Abstract MP02: Quantifying The Impact Of Maintenance And Changes Of Lifestyles On Risk Of Cardiovascular Disease And All-cause Mortality - The Doetinchem Cohort Study

Background: It is not fully understood to what extent changes in lifestyle over time influence the risk of cardiovascular disease (CVD) and death among healthy adults, since most studies assessed lifestyle at a single point in time. Objective: To investigate the association of maintenance and changes in lifestyle profiles over 5 years with risk of CVD and all-cause mortality. Methods: Healthy lifestyle factors (HLF), i.e., healthy diet, physically active, not smoking, moderate alcohol consumption, sufficient sleep duration, and normal weight were assessed among 5,290 CVD- and cancer-free adults aged 25-65 years in 1993-1997 (baseline examination). Participants were categorized as having unhealthy (0-2 HLF), moderately healthy (3-4 HLF), or healthy (5-6 HLF) lifestyles. They were subdivided as maintained, improved, or deteriorated HLF 5 years later (1998-2002). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CI) for combined fatal and non-fatal CVD and all-cause mortality following the risk-change period were estimated using Cox proportional hazards models. Results: Individuals who maintained their HLF had 62% lower risk of CVD (HR: 0.38, 95%CI: 0.23-0.64) (Figure 1) and 54% for all-cause mortality (HR: 0.46, 95%CI: 0.27-0.77) than those who maintained unhealthy lifestyles. In general, compared to maintenance of HLF, improvement and deterioration of HLF were associated with better or worse HRs than their baseline risks for CVD and all-cause mortality, respectively. Conclusion: Maintenance of a healthy lifestyle is associated with significant and independent low risk of CVD and all-cause mortality. Effort is needed to improve the adoption and maintenance of a healthy lifestyle.

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Dietary Omega-3 Fatty Acid Intake and Mortality in CKD Population: A 1999–2014 NHANES Analysis

American Journal of Nephrology ◽

10.1159/000520027 ◽

2021 ◽

pp. 1-10

Author(s):

Wei-Lan Li ◽

Nan-Hui Zhang ◽

Shu-Wang Ge ◽

Gang Xu

Keyword(s):

Cardiovascular Disease ◽

Fatty Acid ◽

Proportional Hazards ◽

Early Death ◽

Cox Proportional Hazards ◽

Omega 3 ◽

Pufa Intake ◽

Dietary Recall ◽

Cox Proportional Hazards Models ◽

All Cause Mortality

Introduction: High risk of early death, especially contributed to cardiovascular disease, exists in patients who have chronic kidney disease (CKD). And the burden of cardiovascular disease is able to be lightened by an increase in omega-3 polyunsaturated fatty acid (omega-3 PUFA). A diet high in omega-3 PUFA in the general population is protective, although it is inconclusive about its beneficial role in the CKD population. Methods: From the 1999 to 2014 National Health and Nutrition Examination Surveys (NHANES), we can collect 2,990 participants who suffered from CKD, who were classified into 4 groups: <0.86, 0.87–1.30, 1.31–1.92, and 1.93–9.65 g/day based on NHANES 24-h dietary recall questionnaire dietary omega-3 PUFA. Moreover, their mortality details were available to be obtained by linking NHANES to the National Death Index. The associations between dietary omega-3 PUFA and mortality were evaluated by constructing multivariable Cox proportional hazards models. Results: Over 8 years of a median follow-up, 864 deaths were recorded. The adjusted hazard ratios (95% confidence interval) for all-cause mortality of the diseased people with CKD in the 2nd (0.87–1.30 g/day), 3rd (0.87–1.30 g/day), and 4th (1.93–9.65 g/day) quartiles of dietary omega-3 PUFA were 0.94 (0.72, 1.23), 0.74 (0.54, 1.02), and 0.67 (0.48, 0.93), respectively, versus those with the lowest quartile of dietary omega-3 PUFA intake (<0.86 g/day) (p for trend = 0.011). Conclusion: There may be a inverse relation of dietary omega-3 PUFA intake and all-cause mortality in patients with CKD. Therefore, an increase of dietary omega-3 PUFA may be encouraged to be used clinically in patients with CKD.

