Adherence to the EAT-Lancet Healthy Reference Diet in relation to Coronary Heart Disease, All-Cause Mortality Risk and Environmental Impact: results from the EPIC-NL Cohort

Objectives: To construct a diet-score measuring the level of adherence to the Healthy Reference Diet (HRD), to explore whether adherence to the HRD is associated with coronary heart disease (CHD), all-cause mortality risk, and to calculate its environmental impact. Design: Prospective cohort study. Setting: The Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL). Participants: 37,349 adults (20-70y) without CHD at baseline. Main outcome measures: Primary outcomes were incident CHD and all-cause mortality. Secondary outcomes were greenhouse gas emission (GHGE), land use, blue water use, freshwater eutrophication, marine eutrophication, and terrestrial acidification. Results: During a median 15.3-year follow-up, 2,543 cases of CHD occurred, and 5,648 individuals died from all causes. The average HRD-score was 73 (SD=10). High adherence to the HRD was associated with a 15% lower risk of CHD (hazard ratio 0.85, 95% confidence interval 0.75 to 0.96), as well as a 17% lower risk of all-cause mortality (hazard ratio 0.83, 95% confidence interval 0.77 to 0.90) in multivariable-adjusted models. Better adherence to the HRD was associated with lower environmental impact from GHGE (β= -0.10 kg CO2-eq, 95% confidence interval -0.13 to -0.07), land use (β= -0.11 m2 per year, 95% confidence interval -0.12 to -0.09), freshwater eutrophication (β= -0.000002 kg P-eq, 95% confidence interval -0.000004 to -0.000001), marine eutrophication (β= -0.00035 kg N-eq, 95% confidence interval -0.00042 to -0.00029), and terrestrial acidification (β = -0.004 kg SO2-eq, 95% confidence interval -0.004 to -0.003), but with higher environmental impact from blue water use (β=0.044 m3, 95% confidence interval 0.043 to 0.045). Conclusion: High adherence to the HRD was associated with lower risk of CHD and all-cause mortality. Additionally, increasing adherence to the HRD could lower some aspects of the environmental impact of diets, but attention is needed for the associated increase in blue water use.

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Abstract 031: Diastolic Blood Pressure, Coronary Artery Calcium, and Cardiac Outcomes in the Multi-ethnic Study of Atherosclerosis

Hypertension ◽

10.1161/hyp.70.suppl_1.031 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

John W McEvoy ◽

Faisal Rahman ◽

Mahmoud Al Rifai ◽

Michael Blaha ◽

Khurram Nasir ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Confidence Interval ◽

Diastolic Blood Pressure ◽

Coronary Artery Calcium ◽

J Curve ◽

Increased Risk ◽

All Cause Mortality

Diastolic blood pressure (BP) has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic BP, our objective was to test whether the J-curve is most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic BP category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic BP of 80 to 89 mmHg (reference), persons with diastolic BP <60 mmHg had increased risk of coronary heart disease events (HR 1.69 [95% confidence interval 1.02-2.79]) and all-cause mortality (HR 1.48 [95% confidence interval 1.10-2.00]), but not stroke. After stratification, associations of diastolic BP <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic BP <60 mmHg was not associated with events when coronary artery calcium was zero. We also found no interaction in the association between low diastolic BP and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with elevated CAC; suggesting that added caution may be needed when pursuing intensive BP treatment targets among persons with subclinical atherosclerosis.

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Cardiovascular Disease and All-Cause Mortality in Male Twins With Discordant Cardiorespiratory Fitness: A Nationwide Cohort Study

American Journal of Epidemiology ◽

10.1093/aje/kwaa060 ◽

2020 ◽

Vol 189 (10) ◽

pp. 1114-1123

Author(s):

Marcel Ballin ◽

Anna Nordström ◽

Peter Nordström

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Confidence Interval ◽

Cardiorespiratory Fitness ◽

Military Service ◽

Lower Risk ◽

Hazard Ratio ◽

Familial Factors ◽

All Cause Mortality

Abstract Whether genetic and familial factors influence the association between cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) is unknown. Two cohorts were formed based on data from 1,212,295 men aged 18 years who were conscripted for military service in Sweden during 1972–1996. The first comprised 4,260 twin pairs in which the twins in each pair had different CRF (≥1 watt). The second comprised 90,331 nonsibling pairs with different CRF and matched on birth year and year of conscription. Incident CVD and all-cause mortality were identified using national registers. During follow-up (median 32 years), there was no difference in CVD and mortality between fitter twins and less fit twins (246 vs. 251 events; hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.83, 1.20). The risks were similar in twin pairs with ≥60-watt difference in CRF (HR = 0.96, 95% CI: 0.57, 1.64). In contrast, in the nonsibling cohort, fitter men had a lower risk of the outcomes than less fit men (4,444 vs. 5,298 events; HR = 0.83, 95% CI: 0.79, 0.86). The association was stronger in pairs with ≥60-watt difference in CRF (HR = 0.65, 95% CI: 0.59, 0.71). These findings indicate that genetic and familial factors influence the association of CRF with CVD and mortality.

