Associations of fat and carbohydrate intake with cardiovascular disease and mortality: prospective cohort study of UK Biobank participants

Abstract Objective To investigate the association of macronutrient intake with all cause mortality and cardiovascular disease (CVD), and the implications for dietary advice. Design Prospective population based study. Setting UK Biobank. Participants 195 658 of the 502 536 participants in UK Biobank completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using Oxford WebQ, a web based 24 hour recall questionnaire, and nutrient intakes were estimated using standard methodology. Cox proportional models with penalised cubic splines were used to study non-linear associations. Main outcome measures All cause mortality and incidence of CVD. Results 4780 (2.4%) participants died over a mean 10.6 (range 9.4-13.9) years of follow-up, and 948 (0.5%) and 9776 (5.0%) experienced fatal and non-fatal CVD events, respectively, over a mean 9.7 (range 8.5-13.0) years of follow-up. Non-linear associations were found for many macronutrients. Carbohydrate intake showed a non-linear association with mortality; no association at 20-50% of total energy intake but a positive association at 50-70% of energy intake (3.14 v 2.75 per 1000 person years, average hazard ratio 1.14, 95% confidence interval 1.03 to 1.28 (60-70% v 50% of energy)). A similar pattern was observed for sugar but not for starch or fibre. A higher intake of monounsaturated fat (2.94 v 3.50 per 1000 person years, average hazard ratio 0.58, 0.51 to 0.66 (20-25% v 5% of energy)) and lower intake of polyunsaturated fat (2.66 v 3.04 per 1000 person years, 0.78, 0.75 to 0.81 (5-7% v 12% of energy)) and saturated fat (2.66 v 3.59 per 1000 person years, 0.67, 0.62 to 0.73 (5-10% v 20% of energy)) were associated with a lower risk of mortality. A dietary risk matrix was developed to illustrate how dietary advice can be given based on current intake. Conclusion Many associations between macronutrient intake and health outcomes are non-linear. Thus dietary advice could be tailored to current intake. Dietary guidelines on macronutrients (eg, carbohydrate) should also take account of differential associations of its components (eg, sugar and starch).

Download Full-text

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.

Download Full-text

Advanced cardiometabolic & inflammatory markers for prediction of cardiovascular disease and cancer

European Heart Journal ◽

10.1093/ehjci/ehaa946.2921 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Radenkovic ◽

S.C Chawla ◽

G Botta ◽

A Boli ◽

M.B Banach ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Score ◽

Cancer Incidence ◽

Risk Function ◽

Patient Characteristics ◽

Risk Scores ◽

Uk Biobank ◽

Training Set ◽

All Cause Mortality ◽

The Uk

Abstract The two leading causes of mortality worldwide are cardiovascular disease (CVD) and cancer. The annual total cost of CVD and cancer is an estimated $844.4 billion in the US and is projected to double by 2030. Thus, there has been an increased shift to preventive medicine to improve health outcomes and development of risk scores, which allow early identification of individuals at risk to target personalised interventions and prevent disease. Our aim was to define a Risk Score R(x) which, given the baseline characteristics of a given individual, outputs the relative risk for composite CVD, cancer incidence and all-cause mortality. A non-linear model was used to calculate risk scores based on the participants of the UK Biobank (= 502548). The model used parameters including patient characteristics (age, sex, ethnicity), baseline conditions, lifestyle factors of diet and physical activity, blood pressure, metabolic markers and advanced lipid variables, including ApoA and ApoB and lipoprotein(a), as input. The risk score was defined by normalising the risk function by a fixed value, the average risk of the training set. To fit the non-linear model >400,000 participants were used as training set and >45,000 participants were used as test set for validation. The exponent of risk function was represented as a multilayer neural network. This allowed capturing interdependent behaviour of covariates, training a single model for all outcomes, and preserving heterogeneity of the groups, which is in contrast to CoxPH models which are traditionally used in risk scores and require homogeneous groups. The model was trained over 60 epochs and predictive performance was determined by the C-index with standard errors and confidence intervals estimated with bootstrap sampling. By inputing the variables described, one can obtain personalised hazard ratios for 3 major outcomes of CVD, cancer and all-cause mortality. Therefore, an individual with a risk Score of e.g. 1.5, at any time he/she has 50% more chances than average of experiencing the corresponding event. The proposed model showed the following discrimination, for risk of CVD (C-index = 0.8006), cancer incidence (C-index = 0.6907), and all-cause mortality (C-index = 0.7770) on the validation set. The CVD model is particularly strong (C-index >0.8) and is an improvement on a previous CVD risk prediction model also based on classical risk factors with total cholesterol and HDL-c on the UK Biobank data (C-index = 0.7444) published last year (Welsh et al. 2019). Unlike classically-used CoxPH models, our model considers correlation of variables as shown by the table of the values of correlation in Figure 1. This is an accurate model that is based on the most comprehensive set of patient characteristics and biomarkers, allowing clinicians to identify multiple targets for improvement and practice active preventive cardiology in the era of precision medicine. Figure 1. Correlation of variables in the R(x) Funding Acknowledgement Type of funding source: None

