Prognostic Relevance of Short-Term Blood Pressure Variability

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, assessed through ambulatory BP monitoring, with total and cardiovascular mortality in a large cohort of patients with hypertension. We selected 63 910 subjects from the Spanish ABPM Registry from 2004 to 2014, with a median follow-up of 4.7 years. Systolic and diastolic BP SD from 24 hours, daytime, and nighttime, weighted SD (mean of daytime and nighttime SD weighted for period duration), average real variability (mean of differences between consecutive readings), variation independent of the mean, and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through 24-hour ambulatory BP monitoring performed at baseline. Association with total and cardiovascular mortality (obtained through death certificates) were assessed by Cox regression models adjusted for clinical confounders and BP. Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In fully adjusted models, daytime, nighttime, and weighted SD, systolic and diastolic, as well as diastolic average real variability, were all significantly associated with total and cardiovascular mortality. Hazard ratios for 1 SD increase ranged from 1.05 to 1.09 for total mortality and from 1.07 to 1.12 for cardiovascular mortality. A nighttime systolic SD ≥12 mm Hg was independently associated with total (hazard ratio: 1.13 [95% CI, 1.06–1.21]) and cardiovascular mortality (hazard ratio: 1.21 [95% CI, 1.09–1.36]). We conclude that short-term BP variability is independently associated with total and cardiovascular mortality in patients with hypertension.

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A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

American Journal of Nephrology ◽

10.1159/000493989 ◽

2018 ◽

Vol 48 (4) ◽

pp. 295-305 ◽

Cited By ~ 5

Author(s):

Athanasios Bikos ◽

Elena Angeloudi ◽

Evangelos Memmos ◽

Charalampos Loutradis ◽

Antonios Karpetas ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Blood Pressure Variability ◽

Hemodialysis Patients ◽

Adverse Outcomes ◽

Short Term ◽

Ambulatory Bp Monitoring ◽

Average Real Variability ◽

Regular Hemodialysis ◽

Sustained Increase

Background: Short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Whether BPV is increased in these patients is not clear. The purpose of this study was to compare short-term BPV in patients with and without intradialytic hypertension. Methods: Forty-one patients with and 82 patients without intradialytic hypertension (intradialytic SBP rise ≥10 mm Hg to > 150 mm Hg) matched in a 1: 2 ratio for age, sex, and hemodialysis vintage were included. All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and compared between the 2 groups during the 48-h and the 44-h periods and during the 2 daytime and nighttime periods respectively. Results: During 48-h or 44-h periods and daytime or nighttime, brachial SBP/DBP and aortic SBP/DBP were significantly higher in cases than in controls. All brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were not significantly different between groups during the 48- or 44-h periods (48-h: SBP-ARV 11.59 ± 3.05 vs. 11.70 ± 2.68, p = 0.844, DBP-ARV: 8.60 ± 1.90 vs. 8.90 ± 1.63, p = 0.357). Analysis stratified by day or night between days 1 and 2 revealed, in general, similar results. No significant differences in dipping pattern were observed between groups. Analysis of aortic BPV had similar findings. Conclusions: BPV is similar between those with and without intradialytic hypertension. However, those with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.

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P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

European Heart Journal ◽

10.1093/eurheartj/ehz748.0570 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O L Rueda Ochoa ◽

L R Bons ◽

S Rohde ◽

K E L Ghoud ◽

R Budde ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Mortality ◽

Total Mortality ◽

Population Based ◽

Cardiovascular Outcomes ◽

Increased Risk ◽

Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

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P1136Is there a negative impact of permanent pacemaker implantation in long-term outcomes after transcatheter aortic valve implantation?

EP Europace ◽

10.1093/europace/euaa162.286 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

T J Carvalho Mendonca ◽

L Patricio ◽

M Oliveira ◽

I Rodrigues ◽

G Portugal ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Cardiovascular Mortality ◽