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The Global Blue Water Use for the Dutch Diet and Associated Environmental Impact on Water Scarcity

World Journal of Food Science and Technology ◽

10.11648/j.wjfst.20210501.13 ◽

2021 ◽

Vol 5 (1) ◽

pp. 10

Author(s):

Hollander Anne ◽

Vellinga Reina Elisabeth ◽

Valk Elias de ◽

Toxopeus Ido ◽

Kamp Mirjam van de ◽

...

Keyword(s):

Environmental Impact ◽

Water Use ◽

Water Scarcity ◽

Blue Water

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Abstract P067: Nut Consumption is Associated with a Lower Risk of Death among US Male Physicians

Circulation ◽

10.1161/circ.129.suppl_1.p067 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Luc Djousse ◽

Andrew Petrone ◽

John Gaziano

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Lower Risk ◽

Unsaturated Fatty Acids ◽

Cox Regression ◽

Adjusted Relative Risk ◽

Inverse Association ◽

Risk Of Death ◽

All Cause Mortality ◽

Nut Intake

Background: Previous studies have suggested that nut consumption, a good source of unsaturated fatty acids, magnesium, potassium, fiber, antioxidants, and vitamins is associated with a lower risk of coronary heart disease, type 2 diabetes, and sudden cardiac death. However, limited data are available on the association between nut intake and all-cause mortality. Objective: To test the hypothesis that nut consumption is inversely associated with the risk of all-cause mortality. Methods: A prospective cohort study of 20,742 male physicians from the Physicians’ Health Study. Nut intake was assessed between 1999 and 2002 using a food frequency questionnaire and deaths were ascertained by an endpoint committee. We used Cox regression to estimate multivariable adjusted relative risk of death according to nut consumption. In secondary analyses, we evaluated associations of nut consumption with cause-specific mortality (coronary heart disease, stroke, and cancer deaths). Results: During a median follow-up of 9.5 years, there were 2,732 deaths. The mean age at baseline was 66.6 ± 9.3 years. Median intake of nuts was 1 time per week. Multivariable adjusted hazard ratios (95% CI) were: 1.0 (ref), 0.91 (0.83-1.00), 0.85 (0.76-0.95), 0.86 (0.75-0.98), and 0.74 (0.63-0.87) for nut consumption of never, 1-3/month, 1/week, 2-4/week, and 5+/week, respectively (p for linear trend <0.0001), after adjustment for age, body mass index, alcohol use, smoking, exercise, energy intake, saturated fat, fruit and vegetables, red meat intake, and prevalent diabetes and hypertension. In a secondary analysis, nut intake was inversely related to CVD death; however, only a suggestive and non-statistically significant relation was seen for cancer mortality (Table). Conclusions: Our data are consistent with an inverse association between nut consumption and risk of all-cause mortality in US male physicians.

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Urate lowering therapy is associated with a lower risk of heart failure hospitalisation or mortality in hyperuricaemic patients with heart failure: a comparative effectiveness study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0904 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S.J Kiddle ◽

A Abdul-Sultan ◽

K Andersson Sundell ◽

S Nolan ◽

S Perl ◽

...

Keyword(s):

Heart Failure ◽

Uric Acid ◽

Propensity Score ◽

Confidence Interval ◽

Lower Risk ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Adverse Health Outcomes ◽

