Category Archive for: ‘Disease outcomes’
Physical activity and APOE4 genotype related to cognitive decline
In elderly men of the FINE study a decrease in average physical activity over time was associated with a greater cognitive decline than in those maintaining physical activity. APOE4 carriers with a low level of physical activity are particularly at high risk of cognitive decline.
Lower activity related to cognitive decline
A decrease in the duration of daily activity of more than 60 min per day over 10 years follow-up was associated with an almost 3-fold greater cognitive decline compared to those who maintained their regular activity. A decrease in average intensity of exercise of a half standard deviation was associated with almost a 4 times greater cognitive decline in elderly men from The Netherlands and Italy. [glossary_exclude]
APOE4 modifies the relation of physical activity with cognitive decline
In elderly men from Zutphen, a low (<1 hour/day) compared to a high (>1 hour/day) duration of physical activity was associated with a 2-fold greater cognitive decline. This decline was twice as great in APOE4 carriers.
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.
High blood pressure and smoking were risk factors for three major CVDs while serum cholesterol predicted only CHD
Blood pressure and cigarette smoking predicted overall cardiovascular disease mortality and each major individual cardiovascular disease: that is, coronary heart disease, other heart disease and stroke. Serum cholesterol predicted cardiovascular and coronary heart disease mortality. The association of serum cholesterol with cardiovascular mortality is due to its strong relation to coronary heart disease deaths.
Different cardiovascular diseases
The most common cardiovascular diseases are coronary heart disease, other heart disease, and stroke. In the SCS, coronary heart disease mortality included fatal myocardial infarction and sudden death of probable coronary origin. Mortality from other heart disease, also called atypical coronary heart disease, consists of chronic heart failure and chronic arrhythmias, mostly atrial fibrillation. Mortality from stroke includes both thrombotic and hemorrhagic stroke, which were inseparable under the conditions of these surveys.
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- Boshuizen et al. Am J Epidemiol 2007;165:398-409
A healthful diet and lifestyle is related to low CVD risk
A Mediterranean style diet, a high level of physical activity, not smoking and moderate alcohol consumption were all associated with low 10-year risk of CHD and CVD in the European HALE project. A very low risk of these diseases was observed in elderly men who had four compared to those who had none or one healthful diet and lifestyle factor. We estimate that among elderly men who did not adhere to a low-risk lifestyle pattern, 64% of deaths due to CHD and 61% due to CVD might have been prevented based on the observed risk differences.
Among elderly men, the more healthful factors of diet and lifestyle the lower the CVD mortality observed. More than 60% of CVD mortality was associated with lack of adherence to the low-risk pattern. This finding implies that even at advanced ages those who follow a Mediterranean style diet and maintain a healthful lifestyle are less likely to die from CVD.
High optimism low CVD mortality
Optimism was a relatively stable trait over 15 years in the Zutphen Elderly Study. Elderly men with a high level of optimism had only half the risk of 15-year CVD mortality compared to those with a low level of optimism. Similar results were obtained after adjustment for CVD risk factors, lifestyle factors, living arrangements, self-rated health and depressive symptoms.
Optimism was not related to major cardiovascular risk factors. However, a high level of optimism was associated with better coping behavior, goal-directed efforts such as better self-care, vitality, emotional flexibility and seeking social support. Optimism was also related to physical activity, non-smoking, moderate alcohol intake and higher intakes of fruit, vegetables and whole-grain bread. This suggests that a high level of optimism affects the risk of cardiovascular death through positive psycho-social behaviors, more healthy lifestyle and dietary habits.
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.
Flavan-3-ol intake related to CHD but not to stroke
An average intake of monomeric flavan-3-ols of 124 mg/d, compared to an average intake of 25 mg/d, was associated with a 51% lower 10-year CHD mortality in the Zutphen Elderly Study. Tea is a rich source of both flavan-3-ols and flavonols. Therefore we analyzed also the intake of tea, flavan-3-ols not from tea and flavonols not from tea in relation to fatal CHD. Tea and flavan-3-ols not from tea were inversely related to fatal CHD but flavonols from other sources than tea were not associated. These results suggest that a high intake of flavan-3-ols is related to a low risk of fatal CHD independent of flavonols. In contrast, flavan-3-ols intake was not associated with 10-year stroke incidence.
Measuring flavan-3-ols (catechins)
Flavan-3-ols are a subclass of flavonoids, an extended class of chemically related compounds ubiquitously present in plant foods. Evidence from controlled experiments in people shows that one of the flavan-3-ols, epicatechin, has favorable effects on endothelial function, blood pressure and insulin resistance. The richest sources of flavan-3-ols are tea, apples and chocolate (cocoa).
Chronic diseases associated with all-cause mortality
In middle-aged men from the Seven Countries Study the additional relative risk of death within 15 years varied for seven chronic diseases from 47% for ‘other’ heart disease to 81% for heart attacks.
In older men the additional risk of death for any chronic disease was 95% in Finland, 88% in The Netherlands and 27% in Italy.
The risk of death with an entry class of 3 or more chronic diseases compared to their absence was more than 3 times greater in elderly men from Finland and The Netherlands and 2 times greater in Italy.
These results indicate that the presence of clinically manifest major chronic diseases predicts all-cause mortality and the relation is stronger in northern than in southern Europe.
The scrutinized diseases were heart attack, heart failure, stroke, peripheral arterial disease, other heart disease, diabetes and chronic obstructive pulmonary disease.
Telomere length not related to all-cause mortality
Longer telomeres at baseline did not predict all-cause and cause specific mortality after 7 years of follow-up in the elderly men cohort from Zutphen. The cross-sectional mean telomere length decreased from 5.03 kbp in the 1993 survey to 4.76 kbp in 2000. Telomere shortening is a marker of ageing that might be related to oxidative stress.
Repeated measures of telomere length
Telomeres are nucleoprotein structures at the end of chromosomes. They prevent chromosomal ends from being recognized as double strand breaks and thus apparently protect them from end to end fusion and degradation.
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.