Corrected QT Interval Is Associated With Stroke but Not Coronary Heart Disease: Insights From a General Chinese Population

Background: Prolonged heart rate-corrected QT (QTc) interval has been associated with incident cardiovascular diseases (CVD) in general Western populations. However, this association is unclear in Asian population. We aim to estimate the association between QTc interval and incident CVD in a general Chinese population.Methods: We analyzed 8,867 participants age ≥35 years and free of CVD at baseline in the Northeast China Rural Cardiovascular Health Study. A resting 12-lead electrocardiogram was performed on all participants, and QTc interval computed using the Framingham formula. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for associations between QTc interval and incident stroke, coronary heart disease, and combined CVD events.Results: Over a median follow-up of 4.66 years, a total of 439 CVD events occurred (298 stroke cases and 152 CHD cases). After full adjustment, prolonged QTc defined by a sex-specific cutoff was associated with increased risk of developing stroke (HR: 1.82, 95% CI 1.20–2.75, P = 0.004) and combined CVD (HR: 1.52, 95% CI 1.05–2.19, P = 0.026). Spline analyses demonstrated no clear thresholds; when modeled as a linear relationship, each 10 ms increase of QTc interval was associated with an HR of 1.12 (95% CI 1.06–1.19, P < 0.001) for stroke and an HR of 1.10 (95% CI 1.05–1.15, P < 0.001) for combined CVD. Baseline QTc interval was not associated with incident CHD with either modeling strategy.Conclusions: Baseline QTc interval is associated with incident stroke and CVD in adults without prior CVD from a general Chinese population.

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Abstract TP185: CRP as a Predictor for Hemorrhagic vs Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp185 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Stephanie Lyden ◽

Adam DeHavenon ◽

Vivek Reddy ◽

Jennifer Majersik

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Cardiovascular Health ◽

Proportional Hazards ◽

Elevated Serum ◽

Cox Proportional Hazards ◽

Health Study ◽

Secondary Outcome ◽

Cardiovascular Health Study ◽

Increased Risk

Background: Studies have found an association between elevated serum C reactive protein (CRP) levels and increased ischemic stroke risk 2,4-5 . Other studies have looked at whether CRP levels correlate with outcome and severity after ICH 1,3 . Less research has been done looking at CRP levels and the risk for hemorrhagic stroke. This study aims to confirm the association of baseline elevated serum CRP levels and increased risk for ischemic stroke, thus validating this dataset, and to evaluate whether these levels correlate with an increased risk for hemorrhagic stroke. Methods: This is a secondary analysis of the data from the Cardiovascular Health Study (CHS). The primary outcome is ischemic stroke and the secondary outcome is hemorrhagic stroke. The primary predictor is CRP level at baseline, as a continuous value and, after dividing into quintiles, a comparison between the lowest and highest quintiles. We fit Cox proportional hazards models and adjusted for baseline covariates that were associated with the outcomes, which for ischemic stroke included age, race, cholesterol, diabetes, hypertension, atrial fibrillation, and history of TIA or myocardial infarction; and for hemorrhagic stroke included age, cholesterol, diabetes, and hypertension. Results: We included 5,681 patients, of whom 918 (16.2%) had ischemic stroke and 150 (2.6%) had hemorrhagic stroke. Mean (SD) days of follow-up was 4,403 (2,504) and mean (SD) CRP was 4.8 (8.3). We found that baseline CRP was associated with ischemic stroke (HR 1.01, 95% CI 1.00-1.02, p=0.005), but not hemorrhagic stroke (HR 1.00, 95% CI 0.97-1.02, p=0.781). When comparing the highest to lowest quintile of CRP, we found a clinically significant increased risk of ischemic stroke (HR 1.37, 95% CI 1.11-1.70, p=0.004) (Figure 1), but again not for hemorrhagic stroke (p=0.852). Conclusion: Our analysis found that elevated baseline CRP levels are associated with an increased risk for ischemic stroke, but not hemorrhagic stroke.