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Plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans: A cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003863 ◽

2022 ◽

Vol 19 (1) ◽

pp. e1003863

Author(s):

Leah J. Weston ◽

Hyunju Kim ◽

Sameera A. Talegawkar ◽

Katherine L. Tucker ◽

Adolfo Correa ◽

...

Keyword(s):

Cardiovascular Disease ◽

Proportional Hazards ◽

Black Americans ◽

Cox Proportional Hazards ◽

Cvd Risk ◽

African American Adults ◽

Education And Health ◽

Cox Proportional Hazards Models ◽

Heart Study ◽

All Cause Mortality

Background Prior studies have documented lower cardiovascular disease (CVD) risk among people with a higher adherence to a plant-based dietary pattern. Non-Hispanic black Americans are an understudied group with high burden of CVD, yet studies of plant-based diets have been limited in this population. Methods and findings We conducted an analysis of prospectively collected data from a community-based cohort of African American adults (n = 3,635) in the Jackson Heart Study (JHS) aged 21–95 years, living in the Jackson, Mississippi, metropolitan area, US, who were followed from 2000 to 2018. Using self-reported dietary data, we assigned scores to participants’ adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI). Cox proportional hazards models were used to estimate associations between plant-based diet scores and CVD incidence and all-cause mortality. Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics (age, sex, and education) and health behaviors (smoking, alcohol intake, margarine intake, physical activity, and total energy intake), no significant association was observed between plant-based diets and incident CVD for overall PDI (hazard ratio [HR] 1.06, 95% CI 0.78–1.42, p-trend = 0.72), hPDI (HR 1.07, 95% CI 0.80–1.42, p-trend = 0.67), and uPDI (HR 0.95, 95% CI 0.71–1.28, p-trend = 0.76). Corresponding HRs (95% CIs) for all-cause mortality risk with overall PDI, hPDI, and uPDI were 0.96 (0.78–1.18), 0.94 (0.76–1.16), and 1.06 (0.86–1.30), respectively. Corresponding HRs (95% CIs) for incident coronary heart disease with overall PDI, hPDI, and uPDI were 1.09 (0.74–1.61), 1.11 (0.76–1.61), and 0.79 (0.52–1.18), respectively. For incident total stroke, HRs (95% CIs) for overall PDI, hPDI, and uPDI were 1.00 (0.66–1.52), 0.91 (0.61–1.36), and 1.26 (0.84–1.89) (p-trend for all tests > 0.05). Limitations of the study include use of self-reported dietary intake, residual confounding, potential for reverse causation, and that the study did not capture those who exclusively consume plant-derived foods. Conclusions In this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality.

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Impact of Retinopathy and Systemic Vascular Comorbidities on All-Cause Mortality

Frontiers in Endocrinology ◽

10.3389/fendo.2021.750017 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhuoting Zhu ◽

Xianwen Shang ◽

Wei Wang ◽

Jason Ha ◽

Yifan Chen ◽

...

Keyword(s):

