The Association Between Lipid Levels and the Risks of Incident Myocardial Infarction, Stroke, and Total Mortality: The Cardiovascular Health Study

Abstract BACKGROUND Anemia has been shown to be a risk factor for coronary artery disease (CAD) and mortality, whereas the role of iron metabolism remains controversial. METHODS We analyzed iron metabolism and its associations with cardiovascular death and total mortality in patients undergoing coronary angiography with a median follow-up of 9.9 years. Hemoglobin and iron status were determined in 1480 patients with stable CAD and in 682 individuals in whom significant CAD had been excluded by angiography. RESULTS Multivariate-adjusted hazard ratios (HRs) for total mortality in the lowest quartiles of iron, transferrin saturation, ferritin, soluble transferrin receptor (sTfR), and hemoglobin were 1.22 (95% CI, 0.96–1.60), 1.23 (95% CI, 0.97–1.56), 1.27 (95% CI, 1.02–1.58), 1.26 (95% CI, 0.97–1.65), and 0.99 (95% CI, 0.79–1.24), respectively, compared to the second or third quartile, which served as reference (1.00) because of a J-shaped association. The corresponding HRs for total mortality in the highest quartiles were 1.44 (95% CI, 1.10–1.87), 1.37 (95% CI, 1.05–1.77), 1.17 (95% CI, 0.92–1.50), 1.76 (95% CI, 1.39–2.22), and 0.83 (95% CI, 0.63–1.09). HRs for cardiovascular death were similar. For hepcidin, the adjusted HRs for total mortality and cardiovascular deaths were 0.62 (95% CI, 0.49–0.78) and 0.70 (95% CI, 0.52–0.90) in the highest quartile compared to the lowest one. CONCLUSIONS In stable patients undergoing angiography, serum iron, transferrin saturation, sTfR, and ferritin had J-shaped associations and hemoglobin only a marginal association with cardiovascular and total mortality. Hepcidin was continuously and inversely related to mortality.

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W14.387 The P12A polymorphism of the peroxisome proliferator-activated receptor gamma-2 gene associated premature coronary heart disease and myocardial infarction. (The Ludwigshafen risk and cardiovascular health study)

Atherosclerosis ◽

10.1016/s0021-9150(04)90386-3 ◽

2004 ◽

Vol 5 (1) ◽

pp. 89

Author(s):

W RENNER

Keyword(s):

Myocardial Infarction ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Peroxisome Proliferator ◽

Peroxisome Proliferator Activated Receptor ◽

Premature Coronary Heart Disease

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Abstract MP11: Association of Sick Sinus Syndrome with Incident Cardiovascular Disease and Mortality: the Atherosclerosis Risk in Communities Study and Cardiovascular Health Study

Circulation ◽

10.1161/circ.129.suppl_1.mp11 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Alvaro Alonso ◽

Paul N Jensen ◽

Faye L Lopez ◽

Lin Y Chen ◽

Bruce M Psaty ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Health ◽

Sick Sinus Syndrome ◽

Health Study ◽

Cardiovascular Health Study ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Incident Cases ◽

The Impact

Background: Sick sinus syndrome (SSS) is a disorder characterized by symptomatic dysfunction of the sinoatrial node. Despite being relatively frequent and a major indication for pacemaker implantation (PMI), the impact of SSS on the risk of other cardiovascular diseases (CVD) and mortality is unclear. Thus, we assessed whether SSS incidence was associated with mortality and CVD in two community-based studies. Methods: We included 19,893 men and women age 45 and older enrolled in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), without pacemaker and free of atrial fibrillation (AF) at baseline. Incident cases of SSS were adjudicated after review of medical charts from hospitalizations with a 427.81 ICD-9 code. Ascertainment of incident CVD (heart failure, myocardial infarction, stroke, AF, PMI) and mortality was done according to standard validated protocols. The association between SSS and the selected outcomes was assessed using age, sex, and race-standardized rates and multivariable Cox models adjusted for potential confounders. Results: During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence = 6 events per 10,000 person-years). Age, sex, and race-standardized rates for each of the outcomes in those with and without SSS are presented in the Table. Overall, individuals with SSS had higher rates of mortality and CVD. These differences were still present, though weakened, after adjustment for baseline cardiovascular risk factors (Table, Model 2). After additional adjustment for incident CVD (Model 3), SSS was no longer associated with higher mortality, myocardial infarction or stroke, but an association with heart failure, AF and PMI remained. Conclusion: Individuals who develop SSS are at increased risk of death and incident CVD. Their management should incorporate comprehensive cardiovascular prevention in addition to symptom relief. The mechanisms underlying these associations warrant further investigation.

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Copper, ceruloplasmin, and long-term cardiovascular and total mortality (The Ludwigshafen Risk and Cardiovascular Health Study)

Free Radical Research ◽

10.3109/10715762.2014.901510 ◽

2014 ◽

Vol 48 (6) ◽

pp. 706-715 ◽

Cited By ~ 16

Author(s):

T. B. Grammer ◽

M. E. Kleber ◽

G. Silbernagel ◽

S. Pilz ◽

H. Scharnagl ◽

...

Keyword(s):

Cardiovascular Health ◽

Total Mortality ◽

Health Study ◽

Cardiovascular Health Study

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n-3 Fatty acids and risk for fatal coronary disease

Proceedings of The Nutrition Society ◽

10.1017/s0029665118002902 ◽

2019 ◽

Vol 78 (4) ◽

pp. 526-531 ◽

Cited By ~ 1

Author(s):

William S. Harris ◽

Francis B. Zotor

Keyword(s):

Fatty Acids ◽

Cardiovascular Health ◽

Controlled Trial ◽

Total Mortality ◽

Plasma Phospholipid ◽

Cardiovascular Death ◽

Health Study ◽

Cardiovascular Health Study ◽

Blood Levels ◽

Omega 3

The purpose of this review is to consider the effects of the long-chain n-3 fatty acids found in marine foods, EPA and DHA, on risk for CVD, particularly fatal outcomes. It will examine both epidemiological and randomised controlled trial findings. The former studies usually examine associations between the dietary intake or the blood levels of EPA + DHA and CVD outcomes or, on occasion, total mortality. For example, our studies in the Framingham Heart Study and in the Women's Health Initiative Memory Study have demonstrated significant inverse relations between erythrocyte EPA + DHA levels (i.e. the Omega-3 Index) and total mortality. Recent data from the Cardiovascular Health Study reported the same relations between plasma phospholipid n-3 levels and overall healthy ageing. As regards randomised trials, studies in the 1990s and early 2000s were generally supportive of a cardiovascular benefit for fish oils (which contain EPA + DHA), but later trials were generally not able to duplicate these findings, at least for total CVD events. However, when restricted to effects on risk for fatal events, meta-analyses have shown consistent benefits for n-3 treatment. Taken together, the evidence is strong for a cardioprotective effect of EPA + DHA, especially when consumed in sufficient amounts to raise blood levels into healthy ranges. Establishing target EPA + DHA intakes to reduce risk for cardiovascular death is a high priority.

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