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Association of oral contraceptives and tubal ligation with risk of early natural menopause

Human Reproduction ◽

10.1093/humrep/deab054 ◽

2021 ◽

Author(s):

C R Langton ◽

B W Whitcomb ◽

A C Purdue-Smithe ◽

L L Sievert ◽

S E Hankinson ◽

...

Keyword(s):

Oral Contraceptives ◽

Proportional Hazards ◽

Reproductive Factors ◽

Cox Proportional Hazards ◽

Tubal Ligation ◽

Health Study ◽

Early Menopause ◽

Natural Menopause ◽

Increased Risk

Abstract STUDY QUESTION What is the association of oral contraceptives (OCs) and tubal ligation (TL) with early natural menopause? SUMMARY ANSWER We did not observe an association of OC use with risk of early natural menopause; however, TL was associated with a modestly higher risk. WHAT IS KNOWN ALREADY OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of early menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. STUDY DESIGN, SIZE, DURATION We examined the association of OC use and TL with natural menopause before the age of 45 years in a population-based study within the prospective Nurses’ Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until early menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. MAIN RESULTS AND THE ROLE OF CHANCE Over 1.6 million person-years, 2579 members of the analytic cohort experienced early natural menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of early menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for early menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of early menopause (HR = 1.17, 95% CI, 1.06-1.28). LIMITATIONS, REASONS FOR CAUTION Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the largest study examining the association of OC use and TL with early natural menopause to date. While TL was associated with a modest higher risk of early menopause, our findings do not support any material hazard or benefit for the use of OCs. STUDY FUNDING/COMPETING INTEREST(S) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. TRIAL REGISTRATION NUMBER N/A

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Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap316 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Stephen P Glasser ◽

Yulia Khodneva ◽

Daniel Lackland ◽

Ronald Prineas ◽

Monika Safford

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cox Proportional Hazards Models ◽

Chd Risk ◽

Regards Study ◽

Chd Risk Factors

Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors. Results: The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP<120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}). Conclusion: In this sample, preHTN may be associated with incident CHD among women but not men.

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Abstract MP53: Consumption Of Ultra-processed Food Is Associated With Risk Of Coronary Heart Disease In The Atherosclerosis Risk In Communities Study

Circulation ◽

10.1161/circ.143.suppl_1.mp53 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Shutong Du ◽

Hyunju Kim ◽

Josef Coresh ◽

Casey M Rebholz

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Food Intake ◽

Proportional Hazards ◽

Sociodemographic Factors ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Processed Food ◽

Cox Proportional Hazards Models ◽

Food And Drink

Introduction: Ultra-processed food defined as food and drink products formulated through sequences of industrial processes, and generally contain non-culinary used additives. Previous studies have linked higher ultra-processed food intake with several cardiometabolic and cardiovascular diseases. However, longitudinal evidence from US populations remains scarce. Hypothesis: We hypothesized that higher intake of ultra-processed food is associated with higher risk of coronary heart disease (CHD). Methods: We selected 12,607 adults aged 44-66 years in 4 US communities from the ARIC study at baseline. Dietary intake data were collected through a validated 66-item food frequency questionnaire. Ultra-processed foods were defined using the NOVA classification and the level of intake was calculated for each participant. We conducted Cox proportional hazards models to study the association between quartiles of ultra-processed food intake and incident CHD. Nonlinearity was assessed by using restricted cubic spline regression. Results: There were 1,899 incident CHD cases documented after an median follow up of 27 years (291,285.2 person-years). Incidence rates were higher in the highest quartile of ultra-processed food intake (71.6 per 10,000 person-years; 95% CI, 65.8-78.0) compared to the lowest quartile (59.7 per 10,000 person-years; 95% CI, 54.3-65.7). Participants in the highest vs. lowest quartile were associated with a 18% higher risk of CHD (Hazard ratio 1.18 [95% CI, 1.04 - 1.34]; P-trend = 0.010) after adjusting for sociodemographic factors and health behaviors. An approximately linear relationship was observed between ultra-processed food intake and risk of CHD after 4 servings/day ( Figure ). Conclusion: In conclusion, higher ultra-processed food intake was associated with a higher risk of coronary heart disease among middle-aged US adults. Further prospective studies are needed to confirm these findings and to investigate the mechanisms by which ultra-processed food may affect health.

