Abstract P042: Association of Long-Term Coffee Consumption with Total and Cause-Specific Mortality

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Ming Ding ◽  
Ambika Satija ◽  
Shilpa Bhupathiraju ◽  
Qi Sun ◽  
Jiali Han ◽  
...  

BACKGROUND: Coffee is one of the most popular beverages worldwide; however, the association between coffee consumption and risk of mortality remains inconclusive. METHOD: We examined the associations of consumption of total, caffeinated, and decaffeinated coffee with risk of subsequent total and cause-specific mortality among 121,704 women in the Nurses’ Health Study (1984 - 2013), 116,683 women in the Nurses’ Health Study 2 (1991 - 2013), and 51,530 men in the Health Professionals Follow-up Study (1986 - 2013). Participants with a history of cancer, heart disease, or stroke at baseline were excluded. Coffee consumption was assessed at baseline using a semi-quantitative food frequency questionnaire. RESULTS: During 5,048,976 person-years of follow-up, 20,025 women and 13,391 men died. Consumption of total, caffeinated, and decaffeinated coffee were non-linearly associated with total mortality (P for non-linear trend < 0.001). The pooled hazard ratios (HRs) for death among participants who drank coffee, as compared with those who did not, were 0.96 (95% CI: 0.92 - 1.00) for coffee consumption less than one cup/d, 0.89 (95% CI: 0.86 - 0.92) for coffee consumption one to three cups/d, 0.91 (95% CI: 0.87 - 0.95) for coffee consumption three to five cups/d, and 1.01 (95% CI: 0.96 - 1.06) for coffee consumption more than five cups/d (p for non-linearity < 0.001; p for non-linear trend < 0.001). When restricting to never smokers, compared to non-drinkers, the multivariate adjusted HRs of total mortality across categories of total coffee consumption were 0.93 (0.86-1.02) for 1 cup/d, 0.87 (0.82-0.96) for 1-3 cups/d, 0.85 (0.77-0.94) for 3-5 cups/d, and 0.83 (0.71-0.97) for >5 cups/d (p for non-linearity = 0.15; p for linear trend <0.001). A significant inverse association was observed for both caffeinated coffee (p for trend < 0.001) and decaffeinated coffee (p for trend = 0.03). CONCLUSION: These data indicate higher consumption of total coffee, caffeinated coffee, and decaffeinated coffee was associated with lower risk of total mortality.

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Paulette D Chandler ◽  
Deirdre Tobias ◽  
Jule E Buring ◽  
I-Min Lee ◽  
Daniel Chasman ◽  
...  

Background: Given the increased prevalence of cancer survivors in the United States, it is imperative to define risk factors for potential reductions in total and cause-specific mortality. Physical activity (PA) represents a promising target for intervention. Design: We prospectively evaluated PA from questionnaires before and after cancer diagnosis with total and cause-specific mortality among 13,297 subjects diagnosed with invasive cancer combined from the Physicians’ Health Study (PHS) (n=6328), Physicians’ Health Study II (PHS II) (n=912), and Women's Health Study (WHS) (n=6057). WHS and PHS participants were free of baseline cancer; PHS II participants reported no active cancer at baseline. We ascertained PA before and after an incident cancer diagnosis based on reports on repeated follow-up questionnaires. Death was ascertained by medical records and death certificates. Cox regression estimated combined hazard ratios (HRs) of mortality by PA adjusted for age, randomized treatments, BMI, and other lifestyle/demographic factors. We evaluated the interaction between PA before and after cancer diagnosis by comparing PA ≤1 versus ≥2 times/wk. Results: The mean follow-up after cancer diagnosis was 8.0, 7.5, and 5.2 y for WHS, PHS, and PHS II, respectively, during which there were 5623 deaths (WHS, 2164; PHS, 3269; PHS II; 190). Higher PA before cancer diagnosis was associated with significantly lower mortality. Compared with PA ≤ once/wk, the HRs (95% CIs) associated with PA 2-4 and >4 times/wk were 0.87 (0.82-0.93) and 0.88 (0.82-0.94) for total mortality; 0.77 (0.63-0.95) and 0.79 (0.62-0.997) for CVD mortality, and 0.90 (0.83-0.98) and 0.90 (0.83-0.98) for cancer mortality. Higher PA after cancer diagnosis was associated with significantly lower total and cancer mortality and non-significantly lower CVD mortality, with HRs (95% CIs) of 0.65 (0.58-0.72) and 0.66 (0.59-0.73) for total mortality; 0.78 (0.59-1.03) and 0.82 (0.61-1.10) for CVD mortality, and 0.66 (0.57-0.77) and 0.64 (0.55-0.74) for cancer mortality. There was a significant interaction of PA before and after cancer diagnosis for total (p int =0.02) and cancer (p int =0.007) mortality, but not CVD mortality (p int =0.38). Conclusions: Greater PA both before and after cancer diagnosis were significantly associated with lower total and cancer mortality. Higher PA before cancer diagnosis was also associated with lower CVD mortality. PA may be an important target for lower mortality after cancer diagnosis.