Proportional Hazards ◽

Vascular Risk Factor ◽

Cox Proportional Hazards ◽

Hypertension Status ◽

Term Survival ◽

Time To Death ◽

Health And Nutrition ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

The Impact

PurposeTo assess the impact of retinopathy and systemic vascular comorbidities on the all-cause mortality in a representative U.S. sample.MethodsA total of 5703 participants (≥40 years old) from the 2005-2008 National Health and Nutrition Examination Survey. The Early Treatment Diabetic Retinopathy Study grading scale was used to evaluate the retinopathy status. Systemic vascular comorbidities included diabetes mellitus (DM), high blood pressure (HBP), chronic kidney disease (CKD) and cardiovascular disease (CVD). Time to death was calculated as the time from baseline to either the date of death or censoring (December 31st, 2015), whichever came first. Risks of mortality were estimated using Cox proportional hazards models after adjusting for confounders and vascular comorbidities.ResultsAfter a median follow-up of 8.33 years (IQR: 7.50-9.67 years), there were 949 (11.8%) deaths from all causes. After adjusting for confounders, the presence of retinopathy predicted higher all-cause mortality (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.08-1.83). The all-cause mortality among participants with both retinopathy and systemic vascular comorbidities including DM (HR, 1.72; 95% CI, 1.21-2.43), HBP (HR, 1.47; 95% CI, 1.03-2.10), CKD (HR, 1.73; 95% CI, 1.26-2.39) and CVD (HR, 1.92; 95% CI, 1.21-3.04) was significantly higher than that among those without either condition. When stratified by diabetic or hypertension status, the co-occurrence of retinopathy and CKD or CVD further increased the all-cause mortality compared to those without either condition.ConclusionsThe co-occurrence of retinopathy and systemic vascular conditions predicted a further increase in the risk of mortality. More extensive vascular risk factor assessment and management are needed to detect the burden of vascular pathologies and improve long-term survival in individuals with retinopathy.

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Hyperuricemia and Incident Cardiovascular Disease and Noncardiac Vascular Events in Patients with Rheumatoid Arthritis

International Journal of Rheumatology ◽

10.1155/2014/523897 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Daniel Kuo ◽

Cynthia S. Crowson ◽

Sherine E. Gabriel ◽

Eric L. Matteson

Keyword(s):

Rheumatoid Arthritis ◽

Cardiovascular Disease ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Vascular Events ◽

Cox Proportional Hazards Models ◽

Peripheral Arterial ◽

The Impact ◽

Incident Cardiovascular Disease

Objective. To evaluate whether hyperuricemia is a risk factor for cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA).Methods. A population-based inception cohort of patients diagnosed between 1980 and 2007 with adult-onset RA was assembled. A comparison cohort of age- and sex-matched subjects without RA (non-RA) was also assembled. All clinically obtained uric acid values were collected. CVD and noncardiac vascular events were recorded for each patient. Cox proportional hazards models were used to assess the impact of hyperuricemia on development of CVD, mortality, and noncardiac vascular disease.Results. In patients without RA, hyperuricemia was associated with heart failure (HR: 1.95; 95% CI: 1.13–3.39) and CVD (HR: 1.59; 95% CI: 0.99–2.55). In patients with RA, hyperuricemia was not significantly associated with CVD but was significantly associated with peripheral arterial events (HR: 2.52; 95% CI: 1.17–5.42). Hyperuricemia appeared to be more strongly associated with mortality among RA patients (HR: 1.96; 95% CI: 1.45–2.65) than among the non-RA subjects (HR: 1.57; 95% CI: 1.09–2.24).Conclusion. In patients with RA, hyperuricemia was a significant predictor of peripheral arterial events and mortality but not of CVD.

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Abstract 16923: Healthy Lifestyle is Inversely Associated With All-Cause Mortality Irrespective of Medication Burden

Circulation ◽

10.1161/circ.142.suppl_3.16923 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Neil Kelly ◽

Orysya Soroka ◽

Chukwuma Onyebeke ◽

Laura Pinheiro ◽

Samprit Banerjee ◽

...