Total Mortality ◽

Permanent Pacemaker ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Introduction Transcatheter aortic valve implantation (TAVI) is an established treatment in patients (P) with aortic stenosis. Despite the continuous developments of this procedure, high-grade conduction disturbances requiring permanent pacemaker (PPM) implantation is still a major and common complication of TAVI. Furthermore, long-term chronic right ventricular pacing has been associated with negative effects on ventricular function and heart failure (HF). Aim to evaluate the long-term impact of PPM after TAVI focusing on mortality and HF hospitalization. Methods We retrospectively examined P who underwent TAVI with a self-expanding valve from 2009 to 2018 at our institution. All P had pre-procedural clinical evaluation, including ECG, cardiac computed tomographic angiography and transthoracic echocardiography. P with previous PPM were excluded. Results 265P (57% male, mean age 81.4 years, 20% with left ventricular ejection fraction <40%) were analysed. Mean STS score and mean Euroscore II were 6.33% and 7.07%, respectively. Mean transvalvular gradient was 52.78 mmHg and mean aortic valve area 0.67 cm2. Forty-seven P (17%) underwent PPM implantation during the first 30 days after TAVI. P requiring PPM had higher prevalence of diabetes mellitus, chronic renal disease, atrial fibrillation and right bundle branch block. During a mean follow-up of 20.3 months, post-TAVI PPM was associated with similar mortality rate (29.8% vs. 25.6%, HR 1.28, 95% CI 0.72-2.29, p = 0.42) and similar cardiovascular mortality (9.8% vs. 6.4%, HR 0.72, 95% CI 0.21-2.4, p = 0.59) compared to P without PPM. There were no significant differences in HF hospitalization (4.9% vs. 2.4%, p = 0.47). Kaplan-Meier curves of total mortality and cardiovascular mortality according to the need for PPM post-TAVI were similar. Conclusions In P submitted to TAVI, PPM implantation is a relatively common finding, not associated with higher risk of total mortality, cardiovascular mortality or HF hospitalization in a long-term follow-up.

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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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The impact of systolic and diastolic blood pressure variability on mortality is age dependent: Data from the Dublin Outcome Study

European Journal of Preventive Cardiology ◽

10.1177/2047487319872572 ◽

2019 ◽

Vol 27 (4) ◽

pp. 355-364 ◽

Cited By ~ 3

Author(s):

Grzegorz Bilo ◽

Eamon Dolan ◽

Eoin O'Brien ◽

Rita Facchetti ◽

Davide Soranna ◽

...

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

Confidence Interval ◽

Diastolic Blood Pressure ◽

Cardiovascular Mortality ◽

Blood Pressure Variability ◽

Strong Predictor ◽

Outcome Study ◽

Short Term ◽

The Impact

Background Twenty-four-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but limited and conflicting evidence is available on the relative prognostic importance of systolic and diastolic BPV. The aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 h with cardiovascular mortality in untreated subjects is affected by age. Design and methods The study included 9154 untreated individuals assessed for hypertension between 1982 and 2002 in the frame of the Dublin Outcome Study, in which 24 h ambulatory blood pressure monitoring was obtained (age 54.1 ± 14.3 years, 47% males). The association of short-term systolic and diastolic blood pressure variability with cardiovascular and all-cause mortality in the entire sample and separately in younger and older age subgroups was assessed over a median follow-up period of 6.3 years. Results Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for daytime standard deviation 1.16 (95% confidence interval 1.08–1.26)) with no significant differences among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for daytime standard deviation 1.72 (95% confidence interval 1.33–2.23)), superseding the predictive value of diastolic BPV in this group. Conclusions Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application.

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Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in CKD Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.04030318 ◽

2019 ◽

Vol 14 (2) ◽

pp. 233-240 ◽

Cited By ~ 11

Author(s):

Francesca Mallamaci ◽

Giovanni Tripepi ◽

Graziella D’Arrigo ◽

Silvio Borrelli ◽

Carlo Garofalo ◽

...

Keyword(s):

Confidence Interval ◽

Cardiovascular Events ◽

Prognostic Value ◽

Clinic Visit ◽

Hazard Ratio ◽

Interquartile Range ◽

Short Term ◽

End Point

Background and objectivesShort-term BP variability (derived from 24-hour ambulatory BP monitoring) and long-term BP variability (from clinic visit to clinic visit) are directly related to risk for cardiovascular events, but these relationships have been scarcely investigated in patients with CKD, and their prognostic value in this population is unknown.Design, setting, participants, & measurementsIn a cohort of 402 patients with CKD, we assessed associations of short- and long-term systolic BP variability with a composite end point of death or cardiovascular event. Variability was defined as the standard deviation of observed BP measurements. We further tested the prognostic value of these parameters for risk discrimination and reclassification.ResultsMean ± SD short-term systolic BP variability was 12.6±3.3 mm Hg, and mean ± SD long-term systolic BP variability was 12.7±5.1 mm Hg. For short-term BP variability, 125 participants experienced the composite end point over a median follow-up of 4.8 years (interquartile range, 2.3–8.6 years). For long-term BP variability, 110 participants experienced the composite end point over a median follow-up of 3.2 years (interquartile range, 1.0–7.5 years). In adjusted analyses, long-term BP variability was significantly associated with the composite end point (hazard ratio, 1.24; 95% confidence interval, 1.01 to 1.51 per 5-mm Hg higher SD of office systolic BP), but short-term systolic BP variability was not (hazard ratio, 0.92; 95% confidence interval, 0.68 to 1.25 per 5-mm Hg higher SD of 24-hour ambulatory systolic BP). Neither estimate of BP variability improved risk discrimination or reclassification compared with a simple risk prediction model.ConclusionsIn patients with CKD, long-term but not short-term systolic BP variability is related to the risk of death and cardiovascular events. However, BP variability has a limited role for prediction in CKD.

