scholarly journals Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study

BMJ ◽  
2019 ◽  
pp. l1855 ◽  
Author(s):  
Alice R Carter ◽  
Dipender Gill ◽  
Neil M Davies ◽  
Amy E Taylor ◽  
Taavi Tillmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Systolic Blood Pressure ◽  
Odds Ratio ◽  
Lower Risk ◽  
Smoking Behaviour ◽  
Mendelian Randomisation

AbstractObjectivesTo investigate the role of body mass index (BMI), systolic blood pressure, and smoking behaviour in explaining the effect of education on the risk of cardiovascular disease outcomes.DesignMendelian randomisation study.SettingUK Biobank and international genome-wide association study data.ParticipantsPredominantly participants of European ancestry.ExposureEducational attainment, BMI, systolic blood pressure, and smoking behaviour in observational analysis, and randomly allocated genetic variants to instrument these traits in mendelian randomisation.Main outcomes measureThe risk of coronary heart disease, stroke, myocardial infarction, and cardiovascular disease (all subtypes; all measured in odds ratio), and the degree to which this is mediated through BMI, systolic blood pressure, and smoking behaviour respectively.ResultsEach additional standard deviation of education (3.6 years) was associated with a 13% lower risk of coronary heart disease (odds ratio 0.86, 95% confidence interval 0.84 to 0.89) in observational analysis and a 37% lower risk (0.63, 0.60 to 0.67) in mendelian randomisation analysis. As a proportion of the total risk reduction, BMI was estimated to mediate 15% (95% confidence interval 13% to 17%) and 18% (14% to 23%) in the observational and mendelian randomisation estimates, respectively. Corresponding estimates were 11% (9% to 13%) and 21% (15% to 27%) for systolic blood pressure and 19% (15% to 22%) and 34% (17% to 50%) for smoking behaviour. All three risk factors combined were estimated to mediate 42% (36% to 48%) and 36% (5% to 68%) of the effect of education on coronary heart disease in observational and mendelian randomisation analyses, respectively. Similar results were obtained when investigating the risk of stroke, myocardial infarction, and cardiovascular disease.ConclusionsBMI, systolic blood pressure, and smoking behaviour mediate a substantial proportion of the protective effect of education on the risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of cardiovascular disease attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.

scholarly journals Association of Cumulative Systolic Blood Pressure With Long-Term Risk of Cardiovascular Disease and Healthy Longevity

Hypertension ◽  
2020 ◽  
Author(s):  
Orna Reges ◽  
Hongyan Ning ◽  
John T. Wilkins ◽  
Colin O. Wu ◽  
Xin Tian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Systolic Blood Pressure ◽  
Healthy Longevity ◽  
All Cause Mortality

Hypertension is a major risk factor for cardiovascular disease (CVD), but previous studies have mostly been limited to a single exam, a single cohort, a short follow-up period, or a limited number of outcomes. This study aimed to assess the association of 10-year cumulative systolic blood pressure (BP) in middle age with long-term risk of any CVD, coronary heart disease, stroke, heart failure, all-cause mortality, and healthy longevity. Individuals (11 502) from 5 racially/ethnically diverse US community-based cohorts were included in this study once they met all the inclusion criteria: ≥10 year of observation in the included cohort, aged 45 to 60 years, free of CVD, and had ≥3 visits with BP exams over the preceding 10 years. For each participant, systolic BP level was predicted for each year of the 10-year prior inclusion, based on the available exams (median of 4.0; spread over, 9.1 [range, 7.2–10] years). Lower 10-year cumulative systolic BP was associated with 4.1 years longer survival and 5.4 years later onset of CVD, resulting in living longer life with a shorter period with morbidity. Models adjusted for sociodemographic characteristics, cardiovascular risk factors, and index systolic BP demonstrated associations of 10-year cumulative systolic BP (per 130 mm Hg×year change, the threshold for stage-1 hypertension) with CVD (hazard ratio [HR], 1.28 [95% CI, 1.20–1.36]), coronary heart disease (HR, 1.29 [95% CI, 1.19–1.40]), stroke (HR, 1.33 [95% CI, 1.20–1.47]), heart failure (HR, 1.12 [95% CI, 1.02–1.23]), and all-cause mortality (HR, 1.21 [95% CI, 1.14–1.29]). These findings emphasize the importance of 10-year cumulative systolic BP as a risk factor to CVD, above and beyond current systolic BP.

