The Association of Abnormal Liver Enzymes with All-Cause and Cause-Specific Mortality: A Large Prospective Population-Based Study

Abstract Background: While the association of elevated levels of liver enzymes (ALT, AST, ALP and GGT) with mortality has been suggested in many studies, evidence of their association appears to be contradictory. The current study aims to investigate the associations of entire ranges of serum liver enzymes with mortality in a large cohort of adults. Methods: In the current study we used the data of repeated measurement phase in Golestan Cohort Study, which was conducted from 2010 to 2012. All liver enzyme levels were categorized into their quintile values, and the association of liver enzymes with mortality rates were evaluated using Cox proportional hazard regression models. Sensitivity analyses were performed by excluding data of first follow-up year, and patients with history of cardiovascular disease (CVD), cancer or viral hepatitis. Results: We included 11,106 individuals with mean age of 56.22 (±7.97) years, 46.2% male. Median follow-up period was 7 years. In the total population, ALT demonstrated a U-shaped association with all-cause mortality; whereas AST showed no significant association. ALP and GGT had linear and positive associations with overall mortality in the total population. CVD-mortality showed associations with low ALT (aHR=1.53, 95% CI: 1.1-2.2), high ALP (aHR=1.79, 1.3-2.6) and high GGT (aHR=2.0, 1.4-2.9). Cancer-mortality was associated with high ALP (aHR=1.9, 1.2-2.9, while GGT had a U-shaped association with cancer mortality, with the middle category (Q3) associated with the lowest cancer-mortality risk (aHR=0.58, 0.4-0.9). High ALT and high AST were associated with cancer-mortality in total sample as well; although, these associations disappeared after the sensitivity analysis. Conclusion: Both low and high levels of ALT are associated with increased all-cause mortality, while only high levels of ALP and GGT have positive associations with all-cause mortality. High levels of all four liver enzymes are associated with cancer mortality. However, only the high levels of ALP and GGT are associated with CVD mortality. Evidence implies that abnormal liver enzymes may be manifestations of metabolic syndrome, CVD, and cancers rather than being their precursors. Yet, they may be useful markers for predicting the survival of patients.

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

BMJ Open ◽

10.1136/bmjopen-2020-039239 ◽

2020 ◽

Vol 10 (12) ◽

pp. e039239

Author(s):

Ying Yue Huang ◽

Chao Qiang Jiang ◽

Lin Xu ◽

Wei Sen Zhang ◽

Feng Zhu ◽

...

Keyword(s):

Cohort Study ◽

Outcome Measures ◽

Mortality Risk ◽

Cancer Mortality ◽

Secondary Outcome ◽

Middle Aged ◽

All Cause Mortality ◽

Older Chinese ◽

Cvd Mortality

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

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Dietary supplement use and mortality in a cohort of Swedish men

British Journal Of Nutrition ◽

10.1017/s0007114507812049 ◽

2008 ◽

Vol 99 (3) ◽

pp. 626-631 ◽

Cited By ~ 23

Author(s):

Maria Messerer ◽

Niclas Håkansson ◽

Alicja Wolk ◽

Agneta Åkesson

Keyword(s):

Dietary Supplements ◽

Dietary Supplement ◽

Cancer Mortality ◽

Inverse Association ◽

Supplement Use ◽

All Cause Mortality ◽

Dietary Supplement Use ◽

Risk Of Cancer ◽

Cvd Mortality

The use of dietary supplements has increased substantially in most industrialized countries. The aim of this study was to prospectively examine the association between use of dietary supplements and all-cause mortality, cancer mortality and CVD mortality in men. We used the population-based prospective cohort of 38 994 men from central Sweden, 45–79 years of age, with no cancer or CVD at baseline and who completed a self-administered FFQ including questions on dietary supplement use and life-style factors in 1997. During average 7.7 years of follow-up, 3403 deaths were ascertained; among them, 771 due to cancer and 930 due to CVD (during 5.9 years of follow-up). In multivariate adjusted models including all men there was no association observed between use of any dietary supplement or of multivitamins, vitamin C, vitamin E or fish oil specifically and all-cause mortality, cancer or CVD mortality. Among current smokers, regular use of any supplement was associated with statistically significant increased risk of cancer mortality: relative risk (RR) 1·46 (95 % CI 1·06, 1·99). Among men reporting an inadequate diet at baseline (assessed by Recommended Food Score), there was a statistically significant inverse association between use of any dietary supplement and CVD mortality (RR 0·72; 95 % CI 0·57, 0·91), no associations were observed among men with adequate diets. In conclusion, we cannot exclude that the use of dietary supplements is harmful for smokers. On the other hand, among men with an insufficient diet, the use of supplements might be beneficial in reducing CVD mortality.