Keyword(s):

Racial Differences ◽

Proportional Hazards ◽

Sedentary Lifestyle ◽

Healthy Lifestyle ◽

Cox Proportional Hazards ◽

Healthy Behaviors ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

High Adherence ◽

Regards Study

Introduction: The benefits of a healthy lifestyle in the context of a high disease and medication burden are not clear. Hypothesis: Healthy lifestyle is inversely associated with all-cause mortality among adults with high medication burden. Methods: We examined participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Exposure variables were 4 healthy behaviors: adherence to a Mediterranean diet, physical activity, smoking abstinence, and sedentary lifestyle avoidance (low TV time). Each behavior was scored from 0-2, where 0 indicated low adherence and 2 indicated high adherence. We also examined a cumulative Health Behavior Score (HBS) based on the sum of individual behavior scores (range 0-8). The main outcome was all-cause mortality. To examine the association between each behavior and mortality, we estimated Cox proportional hazards models for each medication burden stratum (no polypharmacy: 0-4 medications at baseline; polypharmacy: 5-9; hyperpolypharmacy: ≥ 10), adjusting for socio-demographics, health status, comorbid conditions, and medication adherence. Results: Among 20,417 participants (9.8 ± 3.8 years followup), mean age was 64.8 ± 9.2 years, and 56% were women. At baseline, 44% had no polypharmacy, 39% had polypharmacy, and 17% had hyperpolypharmacy. Mortality increased with increasing medication burden (no polypharmacy: 19.1%; polypharmacy: 29.7%; hyperpolypharmacy: 41.3%). The highest score for each behavior was inversely associated with all-cause mortality in all 3 strata. The highest HBS for each stratum conferred substantial benefit (no polypharmacy: HR 0.52 (95% CI 0.45-0.61); polypharmacy: HR 0.55 (95% CI 0.49-0.63); hyperpolypharmacy HR 0.69 (95% CI 0.58-0.82)) (Table). Conclusions: Healthy lifestyle was inversely associated with all-cause mortality irrespective of medication burden, supporting the value of healthy lifestyle counseling even among adults with high medication burden.

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Joint Association of Modifiable Lifestyle and Metabolic Health Status with Incidence of Cardiovascular Diabetes and All-Cause mortality: A Perspective Cohort Study

10.21203/rs.3.rs-133364/v1 ◽

2020 ◽

Author(s):

Yingting Zuo ◽

Haibin Li ◽

Shuohua Chen ◽

Xue Tian ◽

Dapeng Mo ◽

...

Keyword(s):

Health Status ◽

Proportional Hazards ◽

Healthy Lifestyle ◽

Cox Proportional Hazards ◽

Metabolic Health ◽

Metabolic Risk ◽

Cvd Risk ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Joint Associations

Abstract Background We investigated the joint associations of modifiable lifestyle and metabolic factors with incident cardiovascular disease (CVD) and all-cause mortality.MethodsThis study included 94,831 participants (men, 79.76%; median age, 51.60 [43.47-58.87]) without a history of CVD at baseline from Kailuan study during 2006 to 2007 and followed them until new-onset CVD event, death or December 31, 2017. Baseline metabolic health status was assessed by Adult Treatment Panel-III (ATP-III) criteria and five lifestyle factors was collected using a self-reported questionnaire. We performed Cox proportional hazards models to evaluate the joint associations.Results During a median follow-up of 11.03 years, we observed 6,590 CVD events and 9,218 all-cause mortality. Participants within more metabolic risk components and least healthy lifestyle had the highest CVD risk (hazard ratio [HR] 2.06 [95% CI 1.77-2.39]) and mortality risk (HR 1.53 [95% CI 1.31-1.78]), as compared with the less metabolic risk components and most healthy lifestyle group. Compared with the most healthy lifestyle, the HR of CVD for participants with least healthy lifestyle was 1.26 (95% CI 1.17–1.37) in the category with low metabolic risk, 1.16 (95% CI 1.03–1.31) and 1.07 (95% CI 0.90–1.27) for those with medium and high metabolic risk, respectively.ConclusionsWe showed that healthy lifestyle and metabolic health were associated with a lower risk of CVD and all-cause mortality. The association between metabolic risk and the risk of CVD was not modified by healthy lifestyle. Our results indicated that healthy lifestyle should be promoted even for people with high metabolic risk.