Download Full-text

Associations between dietary patterns and the incidence of total and fatal cardiovascular disease and all-cause mortality in 116,806 individuals from the UK Biobank: a prospective cohort study

BMC Medicine ◽

10.1186/s12916-021-01958-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Min Gao ◽

Susan A. Jebb ◽

Paul Aveyard ◽

Gina L. Ambrosini ◽

Aurora Perez-Cornago ◽

...

Keyword(s):

Cardiovascular Disease ◽

Energy Density ◽

Dietary Patterns ◽

Dietary Pattern ◽

Saturated Fat ◽

Dietary Advice ◽

Free Sugars ◽

Linear Association ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Traditionally, studies investigating diet and health associations have focused on single nutrients. However, key nutrients co-exist in many common foods, and studies focusing solely on individual nutrients may obscure their combined effects on cardiovascular disease (CVD) and all-cause mortality. We aimed to identify food-based dietary patterns which operate through excess energy intake and explain high variability in energy density, free sugars, saturated fat, and fiber intakes and to investigate their association with total and fatal CVD and all-cause mortality. Methods Detailed dietary data was collected using a 24-h online dietary assessment on two or more occasions (n = 116,806). We used reduced rank regression to derive dietary patterns explaining the maximum variance. Multivariable Cox-proportional hazards models were used to investigate prospective associations with all-cause mortality and fatal and non-fatal CVD. Results Over an average of 4.9 years of follow-up, 4245 cases of total CVD, 838 cases of fatal CVD, and 3629 cases of all-cause mortality occurred. Two dietary patterns were retained that jointly explained 63% of variation in energy density, free sugars, saturated fat, and fiber intakes in total. The main dietary pattern was characterized by high intakes of chocolate and confectionery, butter and low-fiber bread, and low intakes of fresh fruit and vegetables. There was a positive linear association between the dietary pattern and total CVD [hazard ratio (HR) per z-score 1.07, 95% confidence interval (CI) 1.04–1.09; HRtotal CVD 1.40, 95% CI 1.31–1.50, and HRall-cause mortality 1.37, 95% CI 1.27–1.47 in highest quintile]. A second dietary pattern was characterized by a higher intakes of sugar-sweetened beverages, fruit juice, and table sugar/preserves. There was a non-linear association with total CVD risk and all-cause mortality, with increased risk in the highest quintile [HRtotal CVD 1.14, 95% CI 1.07–1.22; HRall-cause mortality 1.11, 95% CI 1.03–1.19]. Conclusions We identified dietary patterns which are associated with increased risk of CVD and all-cause mortality. These results help identify specific foods and beverages which are major contributors to unhealthy dietary patterns and provide evidence to underpin food-based dietary advice to reduce health risks.