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Survival of Mantle Cell Lymphoma in the Era of Bruton Tyrosine Kinase Inhibitors: A Population-Based Analysis

Blood ◽

10.1182/blood-2021-146417 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 182-182

Author(s):

Mengyang Di ◽

Can Cui ◽

Shalin K. Kothari ◽

Amer M. Zeidan ◽

Nikolai Podoltsev ◽

...

Keyword(s):

Clinical Trial ◽

Research Funding ◽

Age Groups ◽

Population Based ◽

Sensitivity Analyses ◽

Mantle Cell ◽

All Cause Mortality ◽

Bruton Tyrosine Kinase ◽

Support Research

Abstract Background: Despite advances in chemoimmunotherapy and stem cell transplantation, mantle cell lymphoma (MCL) has historically been difficult to treat. Patients with advanced age and high-risk features (e.g. blastoid/pleomorphic features, high MIPI score, complex karyotype, TP53 mutation) face particularly poor outcomes with standard chemoimmunotherapy. Ibrutinib, a Bruton tyrosine kinase inhibitor (BTKi), was approved for second-line use in MCL in 2013. Other BTKis - acalabrutinib and zanubrutinib were approved in 2017 and 2019, respectively. BTKi provides a well-tolerated chemotherapy-free option for these hard-to-treat subgroups, especially the older patients. In this population-based study, we evaluated survival outcomes prior to and after the approval of ibrutinib, and hypothesized that survival benefit observed early after approval would be greatest in older patients not typically candidates for consolidative transplantation in the first-line setting. Methods: Using the Surveillance, Epidemiology, and End Results database, we included all adult patients diagnosed with MCL in the years 2007-2018 and followed them to the end of 2018 or death, whichever came first. The pre-BTKi era was defined by year of diagnosis 2007-2011, and the BTKi era was between 2014 and 2018. The years 2012-2013 were considered as a "washout" period to allow practice change related to the approval of ibrutinib. As age plays an important role in treatment decisions, including whether to use consolidative transplantation, patients were divided based on age at diagnosis: <60, 60-69, 70-79, and ≥80 years. Outcomes of interest included all-cause mortality, and mortality from MCL (MFM). We applied multivariable Cox proportional hazards regression model for all-cause mortality, adjusting for age, sex, race, stage, and median household income at census level, and reported adjusted hazard ratio (HR) with 95% confidence interval (CI). We also conducted multivariable competing risk analyses for MFM, considering all other causes of death as the competing events, and reported subhazard ratio (sHR) with 95% CI. To eliminate potential confounding by duration of follow-up among patients diagnosed in different periods, we used only three-year follow-up data for primary analyses, and all available follow-up data for sensitivity analyses. Results: We identified 7,625 individuals diagnosed with MCL during our study period (3,424 and 4,201 diagnosed during 2007-2011 and 2014-2018, respectively). The majority were male (71%) and white (90%), with 49% of patients 70 years or older. The median follow-up was 9.2 and 2.4 years for patients diagnosed during 2007-2011 and 2014-2018, respectively. The 3-year all-cause mortality and 3-year MFM rates were 39.8% and 27.3%, respectively, in the overall population. Both the 3-year all-cause mortality and MFM increased as age increased. The 3-year all-cause mortality