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1.
Am J Cardiol ; 201: 101-106, 2023 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-37352660

RESUMO

Cardiorespiratory fitness (CRF) is a major risk factor and predictor of atherosclerotic cardiovascular disease. However, the relationship between CRF and risk of aortic stenosis (AS) has not been previously investigated. Thus, we aimed to assess the prospective association between CRF and risk of AS. CRF, as measured by maximal oxygen uptake, was assessed using a respiratory gas exchange analyzer during cardiopulmonary exercise testing in 2,308 men aged 42 to 61 years recruited into the Kuopio Ischemic Heart Disease prospective cohort study. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for AS. During a median follow-up of 27 years, 101 cases of AS occurred. Dose-response analysis suggested there might be a nonlinear relation between CRF levels and AS risk. In an analysis adjusted for age, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking, history of type 2 diabetes mellitus, and coronary heart disease, the HRs 95% (CIs) of AS were 0.57 (0.34 to 0.96) and 0.91 (0.53 to 1.57) for participants in the middle and upper third of CRF levels, respectively, compared with participants in the bottom third. After further adjustment for alcohol consumption, the corresponding HRs (95% CIs) were 0.58 (0.34 to 0.97) and 0.91 (0.53 to 1.56), respectively. In conclusion, higher CRF levels may be associated with a lower incidence of AS in middle-aged and older Finnish men. Given the likely limitations of low statistical power, further research is needed to provide insights into the dose-response nature of any relationship between CRF and AS.


Assuntos
Estenose da Valva Aórtica , Aptidão Cardiorrespiratória , Diabetes Mellitus Tipo 2 , Pessoa de Meia-Idade , Masculino , Humanos , Idoso , Aptidão Cardiorrespiratória/fisiologia , Estudos Prospectivos , Estudos de Coortes , Fatores de Risco , Teste de Esforço , Estenose da Valva Aórtica/epidemiologia , Colesterol , Aptidão Física/fisiologia
2.
Circ Genom Precis Med ; 16(3): 236-247, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37021583

RESUMO

BACKGROUND: Smoking is associated with carotid intima-media thickness (C-IMT). However, knowledge about how genetics may influence this association is limited. We aimed to perform nonhypothesis driven gene-smoking interaction analyses to identify potential genetic variants, among those included in immune and metabolic platforms, that may modify the effect of smoking on carotid intima-media thickness. METHODS: We used baseline data from 1551 men and 1700 women, aged 55 to 79, included in a European multi-center study. Carotid intima-media thickness maximum, the maximum of values measured at different locations of the carotid tree, was dichotomized with cut point values ≥75, respectively. Genetic data were retrieved through use of the Illumina Cardio-Metabo- and Immuno- Chips. Gene-smoking interactions were evaluated through calculations of Synergy index (S). After adjustments for multiple testing, P values of <2.4×10-7 for S were considered significant. The models were adjusted for age, sex, education, physical activity, type of diet, and population stratification. RESULTS: Our screening of 207 586 SNPs available for analysis, resulted in the identification of 47 significant gene-smoking synergistic interactions in relation to carotid intima-media thickness maximum. Among the significant SNPs, 28 were in protein coding genes, 2 in noncoding RNA and the remaining 17 in intergenic regions. CONCLUSIONS: Through nonhypothesis-driven analyses of gene-smoking interactions, several significant results were observed. These may stimulate further research on the role of specific genes in the process that determines the effect of smoking habits on the development of carotid atherosclerosis.


Assuntos
Aterosclerose , Fumar , Masculino , Humanos , Feminino , Fumar/efeitos adversos , Fumar/epidemiologia , Espessura Intima-Media Carotídea , Estudos Transversais , Fatores de Risco , Aterosclerose/genética
3.
Nutr Metab Cardiovasc Dis ; 33(4): 864-867, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36740560

RESUMO

BACKGROUND AND AIMS: Circulating C-reactive protein (CRP) and albumin are commonly used inflammatory biomarkers. C-reactive protein-to-albumin ratio (CAR), a novel inflammatory biomarker, has been suggested to be a more reliable risk indicator compared to CRP or albumin alone. An inflammatory hypothesis has been postulated in VTE aetiology, but the association between CAR and VTE has not been investigated. We aimed to assess the prospective association of CAR with VTE risk. METHODS AND RESULTS: C-reactive protein and albumin were measured in serum samples at baseline from 2479 men aged 42-61 years. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. During a median follow-up of 27.0 years, 168 VTE cases were recorded. In analysis adjusted for potential confounders, the HR (95% CI) for VTE comparing extreme tertiles of CAR was 1.49 (1.01-2.21), which was minimally attenuated on further adjustment for prevalent cancer, a potential mediator 1.48 (1.00-2.19). Serum CRP and albumin were each modestly associated with VTE risk in the same set of participants. CONCLUSION: In middle-aged and older men, elevated serum CAR may be associated with an increased risk of VTE. Further research is needed to replicate or refute these findings in other populations and assess if CAR may be of potential value in VTE management.