scholarly journals What explains the effect of education on cardiovascular disease? Applying Mendelian randomization to identify the consequences of education inequality

2018 ◽  
Author(s):  
Alice R Carter ◽  
Dipender Gill ◽  
Neil M Davies ◽  
Amy E Taylor ◽  
Taavi Tillmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Systolic Blood Pressure ◽  
Body Mass ◽  
Mendelian Randomization

Key PointsQuestionWhat is the role of body mass index, systolic blood pressure and smoking in mediating the effect of education on cardiovascular disease risk?FindingWe find consistent evidence that body mass index, systolic blood pressure and smoking mediate the effect of education, explaining up to 18%, 27% and 33% respectively. Including all three risk factors in a model together explains around 40% of the effect of education.MeaningIntervening on body mass index, systolic blood pressure and smoking would lead to reductions in cases of CVD attributable to lower levels of education. Over half of the effect of education on risk of cardiovascular disease is not mediated through these risk factors.ImportanceLower levels of education are causally related to higher cardiovascular risk, but the extent to which this is driven by modifiable risk factors also associated with education is unknown.ObjectiveTo investigate the role of body mass index, systolic blood pressure and smoking in explaining the effect of education on risk of cardiovascular disease outcomes.DesignMultivariable regression analysis of observational data and Mendelian randomization (MR) analysis of genetic data.SettingUK Biobank and international genome-wide association study consortia.ParticipantsPredominantly individuals of European ancestry.Main outcomes and measuresThe effects of education (per 1-standard deviation increase, equivalent to 3.6 years) on coronary heart disease, cardiovascular disease (all subtypes), myocardial infarction and stroke risk (all measured in odds ratio, OR), and the degree to which this is mediated through body mass index, systolic blood pressure and smoking.ResultsEach additional standard deviation of education associated with 13% lower risk of coronary heart disease (OR 0.87, 95% confidence interval [CI] 0.84 to 0.89) in observational analysis and 37% lower risk (OR 0.63, 95% CI 0.60 to 0.67) in Mendelian randomization analysis. As a proportion of the total risk reduction, body mass index mediated 15% (95% CI 13% to 17%) and 18% (95% CI 14% to 23%) in the observational and Mendelian randomization estimates, respectively. Corresponding estimates for systolic blood pressure were 11% (95% CI 9% to 13%) and 21% (95% CI 15% to 27%), and for smoking, 19% (15% to 22%) and 33% (95% CI 17% to 49%). All three risk factors combined mediated 42% (95% CI 36% to 48%) and 36% (95 % CI 16% to 63%) of the effect of education on coronary heart disease in observational and Mendelian randomization respectively. Similar results were obtained when investigating risk of stroke, myocardial infarction and all-cause cardiovascular disease.Conclusions and relevanceBMI, SBP and smoking mediate a substantial proportion of the protective effect of education on risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of CVD attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.

scholarly journals Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death

2018 ◽  
Vol 128 (2) ◽  
pp. 317-327 ◽  
Author(s):  
Daniel I. Sessler ◽  
Christian S. Meyhoff ◽  
Nicole M. Zimmerman ◽  
Guangmei Mao ◽  
Kate Leslie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Relative Effect ◽  
Noncardiac Surgery ◽  
Binary Variable ◽  
Perioperative Morbidity ◽  
Exposure Variable

Abstract Background The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days. Methods This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of hypotension was the exposure variable intraoperatively and for the remaining day of surgery, whereas hypotension status was treated as binary variable for postoperative days 1 to 4. We estimated the average relative effect of hypotension across components of the composite using a distinct effect generalized estimating model, adjusting for hypotension during earlier periods. Results Among 9,765 patients, 42% experienced hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30 days of surgery. Intraoperatively, the estimated average relative effect across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12; P < 0.001) per 10-min increase in hypotension duration. For the remaining day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001) per 10-min increase in hypotension duration. The average relative effect odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization. Conclusions Clinically important hypotension—a potentially modifiable exposure—was significantly associated with a composite of myocardial infarction and death during each of three perioperative periods, even after adjustment for previous hypotension.