was lower in the BTKi era among all age groups, except patients <60 years old, and the 3-year MFM was lower in the BTKi era among all age groups. The numeric difference of 3-year outcomes was more substantial in patients aged 70-79 for both all-cause mortality (pre-BTKi era: 47.8%, BTKi era: 40.4%) and MFM (pre-BTKi era: 33.9%, BTKi era: 27.5%) (Table, Figure A and B). In the multivariable analyses, risk of death was significantly lower during the BTKi era in the 60-69 (HR:0.85, 95% CI: 0.72-1.00) and 70-79 (HR: 0.80, 95% CI: 0.70-0.92) age groups. MFM was also significantly lower during the BTKi era in these two age groups (60-69: sHR: 0.78, 95% CI: 0.64-0.94; 70-79: sHR: 0.76, 95% CI: 0.65-0.90, Table). The results were largely unchanged in sensitivity analyses (results not shown). Conclusion: In this large population-based cohort analysis of individuals diagnosed with MCL, overall and lymphoma-specific survival improved in the BTKi era. At a median follow up of 2.4 years in our BTKi cohort, significant survival benefits were observed in those older than 60 but less than 80 years of age, and the observed benefits were greatest in the 70-79 age group. Future real-world studies should examine the impact of novel agents on treatment patterns and outcomes of MCL over a longer follow up period. Figure 1 Figure 1. Disclosures Kothari: Incyte pharmaceuticals: Consultancy, Honoraria; Karyopharm pharmaceuticals: Consultancy, Honoraria. Zeidan: Amgen: Consultancy, Research Funding; Astellas: Consultancy; Jasper: Consultancy; BMS: Consultancy, Other: Clinical Trial Committees, Research Funding; Boehringer Ingelheim: Consultancy, Research Funding; BeyondSpring: Consultancy; Acceleron: Consultancy, Research Funding; BioCryst: Other: Clinical Trial Committees; Novartis: Consultancy, Other: Clinical Trial Committees, Travel support, Research Funding; AbbVie: Consultancy, Other: Clinical Trial Committees, Research Funding; Ionis: Consultancy; Loxo Oncology: Consultancy, Other: Clinical Trial Committees; Astex: Research Funding; AstraZeneca: Consultancy; Epizyme: Consultancy; Cardiff Oncology: Consultancy, Other: Travel support, Research Funding; Janssen: Consultancy; Agios: Consultancy; ADC Therapeutics: Research Funding; Jazz: Consultancy; Genentech: Consultancy; Gilead: Consultancy, Other: Clinical Trial Committees; Incyte: Consultancy, Research Funding; Geron: Other: Clinical Trial Committees; Pfizer: Other: Travel support, Research Funding; Daiichi Sankyo: Consultancy; Kura: Consultancy, Other: Clinical Trial Committees; Aprea: Consultancy, Research Funding. Podoltsev: PharmaEssentia: Honoraria; Incyte: Honoraria; Novartis: Honoraria; Bristol-Myers Squib: Honoraria; CTI BioPharma: Honoraria; Celgene: Honoraria; Blueprint Medicines: Honoraria; Pfizer: Honoraria. Neparidze: Janssen: Research Funding; Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees; GlaxoSmithKline: Research Funding. Shallis: Curis: Divested equity in a private or publicly-traded company in the past 24 months. Ma: Celgene/Bristol Myers Squibb: Consultancy, Research Funding. Huntington: AbbVie: Consultancy; TG Therapeutics: Research Funding; SeaGen: Consultancy; DTRM Biopharm: Research Funding; Flatiron Health Inc.: Consultancy; Novartis: Consultancy; Bayer: Honoraria; Pharmacyclics: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria; Genentech: Consultancy; Servier: Consultancy; Thyme Inc: Consultancy; Celgene: Consultancy, Research Funding.

