Category Archive for: ‘CHD risk factors’
Large differences in global CHD risk within Europe
A re-analysis of the 10-year follow-up data of the SCS published in 2000 showed large differences between northern and southern Europe in the number of hard CHD events at the same level of the major risk factors serum cholesterol, blood pressure and smoking. The number of hard CHD events was 3 times higher in northern Europe compared to southern Europe. In the early 1970s Ancel Keys and colleagues published the finding that at the same level of the major risk factors the number of hard CHD events after 5 years of follow-up was twice as great in the US railroad cohort as in the European cohorts.
Implications of differences in global risk for prevention and treatment
It took decades of observational epidemiology and clinical trials before the importance of the global CHD risk concept was accepted by the medical profession. If the level of absolute risk is crucial for taking action, an integrated approach is needed to lower global risk in both cardiac patients and in high-risk persons. The country differences in absolute risk indicate that greater intensity of interventions is required in regions such as northern Europe.
Depressive symptoms related to CVD mortality
Elderly men from the FINE study cohorts of Finland, the Netherlands and Italy who manifested a number of depressive symptoms had a 2-fold greater 10-year CVD mortality. The relative risk did not change after excluding cases that died from CVD in the first 5 years of follow-up. The strongest associations were observed with the mortality from stroke and heart failure and the relation with CHD mortality was of borderline statistical significance. Depressive symptoms were not related to risk of other degenerative heart diseases and no differences in risk from depression were observed between northern and southern Europe.
The results of this study provide strong support for the hypothesis that depressive symptoms are a real and causal risk factor for CVD. Its prospective design, established that the depressive symptoms preceded the fatal CVD event. Furthermore, the large sample size and the long follow-up made it possible to exclude subjects who died from CVD in the first five years after baseline, making reversed causality unlikely, that is, that the event caused the depressive symptoms. Adjustment for many confounding variables made it likely that the depressive symptoms had an independent effect.
In elderly, smoking and heart rate predict all-cause mortality
In elderly men from Finland, The Netherlands and Italy, age, smoking and heart rate were positively associated with excess 10-year all-cause mortality. The association of systolic blood pressure with all-cause mortality was marginally significant at 10 years. HDL-cholesterol and body mass index were significantly inversely related to all-cause mortality after 10 years of follow-up but these associations were no longer significant after excluding early deaths (during the first 5 years of follow-up).
These results suggest that smoking and heart rate (an indicator of physical activity and fitness) remain useful risk factors in prediction of all-cause mortality up to old age.
Many cardiovascular risk factors related to all-cause mortality
In the Seven Countries Study age, systolic blood pressure, smoking and serum cholesterol predicted 25-year all-cause mortality in most cohorts. These risk factors were also predictive of 40-year all-cause mortality in the US railroad and the Cretan cohort.
An analysis of the European cohorts showed that systolic blood pressure remained a strong predictor of excess relative risk of all-cause mortality during 35 years of follow-up. The strength of the association declined with increasing follow-up years (ageing) while absolute risk increased greatly with age.
In the rural Italian cohorts other risk factors were also related to 40-year all-cause mortality, namely: mortality of father and mother before age 60, job-related physical activity (inversely related), body mass index (inverse J-shaped), mid-arm circumference (inversely related), lung function (inversely related) and the presence of corneal arcus, xanthalasmata and of any catagory of clinical CVD, diabetes or cancer at entry.
- Menotti et al. Eur J Epidemiol 2001;17:337-46
- Menotti et al. Eur J Epidemiol 2004;19:417-24,
- Menotti et al. J Hypertension 2004;22:1683-90
- Moschandreas et al. Int J Cardiol 2005;100:85-91
- Menotti et al. Aging Clin Exp Res 2005;18:394-406
Disability and depressive symptoms related to all-cause mortality
Self-rated health, disability and depressive symptoms were independent from each other, and were associated with all-cause mortality in elderly men from Finland, The Netherlands and Italy (the FINE study). After adjustment for the prevalence of chronic diseases severity of disability and depressive symptoms remained related to all-cause mortality.
Combinations of measures also associated with all-cause mortality
For the combination of disability and self-rated health a 3-fold greater mortality risk was observed for men who had severe disability and a poor self-rated health compared to the reference group. Men with severe disability in the two highest categories of depressive symptoms had also a 3-fold higher mortality risk.
