

Increased Risk ◽

The Impact

Abstract Background and Aims Glomerular hyperfiltration is associated with all-cause mortality. Herein, we evaluated the association between glomerular hyperfiltration and the development of malignant disease, the most common cause of death, in an Asian population. Method We retrospectively reviewed the National Health Insurance Service database of Korea for people who received national health screenings from 2012 to 2013. Glomerular hyperfiltration was defined as the 95th percentile and greater after adjusting for age and sex. We performed a multivariate Cox regression analysis using glomerular hyperfiltration at the first health screening as the exposure variable and cancer development as the outcome variable to evaluate the impact of glomerular hyperfiltration on the development of malignant disease. Results A total of 1,953,123 examinations who followed-up for 4.9 years were included in this study. Among the 8 different site-specific malignant disease categories, digestive organs and female genital organs showed a significant associations between glomerular hyperfiltration and malignancy. The population with glomerular hyperfiltration showed an increased risk for stomach cancer (adjusted hazard ratio [aHR], 1.27), colorectal cancer (aHR, 1.23), and liver or intrahepatic malignancy (aHR, 1.40). In addition, the risk for uterine and ovarian cancer was significantly increased in the population with glomerular hyperfiltration (aHR, 1.36). Conclusion Glomerular hyperfiltration was associated with an increased risk for the development of malignant diseases in specific organs, such as the stomach, colorectum, uterus, and ovary. Glomerular hyperfiltration needs to be considered a significant sign of the need to evaluate the possibility of hidden adverse health conditions, including malignancies.

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Modifiable Lifestyle Factors: Opportunities for (Hereditary) Breast Cancer Prevention - a Narrative Review

Breast Care ◽

10.1159/000488995 ◽

2018 ◽

Vol 13 (2) ◽

pp. 108-113 ◽

Cited By ~ 9

Author(s):

Jacqueline Lammert ◽

Sabine Grill ◽

Marion Kiechle

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cancer Prevention ◽

Healthy Lifestyle ◽

Absolute Risk ◽

Lifestyle Factors ◽

Breast Cancer Prevention ◽

The Impact

Increasing rates of obesity, lack of physical activity, sedentary behavior, and frequent alcohol consumption are major lifestyle-related risk factors for breast cancer. In fact, it has been estimated that about one-third of breast cancer cases are attributable to factors women can change. Most research has focused on examining the impact of one single exposure on breast cancer risk while adjusting for other risk modifiers. Capitalizing on big data, major efforts have been made to evaluate the combined impact of well-established lifestyle factors on overall breast cancer risk. At the individual level, data indicate that even simple behavior modifications could have a considerable impact on breast cancer prevention. Moreover, there is emerging new evidence that adopting a healthy lifestyle may be particularly relevant for women with hereditary susceptibility to breast cancer. On the absolute risk scale, studies suggest that the presence of certain risk factors, such as excessive body weight, had a substantially higher impact on breast cancer risk if women had a hereditary predisposition to cancer. The existing body of knowledge gives the medical professionals guidance as to which factors to focus on when counseling patients. However, well-designed randomized controlled trials utilizing objective methods are crucial to providing concrete recommendations.

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Does vitamin D status predict weight gain or increase in waist circumference? Results from the longitudinal Health 2000/2011 Survey

Public Health Nutrition ◽

10.1017/s1368980019004403 ◽

2020 ◽

Vol 23 (7) ◽

pp. 1266-1272 ◽

Cited By ~ 1

Author(s):

Tuija Jääskeläinen ◽

Satu Männistö ◽

Tommi Härkänen ◽

Katri Sääksjärvi ◽

Seppo Koskinen ◽

...

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Weight Gain ◽

Waist Circumference ◽

Healthy Lifestyle ◽

Adult Population ◽

Population Based ◽

Vitamin D Insufficiency ◽

Vitamin D Status

AbstractObjective:To investigate whether vitamin D status predicts weight gain or increase in waist circumference during the 11-year follow-up in general adult population.Design:A population-based longitudinal study.Setting:The study was conducted using data from the nationally representative Health 2000/2011 Survey. The analyses were based on regression models adjusted for sociodemographic and lifestyle factors.Participants:Weight, waist circumference and vitamin D status (serum 25-hydroxyvitamin D concentration analysed with radioimmunoassay) were measured from 2924 participants aged 30–64 years at baseline.Results:In men, low vitamin D status at baseline predicted ≥10 % increase in waist circumference during the follow-up when adjusted for age only (OR for sufficient v. deficient S-25(OH)D 0·41; 95 % CI 0·25, 0·67; P for trend <0·01), but the association with weight gain was only borderline significant. After adjustment for potential confounders, low vitamin D status remained a significant predictor of increase in waist circumference, but the association with weight gain was further attenuated. In women, vitamin D status at baseline did not predict weight gain or increase in waist circumference.Conclusions:Our results suggest that vitamin D insufficiency may be a risk factor of abdominal obesity among men but not among women. In men, it may also increase the risk of weight gain. Further studies are required to confirm these findings and examine potential mechanisms behind them. There is also a possibility that vitamin D is a biomarker of healthy lifestyle rather than an independent risk factor for obesity.