Download Full-text

Multi-trajectories of lipid indices with incident cardiovascular disease, heart failure, and all-cause mortality: 23 years follow-up of two US cohort studies

Journal of Translational Medicine ◽

10.1186/s12967-021-02966-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Fatemeh Koohi ◽

Davood Khalili ◽

Mohammad Ali Mansournia ◽

Farzad Hadaegh ◽

Hamid Soori

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Cohort Studies ◽

Significant Risk ◽

Density Lipoprotein ◽

Lipid Levels ◽

Cvd Risk ◽

All Cause Mortality ◽

Over Time

Abstract Background Understanding the distinct patterns (trajectories) of variation in blood lipid levels before diagnosing cardiovascular disease (CVD) might carry important implications for improving disease prevention or treatment. Methods We investigated 14,373 participants (45.5% men) aged 45–84 from two large US prospective cohort studies with a median of 23 years follow-up. First, we jointly estimated developmental trajectories of lipid indices, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations using group-based multi-trajectory modeling. Then, the association of identified multi-trajectories with incident CVD, heart failure, and all-cause mortality were examined using Cox proportional hazard model. Results Seven distinct multi-trajectories were identified. The majority of participants (approximately 80%) exhibited decreasing LDL-C but rising TG levels and relatively stable HDL-C levels. Compared to the individuals with healthy and stable LDL-C, HDL-C, and TG levels, those in other groups were at significant risk of incident CVD after adjusting for other conventional risk factors. Individuals with the highest but decreasing LDL-C and borderline high and rising TG levels over time were at the highest risk than those in other groups with a 2.22-fold risk of CVD. Also, those with the highest and increased triglyceride levels over time, over optimal and decreasing LDL-C levels, and the lowest HDL-C profile had a nearly 1.84 times CVD risk. Even individuals in the multi-trajectory group with the highest HDL-C, optimal LDL-C, and optimal TG levels had a significant risk (HR, 1.45; 95% CI 1.02–2.08). Furthermore, only those with the highest HDL-C profile increased the risk of heart failure by 1.5-fold (95% CI 1.07–2.06). Conclusions The trajectories and risk of CVD identified in this study demonstrated that despite a decline in LDL-C over time, a significant amount of residual risk for CVD remains. These findings suggest the impact of the increasing trend of TG on CVD risk and emphasize the importance of assessing the lipid levels at each visit and undertaking potential interventions that lower triglyceride concentrations to reduce the residual risk of CVD, even among those with the optimal LDL-C level.

Download Full-text

Abstract 4531: Statin Use Is Associated with Decreased Mortality in Persons with Peripheral Arterial Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_905-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Himabindu Vidula ◽

Lu Tian ◽

Kiang Liu ◽

Mary M McDermott

Keyword(s):

Arterial Disease ◽

Hazard Ratio ◽

Mortality Hazard ◽

All Cause Mortality ◽

Interaction Term ◽

Peripheral Arterial ◽

Mortality Hazard Ratio ◽

Statin Use ◽

Cvd Mortality

We determined whether statin use was associated with lower all-cause and cardiovascular disease (CVD) mortality in persons with lower extremity peripheral arterial disease (PAD). We also determined whether favorable associations of statin use with mortality were stronger in persons with higher C-reactive protein (CRP) compared to those with lower CRP levels. Participants were 681 men and women with PAD from the Walking and Leg Circulation Study (WALCS) and WALCS II prospective cohort studies. Participants were identified from non-invasive vascular laboratories in Chicago. Participants attended a baseline visit and annual visits for a mean follow-up of 3.7 years. Statin use was determined at baseline and each annual visit. Outcome measures were all-cause and CVD mortality. Time dependent Cox regression analyses were used to evaluate associations of statin use and mortality. Analyses were also repeated separately in participants with baseline CRP values above vs. below the median for the cohort. Analyses were adjusted for age, sex, race, comorbid conditions, ankle brachial index, total cholesterol, high density lipoprotein cholesterol, and other confounders. One hundred fifty five (23%) persons died during follow-up. Two hundred ninety (43%) persons were on a statin at baseline. At baseline, median CRP level was 2.6 mg/L. Statin use was associated with significantly lower all-cause mortality (hazard ratio, 0.52 [95% CI, 0.31 to 0.88], P = 0.014) and CVD mortality (hazard ratio, 0.41 [95% CI, 0.17 to 0.99], P = 0.048) as compared to statin non-use. In persons with CRP >2.6 mg/L, statin use was associated with a significantly lower risk of all-cause mortality (hazard ratio, 0.44 [95% CI, 0.23 to 0.88], P = 0.019, interaction term P = 0.67) and CVD mortality (hazard ratio, 0.20 [95% CI, 0.06 to 0.65], P = 0.0075, interaction term P = 0.39). However, in persons with CRP < 2.6 mg/L, statin use was not associated with lower mortality. Among persons with PAD, statin use is associated with significantly lower all-cause and CVD mortality at mean follow-up of 3.7 years. This finding is largely attributable to favorable associations of statin use with lower mortality among PAD patients with elevated baseline CRP levels.