Lowering Therapy ◽

All Cause Mortality

Abstract Background There is a strong association between hyperuricemia (elevated serum uric acid) and the risk of heart failure. However, it remains unclear whether prescribing urate lowering therapies have any bearing on long term clinical outcomes. Purpose In this study, we assessed the impact of urate lowering therapy treatment on the risk of adverse health outcomes (hospitalisation for heart failure and all-cause mortality) in patients with hyperuricemia and heart failure. Methods We utilised data from Clinical Practice Research Datalink (CPRD) GOLD, a UK-based primary care database linked to secondary care (Hospital Episode Statistics) and mortality data (Office of National Statistics). The study population included patients with a first record of hyperuricemia (serum uric acid >7 mg/dl for men and >6 mg/dl for women or a gout diagnosis) between 1990 and 2019 with a history of heart failure. Incident urate lowering therapy users were identified post hyperuricemia diagnosis. To account for potential confounding variables and potential treatment paradigm changes over the study period, a propensity score matched cohort was constructed for urate lowering therapy initiators and non-initiators within 6 month accrual blocks. Adverse health outcomes were compared between matched treatment groups using Cox regression analysis adjusted for the same variables used in the propensity score. Due to extensive treatment switching and discontinuation, on-treatment analysis was the main analysis. Results A total of 2,174 propensity score matched pairs were identified. We found that urate lowering therapy was associated with a 43% lower risk of all-cause mortality or hospitalization for heart failure (Figure 1, adjusted hazard ratio 0.57, 95% confidence interval 0.51–0.65), and a 19% lower risk of cardiovascular mortality or hospitalization for heart failure (Figure 2, adjusted hazard ratio 0.81, 95% confidence interval 0.71–0.92) within five years compared to those not on therapy (on-treatment analysis). In an intention-to-treat sensitivity analysis, urate lowering therapy was associated with a 17% lower risk of all-cause mortality or hospitalization for heart failure (adjusted hazard ratio 0.83, 95% confidence interval 0.76–0.91), and a 11% lower risk of cardiovascular mortality or hospitalization for heart failure (adjusted hazard ratio 0.89, 95% confidence interval 0.81–0.98) within five years compared to those not on urate lowering therapy. Adjusted and non-adjusted hazard ratios were consistent for all outcomes. Conclusion We found that urate lowering therapy was associated with a lower risk of adverse outcomes in hyperuricemia or gout patients with a history of heart failure. These results are consistent with the hypothesis that uric acid lowering may lead to improved outcome in patients with heart failure and hyperuricemia, emphasizing the need to investigate the potential benefits of intense uric acid lowering in prospective randomized controlled trials. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): AstraZeneca Figure 1 (HF = heart failure) Figure 2 (CV = cardiovascular)

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All-Cause Mortality up to and After Coronary Heart Disease and Stroke Events in European Middle-Aged Men

Stroke ◽

10.1161/strokeaha.115.008903 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1371-1373 ◽

Cited By ~ 1

Author(s):

Bilal Majed ◽

Michèle Montaye ◽

Aline Wagner ◽

Dominique Arveiler ◽

Pierre Ducimetiere ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Confidence Interval ◽

Proportional Hazards ◽

Middle Aged ◽

Hazard Ratios ◽

All Cause Mortality ◽

Study Country ◽

Time Dependent Covariates

Background and Purpose— The aim was to investigate prospectively the all-cause mortality risk up to and after coronary heart disease (CHD) and stroke events in European middle-aged men. Methods— The study population comprised 10 424 men 50 to 59 years of age recruited between 1991 and 1994 in France (N=7855) and Northern Ireland (N=2747) within the Prospective Epidemiological Study of Myocardial Infarction. Incident CHD and stroke events and deaths from all causes were prospectively registered during the 10-year follow-up. In Cox’s proportional hazards regression analysis, CHD and stroke events during follow-up were used as time-dependent covariates. Results— A total of 769 CHD and 132 stroke events were adjudicated, and 569 deaths up to and 66 after CHD or stroke occurred during follow-up. After adjustment for study country and cardiovascular risk factors, the hazard ratios of all-cause mortality were 1.58 (95% confidence interval 1.18–2.12) after CHD and 3.13 (95% confidence interval 1.98–4.92) after stroke. Conclusions— These findings support continuous efforts to promote both primary and secondary prevention of cardiovascular disease.

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Birth weight and risk of coronary heart disease in adults: a meta-analysis of prospective cohort studies

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174414000440 ◽

2014 ◽

Vol 5 (6) ◽

pp. 408-419 ◽

Cited By ~ 32

Author(s):

S.-F. Wang ◽

L. Shu ◽

J. Sheng ◽

M. Mu ◽

S. Wang ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Birth Weight ◽

Confidence Interval ◽

Lower Risk ◽

Meta Analysis ◽

Continuous Variable ◽

High Birth Weight ◽

Weighted Estimate ◽

Increased Risk

Some studies have found a significant relationship between birth weight (BW) and the risk of coronary heart disease (CHD) in adulthood, but results were inconsistent. The purpose of this study was to characterize the association between BW and the risk of CHD in adults. Among 144 papers detected by our search, 27 papers provided data on the relationship between BW and CHD, of which 23 papers considered BW as a continuous variable, and 14 articles considered BW as a categorical variable for this meta-analysis. Based on 23 papers, the mean weighted estimate for the association between BW and the combined outcome of non-fatal and fatal CHD was 0.83 [95% confidence interval (CI), 0.80–0.86] per kilogram of BW (P<0.0001). Low birth weight (LBW<2500 g) was associated with increased risk of CHD [odds ratio (OR), 1.19; 95% confidence interval (CI), 1.11–1.27] compared with subjects with BW⩾2500 g. LBW, as compared with normal BW (2500–4000 g), was associated with increased risk of CHD (OR, 1.16; 95% CI, 1.08–1.25). High birth weight (HBW⩾4000 g) was associated with decreased risk of CHD (OR, 0.89; 95% CI, 0.81–0.98) compared with subjects with BW<4000 g. In addition, there was an indication (not quite significant) that HBW was associated with a lower risk of CHD (OR, 0.89; 95% CI, 0.79–1.01), as compared with normal BW. No significant evidence of publication bias was present. These results suggest that LBW is significantly associated with increased risk of CHD and a 1 kg higher BW is associated with a 10–20% lower risk of CHD.