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Effect of Lifestyle Factors on Hypertension by Constitution Type: A Large Community-Based Study

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/3231628 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Ji-Eun Park ◽

Chol Shin ◽

Siwoo Lee

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Healthy Lifestyle ◽

Smoking Status ◽

Lifestyle Factors ◽

Unhealthy Lifestyle ◽

Sasang Constitution ◽

The Difference ◽

Constitution Type ◽

The Impact

Background. The risk of hypertension differs according to lifestyle factors and individual constitution types. The aim of this study was to investigate the effect of lifestyle factors on hypertension and to assess whether those effects differ according to the constitution types. Methods. A total of 5,793 men and women were recruited between 2012 and 2014. Odds ratios for hypertension associated with constitution types and lifestyle factors were estimated. Lifestyle factors included smoking status, body mass index, alcohol consumption, physical activity, and sleep quality. Constitution types were estimated based on the Sasang constitutional medicine as the TE type, SE type, and SY type. Results. The risk of hypertension was significantly higher for SY (odds ratio 1.25 (95% confidence interval 1.03 to 1.52) and TE types (1.38 (1.10 to 1.74)) than the SE type even with adjustment of health behaviors. Compared with individuals who had an unhealthy lifestyle, those with healthy lifestyle scores showed significantly lower risk of hypertension in only SY (odds ratio 0.62 (95% confidence interval 0.48 to 0.81)) and TE types (0.69 (0.58 to 0.81)). The difference in risk for hypertension among constitution types was decreased with a healthy lifestyle (1.34 in SY and 2.35 in TE types, as compared with the SE type) versus an unhealthy lifestyle (2.21 in SY and 3.64 in TE types, as compared with the SE type). Conclusion. The risk of hypertension was different by Sasang constitution types. The impact of lifestyle factors differed according to Sasang constitution types, and the difference in risk of hypertension among constitution types was decreased with a healthy lifestyle.

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Evaluation of community coalition training effects on youth hospital-admitted injury incidence in Victoria, Australia: 2001–2017

Injury Prevention ◽

10.1136/injuryprev-2019-043386 ◽

2019 ◽

Vol 26 (5) ◽

pp. 463-470 ◽

Cited By ~ 1

Author(s):

Janneke Berecki-Gisolf ◽

Bosco Rowland ◽

Nicola Reavley ◽

Barbara Minuzzo ◽

John Toumbourou

Keyword(s):

Risk Factors ◽

Injury Risk ◽

Negative Binomial ◽

Hospital Admissions ◽

Intervention Strategy ◽

Age Groups ◽

Negative Binomial Regression ◽

Population Based ◽

Injury Incidence ◽

The Impact

BackgroundInjuries are one of the three leading causes of morbidity and mortality for young people internationally. Although community risk factors are modifiable causes of youth injury, there has been limited evaluation of community interventions. Communities That Care (CTC) offers a coalition training process to increase evidence-based practices that reduce youth injury risk factors.MethodUsing a non-experimental design, this study made use of population-based hospital admissions data to evaluate the impact on injuries for 15 communities that implemented CTC between 2001 and 2017 in Victoria, Australia. Negative binomial regression models evaluated trends in injury admissions (all, unintentional and transport), comparing CTC and non-CTC communities across different age groups.ResultsStatistically significant relative reductions in all hospital injury admissions in 0–4 year olds were associated with communities completing the CTC process and in 0–19 year olds when communities began their second cycle of CTC. When analysed by subgroup, a similar pattern was observed with unintentional injuries but not with transport injuries.ConclusionThe findings support CTC coalition training as an intervention strategy for preventing youth hospital injury admissions. However, future studies should consider stronger research designs, confirm findings in different community contexts, use other data sources and evaluate intervention mechanisms.

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Final results from a large prospective Italian population study on glioblastoma and correlations with MGMT status: The Project of Emilia-Romagna Region in Neuro-oncology (PERNO).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.2048 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 2048-2048

Author(s):

Alba Ariela Brandes ◽

Mario Ermani ◽

Roberto D'Alessandro ◽

Fiorenzo Albani ◽

Enrico Franceschi ◽

...