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Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap323 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Stephen P Glasser ◽

Daniel L Halberg ◽

Charles Sands ◽

Paul Muntner ◽

Monika Safford

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences ◽

Pulse Pressure ◽

Proportional Hazards ◽

Linear Trend ◽

Cox Proportional Hazards ◽

Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

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Abstract MP49: Sugar Sweetened and Artificially Sweetened Beverages and risk of Mortality in US adults

Circulation ◽

10.1161/circ.129.suppl_1.mp49 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Vasanti S Malik ◽

An Pan ◽

Lawrence de Koning ◽

Eva Schernhammer ◽

Walter C Willett ◽

...

Keyword(s):

Proportional Hazards ◽

Total Mortality ◽

Cox Proportional Hazards ◽

Health Study ◽

Sweetened Beverages ◽

Risk Of Mortality ◽

Regular Consumption ◽

Increased Risk ◽

Artificially Sweetened Beverages ◽

Cvd Mortality

Background: Sugar sweetened beverages (SSBs) are the single largest source of calories and added sugars in the US diet and regular consumption has been associated with weight gain and risk of chronic diseases. Artificially sweetened beverages (ASBs) are often suggested as alternatives to SSB but little is known about their long-term health effects. Whether consumption of SSBs or ASBs is associated with risk of mortality is unknown. Methods: We prospectively followed 38,602 men from the Health Professional’s Follow-up study (1986-2010) and 82,592 women from the Nurses’ Health study (1980-2010) who were free from cardiovascular disease (CVD) and cancer at baseline. Diet was assessed using validated food frequency questionnaires every 4 years and Cox Proportional Hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results: We documented 27,691 deaths (6,631 CVD and 10,447 cancer deaths) during 3.14 million person-years. After adjusting for major dietary and lifestyle risk factors, and BMI, baseline diabetes, hypertension and hypercholesterolemia, consumption of SSBs was associated with an increased risk of total mortality, which was mainly driven by CVD mortality among individuals consuming at least 2 servings per day; pooled HRs (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.95 (0.91, 0.98), 0.96 (0.93, 0.99), 1.02 (0.96, 1.08), and 1.18 (1.04, 1.33), respectively (P-trend= 0.0001) for total mortality, and 1.00, 0.97 (0.90, 1.02), 0.96 (0.90, 1.02), 1.04 (0.93, 1.16) and 1.28 (1.09, 1.51), respectively (P-trend=0.007) for CVD mortality. In contrast, ASBs were not associated with mortality; pooled HR’s (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.92 (0.89, 0.95), 0.91 (0.86, 0.97), 0.91 (0.86, 0.95) and 0.99 (0.85, 1.15), respectively (P-trend=0.50) for total mortality and 1.00, 0.86 (0.80, 0.92), 0.87 (0.81, 0.94), 0.96 (0.88, 1.06) and 0.96 (0.74, 1.25), respectively (P-trend=0.99) for CVD mortality. No associations were observed with cancer mortality for either SSBs or ASBs in multi-variable adjusted models. Conclusion: Regular consumption of SSBs is associated with an increased risk of total and CVD mortality, providing additional support for recommendations and policies to limit intake of these beverages.

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Prevalence and risk factors of prolonged corrected QT interval in general Chinese population

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1244-7 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Qun Ma ◽

Zhao Li ◽

Xiaofan Guo ◽

Liang Guo ◽

Shasha Yu ◽

...