2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1036-1036
Author(s):  
Marta Guasch-Ferre ◽  
Yanping Li ◽  
Walter Willett ◽  
Qi Sun ◽  
Laura Sampson ◽  
...  

Abstract Objectives The association between olive oil intake and the risk of mortality has not been evaluated before in the US population. Our objective was to examine whether olive oil intake is associated with total and cause-specific mortality in two prospective cohorts of US men and women. We hypothesize that higher olive oil consumption is associated with lower risk of total and cause-specific mortality. Methods We followed 61,096 women (Nurses’ Health Study, 1990–2016) and 31,936 men (Health Professionals Follow-up Study, 1990–2016) who were free of diabetes, cardiovascular disease and cancer at baseline. Diet was assessed by a semi quantitative food frequency questionnaire at baseline and then every 4 years. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results During 26 years of follow-up, 32,868 deaths occurred. Compared with those participants who never consumed olive oil, those with higher olive oil intake (&gt;1/2 tablespoon/d or &gt;8g/d) had 15% lower risk of total mortality [pooled hazard ratio (95% confidence interval): 0.85 (0.81, 0.88)] after adjustment for potential confounders. Higher olive oil intake was associated with 15% lower risk of CVD death [0.85 (0.78, 0.92)], 38% lower risk of neurodegenerative disease death [0.62 (0.54, 0.71)], and 12% lower risk of respiratory death [0.88 (0.77, 1.00)]. Replacing 10 g of margarine, mayonnaise, and dairy fat with the equivalent amount of olive oil was associated with 7–20% lower risk of total mortality, and death from CVD, cancer, neurodegenerative, and respiratory diseases. No significant associations were observed when olive oil was replacing other vegetable oils combined (corn, safflower, soybean and canola oil). Conclusions We observed that higher olive oil intake was associated with a lower risk of total mortality and cause-specific mortality in a large prospective cohort of U.S. men and women. The substitution of margarine, mayonnaise, and dairy fat with olive oil was associated with a reduced risk of mortality. Funding Sources This work was supported by grants from the National Institutes of Health.


Circulation ◽  
2019 ◽  
Vol 140 (12) ◽  
pp. 979-991 ◽  
Author(s):  
Megu Y. Baden ◽  
Gang Liu ◽  
Ambika Satija ◽  
Yanping Li ◽  
Qi Sun ◽  
...  