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Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

BMJ ◽

10.1136/bmj.m2297 ◽

2020 ◽

pp. m2297 ◽

Cited By ~ 5

Author(s):

Xiaoyan Cai ◽

Yunlong Zhang ◽

Meijun Li ◽

Jason HY Wu ◽

Linlin Mai ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

General Population ◽

Confidence Interval ◽

Absolute Risk ◽

Meta Analysis ◽

Atherosclerotic Cardiovascular Disease ◽

Increased Risk ◽

All Cause Mortality

Abstract Objective To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. Design Updated meta-analysis. Data sources Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. Review methods Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. Results A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10). Conclusions Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.

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Environmental and Uncertainty Assessment: Hazardous Industry Waste as Aggregate in Cement Production

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.160-162.373 ◽

2010 ◽

Vol 160-162 ◽

pp. 373-378

Author(s):

Jing Lan Hong ◽

Xiang Zhi Li

Keyword(s):

Climate Change ◽

Environmental Impact ◽

Energy Use ◽

Raw Material ◽

Human Toxicity ◽

Cement Production ◽

Industry Waste ◽

Marine Eutrophication ◽

The Impact ◽

Freshwater Eutrophication

A life cycle assessment was carried out to estimate the environmental impact of industry waste as aggregate in cement production. To confirm and add credibility to the study, an uncertainty analysis was also carried out. Results showed the impact seen from climate change, human toxicity, marine eutrophication, marine ecotoxicity, and freshwater eutrophication categories had an important contribution to overall environmental impact, due to energy use and direct emissions from clinker and limestone production stages. The most significant substances contribute to the climate change is CO2 to air; for the human toxicity, it is Hg to air and Mn to water; for the marine eutrophication and marine ecotoxicity, it is nitrate and Ni to water, respectively; for the freshwater eutrophication, it is phosphorus to water. Increasing electricity recovery rate, optimizing the raw material consumption for clinker production are highly recommended to reduce the adverse impact on the environment, and therefore reduce the pressure on the environment from dramatically increased hazardous industry waste disposal.

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Different Types of Statins and All-Cause Mortality during Anticoagulation for Venous Thromboembolism: Validation Study from RIETE Registry

TH Open ◽

10.1055/s-0040-1716734 ◽

2020 ◽

Vol 04 (03) ◽

pp. e236-e244

Author(s):

Carmine Siniscalchi ◽

José M. Suriñach ◽

Adriana Visonà ◽

José L. Fernández-Reyes ◽

Covadonga Gómez-Cuervo ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Confidence Interval ◽

Lower Risk ◽

Multivariable Analysis ◽

Fatal Pulmonary Embolism ◽

Risk Of Death ◽

Fatal Bleeding ◽

All Cause Mortality ◽

Different Types

Abstract Introduction We previously reported that during the course of anticoagulation for venous thromboembolism (VTE) patients using statins were at a lower risk to die than nonusers. Methods We used the Registro Informatizado Enfermedad TromboEmbólica (RIETE) registry to validate our previous findings in a subsequent cohort of patients and to compare the risk of death according to the use of different types of statins. Results From January 2018 to December 2019, 19,557 patients with VTE were recruited in RIETE. Of them, 4,065 (21%) were using statins (simvastatin, 1,406; atorvastatin, 1,328; rosuvastatin, 246; and others, 1,085). During anticoagulation (192 vs.182 days, for statin and no statin users respectively), 500 patients developed a VTE recurrence, 519 suffered major bleeding, and 1,632 died (fatal pulmonary embolism [PE], 88 and fatal bleeding, 78). On multivariable analysis, statin users were at a lower risk to die (hazard ratio [HR] = 0.68; 95% confidence interval [CI]: 0.59–0.79) than nonusers. When separately analyzing the drugs, on multivariable analysis, patients using simvastatin (HR = 0.64; 95% CI: 0.52–0.80), atorvastatin (HR 0.72; 95% CI: 0.58–0.89), or other statins (HR = 0.67; 95% CI: 0.52–0.87) were at a lower risk to die than nonusers. For those using rosuvastatin, difference was not statistically significant (HR = 0.77; 95% CI: 0.50–1.19), maybe due to the sample size. Conclusion Our data validate previous findings and confirm that VTE patients using statins at baseline are at a lower risk to die than nonusers. No statistically differences were found according to type of statins.

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