scholarly journals Standardizing the Comparison of Systolic Blood Pressure vs. Pulse Pressure for Predicting Coronary Heart Disease

2006 ◽  
Vol 8 (6) ◽  
pp. 411-413 ◽  
Author(s):  
Karina W. Davidson ◽  
Donald C. Haas ◽  
Daichi Shimbo ◽  
Thomas G. Pickering ◽  
Bruce S. Jonas
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Systolic Blood Pressure ◽  
Pulse Pressure

scholarly journals Layperson-Oriented versus Clinical-Based Models for Assessing 10-Year Incidence of Coronary Heart Disease: National FINRISK Study

2011 ◽  
Vol 2011 ◽  
pp. 1-9
Author(s):  
Qing Qiao ◽  
Tiina Laatikainen ◽  
Weiguo Gao ◽  
Janne Pitkäniemi ◽  
Erkki Vartiainen
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Systolic Blood Pressure ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Operating Characteristic Curve ◽  
Risk Categories

One laboratory-based and two non-laboratory-based models with and without blood pressure measures are developed based on data of 14815 men and 16617 women aged 25–64 years. During the followup 1134 men and 566 women developed coronary heart disease (CHD). The area under the receiver operating characteristic curve (95% CI) for prediction of CHD incidence was 0.823 (0.807–0.839) for the laboratory-based model, 0.808 (0.791–0.824) and 0.803 (0.787–0.820) for the non-laboratory-based models with and without systolic blood pressure in men (P<0.01for overall comparison), and 0.878 (0.856–0.901), 0.871 (0.848–0.894), and 0.864 (0.840–0.887), respectively, in women (P<0.01). The predicted rates matched well with the observed ones (P>0.10). Compared with the model without blood pressure, the non-laboratory-based model with blood pressure tended to reclassify individuals into the higher risk categories for both event and nonevent groups in both genders. The study concludes the predictive property of the non-laboratory-based models are good.

scholarly journals SEVEN-YEAR INCREASE IN EXERCISE SYSTOLIC BLOOD PRESSURE AT 100W PREDICTS LONG-TERM RISK OF CORONARY HEART DISEASE IN HEALTHY MIDDLE-AGED MEN

2012 ◽  
Vol 59 (13) ◽  
pp. E1627
Author(s):  
Per Torger Skretteberg ◽  
Irene Grundvold ◽  
Sverre Kjeldsen ◽  
Knut Gjesdal ◽  
Knut Liest&oslash;l ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Systolic Blood Pressure ◽  
Middle Aged

scholarly journals PROFIL PENYAKIT JANTUNG KORONER DI IRINA F JANTUNG RSUP PROF. Dr. R. D. KANDOU MANADO

e-CliniC ◽  
2013 ◽  
Vol 1 (1) ◽  
Author(s):  
Andi Eka Dharma Putra Syukri
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Arteries ◽  
Communicable Disease ◽  
Cardiovascular Disorder ◽  
Industrial Country ◽  
Unhealthy Lifestyle ◽  
Old Myocardial Infarction