Background: Plant-based diets have been associated with lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits. However, the association between changes in plant-based diet quality and mortality remains unclear. Methods: We investigated the associations between 12-year changes (from 1986 to 1998) in plant-based diet quality assessed by 3 plant-based diet indices (score range, 18–90)—an overall plant-based diet index (PDI), a healthful PDI, and an unhealthful PDI—and subsequent total and cause-specific mortality (1998–2014). Participants were 49 407 women in the Nurses’ Health Study (NHS) and 25 907 men in the Health Professionals Follow-Up Study (HPFS) who were free from CVD and cancer in 1998. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results: We documented 10 686 deaths including 2046 CVD deaths and 3091 cancer deaths in the NHS over 725 316 person-years of follow-up and 6490 deaths including 1872 CVD deaths and 1772 cancer deaths in the HPFS over 371 322 person-years of follow-up. Compared with participants whose indices remained stable, among those with the greatest increases in diet scores (highest quintile), the pooled multivariable-adjusted HRs for total mortality were 0.95 (95% CI, 0.90–1.00) for PDI, 0.90 (95% CI, 0.85–0.95) for healthful PDI, and 1.12 (95% CI, 1.07–1.18) for unhealthful PDI. Among participants with the greatest decrease (lowest quintile), the multivariable-adjusted HRs were 1.09 (95% CI, 1.04–1.15) for PDI, 1.10 (95% CI, 1.05–1.15) for healthful PDI, and 0.93 (95% CI, 0.88–0.98) for unhealthful PDI. For CVD mortality, the risk associated with a 10-point increase in each PDI was 7% lower (95% CI, 1–12%) for PDI, 9% lower (95% CI, 4–14%) for healthful PDI, and 8% higher (95% CI, 2–14%) for unhealthful PDI. There were no consistent associations between changes in plant-based diet indices and cancer mortality. Conclusions: Improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of an unhealthful plant-based diet was associated with a higher risk of total and CVD mortality.


Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Mercedes Sotos-Prieto ◽  
Howard D Sesso ◽  
Frank B Hu ◽  
Walter C Willett ◽  
Stephanie E Chiuve

Background: The previously validated Healthy Heart Score, based on modifiable health behaviors (diet, physical activity, alcohol intake, smoking, and body weight), effectively predicted the 20-year risk of CVD in mid-adulthood. While these lifestyle behaviors are independently associated with many chronic diseases, it remains unknown whether the Healthy Heart Score may extend to an association with overall mortality risk. Thus, we examined the Healthy Heart Score and total and cause-specific mortality in the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS). Methods: We conducted a prospective analysis among 58,319 women in the NHS (1984-2010) aged 30-55 y and 30,713 in men in the HPFS (1986-2010) aged 40-75 y free of cancer and CVD at baseline. The Healthy Heart Score was calculated at baseline and included 9 factors that best estimated CVD risk: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits and vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats). Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) and adjusted for various demographics, medical history, medication use and total energy. Results: During 2,075,504 years of follow-up, there were 19,181 total deaths, including 11,464 in women and 7,717 in men. Compared to participants with the lowest predicted 20-year CVD risk based on the Healthy Heart Score (1 st quintile, median CVD risk: 0.01%), participants with the highest predictive CVD risk (5 th quintile, median CVD risk: 0.03%) had a pooled HR (95%CI) of 2.26 (1.86, 2.13) for total mortality; 2.89 (95 CI%, 1.93, 4.32) for CVD mortality; and 2.55 (95% CI 2.39, 2.72) for cancer mortality. Participants in the 5 th quintile vs . the 1 st quintile of the Healthy Heart Score had also a significantly greater risk of death due to CHD (3.40 [2.20, 5.26]), stroke (1.77 [1.00, 3.14]), lung cancer (6.02 [2.83, 12.79]), breast cancer (1.45 [1.13, 1.85]), colon cancer (1.51 (1.17, 1.94)), respiratory disease (3.94 (1.03, 15.14)), and diabetes (3.63 (2.00, 6.59)). Conclusion: The Healthy Heart Score, comprised of 9 self-reported, modifiable lifestyle predictors of CVD, is strongly associated with a greater risk of all-cause and cause-specific mortality. This risk score is a potentially useful tool for risk assessment and counseling of healthy lifestyles to promote longevity


2020 ◽  
pp. 204748732090906 ◽  
Author(s):  
P Bazal ◽  
A Gea ◽  
AM Navarro ◽  
J Salas-Salvadó ◽  
D Corella ◽  
...  

