Independent and Synergistic Associations of Biomarkers of Vitamin D Status With Risk of Coronary Heart Disease

Objective— To comprehensively evaluate the independent associations and potential interactions of vitamin D–related biomarkers including total and bioavailable 25-hydroxyvitamin D (25OHD), VDBP (vitamin D binding protein), and parathyroid hormone (PTH) with risk of coronary heart disease (CHD). Approach and Results— We prospectively identified incident cases of nonfatal myocardial infarction and fatal CHD among women in the Nurses’ Health Study during 20 years of follow-up (1990–2010). Using risk-set sampling, 1 to 2 matched controls were selected for each case. The analysis of 25OHD and PTH included 382 cases and 575 controls; the analysis of VDBP included 396 cases and 398 controls. After multivariate adjustment, plasma levels of total 25OHD, bioavailable 25OHD, and PTH were not significantly associated with CHD risk. VDBP was associated with a lower CHD risk with an extreme-quartile odds ratio of 0.60 (95% confidence interval, 0.39–0.92; P trend=0.02). When examining the biomarkers jointly, a significant, inverse association between 25OHD and CHD was observed among participants with higher PTH levels ( P for interaction=0.02). The odds ratio (95% confidence interval) comparing the highest quartile of 25OHD to lowest was 0.43 (0.23–0.82; P trend=0.003) when PTH levels were above population median (35.3 pg/mL), whereas among the rest of participants the corresponding odds ratio (95% confidence interval) was 1.28 (0.70–2.36; P trend=0.43). Conclusions— Our data suggest that higher 25OHD levels were associated with a lower CHD risk when PTH levels were high, whereas no association was observed for participants with low PTH levels. VDBP but not bioavailable 25OHD was independently associated with lower CHD risk.

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Abstract P001: Dietary and Plasma Magnesium and Risk of Coronary Heart Disease among Women

Circulation ◽

10.1161/circ.125.suppl_10.ap001 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Stephanie E Chiuve ◽

Kathryn M Rexrode ◽

Qi Sun ◽

Eric N Taylor ◽

Gary C Curhan ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Lower Risk ◽

Threshold Effect ◽

Health Study ◽

Control Analysis ◽

Inverse Association ◽

Chd Risk ◽

Plasma Magnesium ◽

Chd Risk Factors

Background: Plasma magnesium (Mg) has been strongly associated with lower risk of fatal coronary heart disease (CHD) and sudden cardiac death, which may be due to its anti-arrhythmic properties. Mg also affects endothelial function, inflammation, blood pressure and diabetes and thus may impact atherosclerosis in general. We examined the association between magnesium, measured in diet and plasma, and risk of fatal, nonfatal and total CHD among women in the Nurses’ Health Study. Design: The association for Mg intake was examined prospectively among 86,361 women free of disease in 1980. Mg intake and other covariates were ascertained updated every 2-4 years through questionnaires and 3661 cases of CHD (1214 fatal/2447 nonfatal) were documented through 2008. For plasma Mg, we conducted a nested case-control analysis with 405 CHD (63 fatal/342 nonfatal) cases, matched to controls (1:1) on age, smoking, fasting status, and date of blood sampling. Results: Dietary magnesium was inversely associated with risk of CHD, even after controlling for diet and CHD risk factors (RR comparing extreme quintiles: 0.75; 95%CI: 0.64, 0.89; P trend=0.002) (Table 1). The relationship with plasma Mg was less linear ( P trend=0.09) with a potential threshold effect at the 2 nd quintile. The RR of CHD comparing plasma Mg >2.0 v. ≤2.0 mg/dl was 0.49 (95%CI: 0.32, 0.74). The associations for dietary and plasma Mg appeared stronger for fatal versus nonfatal CHD. The RR (95%CI; P trend) comparing the highest to lowest quintile of dietary Mg was 0.60 (0.45, 0.79; p <0.001) for fatal and 0.85 (0.70, 1.04; p = 0.14) for nonfatal CHD. The RR (95%CI) comparing plasma Mg >2.0 v. ≤2.0 mg/dl was 0.23 (0.07, 0.81) for fatal and 0.55 (0.35, 0.86) for nonfatal CHD. Conclusions: Higher levels of Mg, in diet and plasma, were associated with lower risk of total CHD among women. The consistent inverse association found between two measures of Mg and CHD risk supports the hypothesis that Mg might lower CHD risk through multiple mechanisms, and may be most strongly protective for fatal events.