Abstract: Heart and Blood Vessels Disease is the leading cause of cardiovascular disorder that mostly happened in developed or industrial country, related to new communicable disease or “infection” caused by imitation of unhealthy lifestyle.1 The cardiovascular disease divided into several type of heart disease such as; coronary heart disease (CHD) that caused by narrowing of of the coronary arteries due to deposition of fat gathering in and around the cells lining the walls of the coronary arteries and blocking of the blood flow. This research aimed to know the  CHD Profile in Irina F Jantung of RSUP Prof.Dr. R.D Kandou Manado in period of January-December 2010. This was retrospective-descriptive study that used medical records in Irina F Jantung of RSUP. Prof. Dr. R.D Kandou Manado. During this period of this research reported 230 cases of CHD; 69 cases (30%) byage groups 61-70 years old, 159 cases (69,13%) by gender and 86 cases were accompanied disease with the greatest proportion of Hypertension 52 cases (55,32%), and Old Myocardial Infarction (OMI) 71 cases (30,87%) as being the most clinical symptom. The frequency of Cardiovascular disease will be increasing every year if there’s no change of diet and unhealthy lifestyle by people in both urban and rural environments and other degenerative diseases are caused. Key words: Heart Disease, Coronary Heart Disease, Old Myocardial Infarction   ABSTRAK : Penyakit Jantung dan Pembuluh Darah (PJPD) adalah penyakit yang mengakibatkan gangguan jantung dan pembuluh darah, paling sering terjadi di negara maju atau negara industri akibat ‘penularan’ yang disebabkan peniruan gaya hidup kurang sehat.1 Penyakit Jantung ini terbagi dalam beberapa jenis penyakit jantung lainnya diantaranya adalah Penyakit Jantung Koroner (PJK) penyakit jantung yang disebabkan oleh penyempitan arteri koroner akibat dari berkumpulnya endapan lemak di dalam dan sekitar sel yang melapisi dinding arteri koroner sehingga menyumbat aliran darah. Tujuan penelitian ini adalah untuk mengetahui Profil PJK di Irina F Jantung Rsup Prof. Dr. R. D Kandou Manado Periode Januari 2010 - Desember 2010. Penelitian ini bersifat deskriptif dengan metoderetrospektif menggunakan buku register di Irina F Jantung RSUP. Prof. Dr. R.D Kandou Manado periode Januari 2010 sampai Desember 2010. Selama periode Januari 2010 sampai Desember 2010 di Irina F Jantung Rsup Prof. Dr. R. D Kandou Manado tercatat 230 kasus PJK. Berdasarkan kelompok Umur 61-70 tahun sebanyak 69 kasus (30%), Jenis Kelamin sebanyak 159 kasus (69,13%), 86 kasus disertai penyakit penyerta yang terbanyak diantaranya Hipertensi 52 kasus (55,32%), dan manifestasi klinis yang didapat adalah Old Myocardial Infarction (OMI) sebanyak 71 kasus (30,87%). Setiap tahun frekuensi penyakit ini akan terus meningkat jika tidak di atur pola makan atau gaya hidup masyarakat yang kurang sehat, baik di lingkungan urban maupun rural dan disebabkan penyakit degeneratif lainnya. Kata kunci: Penyakit Jantung, Jantung Koroner, Old infark miokard

scholarly journals High Blood Pressure and Cardiovascular Disease

Hypertension ◽  
2020 ◽  
Vol 75 (2) ◽  
pp. 285-292 ◽  
Author(s):  
Flávio D. Fuchs ◽  
Paul K. Whelton
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Cohort Studies ◽  
High Blood Pressure ◽  
Population Distribution ◽  
Meta Analysis ◽  
Age Related

Fragmented investigation has masked the overall picture for causes of cardiovascular disease (CVD). Among the risk factors for CVD, high blood pressure (BP) is associated with the strongest evidence for causation and it has a high prevalence of exposure. Biologically, normal levels of BP are considerably lower than what has typically been characterized as normal in research and clinical practice. We propose that CVD is primarily caused by a right-sided shift in the population distribution of BP. Our view that BP is the predominant risk factor for CVD is based on conceptual postulates that have been tested in observational investigations and clinical trials. Large cohort studies have demonstrated that high BP is an important risk factor for heart failure, atrial fibrillation, chronic kidney disease, heart valve diseases, aortic syndromes, and dementia, in addition to coronary heart disease and stroke. In multivariate modeling, the presumed attributable risk of high BP for stroke and coronary heart disease has increased steadily with progressive use of lower values for normal BP. Meta-analysis of BP-lowering randomized controlled trials has demonstrated a benefit which is almost identical to that predicted from BP risk relationships in cohort studies. Prevention of age-related increases in BP would, in large part, reduce the vascular consequences usually attributed to aging, and together with intensive treatment of established hypertension would eliminate a large proportion of the population burden of BP-related CVD.

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