Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies

Abstract Objective To examine whether overall lifestyles mediate associations of socioeconomic status (SES) with mortality and incident cardiovascular disease (CVD) and the extent of interaction or joint relations of lifestyles and SES with health outcomes. Design Population based cohort study. Setting US National Health and Nutrition Examination Survey (US NHANES, 1988-94 and 1999-2014) and UK Biobank. Participants 44 462 US adults aged 20 years or older and 399 537 UK adults aged 37-73 years. Exposures SES was derived by latent class analysis using family income, occupation or employment status, education level, and health insurance (US NHANES only), and three levels (low, medium, and high) were defined according to item response probabilities. A healthy lifestyle score was constructed using information on never smoking, no heavy alcohol consumption (women ≤1 drink/day; men ≤2 drinks/day; one drink contains 14 g of ethanol in the US and 8 g in the UK), top third of physical activity, and higher dietary quality. Main outcome measures All cause mortality was the primary outcome in both studies, and CVD mortality and morbidity in UK Biobank, which were obtained through linkage to registries. Results US NHANES documented 8906 deaths over a mean follow-up of 11.2 years, and UK Biobank documented 22 309 deaths and 6903 incident CVD cases over a mean follow-up of 8.8-11.0 years. Among adults of low SES, age adjusted risk of death was 22.5 (95% confidence interval 21.7 to 23.3) and 7.4 (7.3 to 7.6) per 1000 person years in US NHANES and UK Biobank, respectively, and age adjusted risk of CVD was 2.5 (2.4 to 2.6) per 1000 person years in UK Biobank. The corresponding risks among adults of high SES were 11.4 (10.6 to 12.1), 3.3 (3.1 to 3.5), and 1.4 (1.3 to 1.5) per 1000 person years. Compared with adults of high SES, those of low SES had higher risks of all cause mortality (hazard ratio 2.13, 95% confidence interval 1.90 to 2.38 in US NHANES; 1.96, 1.87 to 2.06 in UK Biobank), CVD mortality (2.25, 2.00 to 2.53), and incident CVD (1.65, 1.52 to 1.79) in UK Biobank, and the proportions mediated by lifestyle were 12.3% (10.7% to 13.9%), 4.0% (3.5% to 4.4%), 3.0% (2.5% to 3.6%), and 3.7% (3.1% to 4.5%), respectively. No significant interaction was observed between lifestyle and SES in US NHANES, whereas associations between lifestyle and outcomes were stronger among those of low SES in UK Biobank. Compared with adults of high SES and three or four healthy lifestyle factors, those with low SES and no or one healthy lifestyle factor had higher risks of all cause mortality (3.53, 3.01 to 4.14 in US NHANES; 2.65, 2.39 to 2.94 in UK Biobank), CVD mortality (2.65, 2.09 to 3.38), and incident CVD (2.09, 1.78 to 2.46) in UK Biobank. Conclusions Unhealthy lifestyles mediated a small proportion of the socioeconomic inequity in health in both US and UK adults; therefore, healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted. Nevertheless, healthy lifestyles were associated with lower mortality and CVD risk in different SES subgroups, supporting an important role of healthy lifestyles in reducing disease burden.

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Association between selenium intake, diabetes, and mortality in adults: findings from National Health and Nutrition Examination Survey (NHANES) 2003-2014

British Journal Of Nutrition ◽

10.1017/s000711452100177x ◽

2021 ◽

pp. 1-24

Author(s):

Bushra Hoque ◽

Zumin Shi

Keyword(s):