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Persistent emotional distress after a first-time myocardial infarction and its association to late cardiovascular and non-cardiovascular mortality

European Journal of Preventive Cardiology ◽

10.1177/2047487319841475 ◽

2019 ◽

Vol 26 (14) ◽

pp. 1510-1518 ◽

Cited By ~ 5

Author(s):

Claudia T Lissåker ◽

Fredrika Norlund ◽

John Wallert ◽

Claes Held ◽

Erik MG Olsson

Keyword(s):

Myocardial Infarction ◽

Confidence Interval ◽

Emotional Distress ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Specific Treatment ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

First Time

Background Patients with symptoms of depression and/or anxiety – emotional distress – after a myocardial infarction (MI) have been shown to have worse prognosis and increased healthcare costs. However, whether specific subgroups of patients with emotional distress are more vulnerable is less well established. The purpose of this study was to identify the association between different patterns of emotional distress over time with late cardiovascular and non-cardiovascular mortality among first-MI patients aged <75 years in Sweden. Methods We utilized data on 57,602 consecutive patients with a first-time MI from the national SWEDEHEART registers. Emotional distress was assessed using the anxiety/depression dimension of the European Quality of Life Five Dimensions questionnaire two and 12 months after the MI, combined into persistent (emotional distress at both time-points), remittent (emotional distress at the first follow-up only), new (emotional distress at the second-follow up only) or no distress. Data on cardiovascular and non-cardiovascular mortality were obtained until the study end-time. We used multiple imputation to create complete datasets and adjusted Cox proportional hazards models to estimate hazard ratios. Results Patients with persistent emotional distress were more likely to die from cardiovascular (hazard ratio: 1.46, 95% confidence interval: 1.16, 1.84) and non-cardiovascular causes (hazard ratio: 1.54, 95% confidence interval: 1.30, 1.82) than those with no distress. Those with remittent emotional distress were not statistically significantly more likely to die from any cause than those without emotional distress. Discussion Among patients who survive 12 months, persistent, but not remittent, emotional distress was associated with increased cardiovascular and non-cardiovascular mortality. This indicates a need to identify subgroups of individuals with emotional distress who may benefit from further assessment and specific treatment.

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4070Clinical impact of mitral regurgitation before or following transcatheter aortic valve replacement in patients with aortic stenosis: a nationwide multivariable analysis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0094 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Fauchier ◽

A Bernard ◽

A Bisson ◽

T Lacour ◽

J Herbert ◽

...

Keyword(s):

Transcatheter Aortic Valve Replacement ◽

Independent Predictor ◽

Multivariable Analysis ◽

Total Mortality ◽

Transcatheter Aortic Valve ◽

Mortality Hazard ◽

History Of ◽

The Impact ◽

Mortality Hazard Ratio

Abstract Patients undergoing transcatheter aortic valve replacement (TAVR) may have concomitant mitral regurgitation (MR). The impact of MR at baseline or after TAVR on subsequent prognosis remains to be more precisely determined. We analysed the impact of MR before or after TAVR on prognosis in the systematic analysis of patients treated with TAVR at a nationwide level. Methods Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Cox regression was used for the analysis of predictors of events during follow-up. Results A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Moderate/severe MR was present at baseline (MRb) in 9.5% of the patients. Few patients (1.6%) revealed moderate/severe MR post-TAVR (MRpt). Mean follow-up was 1.31±1.61 years. MRb was associated with an increased cardiovascular mortality (Hazard ratio 1.29, 95% CI 1.20–1.39) and total mortality (Hazard ratio 1.15, 95% CI 1.10–1.21). However, MRb was not an independent predictor in multivariable analysis, neither for cardiovascular mortality (adjusted HR 1.06, 95% CI 0.98–1.14) nor for total mortality (adjusted HR 1.01, 95% CI 0.96–1.07). MRpt was not a predictor of cardiovascular or total mortality. Older age, male sex, history of pulmonary edema/cardiogenic shock, atrial fibrillation, myocardial infarction, diabetes, renal failure, liver disease, pulmonary disease, previous cancer and anemia at baseline independently predicted mortality during follow-up. All of them (but history of cancer) were also independent predictor of cardiovascular death. Conclusion Baseline MR was associated with increased cardiovascular and totality mortality following TAVR but was not an independent predictor of any of them. By contrast, several other predictors of cardiovascular and total mortality were identified. This suggests that MR should not be directly considered to establish the strategy for TAVR decision or for avoiding TAVR-related futility.

