Category Archive for: ‘Disease outcomes’
High flavonol intake and low CHD risk
In 1993 the Zutphen Elderly Study showed that a high intake of flavonols was associated with a low risk of CHD. Elderly men in Zutphen with an average intake of 42 mg/d, compared to those with 12 mg/d, had a 68% lower risk of fatal CHD after 5 years of follow-up, confirmed in the 10-year data.
High flavonol intake also related to low stroke incidence
In 1996, we published the results of a study using the average flavonol intake of the Zutphen men in the period 1960-1970 and the 15-year incidence of stroke. Men with an average flavonol intake of 33 mg/d, compared to 14 mg/d, had a 73% lower risk of stroke.
What are flavonols?
The most common flavonol estimated in the diet was quercetin. Flavonols are a subclass of the flavonoids, an extended class of chemically related compounds ubiquitously present in plant foods. In a range of experimental models, these compounds have demonstrated biological effects, which may partially explain the beneficial health effects of a diet high in vegetables and fruits. They are particularly present in tea, apples, onions and red wine.
- Hertog et al. 1993;342:1007-42
- Hertog et al. 1997;349:699
- Keli et al. Arch Intern Med 1996;156:637-42
Silent ECG findings related to CHD mortality
Silent ECG findings meeting specified criteria of the Minnesota Code were found at entry in half of the elderly men from Finland, the Netherlands and Italy. Major Q-waves, ST-T patterns, and arrhythmias were associated with a 3 times greater 10-year CHD mortality rate compared to those with absent or marginal findings. Lesser Q-waves, ST-T patterns, and frequent premature beats were associated with almost twice greater risk. Of the individual codable items, significant associations were observed for major Q-waves, major ST-T patterns, and arrhythmias. A Cardiac Infarction Injury Score designed to discriminate between the presence or absence of a heart attack, along with ST-T patterns were significantly related to risk of fatal CHD in middle-aged and elderly men in Zutphen.
The prevalence of specified ECG findings was high. Major ECG findings were strongly related to fatal CHD. Strength of the associations was similar across cultures despite large differences in absolute risk.
- Blackburn et al. Circulation 1960;21:1160-75
- Menotti et al. Acta Cardiol 2001;56:27-36
- Dekker et al. J Clin Epidemiol 1995;48:833-40
- Dekker et al. J Am Coll Cardiol 1995;25:1321-6
BMI not related to CHD mortality
Body mass index (BMI=Weight/height2) is the most frequently used indicator of body fatness. In middle-aged men of the SCS, BMI was inconsistently related to 10- and 25-year CHD mortality.
Weight fluctuation linked to increased CHD risk
Changes in body weight during the first 10 years of follow-up were related to CHD mortality during the following 15 year. Middle-aged men who gained more than 2 kg, put on an average weight of 7 kg. They had a 20% greater CHD mortality risk (not statistically significant) compared to those whose weight remained stable. A similar result was obtained in men who decreased more than 2 kg weight and lost on average 5 kg. Men were defined as “fluctuating” when their weight at the second examination differed more than 2 kg with their weight at examination 1 or 3. These men lost on average 1 kg and had a significant 50% higher CHD mortality risk compared to those who kept their weight constant. These results indicated that fluctuating weight, the so-called yo-yo effect, rather than BMI per se, was associated with greater CHD risk.
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- Keys et al. Harvard University Press ISBN 0-674-80273-3, 1980:161-195
- Peters et al. Int J Obesity 1995;19:862-8
- Menotti et al. J Cardiovasc Risk 1996;3:69-75
Glucose intolerance and diabetes associated with the risk of fatal CHD
Dutch men aged 50-69 with glucose intolerance at entry, followed for 15 years, had a 2-fold greater risk of fatal CHD compared to men with a normal glucose tolerance. A similar result was obtained for men who entered the study with clinical diabetes.
In 1970 in the Zutphen Study a glucose tolerance test was carried out with an oral load of 50 g glucose. Blood samples were taken after 30, 60, 120 and 150 minutes. The area under the curve of glucose values was calculated and ‘glucose intolerance’ was based on values above the median.
Blood pressure a strong predictor of CVD mortality
Systolic blood pressure in middle-aged men was an important predictor of 10-, 25-, 35- and 40-year CHD mortality in all cohorts. The 35-year follow-up data showed that past blood pressure levels are more important than recent values. Systolic blood pressure was also strongly associated with 25-, 35- and 40-year stroke mortality. Both recent and past blood pressure level were strongly predictive of stroke. The Zutphen Study found that the strength of the relation between blood pressure and 15-year stroke incidence doubled when 11 repeated casual pressures were measured. Blood pressure was also strongly related to 40-year total CVD mortality in the US railroad cohort.
Population differences in absolute CHD risk
The results after 10 and 25 years of follow-up showed that the relative risks from blood pressure level are similar across cohorts, while at the same level of blood pressure the absolute risks of CHD mortality are different. High absolute risk was present in Northern Europe and the United States and low risk in Mediterranean Southern Europe and Japan.
Relative risk of CHD associated with blood pressure is similar but absolute risk differs among the cohorts. This implies that elevated blood pressure levels need to be treated more intensely in high risk cultures to achieve target levels and potential prevention.
- Keys et al. Harvard University Press. ISBN 0-674-802733, 1980:103-20
- Keli et al. Stroke 1992;23:347-51
- Menotti et al. J Cardiovasc Risk 1996;3:69-75
- Menotti et al. Stroke 1996;27:381-7
- Van den Hoogen et al. N Engl J Med 2000;342:1-8
- Menotti et al. J Hypertension 2004;22:1683-90
- Menotti et al. Eur J Epidemiol 2004;19:417-24
- Boshuizen et al. Am J Epidemiol 2007;165:398-409