National Health ◽

Cox Regression ◽

Inverse Association ◽

Nutrition Examination Survey ◽

Health And Nutrition ◽

Hazard Ratios ◽

The Us ◽

All Cause Mortality ◽

Cvd Mortality

Abstract Selenium (Se) is a trace mineral that has antioxidant and anti-inflammatory properties. This study aimed to investigate the association between Se intake, diabetes, all-cause and cause-specific mortality in a representative sample of US adults. Data from 18,932 adults who attended the 2003-2014 National Health and Nutrition Examination Survey (NHANES) were analysed. Information on mortality was obtained from the US mortality registry updated to 2015. Multivariable logistic regression and Cox regression were used. Cross-sectionally, Se intake was positively associated with diabetes. Comparing extreme quartiles of Se intake, the odds ratio (OR) for diabetes was 1.44 (95% CI: 1.09–1.89). During a mean of 6.6 years follow-up, there were 1627 death (312 CVD, 386 cancer). High intake of Se was associated with a lower risk of all-cause mortality. When comparing the highest with the lowest quartiles of Se intake, the hazard ratios (HRs) for all-cause, CVD mortality, cancer mortality and other mortality were: 0.77 (95% CI 0.59-1.01), 0.62 (95% CI, 0.35-1.13), 1.42 (95% CI, 0.78-2.58) and 0.60 (95% CI,0.40-0.80), respectively. The inverse association between Se intake and all-cause mortality was only found among white participants. In conclusion, Se intake was positively associated with diabetes but inversely associated with all-cause mortality. There was no interaction between Se intake and diabetes in relation to all-cause mortality.

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Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank

10.2337/figshare.16965199 ◽

2021 ◽

Author(s):

Han Han ◽

Yaying Cao ◽

Chengwu Feng ◽

Yan Zheng ◽

Klodian Dhana ◽

...

Keyword(s):

Type 2 Diabetes ◽

Respiratory Disease ◽

Digestive Disease ◽

Diabetes Management ◽

Healthy Lifestyle ◽

Population Attributable Risk ◽

Uk Biobank ◽

All Cause Mortality ◽

Specific Mortality

<a>Objective: </a><a></a><a></a><a></a><a></a><a>To evaluate the association of a healthy lifestyle, involving seven low-risk factors mentioned in diabetes management guidelines (no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, less sedentary behavior, adequate sleep duration, and appropriate social connection), with all-cause and cause-specific mortality among individuals with type 2 diabetes.</a> Research Design and Methods: This study included 13,366 participants with baseline type 2 diabetes from the UK Biobank free of CVD or cancer. Lifestyle information was collected through a baseline questionnaire. <a>Results: During a median follow-up of 11.7 years, 1,561 deaths were documented, with 625 from cancer, 370 from CVD, 115 from respiratory disease, 81 from digestive disease, and 74 from neurodegenerative disease.</a><a> In multivariate-adjusted model, each lifestyle factor was significantly associated with all-cause mortality and hazard ratios (95% CIs) associated with the lifestyle score (scoring 6-7 vs. 0-2 unless specified) were 0.42 (0.34, 0.52) for all-cause mortality, 0.57 (0.41, 0.80) for cancer mortality, 0.35 (0.22, 0.56) for CVD mortality, 0.26 (0.10, 0.63) for respiratory mortality, and 0.28 (0.14, 0.53) for digestive mortality (scoring 5-7 vs. 0-2). In the population-attributable-risk analysis, 27.1% (95% CI: 16.1, 38.0%) death was attributable to a poor lifestyle (scoring 0-5). </a><a>The association between a healthy lifestyle and all-cause mortality was consistent, irrespective of factors reflecting diabetes severity (diabetes duration, glycemic control, diabetes-related microvascular disease, and diabetes medication)</a>. Conclusions: <a></a><a></a>A healthy lifestyle was associated with a lower risk of mortality due to all-cause, CVD, cancer, respiratory disease, and digestive disease among individuals with type 2 diabetes.

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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.

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Abstract 5008: Lifestyle Practices in Adults 65 Years and Older and 7-Year Follow-up Mortality: The Chicago Heart Association Detection Project in Industry Study (CHA)

Circulation ◽

10.1161/circ.118.suppl_18.s_1129-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Thanh Huyen T Vu ◽

Daniel B Garside ◽

Martha L Daviglus

Keyword(s):