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Abstract 11597: Voluntary and Occupational Physical Activity Have Different Effects on Mortality

Circulation ◽

10.1161/circ.132.suppl_3.11597 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Martin Bahls ◽

Sebastian Baumeister ◽

Henry Völzke ◽

Sven Gläser ◽

Michael Leitzmann ◽

...

Keyword(s):

Physical Activity ◽

Oxygen Consumption ◽

Cancer Mortality ◽

Leisure Time ◽

Large Population ◽

Cardiopulmonary Exercise Testing ◽

All Cause Mortality ◽

Reduced Risk ◽

Cvd Mortality

Introduction: Animal studies suggest oppositional effects for voluntary and involuntary physical activity (PA). To assess this in humans, we used distinct domains of PA (sports, leisure time, work) as well as physical fitness and associated these variables with all-cause, cardiovascular (CVD) and cancer mortality in a large population-based cohort. Methods: Data of 2,925 participants from the Study of Health in Pomerania (SHIP-1) were used [median age: 48 (interquartile range (IQR): 35, 62) years (y), 52% [[female symbol]]]. All-cause and cause-specific mortality was determined after a median follow-up of 7.0 y (IQR: 5.6 - 6.2). A Sports index (SI), Leisure Time index (LTI) and Work index (WI) were assessed using a modified Baecke questionnaire. Maximal oxygen consumption (VO2peak), oxygen consumption at the anaerobic threshold (VO2@AT), and maximal work load (Wmax) were measured on a bicycle ergometer during symptom-limited cardiopulmonary exercise testing (CPET). Cox models were adjusted for sex, age, smoking, alcohol consumption, years of schooling, income, and body mass index. Results: A total of 156 subjects died due to all-cause, 53 due to CVD and 50 due to cancer after follow-up. After adjustment, SI [hazard ratio (HR) per SD: 0.27; 95%-confidence interval (CI): 0.13; 0.55] and LTI (HR per SD: 0.34; 95%-CI: 0.15; 0.77) were associated with a reduced risk of all-cause mortality. WI was not associated with all-cause mortality. SI was associated with reduced risk of CVD mortality (HR: 0.26; 95%-CI: 0.07; 0.96). All CPET measures were significantly related to reduced risk of all-cause and cancer mortality (VO2peak - all-cause HR per SD: 0.007; 95%-CI: 0.001; 0.057 and cancer HR per SD: 0.011; 95%-CI: 0.005; 0.210; VO2@AT - all-cause HR per SD: 0.047; 95%-CI: 0.001; 0.028 and cancer HR per SD: 0.052; 95%-CI: 0.004; 0.073; Wmax - all-cause HR per SD: 0.012; 95%-CI: 0.002; 0.074 and cancer HR per SD: 0.01; 95%-CI: 0.0007; 0.166). Conclusion: Voluntary PA was associated with a reduced risk for all-cause and CVD mortality, while occupational PA was not. Exercise capacity was inversely related to all-cause and cancer mortality. Our results indicate that the benefits of PA may be limited to voluntary PA. Thus, questionnaires need to differentiate between voluntary and occupational PA.

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Association between Urinary Cadmium-to-Zinc Intake Ratio and Adult Mortality in a Follow-Up Study of NHANES 1988–1994 and 1999–2004

Nutrients ◽

10.3390/nu12010056 ◽

2019 ◽

Vol 12 (1) ◽

pp. 56

Author(s):

Kijoon Kim ◽

Melissa M. Melough ◽

Junichi R. Sakaki ◽

Kyungho Ha ◽

Dalia Marmash ◽

...

Keyword(s):

Cancer Mortality ◽

Adult Mortality ◽

Urinary Cadmium ◽

Toxic Heavy Metal ◽

Zinc Intake ◽

Follow Up Study ◽

All Cause Mortality ◽

Cvd Mortality ◽

Intake Ratio

Cadmium (Cd) is a toxic heavy metal associated with increased mortality, but the effect of zinc (Zn) intake on the association between Cd and mortality is unknown. The objective of this study was to examine the association of urinary Cd to Zn intake ratio (Cd/Zn ratio) and mortality risk. In total, 15642 US adults in NHANES 1988–1994 and 1999–2004 were followed until 2011 (15-year mean follow-up). Of the 5367 total deaths, 1194 were attributed to cancer and 1677 were attributed to CVD. After adjustment for potential confounders, positive associations were observed between urinary Cd and all-cause mortality (HR for highest vs. lowest quartile: 1.38; 95% CI: 1.14–1.68) and cancer mortality (HR: 1.54; CI: 1.05–2.27). Urinary Cd was positively associated with cancer mortality among the lowest Zn consumers, and the association diminished among the highest Zn consumers. Positive relationships were observed between the Cd/Zn ratio and all-cause mortality (HR: 1.54; CI: 1.23–1.93), cancer mortality (HR: 1.65; CI: 1.11–2.47) and CVD mortality (HR: 1.49; CI: 1.18–1.88). In conclusion, these findings indicate that Zn intake may modify the association between Cd and mortality. Furthermore, the Cd/Zn ratio, which was positively associated with mortality from all causes, cancer, and CVD, may be an important predictor of mortality.

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The Japanese food score and risk of all-cause, CVD and cancer mortality: the Japan Collaborative Cohort Study

British Journal Of Nutrition ◽

10.1017/s000711451800154x ◽

2018 ◽

Vol 120 (4) ◽

pp. 464-471 ◽

Cited By ~ 16

Author(s):

Emiko Okada ◽

Koshi Nakamura ◽

Shigekazu Ukawa ◽

Kenji Wakai ◽

Chigusa Date ◽

...