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Abstract 13168: Food Quality Score and the Risk of Coronary Heart Disease

Circulation ◽

10.1161/circ.132.suppl_3.13168 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Teresa Fung ◽

An Pan ◽

Tao Hou ◽

Dariush Mozzafarian ◽

Shilpa Bhupathiraju ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Food Quality ◽

Diet Quality ◽

Healthy Eating Index ◽

Quality Score ◽

Health Study ◽

Standard Deviation Increase ◽

Chd Risk ◽

History Of

Introduction: We have previously derived a food based diet quality score associated with weight change. In this analysis, we prospectively assessed the association between this score and risk of coronary heart disease (CHD). Methods: We followed 74,667 women in the Nurse’ Health Study (baseline age 35-55 y), 28,977 men in the Health Professionals Follow-up Study (baseline age 50-72), and 92,513 women in the Nurses’ Health Study 2 (baseline age 25-42) without a history of cardiovascular disease for up to 26 years between 1984 and 2011. Diet was assessed up to 7 times using repeated food frequency questionnaires. We computed the Food Quality Score (FQS) for each individual. A higher FQS score represents a healthier diet. The association between the FQS and CHD risk was assessed using Cox proportional hazard model controlling for potential confounders. We also compared the strength of association of FQS with other diet quality scores. Results: We ascertained 6497 incident CHD events, including 4594 nonfatal myocardial infarct (MI) and 2055 fatal cases. Comparing top to bottom deciles, the pooled RR was 0.66 (95% CI=0.58-0.74, p trend<0.001) for total CHD, 0.63 (0.54-0.73, p trend<0.001) for non-fatal MI, and 0.73 (0.59-0.90, p trend=0.001) for fatal MI. The association for CHD was significant in lean (BMI<25) and overweight (BMI>=25) individuals, those with or without a family history of MI, and physical activity above or below the median. When comparing the FQS with other diet quality scores that have previously been associated to lower CHD risk, one standard deviation increase in the FQS was not significantly different from the Alternate Mediterranean Diet score, the Alternate Healthy Eating Index-2010 or the Dietary Approaches to Stop Hypertension score in its association with CHD risk. Conclusion: A higher FQS was associated with lower CHD risk. The FQS was comparable to food and nutrient based diet quality score that have previously been associated with lower CVD risk and indicates a potential to develop a simple food only diet quality for public health applications of assessing diet quality.

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Abstract 19: Dietary Lipophilic Load and Dietary Lipophilic Index with Risk of Coronary Heart Disease in Middle-Aged Women: Beyond Conventional Fat Classifications

Circulation ◽

10.1161/circ.131.suppl_1.19 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Eric L Ding ◽