Healthy Lifestyle ◽

Heavy Drinking ◽

Heart Association ◽

Older Age ◽

Unhealthy Lifestyle ◽

Industry Study ◽

Hazard Ratios ◽

Lifestyle Practices ◽

All Cause Mortality

Background and Objective : Prospective data on combined effects of lifestyle practices (smoking, heavy drinking, and physical inactivity) in older age on mortality are limited. We examine the combined impact of lifestyle behaviors in adults 65 years and older on CVD, non-CVD, cancer, and all-cause mortality after 7 years of follow-up. Methods : In 1996, a health survey was mailed to all surviving participants, ages 65–102, from the Chicago Heart Association Detection Project in Industry Study. The response rate was 60% and the sample included 4,200 male and 3,288 female respondents. Unhealthy lifestyle (un-HL) practices were classified into three groups as having two or more , one , or none of the following three un-HL factors (current smoking or stopped smoking only within the past 10 years; heavy drinking ->15 g/day for women or >30 g/day for men; and infrequent exercise). Vital status was ascertained through 2003 via the National Death Index. Results : With adjustment for age, race, education, marital status, living arrangement, and BMI, the hazards of CVD, non-CVD, cancer, and all-cause mortality were highest among men and women who had two or more un-HL factors and lowest among those who had healthy lifestyle. For example, in men, compared to those with none un-HL factors, the hazard ratios (95%CIs) of all-cause death for those with two or more and one un-HL factors were 2.10 (1.73–2.46) and 1.56 (1.36–1.77), respectively. Associations were attenuated somewhat but remained strongly significant with further adjustment for comorbidities (see table ). Conclusion : Having no unhealthy lifestyle factors in older age is associated with a lower risk for CVD, non-CVD, cancer, and all-cause death. These results should encourage healthy lifestyle practices in elderly people to decrease mortality and promote longevity. Adjusted* Hazard Ratios (95% CIs) for CVD, Non-CVD, Cancer, and All-Cause Death by Number of Unhealthy Lifestyle Factors in 1996 and Gender

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Cognitive Function and Mortality: Results from Kaunas HAPIEE Study 2006–2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072397 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2397

Author(s):

Abdonas Tamosiunas ◽

Laura Sapranaviciute-Zabazlajeva ◽

Dalia Luksiene ◽

Dalia Virviciute ◽

Martin Bobak

Keyword(s):

Cognitive Function ◽

Baseline Survey ◽

Cardiovascular Disease Mortality ◽

Follow Up Study ◽

Kaplan Meier ◽

Disease Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Cvd Mortality

Background: The purpose of the study is to evaluate the association between cognitive function and risk of all-cause and cardiovascular disease mortality during 10 years of the follow-up. Methods: 7087 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008. During 10 years of follow-up, all-cause and CVD mortality risk were evaluated. Results: During 10 years of follow-up, 768 (23%) men and 403 (11%) women died (239 and 107 from CVD). After adjustment for sociodemographic, biological, lifestyle factors, and illnesses, a decrease per 1 standard deviation in different cognitive function scores increased risk for all-cause mortality (by 13%–24% in men, and 17%–33% in women) and CVD mortality (by 19%–32% in men, and 69%–91% in women). Kaplan-Meier survival curves for all-cause and CVD mortality, according to tertiles of cognitive function, revealed that the lowest cognitive function (1st tertile) predicts shorter survival compared to second and third tertiles (p < 0.001). Conclusions: The findings of this follow-up study suggest that older participants with lower cognitive functions have an increased risk for all-cause and CVD mortality compared to older participants with a higher level of cognitive function.

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

BMJ ◽

10.1136/bmj.m688 ◽

2020 ◽

pp. m688 ◽

Cited By ~ 4

Author(s):

Frederick K Ho ◽

Stuart R Gray ◽

Paul Welsh ◽

Fanny Petermann-Rocha ◽

Hamish Foster ◽

...

Keyword(s):

Cardiovascular Disease ◽

Energy Intake ◽

Hazard Ratio ◽

Dietary Advice ◽

Macronutrient Intake ◽

Uk Biobank ◽

All Cause Mortality ◽

Non Linear ◽

Average Hazard Ratio

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).

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Adiposity change and mortality in middle-aged to older Chinese: an 8-year follow-up of the Guangzhou Biobank Cohort Study

BMJ Open ◽

10.1136/bmjopen-2020-039239 ◽

2020 ◽

Vol 10 (12) ◽

pp. e039239

Author(s):

Ying Yue Huang ◽

Chao Qiang Jiang ◽

Lin Xu ◽

Wei Sen Zhang ◽

Feng Zhu ◽

...