Aims The association between caffeinated coffee consumption and atrial fibrillation remains unclear. Recent studies suggest an inverse association only between a moderate caffeinated coffee consumption and atrial fibrillation, but others have reported no association. The aim of our study was to prospectively assess the association between caffeinated coffee consumption and atrial fibrillation in two Spanish cohorts, one of adults from a general population and another of elderly participants at high cardiovascular risk. Methods and results We included 18,983 and 6479 participants from the ‘Seguimiento Universidad de Navarra’ (SUN) and ‘Prevención con Dieta Mediterránea’ (PREDIMED) cohorts, respectively. Participants were classified according to their caffeinated coffee consumption in three groups: ≤3 cups/month, 1–7 cups/week, and >1 cup/day. We identified 97 atrial fibrillation cases after a median follow-up of 10.3 years (interquartile range 6.5–13.5), in the SUN cohort and 250 cases after 4.4 years median follow-up (interquartile range 2.8–5.8) in the PREDIMED study. No significant associations were observed in the SUN cohort although a J-shaped association was suggested. A significant inverse association between the intermediate category of caffeinated coffee consumption (1–7 cups/week) and atrial fibrillation was observed in PREDIMED participants with a multivariable-adjusted hazard ratio = 0.53 (95% confidence interval 0.36–0.79) when compared with participants who did not consume caffeinated coffee or did it only occasionally. No association was found for higher levels of caffeinated coffee consumption (>1 cup per day), hazard ratio = 0.79 (95% confidence interval 0.49–1.28). In the meta-analysis of both PREDIMED and SUN studies, the hazard ratio for intermediate consumption of caffeinated coffee was 0.60 (95% confidence interval 0.44–0.82) without evidence of heterogeneity. Similar findings were found for the association between caffeine intake and atrial fibrillation risk. Conclusion Intermediate levels of caffeinated coffee consumption (1–7 cups/week) were associated with a reduction in atrial fibrillation risk in two prospective Mediterranean cohorts.


2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 226-226
Author(s):  
Xiaoran Liu ◽  
Marta Liu Guasch-Ferré ◽  
Deirdre Liu ◽  
Yanping Li

Abstract Objectives We aim to 1) examine the association between walnut consumption and subsequent total and cause-specific mortality; 2) to estimate life expectancy that would be potentially gained by varying intake of walnuts in U.S. women and men. Methods Walnut consumption was assessed using validated food frequency questionnaires in 1998 (baseline year) and updated every 4 years. We included data from 68,308 women of the Nurses’ Health Study (1998–2016) and 26,760 men of the Health Professionals Follow-up Study (1998–2016) who were free of cancer, heart disease, and stroke at baseline. We used Cox regression models adjusting for confounders to estimate mortality risk associated with walnut consumption stratified by sex and dietary quality. We used population based multistate life tables to calculate the differences in life expectancy and years lived in relation to walnut consumption. Results During up to 18 years of follow-up, we documented 30,502 deaths from any cause. The multivariable-adjusted hazard ratios (HRs) for total mortality across categories of walnut intake (servings/week), as compared to non-consumers, were 0.91 (95% confidence interval [CI], 0.89–0.94), for &lt;1 serving/week, 0.87 (95% CI, 0.83–0.92) for 1 serving/week, 0.79 (95% CI, 0.75–0.85), for 2–4 servings/week, and 0.77 (95% CI,: 0.71–0.81) for &gt;= 5 servings/week (P for trend &lt;0.0001). Per 0.5 serving/day walnut consumption was associated of a reduced risk of total mortality (HR: 0.82, 95% CI,: 0.77–0.88), CVD mortality (HR: 0.78, 95% CI,: 0.67–0.33), and cancer mortality (HR: 0.93, 95% CI:, 0.81–1.07) in participants with a suboptimal diet (AHEI score &lt;60% of cohort distribution). A greater life expectancy of 1.78 years in women and 1.94 years in men was observed among those who consumed walnuts more than 5 servings/week, compared to non-consumers at age 60. Conclusions Higher walnut consumption was associated with lower risk for total mortality and longer estimated life expectancy among U.S. men and women of two prospective cohort studies. Our results provide evidence on the potential role of walnut in the prevention of premature death. Funding Sources UM1 CA186107, UM1 CA176726, UM1 CA167552 Y.L. was partly funded by the California Walnut Commission. The funders have no roles in the design and conduct of the study.


Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2699
Author(s):  
Xiaoran Liu ◽  
Marta Guasch-Ferré ◽  
Deirdre K. Tobias ◽  
Yanping Li

Walnut consumption is associated with health benefits. We aimed to (1) examine the association between walnut consumption and mortality and (2) estimate life expectancy in relation to walnut consumption in U.S. adults. We included 67,014 women of the Nurses’ Health Study (1998–2018) and 26,326 men of the Health Professionals Follow-up Study (1998–2018) who were free of cancer, heart disease, and stroke at baseline. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During up to 20 years of follow-up, we documented 30,263 deaths. The hazard ratios for total mortality across categories of walnut intake (servings/week), as compared to non-consumers, were 0.95 (95% confidence interval (CI), 0.91, 0.98) for <1 serving/week, 0.94 (95% CI, 0.89, 0.99) for 1 serving/week, 0.87 (95% CI, 0.82, 0.93) for 2–4 servings/week, and 0.86 (95% CI, 0.79, 0.93) for >=5 servings/week (p for trend <0.0001). A greater life expectancy at age 60 (1.30 years in women and 1.26 years in men) was observed among those who consumed walnuts more than 5 servings/week compared to non-consumers. Higher walnut consumption was associated with a lower risk of total and CVD mortality and a greater gained life expectancy among U.S. elder adults.


2020 ◽  
Vol 35 (10) ◽  
pp. 913-924
Author(s):  
Marko Lukic ◽  
Runa Borgund Barnung ◽  
Guri Skeie ◽  
Karina Standahl Olsen ◽  
Tonje Braaten

Abstract Coffee consumption has previously been reported to reduce overall and cause-specific mortality. We aimed to further investigate this association by coffee brewing methods and in a population with heavy coffee consumers. The information on total, filtered, instant, and boiled coffee consumption from self-administered questionnaires was available from 117,228 women in the Norwegian Women and Cancer (NOWAC) Study. We used flexible parametric survival models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause, cardiovascular, and cancer mortality by total coffee consumption and brewing methods, and adjusted for smoking status, number of pack-years, age at smoking initiation, alcohol consumption, body mass index, physical activity, and duration of education. During 3.2 million person-years of follow-up, a total of 16,106 deaths occurred. Compared to light coffee consumers (≤ 1 cup/day), we found a statistically significant inverse association with high-moderate total coffee consumption (more than 4 and up to 6 cups/day, HR 0.89; 95% CI 0.83–0.94) and all-cause mortality. The adverse association between heavy filtered coffee consumption (> 6 cups/day) and all-cause mortality observed in the entire sample (HR 1.09; 95% CI 1.01–1.17) was not found in never smokers (HR 0.85; 95% CI 0.70–1.05). During the follow-up, both high-moderate total and filtered coffee consumption were inversely associated with the risk of cardiovascular mortality (HR 0.79; 95% CI 0.67–0.94; HR 0.80; 95% CI 0.67–0.94, respectively). The association was stronger in the analyses of never smokers (> 6 cups of filtered coffee/day HR 0.20; 95% CI 0.08–0.56). The consumption of more than 6 cups/day of filtered, instant, and coffee overall was found to increase the risk of cancer deaths during the follow-up. However, these associations were not statistically significant in the subgroup analyses of never smokers. The data from the NOWAC study indicate that the consumption of filtered coffee reduces the risk of cardiovascular deaths. The observed adverse association between coffee consumption and cancer mortality is most likely due to residual confounding by smoking.


Author(s):  
Jongeun Rhee ◽  
Erikka Loftfield ◽  
Neal D Freedman ◽  
Linda M Liao ◽  
Rashmi Sinha ◽  
...  