Katerina M De Vito ◽

Hongyu Wu ◽

Qi Sun ◽

An Pan ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Dietary Fat ◽

Hdl Cholesterol ◽

Health Study ◽

Chd Risk ◽

Increased Risk ◽

Total Fat ◽

Traditional Risk Factors

Introduction: Studies indicate dietary types of fats are associated with risk of coronary heart disease (CHD). Traditional broad classifications may incompletely capture the diversity of fatty acids on CHD. The novel lipid index Dietary Lipophilic Load (DLL) reflects a unique combination of fatty acid fluidity, intermolecular attraction, plus relative fat quantity, while Dietary Lipophilic Index (DLI) is a measure of average fat fluidity, regardless of fat quantity. Thus, we evaluated the association, DLL and DLI, with risk of incident CHD. METHODS: Participants included 30,932 women in the Women’s Health Study (WHS), who were free of major chronic diseases at baseline. DLL was calculated by weighted summation of the multiplicative product of each fatty acid’s intakes (g/day) and its melting points (Celcius); DLI was calculated by dividing DLL by total fat intake (g/day). Hazard ratios (HRs) were adjusted for established risk factors, with updated dietary data, and potential mediators. We also investigated hypothesized interactions with C-Reactive Protein (CRP). RESULTS: There were 1137 cases of incident CHD in 525,828 person-years over 19 years follow-up. At baseline in over 27,000 women with blood samples, DLL and DLI were not correlated with serum cholesterol, triglyceride, HbA1c, ICAM-1, or CRP biomarkers (r<0.02 for all). In overall multivariate analysis, DLL was associated with higher risk of CHD (extreme quintile HR=1.40, 95%CI: 1.11-1.76, P trend=0.0002), while DLI was not (HR=0.83, 95%CI: 0.67-1.03, P trend=0.75). DLL results were independent beyond adjustment for dietary trans, saturated, monounsaturated, and polyunsaturated fats, nor their aggregate adjustment or the P:S ratio. DLL effects persisted even adjusting for CRP (HR=1.29, P-trend=1 mg/dL for DLL (extreme quintile HR=1.38, 1.02-1.88), than among individuals with low CRP <1 mg/dl for DLL (HR=1.08, 0.68-1.72), with P-interaction<0.0001. Furthermore, CRP also modified DLI, where effects again diverged among higher CRP (HR=0.98, 0.73-1.31) versus low CRP (HR=0.45, 0.27-0.74), with P-interaction<0.0001. Moreover, adjustment of triglycerides, HbA1c, ICAM-1, LDL or HDL cholesterol also did not materially affect overall results. CONCLUSION: Results indicate that DLL is associated with increased risk of incident CHD, independent of traditional risk factors, conventional dietary fat classifications, and major CHD biomarkers. Effects of DLL and DLI appear to be modified by levels of CRP. DLL appears to be an important novel dietary fat index that captures additional CHD risk information beyond biomarkers and traditional dietary fat categories. Further studies are warranted.

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Abstract P186: Circulating Desphospho-uncarboxylated Matrix Gla Protein and the Risk of Coronary Heart Disease and Stroke

Circulation ◽

10.1161/circ.129.suppl_1.p186 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Geertje W Dalmeijer ◽

Yvonne T van der Schouw ◽

Elke J Magdeleyns ◽

Cees Vermeer ◽

W. Monique M Verschuren ◽

...

Keyword(s):

Coronary Heart Disease ◽

Cohort Study ◽

Heart Disease ◽

General Population ◽

Vitamin K ◽

Stroke Risk ◽

Matrix Gla Protein ◽

Chd Risk ◽

Increased Risk ◽

Incident Cases

Background: Matrix Gla protein (MGP) is a vitamin K dependent protein and a potent inhibitor of vascular calcification. Desphospho-uncarboxylated MGP (dp-ucMGP) is a marker for vitamin K status with high dp-ucMGP concentration reflecting a low vitamin K status. High dp-ucMGP concentrations are thought to be associated with an increased risk of cardiovascular disease, but this has never been investigated in the general population. Objective: This study aimed to investigate the association of dp-ucMGP with incident coronary heart disease (CHD) or stroke in the general population. Design and Methods: A prospective case-cohort study with a representative baseline sample of 1406 participants and 1154 and 380 incident cases of CHD and stroke, respectively, was nested within the EPIC-NL study. Dp-ucMGP concentrations were measured by ELISA technique in baseline plasma samples. The incidence of fatal and non-fatal CHD and stroke was obtained by linkage to national registers. Cox proportional hazard models adapted for the case-cohort design were used to calculate hazard ratios (HRs) per standard deviation (SD) and per quartile of circulating dp-ucMGP levels, adjusted for cardiovascular risk factors. Results: This case-cohort study had an average follow-up of 11.5 years. Circulating dp-ucMGP levels were not associated with CHD risk with a HR per SD of 1.00 (95% CI: 0.93-1.07) and a HR Q4 vs Q1 of 0.94 (95% CI: 0.79-1.13) after multivariate adjustment. Circulating dp-ucMGP was not associated with stroke risk with a HR per SD of 0.98 (95% CI: 0.90-1.08) and a HR Q4 vs Q1 of 1.09 (95% CI: 0.78-1.51). Conclusion: This study does not support the hypothesis that high dp-ucMGP levels, reflecting a poor vitamin K status, are associated with increased CHD or stroke risk.