Keyword(s):

Cohort Study ◽

Outcome Measures ◽

Mortality Risk ◽

Cancer Mortality ◽

Secondary Outcome ◽

Middle Aged ◽

All Cause Mortality ◽

Older Chinese ◽

Cvd Mortality

ObjectiveTo examine the associations of change in body mass index (BMI) and waist circumference (WC) over an average of 4 years with subsequent mortality risk in middle-aged to older Chinese.DesignProspective cohort study based on the Guangzhou Biobank Cohort Study.SettingCommunity-based sample.Participants17 773 participants (12 956 women and 4817 men) aged 50+ years.Primary and secondary outcome measuresPrimary outcome measure was all-cause mortality. Secondary outcome measures were cardiovascular disease (CVD) and cancer mortality. Causes of death were obtained via record linkage, and coded according to the International Classification of Diseases (tenth revision).Results1424 deaths (53.4% women) occurred in the 17 773 participants (mean age 61.2, SD 6.8 years) during an average follow-up of 7.8 (SD=1.5) years, and 97.7% of participants did not have an intention of weight loss . Compared with participants with stable BMI, participants with BMI loss (>5%), but not gain, had a higher risk of all-cause mortality (HR=1.49, 95% CI 1.31 to 1.71), which was greatest in those who were underweight (HR=2.45, 95% CI 1.31 to 4.59). Similar patterns were found for WC. In contrast, for participants with a BMI of ≥27.5 kg/m2, BMI gain, versus stable BMI, was associated with 89% higher risk of all-cause mortality (HR=1.89, 95% CI 1.25 to 2.88), 72% higher risk of CVD mortality (HR=1.72, 95% CI 0.80 to 3.72) and 2.27-fold risk of cancer mortality (HR=2.27, 95% CI 1.26 to 4.10).ConclusionIn older people, unintentional BMI/WC loss, especially in those who were underweight was associated with higher mortality risk. However, BMI gain in those with obesity showed excess risks of all-cause and cancer mortality, but not CVD mortality. Frequent monitoring of changes in body size can be used as an early warning for timely clinical investigations and interventions and is important to inform appropriate health management in older Chinese.

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P0792FAT ATTENUATION INDEX OF CORONARY ARTERY IN COMPUTED TOMOGRAPHY ANGIOGRAPHY PREDICTS LONG-TERM OUTCOME IN CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0792 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Nam-Jun Cho ◽

Soon hyo Kwon ◽

Bo Da Nam ◽

Kyoungin Choi

Keyword(s):

Coronary Artery ◽

Kidney Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Adjusted Risk ◽

Attenuation Index ◽

All Cause Mortality ◽

Long Term Mortality

Abstract Background and Aims Perivascular fat attenuation index (FAI) of coronary artery represents the degree of coronary inflammation. High coronary artery FAI in computed tomography angiography (CTA) is associated with increased all-cause and cardiac mortality in general population. However, the ability of the perivascular FAI using coronary CTA to predict long term outcome in chronic kidney disease (CKD) patients is unknown. Method This is a single center retrospective study. We analyzed coronary FAIs on CTA for CKD including patients with end stage renal disease (ESRD). The patients with percutaneous coronary intervention or coronary artery bypass graft were excluded. Mapping and analysis of perivascular FAI were performed around proximal three major coronary arteries. We assessed the prognostic value of FAI of CTA for long-term mortality (data from the Korean National Statistical Office) with Cox regression models, adjusted for age, sex, dialysis vintage, and clinical parameters. Results Between January 2012 and June 2018, 268 CKD patients were included. Mean age of this cohort was 64.5 ± 12.0 years, and 132 (49.3%) participants were men. 109 (44.7%) participants has diabetic kidney disease, and 179 (66.4%) participants were on hemodialysis. Median follow-up after coronary CTA was 29.2 (15.1 − 46.3) months. During follow-up, there were 43 (20.6%) deaths. The optimum cut-off value of FAI around the left anterior descending artery (LAD) was ascertained as -65.5 Hounsfield unit. The high perivascular FAI around the LAD was significantly associated with higher adjusted risk of all-cause mortality (hazard ratio, 2.15; 95% CI, 1.07–4.32). In ESRD subgroup, the high perivascular FAI group also has higher adjusted risk of all-cause mortality compared to low perivascular FAI group (hazard ratio, 2.43; 95% CI, 1.16–5.09). Conclusion The perivascular FAI around LAD predicts the long-term mortality in patients with CKD. This could provide the chance of early primary intervention in CKD patients.