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The Association of Orthostatic Hypotension with Ambulatory Blood Pressure Phenotypes in SPRINT

American Journal of Hypertension ◽

10.1093/ajh/hpaa184 ◽

2020 ◽

Author(s):

Lama Ghazi ◽

Paul E Drawz ◽

Nicholas M Pajewski ◽

Stephen P Juraschek

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Treatment Strategies ◽

Ambulatory Bp Monitoring ◽

Increased Risk ◽

Trial Testing ◽

The Difference ◽

Pattern Versus ◽

Reverse Dipping

Abstract Background Clinic blood pressure (BP) when measured in the seated position, can miss meaningful BP phenotypes, including low ambulatory BP (white coat effects [WCE]) or high supine BP (nocturnal non-dipping). Orthostatic hypotension (OH) measured via both seated (or supine) and standing BP, could identify phenotypes poorly captured by seated clinic BP alone. Methods We examined the association of OH with WCE and night-to-daytime systolic BP (SBP) in a subpopulation of SPRINT, a randomized trial testing the effects of intensive or standard (<120 versus <140mmHg) SBP treatment strategies in adults at increased risk of cardiovascular disease. OH was assessed during follow-up (6, 12, 24 months) and defined as a decrease in mean seated SBP ≥20 or diastolic BP ≥10 mmHg after 1 min of standing. WCE, based on 24-hour ambulatory BP monitoring performed at 27 months, was defined as the difference between 27-month seated clinic and daytime ambulatory BP ≥20/≥10 mmHg. Reverse dipping was defined as a ratio of night-to-daytime SBP >1. Results Of 897 adults (mean age 71.5±9.5 years, 29% female, 28% black), 128 had OH at least once. Among those with OH, 15% had WCE (versus 7% without OH). Moreover, 25% of those with OH demonstrated a non-dipping pattern (versus 14% without OH). OH was positively associated with both WCE (OR=2.24; 95% CI: 1.28,4.27) and reverse dipping (OR=2.29; 95% CI: 1.31, 3.99). Conclusions The identification of OH in clinic was associated with two BP phenotypes often missed with traditional seated BP assessments. Further studies on mechanisms of these relationships are needed.

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Associations of dairy intake with risk of mortality in women and men: three prospective cohort studies

BMJ ◽

10.1136/bmj.l6204 ◽

2019 ◽

pp. l6204 ◽

Cited By ~ 10

Author(s):

Ming Ding ◽

Jun Li ◽

Lu Qi ◽

Christina Ellervik ◽

Xuehong Zhang ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cancer Mortality ◽

Total Mortality ◽

Hazard Ratio ◽

Health Study ◽

Dairy Foods ◽

Prospective Cohort Studies ◽

Dairy Consumption ◽

Risk Of Mortality

AbstractObjectiveTo examine the association of consumption of dairy foods with risk of total and cause specific mortality in women and men.DesignThree prospective cohort studies with repeated measures of diet and lifestyle factors.SettingNurses’ Health Study, Nurses’ Health Study II, and the Health Professionals Follow-up Study, in the United States.Participants168 153 women and 49 602 men without cardiovascular disease or cancer at baseline.Main outcome measureDeath confirmed by state vital records, the national death index, or reported by families and the postal system. During up to 32 years of follow-up, 51 438 deaths were documented, including 12 143 cardiovascular deaths and 15 120 cancer deaths. Multivariable analysis further adjusted for family history of cardiovascular disease and cancer, physical activity, overall dietary pattern (alternate healthy eating index 2010), total energy intake, smoking status, alcohol consumption, menopausal status (women only), and postmenopausal hormone use (women only).ResultsCompared to the lowest category of total dairy consumption (average 0.8 servings/day), the multivariate pooled hazard ratio for total mortality was 0.98 (95% confidence interval 0.96 to 1.01) for the second category of dairy consumption (average 1.5 servings/day), 1.00 (0.97 to 1.03) for the third (average 2.0 servings/day), 1.02 (0.99 to 1.05) for the fourth (average 2.8 servings/day), and 1.07 (1.04 to 1.10) for highest category (average 4.2 servings/day; P for trend <0.001). For the highest compared to the lowest category of total dairy consumption, the hazard ratio was 1.02 (0.95 to 1.08) for cardiovascular mortality and 1.05 (0.99 to 1.11) for cancer mortality. For subtypes of dairy products, whole milk intake was significantly associated with higher risks of total mortality (hazard ratio per 0.5 additional serving/day 1.11, 1.09 to 1.14), cardiovascular mortality (1.09, 1.03 to 1.15), and cancer mortality (1.11, 1.06 to 1.17). In food substitution analyses, consumption of nuts, legumes, or whole grains instead of dairy foods was associated with a lower mortality, whereas consumption of red and processed meat instead of dairy foods was associated with higher mortality.ConclusionThese data from large cohorts do not support an inverse association between high amount of total dairy consumption and risk of mortality. The health effects of dairy could depend on the comparison foods used to replace dairy. Slightly higher cancer mortality was non-significantly associated with dairy consumption, but warrants further investigation.

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