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Abstract MP054: Associations of Monounsaturated Fat From Plant and Animal Sources With Coronary Heart Disease Risk

Circulation ◽

10.1161/circ.135.suppl_1.mp054 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Geng Zong ◽

Yanping Li ◽

Anne Wanders ◽

Peter Zock ◽

Laura Sampson ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Disease Risk ◽

Saturated Fat ◽

Health Benefit ◽

Dietary Factors ◽

Health Study ◽

Monounsaturated Fat ◽

Chd Risk ◽

Highly Correlated

Background: The association between monounsaturated fat (MUFA) intake and coronary heart disease (CHD) risk remains unclear. We aimed to investigate whether MUFA from plant foods (MUFA-P) and animal foods (MUFA-A) show different associations with CHD risk in two large prospective studies of U.S. men and women. Method: We calculated MUFA-P and MUFA-A among 60,931 women in the Nurses’ Health Study (1990-2012), and 28,445 men in the Health Professionals Follow-Up Study (1990-2010). Diet was assessed by validated food-frequency questionnaire every 4 years. CHD incidence was self-reported and confirmed by review of medical records or death certificates. Result: MUFA-A (median intake: 5.8-6.1% energy) was highly correlated with saturated fat (SFA; spearman correlation [ r ] =0.81-0.83) but not polyunsaturated fat (PUFA, r =0.04 -0.19), whereas MUFA-P intake (median: 5.3-5.4.9% energy) was strongly correlated with PUFA(r=0.61 for both cohorts) but not SFA ( r =0.20-0.21; All P<0.001). In multivariate models adjusted for demographic, lifestyle, and dietary factors, hazard ratios of CHD (HR, 95% confidence interval[95%CI]) from low to high total MUFA quintiles were 1 (reference), 0.92 (0.83, 1.02), 1.03 (0.93, 1.05), 0.89 (0.79,1.00). 0.95(0.873, 1.08; P trend =0.42). For MUFA P these were 1(reference), 0.98 (0.89, 1.07), 0.90 (0.82, 0.99), 0.85 (0.77, 0.93), and 0.86 (0.78, 0.94; P trend <0.001) and for MUFA-A 1(reference), 1.09 (0.99, 1.20), 1.22 (1.11, 1.35), 1.26 (1.13, 1.39), and 1.33 (1.19, 1.48; P trend <0.001). In the energy-density model, CHD risk was lower when MUFA-P iso-calorically replaced 1% energy from total SFA (HR [95%CI]: 0.96[0.92, 1.00]; P=0.03), with no significant changes when MUFA-A replacing SFA (HR [95%CI]: 1.01[0.95, 1.07]; P=0.76). When grouping fat intake as the sum of animal MUFA plus saturated fat and the sum of plant MUFA plus PUFA, the HR (95%CI) of CHD was 0.96 (0.95, 0.98; P<0.001) for replacing 1% energy from the former with the latter. Conclusion: Because MUFA compositions of animal and plant origins are largely similar, our data suggested other components in plant and animal foods may lead to the observed different associations of MUFA-P and MUFA-A with CHD risk. These findings provided a possible explanation on current controversies regarding MUFA intake and CHD risk, and further support health benefit of MUFA intake.