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Added value of cardiovascular calcifications for prediction of recurrent cardiovascular events and cardiovascular interventions in patients with established cardiovascular disease

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02164-9 ◽

2021 ◽

Author(s):

Cilie C. van ’t Klooster ◽

◽

Yolanda van der Graaf ◽

Hendrik M. Nathoe ◽

Michiel L. Bots ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Valve ◽

Cardiovascular Events ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Added Value ◽

Cvd Risk ◽

Major Cardiovascular Events ◽

Cox Proportional Hazards Models ◽

Cardiovascular Interventions

AbstractThe purpose is to investigate the added prognostic value of coronary artery calcium (CAC), thoracic aortic calcium (TAC), and heart valve calcium scores for prediction of a combined endpoint of recurrent major cardiovascular events and cardiovascular interventions (MACE +) in patients with established cardiovascular disease (CVD). In total, 567 patients with established CVD enrolled in a substudy of the UCC-SMART cohort, entailing cardiovascular CT imaging and calcium scoring, were studied. Five Cox proportional hazards models for prediction of 4-year risk of MACE + were developed; traditional CVD risk predictors only (model I), with addition of CAC (model II), TAC (model III), heart valve calcium (model IV), and all calcium scores (model V). Bootstrapping was performed to account for optimism. During a median follow-up of 3.43 years (IQR 2.28–4.74) 77 events occurred (MACE+). Calibration of predicted versus observed 4-year risk for model I without calcium scores was good, and the c-statistic was 0.65 (95%CI 0.59–0.72). Calibration for models II–V was similar to model I, and c-statistics were 0.67, 0.65, 0.65, and 0.68 for model II, III, IV, and V, respectively. NRIs showed improvement in risk classification by model II (NRI 15.24% (95%CI 0.59–29.39)) and model V (NRI 20.00% (95%CI 5.59–34.92)), but no improvement for models III and IV. In patients with established CVD, addition of the CAC score improved performance of a risk prediction model with classical risk factors for the prediction of the combined endpoint MACE+ . Addition of the TAC or heart valve score did not improve risk predictions.

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AUTOMATED MEASUREMENT OF MUSCLE DENSITY ON COMPUTED TOMOGRAPHY (CT) PREDICTS ALL-CAUSE MORTALITY IN OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3234 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S883-S883

Author(s):

Leon Lenchik ◽

Ryan Barnard ◽

Robert D Boutin ◽

Stephen B Kritchevsky ◽

Ashley A Weaver ◽

...

Keyword(s):

Proportional Hazards ◽

Learning Algorithm ◽

Cox Proportional Hazards ◽

Muscle Density ◽

National Lung Screening Trial ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Automated Machine Learning ◽

Lung Screening ◽

Paraspinous Muscle

Abstract The purpose was to examine the association of paraspinous muscle density (CT surrogate of myosteatosis) with all-cause mortality in 6803 men and 4558 women, age 60-69 years (mean age 63.6) in the National Lung Screening Trial. Our fully-automated machine learning algorithm: 1) selected the appropriate CT series, 2) chose a single CT image at the level of T12 vertebra, 3) segmented the left paraspinous muscle, and 4) recorded the muscle density in Hounsfield Units (HU). Association between baseline muscle density and all-cause mortality was determined using Cox proportional hazards models, adjusted for age, race, body mass index, pack years of smoking, and presence of diabetes, lung disease, cardiovascular disease, and cancer at enrollment. After a mean 6.44 ± 1.06 years of follow-up, 635 (9.33%) men and 265 (5.81%) women died. In men, lower muscle density on baseline CT examinations was associated with increased all-cause mortality (HR per SD = 0.90; CI = 0.83, 0.99; p=0.03). Each standard deviation (7.8 HU) decrease in muscle density was associated with a 10% increase in mortality. In women, the association did not reach significance.