Keyword(s):

Cohort Study ◽

Cancer Mortality ◽

Food Groups ◽

Hazard Ratios ◽

All Cause Mortality ◽

Japanese Diet ◽

Cvd Mortality

AbstractFew studies have reported the association between the Japanese diet as food score and mortality. This study aimed to investigate adherence to the Japanese food score associated with all-cause, CVD and cancer mortality. A total of 58 767 (23 162 men and 34 232 women) Japanese participants aged 40–79 years, who enrolled in the Japan Collaborative Cohort Study between 1988 and 1990, were included. The Japanese food score was derived from the components of seven food groups (beans and bean products, fresh fishes, vegetables, Japanese pickles, fungi, seaweeds and fruits) based on the FFQ. The total score ranged from 0 to 7, and participants were divided into five categories based on scores (0–2, 3, 4, 5 and 6–7). Hazard ratios (HR) and 95 % CI for all-cause, CVD and cancer mortality based on sex were estimated using Cox proportional models. During the follow-up period until 2009, 11 692 participants with all-cause, 3408 with CVD and 4247 with cancer died. The multivariable HR in the 6–7 and 0–2 Japanese food score groups were 0·93 (95 % CI 0·86, 1·01) in men and 0·82 (95 % CI 0·75, 0·90) in women for all-cause mortality and 0·89 (95 % CI 0·76, 1·04) in men and 0·66 (95 % CI 0·56, 0·77) in women for CVD mortality. Our findings suggest that adherence to the Japanese food score consisting of food combinations characterised by a Japanese diet may help in preventing all-cause and CVD mortality, especially in women.

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Frailty index as a predictor of all-cause and cause-specific mortality in a Swedish population-based cohort

10.1101/207381 ◽

2017 ◽

Cited By ~ 1

Author(s):

M Jiang ◽

AD Foebel ◽

R Kuja-Halkola ◽

I Karlsson ◽

NL Pedersen ◽

...

Keyword(s):

Frailty Index ◽

Population Based ◽

Swedish Population ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Specific Mortality ◽

Younger Men ◽

Cvd Mortality

AbstractBackgroundFrailty is a complex manifestation of aging and associated with increased risk of mortality and poor health outcomes. Younger individuals (under 65 years) typically have low levels of frailty and are less-studied in this respect. Also, the relationship between the Rockwood frailty index (FI) and cause-specific mortality in community settings is understudied.MethodsWe created and validated a 42-item Rockwood-based FI in The Swedish Adoption/Twin Study of Aging (n=1477; 623 men, 854 women; aged 29-95 years) and analyzed its association with all-cause and cause-specific mortality in up to 30-years of follow-up. Deaths due to cardiovascular disease (CVD), cancer, dementia and other causes were considered as competing risks.ResultsOur FI demonstrated construct validity as its associations with age, sex and mortality were similar to the existing literature. The FI was independently associated with increased risk for all-cause mortality in younger (<65 years; HR per increase in one deficit 1.11, 95%CI 1.07-1.17) and older (≥65 years; HR 1.07, 95%CI 1.04-1.10) women and in younger men (HR 1.05, 95%CI 1.01-1.10). In cause-specific mortality analysis, the FI was strongly predictive of CVD mortality in women (HR per increase in one deficit 1.13, 95%CI 1.09-1.17), whereas in men the risk was restricted to deaths from other causes (HR 1.07, 95%CI 1.01-1.13).ConclusionsThe FI showed good predictive value for all-cause mortality especially in the younger group. The FI predicted CVD mortality risk in women, whereas in men it captured vulnerability to death from various causes.

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P645Low levels of low density lipoprotein cholesterol and cardiovascular, cancer and all-cause mortality outcomes

European Heart Journal ◽

10.1093/eurheartj/ehz747.0252 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Sung ◽

J Y Lee ◽

S J Lee

Keyword(s):