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Abstract MP025: Physical Activity and Risk of Coronary Heart Disease in Young Women

Circulation ◽

10.1161/circ.125.suppl_10.amp025 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Andrea K Chomistek ◽

Kenneth J Mukamal ◽

A. H Eliassen ◽

Eric B Rimm

Keyword(s):

Physical Activity ◽

High School ◽

Coronary Heart Disease ◽

Heart Disease ◽

Young Women ◽

Leisure Time Physical Activity ◽

Strenuous Exercise ◽

Health Study ◽

Chd Risk

Background: The majority of studies on the association between physical activity and coronary heart disease (CHD) risk have been conducted in middle-aged and older populations. Although physical activity has been shown to lower risk of CHD in women by approximately 30%, evidence for the benefits of exercise for CHD in young women is very limited. Methods and Results: We conducted a prospective cohort study among 114 054 women, 25–42 years of age at baseline, enrolled in the Nurses’ Health Study II and followed from 1989 to 2009. Leisure-time physical activity was assessed at baseline and during follow-up through a series of questions on the specific type of activity and the average time per week spent on the activity over the previous year. Additionally, at baseline, women were asked the number of months per year they participated in strenuous exercise or sports during high school and ages 18–22. During 20 years of follow-up, we documented 518 new cases of non-fatal MI and fatal CHD. After adjusting for age and other cardiovascular risk factors, the rate ratios (RR) (95% confidence intervals [CI]) corresponding to 0, 0.1 – 3.5, 3.6 – 8.8, 8.9 – 21.0, and > 21 MET-hours/week of physical activity were 1.0, 0.93 (0.71, 1.21), 0.73 (0.56, 0.95), 0.67 (0.52, 0.88), and 0.63 (0.49, 0.83) (p for trend = 0.001). There was no evidence of effect modification by age or body mass index. Specifically in women less than 50 years of age, the corresponding RR were 1.0, 0.97 (0.70, 1.35), 0.75 (0.53, 1.04), 0.69 (0.50, 0.96), and 0.63 (0.45, 0.88) (p for trend = 0.008). Brisk walking alone was also associated with significant reductions in CHD risk. In contrast to physical activity during adulthood, frequency of participation in strenuous activity in high school or during ages 18–22 was not associated with risk of CHD when adjusted for current physical activity. Conclusions: These prospective data suggest that physical activity is associated with substantial risk reductions in the incidence of coronary heart disease in young women.

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Polygenic Risk Score for Coronary Heart Disease Modifies the Elevated Risk by Cigarette Smoking for Disease Incidence

Circulation Genomic and Precision Medicine ◽

10.1161/circgen.117.001856 ◽

2018 ◽

Vol 11 (1) ◽

Cited By ~ 6

Author(s):

George Hindy ◽

Frans Wiberg ◽

Peter Almgren ◽

Olle Melander ◽

Marju Orho-Melander

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Confidence Interval ◽

Odds Ratio ◽

Risk Category ◽

Polygenic Risk Score ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

Polygenic Risk ◽

Never Smokers

Background: Coronary heart disease (CHD) is a multifactorial disease with both genetic and environmental components. Smoking is the most important modifiable risk factor for CHD. Our aim was to test whether the increased CHD incidence by smoking is modified by genetic predisposition to CHD. Methods and Results: Our study included 24 443 individuals from the MDCS (Malmö Diet and Cancer Study). A weighted polygenic risk score (PRS) was created by summing the number of risk alleles for 50 single-nucleotide polymorphisms associated with CHD. Individuals were classified as current, former, or never smokers. Interactions were primarily tested between smoking status and PRS and secondarily with individual single-nucleotide polymorphisms. Then, the predictive use of PRS for CHD incidence was tested among different smoking categories. During a median follow-up time of 19.4 years, 3217 incident CHD cases were recorded. The association between smoking and CHD was modified by the PRS ( P interaction =0.005). The magnitude of increased incidence of CHD by smoking was highest among individuals in the lowest tertile of PRS (odds ratio, 1.42; 95% confidence interval, 1.29–1.56 per smoking risk category) compared with the highest tertile (odds ratio, 1.20; 95% confidence interval, 1.11–1.30 per smoking risk category). This interaction was stronger among men ( P interaction =0.001) compared with women ( P interaction =0.44). The PRS provided a significantly better net reclassification and discrimination on top of traditional risk factors among never smokers compared with current smokers ( P <0.001). Conclusions: Genetic predisposition to CHD modifies the associated increased CHD risk by smoking. The PRS has a better predictive use among never smokers compared with smokers.