Abstract Background Coffee consumption has been associated with a reduced risk of some cancers, but the evidence for renal cell carcinoma (RCC) is inconclusive. We investigated the relationship between coffee and RCC within a large cohort. Methods Coffee intake was assessed at baseline in the National Institutes of Health–American Association of Retired Persons Diet and Health Study. Among 420 118 participants eligible for analysis, 2674 incident cases were identified. We fitted Cox-regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for coffee consumption vs non-drinkers. Results We observed HRs of 0.94 (95% CI 0.81, 1.09), 0.94 (0.81, 1.09), 0.80 (0.70, 0.92) and 0.77 (0.66, 0.90) for usual coffee intake of &lt;1, 1, 2–3 and ≥4 cups/day, respectively (Ptrend = 0.00003). This relationship was observed among never-smokers (≥4 cups/day: HR 0.62, 95% CI 0.46, 0.83; Ptrend = 0.000003) but not ever-smokers (HR 0.85, 95% CI 0.70, 1.05; Ptrend = 0.35; Pinteraction = 0.0009) and remained in analyses restricted to cases diagnosed &gt;10 years after baseline (HR 0.65, 95% CI 0.51, 0.82; Ptrend = 0.0005). Associations were similar between subgroups who drank predominately caffeinated or decaffeinated coffee (Pinteraction = 0.74). Conclusion In this investigation of coffee and RCC, to our knowledge the largest to date, we observed a 20% reduced risk for intake of ≥2 cups/day vs not drinking. Our findings add RCC to the growing list of cancers for which coffee consumption may be protective.


2018 ◽  
Vol 108 (3) ◽  
pp. 476-484 ◽  
Author(s):  
Marcia C de Oliveira Otto ◽  
Rozenn N Lemaitre ◽  
Xiaoling Song ◽  
Irena B King ◽  
David S Siscovick ◽  
...  

ABSTRACT Background Controversy has emerged about the benefits compared with harms of dairy fat, including concerns over long-term effects. Previous observational studies have assessed self-reported estimates of consumption or a single biomarker measure at baseline, which may lead to suboptimal estimation of true risk. Objective The aim of this study was to investigate prospective associations of serial measures of plasma phospholipid fatty acids pentadecanoic (15:0), heptadecanoic (17:0), and trans-palmitoleic (trans-16:1n–7) acids with total mortality, cause-specific mortality, and cardiovascular disease (CVD) risk among older adults. Design Among 2907 US adults aged ≥65 y and free of CVD at baseline, circulating fatty acid concentrations were measured serially at baseline, 6 y, and 13 y. Deaths and CVD events were assessed and adjudicated centrally. Prospective associations were assessed by multivariate-adjusted Cox models incorporating time-dependent exposures and covariates. Results During 22 y of follow-up, 2428 deaths occurred, including 833 from CVD, 1595 from non-CVD causes, and 1301 incident CVD events. In multivariable models, circulating pentadecanoic, heptadecanoic, and trans-palmitoleic acids were not significantly associated with total mortality, with extreme-quintile HRs of 1.05 for pentadecanoic (95% CI: 0.91, 1.22), 1.07 for heptadecanoic (95% CI: 0.93, 1.23), and 1.05 for trans-palmitoleic (95% CI: 0.91, 1.20) acids. Circulating heptadecanoic acid was associated with lower CVD mortality (extreme-quintile HR: 0.77; 95% CI: 0.61, 0.98), especially stroke mortality, with a 42% lower risk when comparing extreme quintiles of heptadecanoic acid concentrations (HR: 0.58; 95% CI: 0.35, 0.97). In contrast, heptadecanoic acid was associated with a higher risk of non-CVD mortality (HR: 1.27; 95% CI: 1.07, 1.52), which was not clearly related to any single subtype of non-CVD death. No significant associations of pentadecanoic, heptadecanoic, or trans-palmitoleic acids were seen for total incident CVD, coronary heart disease, or stroke. Conclusions Long-term exposure to circulating phospholipid pentadecanoic, heptadecanoic, or trans-palmitoleic acids was not significantly associated with total mortality or incident CVD among older adults. High circulating heptadecanoic acid was inversely associated with CVD and stroke mortality and potentially associated with higher risk of non-CVD death.


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