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Eosinophil count and mortality risk in incident hemodialysis patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz296 ◽

2020 ◽

Vol 35 (6) ◽

pp. 1032-1042

Author(s):

Duk-Hee Kang ◽

Yuji Lee ◽

Carola Ellen Kleine ◽

Yong Kyu Lee ◽

Christina Park ◽

...

Keyword(s):

Mortality Risk ◽

Eosinophil Count ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Time Varying ◽

Cox Proportional Hazards Models ◽

Lower Baseline ◽

All Cause Mortality ◽

Relationship Of ◽

The Relationship

Abstract Background Eosinophils are traditionally known as moderators of allergic reactions; however, they have now emerged as one of the principal immune-regulating cells as well as predictors of vascular disease and mortality in the general population. Although eosinophilia has been demonstrated in hemodialysis (HD) patients, associations of eosinophil count (EOC) and its changes with mortality in HD patients are still unknown. Methods In 107 506 incident HD patients treated by a large dialysis organization during 2007–11, we examined the relationships of baseline and time-varying EOC and its changes (ΔEOC) over the first 3 months with all-cause mortality using Cox proportional hazards models with three levels of hierarchical adjustment. Results Baseline median EOC was 231 (interquartile range 155–339) cells/μL and eosinophilia (>350 cells/μL) was observed in 23.4% of patients. There was a gradual increase in EOC over time after HD initiation with a median ΔEOC of 5.1 (IQR −53–199) cells/μL, which did not parallel the changes in white blood cell count. In fully adjusted models, mortality risk was highest in subjects with lower baseline and time-varying EOC (<100 cells/μL) and was also slightly higher in patients with higher levels (≥550 cells/μL), resulting in a reverse J-shaped relationship. The relationship of ΔEOC with all-cause mortality risk was also a reverse J-shape where both an increase and decrease exhibited a higher mortality risk. Conclusions Both lower and higher EOCs and changes in EOC over the first 3 months after HD initiation were associated with higher all-cause mortality in incident HD patients.

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Association of pulse pressure with all-cause mortality in young adults

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137070 ◽

2019 ◽

Vol 96 (1138) ◽

pp. 461-466

Author(s):

Jie LI ◽

Jia-Yi Huang ◽

Kenneth Lo ◽

Bin Zhang ◽

Yu-Qing Huang ◽

...

Keyword(s):

Young Adults ◽

Pulse Pressure ◽

Subgroup Analysis ◽

Proportional Hazards ◽

Continuous Variable ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

All Cause Mortality ◽

Cox Analysis

BackgroundPulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults.ObjectiveTo assess the association of pulse pressure (PP) with all-cause mortality in young adults.MethodsThis cohort from the 1999–2006 National Health and Nutrition Examination Survey included adults aged 18–40 years. All included participants were followed up until the date of death or 31 December 2015. PP was categorised into three groups: <50, 50~60, ≥60 mm Hg. Cox proportional hazards models and subgroup analysis were performed to estimate the adjusted HRs and 95% CIs for all-cause mortality.ResultsAfter applying the exclusion criteria, 8356 participants (median age 26.63±7.01 years, 4598 women (55.03%)) were included, of which 265 (3.17%) have died during a median follow-up duration of 152.96±30.45 months. When treating PP as a continuous variable, multivariate Cox analysis showed that PP was an independent risk factor for all-cause mortality (HR 1.94, 95% CI 1.02 to 3.69; p=0.0422). When using PP<50 mm Hg as referent, from the 50~60 mm Hg to the ≥60 mm Hg group, the risks of all-cause mortality for participants with PP ranging 50–60 mm Hg or ≥60 mm Hg were 0.93 (95% CI 0.42 to 2.04) and 1.15 (95% CI 0.32 to 4.07) (P for tend was 0.959). Subgroup analysis showed that PP (HR 2.00, 95% CI 1.05 to 3.82; p=0.0360) was associated with all-cause mortality among non-hypertensive participants.ConclusionAmong young adults, higher PP was significantly associated with an increased risk of all-cause mortality, particularly among those without hypertension.

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