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Habitual sleep quality, plasma metabolites and risk of coronary heart disease in post-menopausal women

International Journal of Epidemiology ◽

10.1093/ije/dyy234 ◽

2018 ◽

Vol 48 (4) ◽

pp. 1262-1274 ◽

Cited By ~ 6

Author(s):

Tianyi Huang ◽

Oana A Zeleznik ◽

Elizabeth M Poole ◽

Clary B Clish ◽

Amy A Deik ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Sleep Quality ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Health Study ◽

Plasma Metabolites ◽

Cardiometabolic Health ◽

Chd Risk ◽

Chd Risk Factors

Abstract Background Epidemiologic studies suggest a strong link between poor habitual sleep quality and increased cardiovascular disease risk. However, the underlying mechanisms are not entirely clear. Metabolomic profiling may elucidate systemic differences associated with sleep quality that influence cardiometabolic health. Methods We explored cross-sectional associations between sleep quality and plasma metabolites in a nested case–control study of coronary heart disease (CHD) in the Women’s Health Initiative (WHI; n = 1956) and attempted to replicate the results in an independent sample from the Nurses’ Health Study II (NHSII; n = 209). A sleep-quality score (SQS) was derived from self-reported sleep problems asked in both populations. Plasma metabolomics were assayed using LC–MS with 347 known metabolites. General linear regression was used to identify individual metabolites associated with continuous SQS (false-discovery rate <0.05). Using least absolute shrinkage and selection operator (LASSO) algorithms, a metabolite score was created from replicated metabolites and evaluated with CHD risk in the WHI. Results After adjusting for age, race/ethnicity, body mass index (BMI) and smoking, we identified 69 metabolites associated with SQS in the WHI (59 were lipids). Of these, 16 were replicated in NHSII (15 were lipids), including 6 triglycerides (TAGs), 4 phosphatidylethanolamines (PEs), 3 phosphatidylcholines (PCs), 1 diglyceride (DAG), 1 lysophosphatidylcholine and N6-acetyl-L-lysine (a product of histone acetylation). These metabolites were consistently higher among women with poorer sleep quality. The LASSO selection resulted in a nine-metabolite score (TAGs 45: 1, 48: 1, 50: 4; DAG 32: 1; PEs 36: 4, 38: 5; PCs 30: 1, 40: 6; N6-acetyl-L-lysine), which was positively associated with CHD risk (odds ratio per SD increase in the score: 1.16; 95% confidence interval: 1.05, 1.28; p = 0.0003) in the WHI after adjustment for matching factors and conventional CHD risk factors. Conclusions Differences in lipid metabolites may be an important pathogenic pathway linking poor habitual sleep quality and CHD risk.

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Circulating Calcitriol Concentrations and Total Mortality

Clinical Chemistry ◽

10.1373/clinchem.2008.120006 ◽

2009 ◽

Vol 55 (6) ◽

pp. 1163-1170 ◽

Cited By ~ 72

Author(s):

Armin Zittermann ◽

Stefanie S Schleithoff ◽

Sabine Frisch ◽

Christian Götting ◽

Joachim Kuhn ◽

...