Download Full-text

Abstract WP226: The Association of Green Tea and Coffee Consumption With Mortality From Cardiovascular Disease and All Causes Among Persons With and Without History of Stroke or Myocardial Infarction: The JACC Study

Stroke ◽

10.1161/str.51.suppl_1.wp226 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Masayuki Teramoto ◽

Isao Muraki ◽

Kokoro Shirai ◽

Akiko Tamakoshi ◽

Hiroyasu Iso

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

General Population ◽

Green Tea ◽

Coffee Consumption ◽

Tea Consumption ◽

Food Frequency ◽

All Cause Mortality ◽

History Of

Background: Both green tea and coffee consumption have been associated with lower risks of mortality from cardiovascular disease (CVD) and all causes in general population, but little is known about those impact on persons with history of CVD. We examined the association of those consumption with these mortalities among persons with and without history of stroke or myocardial infarction in general population. Methods: The study subjects were 60,664 participants (896 stroke and 1751 myocardial infarction survivors and 58,017 persons with no history of stroke or myocardial infarction), aged 40-79 years at the baseline (1988-1990), who completed a lifestyle and medical history questionnaire including self-administered food frequency under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). Results: During the median follow-up of 18.5 years, a total of 12,745 (7,458 men and 5,287 women) deaths including 3,737 CVD deaths were documented. Green tea and coffee consumption were inversely associated with CVD and all-cause mortality among myocardial infarction survivors as well as persons without history of stroke or myocardial infarction. After adjustment for known cardiovascular risk factors, the lower risks of mortality from CVD and all-causes associated with frequent green tea consumption (5-6 and ≥7 cups/day) or coffee consumption (≥2 cups/day) remained statistical. Conclusions: Both green tea and coffee consumption were inversely associated with risks of CVD and all-cause mortality among myocardial infarction survivors and persons without history of stroke or myocardial infarction.

Download Full-text

Short- and Long-Term Outcomes of Catheter-Directed Thrombolysis versus Pulmonary Artery Embolectomy in Pulmonary Embolism: A National Population-Based Study

Journal of Endovascular Therapy ◽

10.1177/15266028211054763 ◽

2021 ◽

pp. 152660282110547

Author(s):