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Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Cardiology ◽

10.1159/000471845 ◽

2017 ◽

Vol 138 (1) ◽

pp. 26-33 ◽

Cited By ~ 3

Author(s):

Xili Lu ◽

Wei Wang ◽

Ling Zhu ◽

Yilu Wang ◽

Kai Sun ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

Fragmented Qrs ◽

All Cause Mortality ◽

The Relationship ◽

Cvd Mortality

Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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P238 RA and multimorbidity in UK Biobank: association with all-cause mortality and major adverse cardiac events

Rheumatology ◽

10.1093/rheumatology/keaa111.232 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Barbara Nicholl ◽

Ross McQueenie ◽

Bhautesh Jani ◽

Sara Macdonald ◽

Colin McCowan ◽

...

Keyword(s):

Health Outcomes ◽

Major Adverse Cardiac Events ◽

Uk Biobank ◽

Cardiac Events ◽

Long Term Conditions ◽

Increased Risk ◽

Adverse Cardiac Events ◽

Wide Range ◽

All Cause Mortality

Abstract Background Multimorbidity, the presence of ≥ 2 long-term conditions (LTCs) is common in people with rheumatoid arthritis (RA). However, most research in RA has focused on cardiovascular disease and depression as co-occurring morbidities, rather than multiple LTCs or a wide range of conditions. This study hypothesised that risk of all-cause mortality and major adverse cardiac events (MACE) would be greater in those with RA and ≥2 LTCs than those with RA only. Further, we explored which individual LTCs were associated with increased risk of mortality and MACE. Methods Data from UK Biobank, a cohort of over 500,000 adults aged 37-73 years across England, Scotland and Wales was analysed. RA and 42 other LTCs of interest were self-reported by participants in a questionnaire and nurse-led interview. Information on sociodemographic (age, gender, socioeconomic status) and lifestyle factors (smoking status, BMI, alcohol frequency, physical activity) were also gathered. Rheumatoid factor levels were also determined. MACE and mortality were classified using linked hospitalisations and mortality register data (median follow up time 9 years). Data were analysed using age-adjusted Cox’s proportional hazard modelling to calculate risk of all-cause mortality or MACE, adjusted for variables listed above. Predictor variable: no RA no LTCs (reference group), only RA, RA + 1-3LTCs, RA + ≥4LTCs. Finally, the relationship between comorbidity with individual LTCs (of the 42 studied) and both health outcomes was considered. Results 5,658 (1.1%) of participants in UK Biobank self-reported RA (69.8% female, mean age 59 years). 74.7% of participants reported at least one LTC in addition to RA (1-3 LTCs 64.3%, ≥4 LTCs 10.4%), compared to 63.8% of participants without RA. 7.7% (N = 437) of participants with RA died and 5.9% (n = 331) had MACE events during the follow-up period. There was a dose response relationship in RA between LTC category and all-cause mortality and MACE risk. Only RA: mortality HR 1.42, 95% CI 1.08, 1.87, MACE HR 1.61 95% CI 1.20, 2.18; RA + 1-3LTCs: mortality HR 1.99 95% CI 1.74, 2.27, MACE HR 1.89, 95% CI 1.61, 2.20; RA + ≥4LTCs: mortality HR 3.34, 95% CI 2.64, 4.22; MACE HR 3.45, 95% CI 2.66, 4.49) compared to those with no RA no LTCs (results presented from fully adjusted models). Of the 42 individual LTCs considered, comorbid osteoporosis was the most concerning; participants with both RA and osteoporosis had a two-fold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55, 3.12) and three-fold increased risk of MACE outcomes (HR 3.17, 95% CI 2.17, 4.64) compared to those with neither condition. Conclusion Participants with RA and multimorbidity or comorbidity, particularly osteoporosis, are at increased risk of adverse health outcomes. These results have important clinical relevance for the monitoring and optimal management of RA across the healthcare system. Disclosures B. Nicholl None. R. McQueenie None. B. Jani None. S. Macdonald None. C. McCowan None. J. Canning None. F. Mair None. S. Siebert None.

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