Keyword(s):

Heart Failure ◽

Vitamin D ◽

Coronary Heart Disease ◽

Renal Failure ◽

Heart Disease ◽

Total Mortality ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Heart Center

Abstract Background: Evidence is accumulating that vitamin D supplementation of patients with low 25-hydroxyvitamin D concentrations is associated with lower cardiovascular morbidity and total mortality during long-term follow-up. Little is known, however, about the effect of low concentrations of the vitamin D hormone calcitriol on total mortality. We therefore evaluated the predictive value of circulating calcitriol for midterm mortality in patients of a specialized heart center. Methods: This prospective cohort study included 510 patients, 67.7% with heart failure (two-thirds in end stage), 64.3% hypertension, 33.7% coronary heart disease, 20.2% diabetes, and 17.3% renal failure. We followed the patients for up to 1 year after blood collection. For data analysis, the study cohort was stratified into quintiles of circulating calcitriol concentrations. Results: Patients in the lowest calcitriol quintile were more likely to have coronary heart disease, heart failure, hypertension, diabetes, and renal failure compared to other patients. They also had low 25-hydroxyvitamin D concentrations and high concentrations of creatinine, C-reactive protein, and tumor necrosis factor α. Eighty-two patients (16.0%) died during follow-up. Probability of 1-year survival was 66.7% in the lowest calcitriol quintile, 82.2% in the second quintile, 86.7% in the intermediate quintile, 88.8% in the fourth quintile, and 96.1% in the highest quintile (P < 0.001). Discrimination between survivors and nonsurvivors was best when a cutoff value of 25 ng/L was applied (area under the ROC curve 0.72; 95% CI 0.66–0.78). Conclusions: Decreased calcitriol levels are linked to excess midterm mortality in patients of a specialized heart center. .

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Exploring the interplay between job strain and different domains of physical activity on the incidence of coronary heart disease in adult men

European Journal of Preventive Cardiology ◽

10.1177/2047487319852186 ◽

2019 ◽

Vol 26 (17) ◽

pp. 1877-1885 ◽

Cited By ~ 2

Author(s):

Marco M Ferrario ◽

Giovanni Veronesi ◽

Mattia Roncaioli ◽

Andreas Holtermann ◽

Niklas Krause ◽

...

Keyword(s):

Physical Activity ◽

Coronary Heart Disease ◽

Heart Disease ◽

Confidence Interval ◽

Protective Effect ◽

Job Strain ◽

Joint Effect ◽

Hazard Ratio ◽

Cox Models ◽

Chd Risk

Aims The aim of this study was to investigate the independent associations of occupational (OPA) and sport physical activity (SpPA) and job strain on the incidence of coronary heart disease (CHD) events, and to explore their interplay. Methods The study sample included 3310 25–64-year-old employed men, free of CHD at baseline, recruited in three population-based and one factory-based cohorts. OPA and SpPA, and job strain were assessed by the Baecke and the Job Content Questionnaires, respectively. We estimated the associations between different domains of physical activity and job strain with CHD, adjusting for major risk factors using Cox models. Results During follow-up (median=14 years), 120 CHD events, fatal and non-fatal, occurred. In the entire sample, a higher CHD risk was found for high job strain (hazard ratio=1.55, 95% confidence interval: 1.05–2.31). The joint effect of low OPA and high job strain was estimated as a hazard ratio of 2.53 (1.29–4.97; reference intermediate OPA with non-high strain). With respect to intermediate OPA workers, in stratified analysis when SpPA is none, low OPA workers had a hazard ratio of 2.13 (95% confidence interval: 1.19–3.81), increased to 3.95 (1.79–8.78) by the presence of high job strain. Low OPA–high job strain workers take great advantage from SpPA, reducing their risk up to 90%. In contrast, the protective effect of SpPA on CHD in other OPA–job strain categories was modest or even absent, in particular when OPA is high. Conclusions Our study shows a protective effect of recommended and intermediate SpPA levels on CHD risk among sedentary male workers. When workers are jointly exposed to high job strain and sedentary work their risk further increases, but this group benefits most from regular sport physical activity.

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