Keyword(s):

Population Study ◽

Performance Status ◽

Daily Practice ◽

Population Based ◽

Italian Population ◽

Mgmt Methylation ◽

Emilia Romagna Region ◽

Extent Of Surgery ◽

Successful Approach ◽

The Impact

2048 Background: The impact on the general population of temozolomide concurrent with and adjuvant to radiotherapy (RT/TMZ) was assessed in the context of the Registry of the Project of the Emilia-Romagna Region in Neuro-Oncology (PERNO), the first Italian prospective observational population-based study in the field of neuro-oncology. Methods: Patients (pts) meeting the following inclusion criteria were evaluated: age ≥18 years; PS 0-3; histologically confirmed GBM, no previous or concomitant non-glial tumoral disease, residence in the Emilia Romagna region. The data were collected prospectively. Results: Study accrual, started on January 1 2009, was closed, as planned, on December 31 2010. Two hundred sixty-eight pts (F=111, M=157; median age, 63.5 [range 29-34] years) were studied. mOS was 10.7 months (95%CI: 9.2 – 12.3). MGMT status, assessed in 186 (89%) of 210 pts who had at least radiotherapy was evaluable in 174 pts (83%), being methylated in 76 (43.7%), and unmethylated in 98 (56.3%) pts. mOS for pts with MGMT methylated status was 18.5 months (95%CI: 14.4-22.6), and 12.4 months for those with MGMT unmethylated status (95%CI: 10.5 - 14.3, p<0.0001). 140 pts <70 years were treated with RT/TMZ; mOS in this group was 16.4 months (95% CI: 14.5 – 18.4). mOS was 20 months in the 59 pts (42%) harboring MGMT methylation (95% CI: 12.8 - 27.2), and 13.5 months in the 73 pts (52%) without MGMT methylation (95% CI: 10.8 – 16.2, p<0.0001). At multivariate analysis, a significant prognostic role was found for performance status (p=0.001), extent of surgery (p=0.009), age (p=0.004), postsurgical treatment (p=0.03), and MGMT status (methylated vs unmethylated, p=0.01). Conclusions: The data from the present large prospective population study are in line with those reported in the EORTC/NCIC randomized trial, confirming that this successful approach has been widely incorporated in daily practice.

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Impact of putative chemopreventative agents on prostate cancer diagnosis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.40 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 40-40

Author(s):

Hanan Goldberg ◽

Faizan Moshin ◽

Zachary William Abraham Klaassen ◽

Thenappan Chandrasekar ◽

Christopher Wallis ◽

...

Keyword(s):

Prostate Cancer ◽

Cox Regression ◽

Large Population ◽

Multivariable Analysis ◽

Population Based ◽

Cumulative Exposure ◽

Population Based Study ◽

Diagnosis Rate ◽

The Impact

40 Background: Prostate cancer (PC) is the most common non-cutaneous cancer in Canadian men and the third most common cause of cancer death in Canada. Several studies have shown that use of commonly prescribed medications, including those used for diabetes and hypercholesterolemia, is associated with improved survival in various malignancies, including PC. There has not been any large population-based study, examining the effects of these and other commonly prescribed medications, on the rate of PC diagnosis, over a 20 years follow-up period. Methods: A retrospective population-based study using data from the institute of clinical evaluative sciences, including all male patients aged 65 and above in Ontario who have had a negative first prostate biopsy between 1994 and 2016. We assessed the impact of commonly prescribed medications on PC diagnosis. The medications included Statins (hydrophilic and hydrophobic), diabetes drugs (metformin, insulins, sulfonylureas, and thizolidinedions), proton pump inhibitors, 5 alpha reductase inhibitors, and alpha blockers. Time dependent Cox regression proportional hazards models were performed determine predictors of PC diagnosis. Medication exposure was time varying and modeled as “ever” vs. “never” use or as cumulative exposure for 6 months of usage. A priori variables included in the model included age, ADG comorbidity score, rurality index, index year, and all medications. Results: A total of 51,415 men were analyzed over a mean (SD) follow-up time of 8.06 (5.44) years. Overall, 10,466 patients (20.4%) were diagnosed with PC, 16,726 (32.5%) had died, and 1,460 (2.8%) patients died of PC. On multivariable analysis increasing age and rurality index were associated with higher PC diagnosis rate, while a more recent index year, and usage of hydrophilic statins was associated with a lower diagnosis rate in both “ever” vs. “never” and cumulative models (HR 0.832, 95% CI 0.732-0.946, p = 0.005, HR 0.973 95% CI 0.951-0.995, p = 0.016, respectively). Conclusions: Hydrophilic statins are associated with a clinically significant lower PC diagnosis. To our knowledge this is the first study demonstrating a clear advantage of one group of statins (hydrophilic) over another (hydrophobic) in PC prevention.

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