These results suggest that for adequate prognosis of mortality and for developing intervention strategies information is needed on other and different health outcomes.
Cardiovascular risk factors associated with disability.
Elderly men from Zutphen were divided at baseline in those with a high cardiovascular risk, defined as 2 or more of the following traditional cardiovascular risk factors: obesity, smoking, hypertension, hypercholesterolemia and diabetes and a low-risk group with less than 2 risk factors. Men at baseline with a high cardiovascular risk had compared to those with a low risk a 2-fold or greater risk of functional disabilities after 5, 10 or 15 years. These results suggest that elevated cardiovascular risk factor might prevent or postpone disability.
Design of the study
In the Zutphen Elderly Study, traditional cardiovascular risk factors measured in 1985 were evaluated in relation to information on self-reported disabilities collected in 1990, 1995 and 2000.
Depression and physical inactivity, two sides of the same coin?
The relationship between depressive symptoms and CVD risk may be the consequence of a more sedentary lifestyle of depressed persons. Thus, physical inactivity may be the intermediate factor in the relation between depressive symptoms and CVD. The independent and combined effects of depressive symptoms and physical activity on CVD mortality were investigated prospectively in elderly men from the FINE study cohorts of Finland, the Netherlands and Italy.
Physical inactivity and depression both related to cardiovascular risk.
A 30 min/d lower level of physical activity at entry was associated with a 9% excess CVD mortality after 10 years. A one-standard deviation greater score for depressive symptoms was related to a 37% higher CVD mortality, after adjustment for physical activity. The excess risk of CVD mortality attributable to the combined effect of depressive symptoms with inactivity was 47%. The greater risk of CVD due to depressive symptoms cannot be explained by physical inactivity. However, depressive symptoms and physical inactivity may interact to increase CVD risk.
Poor lung function associated with depression
Data from the Finnish and Italian cohorts showed that poor lung function in men aged 50-69 was associated with subsequent depressive symptoms 15-30 years later. This association was stronger in men with chronic diseases than in those without.
Decline in serum cholesterol predictor of depression
Among elderly men from Finland, The Netherlands and Italy, a 5-year decline in total serum cholesterol level was a predictor of depressive symptoms 5 years later. Men with two or more cardiovascular risk factors at entry (obesity, smoking, hypertension, hypercholesterolaemia, or diabetes) had no higher future risk of depression in the Zutphen Elderly Study.
- Giltay et al Am J Geriatr Psychiatry 2008;16:874-82
- Bots et al. Int J Geriatr Psychiatry 2008;23:478-84
- Giltay et al. Psychosomatic Med 2010;72:53-60
Living together associated with lower cognitive decline
In elderly men from Finland, The Netherlands and Italy information was collected on marital status and living situation in 1985 and again in 1990. This was related to cognitive decline during the next 10 years. Men who were married or who lived with others (with spouse, children, others or in a nursing home) in both 1985 and 1990, had the smallest subsequent 10-year cognitive decline.
The influence of marriage
Elderly men who lost a partner and those who were unmarried in the two examination rounds had a 2 times greater cognitive decline compared with those who were married in both years. Men who started to live alone between 1985 and 1990, had a cognitive decline 2 times greater and those who lived alone in both years had a cognitive decline 3.5 times greater than that of men who lived with others in both years.
Genotype apolipoprotein E4 (APOE4) associated with cognitive decline
The Zutphen Elderly Study showed that the risk of cognitive decline over three years was 3 times greater among the carriers of an isoform (certain variety of the genotype apolipoprotein E) called APOE4, compared to that of non-carriers.
Synergistic effect of genotype APOE4 and stroke on cognitive decline
Carriers of APOE4 without stroke had a 3 times greater risk of cognitive decline; non-carriers with stroke had a 5 times greater decline and those with both risk factors had a 17 times greater risk of decline.
Cognitive decline is a potential risk factor for reduced cognitive functioning. The genetic heterogeneity of apolipoprotein E may be involved in the etiology of familial Alzheimer disease. The apolipoprotein E polymorphism affects serum lipoprotein levels and the APOE4 isoform is increased in Alzheimer disease.