Donna Shu-Han Lin ◽

Yu-Sheng Lin ◽

Jen-Kuang Lee ◽

Wen-Jone Chen

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Hazard Ratio ◽

Hospital Death ◽

Research Database ◽

Old Patients ◽

Catheter Directed Thrombolysis ◽

All Cause Mortality

Objectives: This study aimed to compare the short-term and long-term follow-up outcomes of catheter-directed thrombolysis (CDT) with those of pulmonary artery embolectomy (PAE) for patients with acute pulmonary embolism (PE) included in a nationwide cohort. Background: Data allowing direct comparisons between CDT and PAE are lacking in the literature, and the optimal management of high-risk and intermediate-risk PE is still debated. Methods: A retrospective cohort study was conducted with data for 2001 through 2013 collected from the Taiwan National Health Insurance Research Database (NHIRD). Patients who were first admitted for PE and treated with either CDT or PAE were included and compared. In-hospital outcomes included in-hospital death and safety (bleeding and cardiac arrhythmias) outcomes. Follow-up outcomes included all-cause mortality and recurrent PE during the 1- and 2-year follow-up periods and through the last follow-up. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to minimize possible selection bias, including indices for multimorbidity such as the Charlson’s Comorbidity Index (CCI) and HAS-BLED scores. Results: A total of 389 patients treated between January 1, 2001, and December 31, 2013, were identified; 169 underwent CDT and 220 underwent PAE. After IPTW, there were no significant differences in in-hospital mortality (18.2% vs 21.3%; odds ratio 1.07, 95% confidence interval [CI]: 0.70–1.62) or the incidence of safety outcomes between the CDT and PAE groups. The risks of all-cause mortality (30% vs 29.5%; hazard ratio 1.16, 95% CI: 0.89–1.53), recurrent PE (7.2% vs 8.7%; subdistribution hazard ratio [SHR] 0.68, 95% CI: 0.39–1.21) and new-onset pulmonary hypertension (SHR 0.25, 95% CI: 0.05–1.32) were also not significantly different between the CDT and PAE groups at 2 years of follow-up. Subgroup analysis indicated that PAE may be associated with a more favorable 2-year mortality in patients <65 years old, patients with CCI scores of <3, patients with HAS-BLED scores of 1 to 2, and patients without cardiogenic shock (all P for interaction <.05). Conclusions: In patients with PE who required reperfusion therapy, CDT and PAE resulted in similar in-hospital and long-term all-cause mortality rates and long-term rates of recurrent PE. Bleeding risks were also comparable in the 2 groups.

Download Full-text

Urinary Ethyl Glucuronide as Measure of Alcohol Consumption and Risk of Cardiovascular Disease: A Population‐Based Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.119.014324 ◽

2020 ◽

Vol 9 (7) ◽

Cited By ~ 1

Author(s):

Inge A. T. van de Luitgaarden ◽

Ilse C. Schrieks ◽

Lyanne M. Kieneker ◽

Daan J. Touw ◽

Adriana J. van Ballegooijen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Alcohol Consumption ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Self Report ◽

Ethyl Glucuronide ◽

Categorical Variables ◽

Study Cohort ◽

Cvd Risk ◽

All Cause Mortality

Background Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease (CVD) and all‐cause mortality compared with heavy drinkers and abstainers. To date, studies have relied on self‐reported consumption, which may be prone to misclassification. Urinary ethyl glucuronide (EtG) is an alcohol metabolite and validated biomarker for recent alcohol consumption. We aimed to examine and compare the associations of self‐reported alcohol consumption and EtG with CVD and all‐cause mortality. Methods and Results In 5676 participants of the PREVEND (Prevention of Renal and Vascular End‐Stage Disease) study cohort, EtG was measured in 24‐hour urine samples and alcohol consumption questionnaires were administered. Participants were followed up for occurrence of first CVD and all‐cause mortality. Cox proportional hazards regression models, adjusted for age, sex, and CVD risk factors, were fitted for self‐reported consumption, divided into 5 categories: abstention, 1 to 4 units/month (reference), 2 to 7 units/week, 1 to 3 units/day, and ≥4 units/day. Similar models were fitted for EtG, analyzed as both continuous and categorical variables. Follow‐up times differed for CVD (8 years; 385 CVD events) and all‐cause mortality (14 years; 724 deaths). For both self‐reported alcohol consumption and EtG, nonsignificant trends were found toward J‐shaped associations between alcohol consumption and CVD, with higher risk in the lowest (hazard ratio for abstention versus 1–4 units/month, 1.42; 95% CI, 1.02–1.98) and highest drinking categories (hazard ratio for ≥4 units/day versus 1–4 units/month, 1.11; 95% CI, 0.68–1.84). Neither self‐report nor EtG was associated with all‐cause mortality. Conclusions Comparable associations with CVD events and all‐cause mortality were found for self‐report and EtG. This argues for the validity of self‐reported alcohol consumption in epidemiologic research.

Download Full-text

Impact of cardiorespiratory fitness on survival in men with low socioeconomic status

European Journal of Preventive Cardiology ◽

10.1177/2047487319901057 ◽

2020 ◽

pp. 204748731990105

Author(s):

Sae Young Jae ◽

Sudhir Kurl ◽

Kanokwan Bunsawat ◽

Barry A Franklin ◽

Jina Choo ◽

...