Cancer Mortality ◽

Validation Cohort ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

All Cause Mortality ◽

Low Levels ◽

Cvd Mortality

Abstract Aims The effect of low concentrations of low density lipoprotein-cholesterol (LDL-C) on cardiovascular disease (CVD) cancer and all-cause mortality is still controversial. In a large, young, well characterized, relatively healthy occupational cohort (Kangbuk Samsung health study, KSHS), we tested associations between low levels of LDL-C concentration, and CVD, cancer and all- cause mortality. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES). Methods and results 347,971 subjects in KSHS (mean age 39.6 years, 57.4% men) were studied over a mean follow up of 5.64±3.27 years. All subjects treated with any lipid lowering therapy were excluded. After excluding the data from subjects who died during the first 3 years of follow up, five groups were defined according to baseline LDL-C concentration (<70, 70–99, 100–129, 130–159, ≥160 mg/dL). Hazard ratios (HR and 95% CIs) for all-cause mortality, CVD and cancer mortality were estimated using Cox proportional hazards models. In the KoGES validation cohort, 182,943 subjects (mean age 53.1 years, 34.6% men) were studied over a mean follow up of 8.57±2.59 years with same methods. 2,028 deaths (897 from cancer and 282 from CVD) occurred during follow-up in KSHS. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55–2.47), CVD mortality (HR 2.02, 1.11–3.64) and cancer mortality (HR 2.06, 1.46–2.90) compared to the reference group (LDL 120–139 mg/dL). This association was more prominent in men than in women. In the validation cohort, 2,338 deaths (1,823 from cancer and 199 from CVD) occurred during follow-up. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.81, 1.44–2.28). Men in the lowest LDL-C group had a higher risk of CVD mortality (HR 3.15, 1.21–8.21) and cancer mortality (1.34, 0.99–1.82) in the KoGES cohort. Conclusions Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD and all-cause mortality especially in men.

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Trajectories of physical activity from midlife to old age and associations with subsequent cardiovascular disease and all-cause mortality

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-212706 ◽

2019 ◽

Vol 74 (2) ◽

pp. 130-136 ◽

Cited By ~ 4

Author(s):

Daniel Aggio ◽

Efstathios Papachristou ◽

Olia Papacosta ◽

Lucy T Lennon ◽

Sarah Ash ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Old Age ◽

Sensitivity Analyses ◽

Mortality And Morbidity ◽

Heart Study ◽

All Cause Mortality ◽

Cvd Mortality

IntroductionIt is well established that physical activity (PA) protects against mortality and morbidity, but how long-term patterns of PA are associated with mortality and cardiovascular disease (CVD) remains unclear.Methods3231 men recruited to the British Regional Heart Study, a prospective cohort study, reported usual PA levels at baseline in 1978–1980 (aged 40–59 years) and at 12-year, 16-year and 20-year follow ups. Twenty-year trajectories of PA, spanning from 1978/1980 to 2000, were identified using group-based trajectory modelling. Men were subsequently followed up until 30 June 2016 for mortality through National Health Service central registers and for non-fatal CVD events through primary and secondary care records. Data analyses were conducted in 2019.ResultsThree PA trajectories were identified: low/decreasing (22.7%), light/stable (51.0%) and moderate/increasing (26.3%). Over a median follow-up of 16.4 years, there were 1735 deaths. Compared with the low/decreasing group, membership of the light/stable (HR 0.83, 95% CI 0.74 to 0.94) and moderate/increasing (HR 0.76, 95% CI 0.66 to 0.88) groups was associated with a lower risk of all-cause mortality. Similar associations were observed for CVD mortality, major coronary heart disease and all CVD events. Associations were only partially explained by a range of confounders. Sensitivity analyses suggested that survival benefits were largely driven by most recent/current PA.ConclusionsA dose-response relationship was observed, with higher levels of PA from midlife to old age associated with additional benefits. However, even fairly modest and sustained PA was protective and may be more achievable for the most inactive.

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Association of BMI with risk of CVD mortality and all-cause mortality

Public Health Nutrition ◽

10.1017/s136898001600344x ◽

2017 ◽

Vol 20 (7) ◽

pp. 1226-1234 ◽

Cited By ~ 7

Author(s):

Chee Cheong Kee ◽

Mohd Ghazali Sumarni ◽

Kuang Hock Lim ◽

Sharmini Selvarajah ◽

Jamaiyah Haniff ◽

...

Keyword(s):

Dietary Habits ◽

Cox Regression ◽

Population Based ◽

Mortality Data ◽

Positive Trend ◽

Increased Risk ◽

All Cause Mortality ◽

Never Smokers ◽

Cvd Mortality

AbstractObjectiveTo determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults.DesignPopulation-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers.SettingAll fourteen states in Malaysia.SubjectsMalaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey.ResultsTotal follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0–29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2).ConclusionsUnderweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted.

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