Keyword(s):

Risk Factors ◽

Rural Areas ◽

Chinese Population ◽

Liaoning Province ◽

Qtc Interval ◽

Qtc Prolongation ◽

Cvd Risk ◽

Specific Risk ◽

Increased Risk ◽

General Chinese Population

Abstract Background Corrected QT (QTc) interval has been correlated with total and CVD mortality. Although much is known about the relation between prolonged QTc interval and clinical outcome, there is no information on the prevalence and specific risk factors of QTc prolongation in general Chinese population. We evaluated the prevalence of prolonged QTc interval and its risk factors in general Chinese population, aiming to fill in the gaps in the literature and provide evidence for potential CVD risk prediction and disease burden estimate in community. Methods A population-based survey was conducted on 11,209 participants over the age of 35 in rural areas of Liaoning Province from 2012 to 2013. Twelve-lead ECGs and automatic analysis were performed on all participants. Logistic regression adjustments were made by using the Bazett’s formula to correlate specific risk factors with prolonged QTc intervals (> 440 ms) for potential confounders. Results The overall prevalence of prolonged QTc interval was 31.6%. The prevalence increased significantly with age (24.1% among those aged 35–44 years; 28.3%, 45–54 years; 35.2%, 55–64 years; 43.4%, ≥65 years, P < 0.001). Participants with a history of CVD had a higher prevalence of QTc prolongation (40.7% vs. 30.0%). In the fully adjusted logistic regress model, older age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated independently with increased risk for prolonged QTc interval (All P < 0.05). We found no significant differences between general obesity, hypocalcemia and hypomagnesemia with prolongation of QTc interval. Female sex showed opposite results after applying clinical diagnostic criteria, and high physical activity could reduce the risk of prolonged QTc interval. Conclusions The prevalence of prolonged QTc interval was relatively high in general Chinese population and listed relevant factors, which would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies in community.

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Sedentary Behaviors, TV Viewing Time, and Risk of Young-Onset Colorectal Cancer

JNCI Cancer Spectrum ◽

10.1093/jncics/pky073 ◽

2018 ◽

Vol 2 (4) ◽

Cited By ~ 18

Author(s):

Long H Nguyen ◽

Po-Hong Liu ◽

Xiaobin Zheng ◽

NaNa Keum ◽

Xiaoyu Zong ◽

...

Keyword(s):

Colorectal Cancer ◽

Proportional Hazards ◽

Statistical Tests ◽

Cox Proportional Hazards ◽

Health Study ◽

Viewing Time ◽

Sedentary Behaviors ◽

Tv Viewing ◽

Young Onset ◽

Increased Risk

Abstract Background Colorectal cancer (CRC) diagnosed before age 50 years, or young-onset CRC, is increasing globally with undefined etiology. A sedentary lifestyle is an emerging risk factor for CRC after age 50 years, but its role in young-onset CRC is unknown. Methods We prospectively evaluated sedentary behaviors, primarily time watching television (TV), and risk of young-onset CRC among 89 278 women in the Nurses’ Health Study II ages 25–42 years at recruitment (1991–2011). We used Cox proportional hazards modelling to estimate relative risks (RR) and 95% confidence intervals (CIs). Statistical tests were two-sided. Results We documented 118 young-onset CRCs over 1 262 540 person-years. Sedentary TV viewing time was statistically significantly associated with increased risk of young-onset CRC, after adjusting for putative risk factors, including obesity and physical activity. Compared to no more than 7 hours per week, women with 7.1–14 hours per week of TV time had a multivariable relative risk (RR) of 1.12 (95% confidence interval [CI] = 0.72 to 1.75), further increased for greater than 14 hours per week (RR = 1.69, 95% CI = 1.07 to 2.67, Ptrend = .03). This association was observed among participants without a CRC family history and was more pronounced for rectal cancer (RR for >14 vs ≤7 hours per week 2.44, 95% CI = 1.03 to 5.78, Ptrend = .04). Overweight or obese participants may be more susceptible. Conclusion Independent of exercise and obesity, prolonged sedentary TV viewing time, a surrogate for a more inactive lifestyle, was associated with increased risk of young-onset CRC, particularly of the rectum. These findings provide further evidence on the importance of maintaining an active lifestyle.

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