Keyword(s):

Cardiovascular Disease ◽

Low Socioeconomic Status ◽

Hazard Ratio ◽

Low Ses ◽

Low Socioeconomic ◽

Cardiovascular Disease Mortality ◽

Mortality Hazard ◽

Disease Mortality ◽

All Cause Mortality ◽

Mortality Hazard Ratio

Aims Although both low socioeconomic status (SES) and poor cardiorespiratory fitness (CRF) are associated with increased chronic disease and heightened mortality, it remains unclear whether moderate-to-high levels of CRF are associated with survival benefits in low SES populations. This study evaluated the hypothesis that SES and CRF predict all-cause mortality and cardiovascular disease mortality and that moderate-to-high levels of CRF may attenuate the association between low SES and increased mortality. Methods This study included 2368 men, who were followed in the Kuopio Ischaemic Heart Disease Study cohort. CRF was directly measured by peak oxygen uptake during progressive exercise testing. SES was characterized using self-reported questionnaires. Results During a 25-year median follow-up, 1116 all-cause mortality and 512 cardiovascular disease mortality events occurred. After adjusting for potential confounders, men with low SES were at increased risks for all-cause mortality (hazard ratio 1.49, 95% confidence interval: 1.30–1.71) and cardiovascular disease mortality (hazard ratio1.38, 1.13–1.69). Higher levels of CRF were associated with lower risks of all-cause mortality (hazard ratio 0.54, 0.45–0.64) and cardiovascular disease mortality (hazard ratio 0.53, 0.40–0.69). In joint associations of SES and CRF with mortality, low SES-unfit had significantly higher risks of all-cause mortality (hazard ratio 2.15, 1.78–2.59) and cardiovascular disease mortality (hazard ratio 1.95, 1.48-2.57), but low SES-fit was not associated with a heightened risk of cardiovascular disease mortality (hazard ratio 1.09, 0.80-1.48) as compared with their high SES-fit counterparts. Conclusion Both SES and CRF were independently associated with subsequent mortality; however, moderate-to-high levels of CRF were not associated with an excess risk of cardiovascular disease mortality in men with low SES.

Download Full-text

Associations of Cardiovascular and All-Cause Mortality with Metabolic Syndrome in Hemodialysis Patients: A Prospective Single-Center Study

Medicina ◽

10.3390/medicina55100694 ◽

2019 ◽

Vol 55 (10) ◽

pp. 694

Author(s):

Zorica Dimitrijevic ◽

Andriana Jovanovic ◽

Mina Cvetkovic ◽

Tamara Vrecic ◽

Emina Kostic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Metabolic Disorders ◽

Cardiometabolic Risk ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Single Center Study ◽

All Cause Mortality

Background and objectives: Metabolic syndrome (MetS) is a cluster of risk factors, such as abdominal obesity, insulin resistance, dyslipidemia and hypertension, that together increase the risk of cardiovascular disease. Chronic hemodialysis (HD) patients have multiple comorbidities and many metabolic disorders, causing the frequent occurrence of metabolic syndrome. The goal of this study was to assess the prevalence of MetS in HD patients, and its association with all-cause and cardiovascular (CV) mortality. Patients and methods: A total of 138 HD patients were included in this prospective study. We analyzed demographic, anthropometric and biochemical data. Outcome measures were all-cause and CV mortality during the three-year follow-up. Results: MetS was diagnosed in 57.24% of enrolled patients. During the 36 months of follow-up, 33 patients died. MetS patients showed a significantly higher mortality rate than non-MetS (30.4% versus 16.36%, p < 0.001). The association of different MetS components with cardiovascular mortality reached significance when a minimum of three components were present (1.81 (95% confidence interval CI = 1.21–2.33)), with a grouped increase in effect size for subjects with four or five MetS components. Subjects with MetS exhibited nearly twice as high risk for all-cause (hazard ratio HR = 1.99 (95%CI) = 1.42–2.97) and 2.5 times for CV (HR = 2.51 (95%CI) = 1.25–3.83) mortality compared with those without MetS, after adjustment for age, gender, and cardiovascular disease. Conclusions: The study demonstrates that MetS is widespread in HD patients. In future, the focus must be on an active screening approach, and treatment of cardiometabolic risk factors, aiming to reduce mortality.

Download Full-text