Assuntos
Proteína C-Reativa , Tromboembolia Venosa , Masculino , Pessoa de Meia-Idade , Humanos , Idoso , Proteína C-Reativa/análise , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Estudos Prospectivos , Albumina Sérica/metabolismo , Fatores de Risco , Biomarcadores
4.
Am J Cardiol ; 186: 170-175, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36307347

RESUMO

Remnant cholesterol (RC) and non-high-density lipoprotein cholesterol (non-HDL-C) may contribute to the residual risk for atherosclerotic cardiovascular disease. High cardiorespiratory fitness (CRF) is associated with favorable traditional lipid profiles, but its relation with RC and non-HDL-C remains unclear. We analyzed cross-sectional data on 4,613 healthy men (mean age 49 years). CRF was measured using peak oxygen uptake during incremental exercise testing and categorized into quartiles. RC was estimated as total cholesterol minus HDL-C and low-density lipoprotein cholesterol, and elevated RC was defined as ≥38 mg/100 ml (90 percentile). Non-HDL-C was calculated as total cholesterol minus HDL-C, and high non-HLD-C was defined as ≥190 mg/100 ml. CRF was inversely associated with RC (ß -0.31, 95% confidence interval [CI] -0.39 to -0.24) and non-HDL-C (ß -0.34, 95% CI -0.57 to -0.11) after adjustment for several risk factors. Each metabolic equivalent increment in CRF was associated with lower odds of having elevated RC (odds ratio [OR] 0.85, 95% CI 0.77 to 0.93) and non-HDL-C (OR 0.93, 95% CI 0.85 to 1.00) in multivariable analysis. Compared with the bottom quartile, the top quartile of CRF had significantly lower odds of elevated RC (OR 0.63, 95% CI 0.45 to 0.88) and non-HDL-C (OR 0.68, 95% CI 0.51 to 0.91). In conclusion, higher CRF was independently associated with lower levels of RC and non-HDL-C and lower odds of the prevalence of elevated RC and non-HDL-C in healthy men.


Assuntos
Aptidão Cardiorrespiratória , Masculino , Humanos , Pessoa de Meia-Idade , Estudos Transversais , Colesterol , Lipoproteínas , HDL-Colesterol , Fatores de Risco
5.
Scand J Med Sci Sports ; 32(5): 913-923, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35103994

RESUMO

OBJECTIVE: To examine the combined effects of cardiorespiratory fitness (CRF) and prediabetes or diabetes on cardiovascular and noncardiovascular mortality. PATIENTS AND METHODS: This prospective study evaluated a population-based cohort of 1562 men aged 42-60 years at baseline (1984-1989). We utilized maximal oxygen uptake (VO2max ) for assessing aerobic capacity and CRF in the cohort and stratified participants into six groups according to both their glucose status (diabetes, prediabetes, or no diabetes) and whether they were below- or above-median VO2max . Deaths in the cohort were recorded till December 31 2016. Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for cardiovascular and noncardiovascular mortality. Smoking, alcohol consumption, BMI, blood pressure, cholesterol, diagnosis of ischemic heart disease, and socioeconomic status served as covariates in the mortality analyses. RESULTS: During the follow-up (mean 24.2 years), 341 men died from cardiovascular and 468 men from noncardiovascular causes. When compared to men with no diabetes and above-median VO2max , the presence of either diabetes (HR = 4.10, 95% CI: 2.27-7.40) or prediabetes (HR = 2.10, 95% CI: 1.18-3.73) combined with below-median VO2max increased the risk of cardiovascular death. Noncardiovascular mortality was increased by low oxygen uptake in men with prediabetes (HR = 2.24, 95% CI: 1.30-3.84), and among men with diabetes, the increase was not statistically significant (HR = 1.99, 95% CI: 0.91-4.32). CONCLUSIONS: Cardiorespiratory fitness modifies the risk of death related to prediabetes and diabetes. This highlights the importance of CRF assessment and interventions to support the uptake of regular physical activity among aging men with disturbed glucose metabolism.


Assuntos
Aptidão Cardiorrespiratória , Doenças Cardiovasculares , Diabetes Mellitus , Estado Pré-Diabético , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Glucose , Humanos , Masculino , Oxigênio , Aptidão Física/fisiologia , Estudos Prospectivos , Fatores de Risco
6.
Adv Life Course Res ; 53: 100494, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36652218

RESUMO

Sense of coherence (SOC) scale measures one's orientation to life. SOC is the core construct in Antonovsky's salutogenic model of health. It has been shown that weak SOC correlates with poor perceived health, low quality of life, and increased mortality. Some studies have indicated that SOC is not stable across life, but there are no previous studies on how a change of SOC is reflected in mortality. However, there is some evidence that a change in perceived quality of life is associated with mortality. The study explores the association between the change in SOC and mortality using longitudinal data from a cohort of middle-aged Finnish men recruited between 1986 and 1989. Approximately 11 years after the baseline examinations, between 1998 and 2001, 854 men returned the SOC questionnaire a second time. The baseline SOC was adjusted for the regression to the mean phenomenon between the two measurements. The hazard ratios of the SOC difference scores were adjusted for initial SOC age and 12 somatic risk factors of mortality (alcohol consumption, blood pressure, body mass index, cholesterol concentration, physical activity, education, smoking, marital status, employment status, history of cancer, history of cardiovascular disease and diabetes). SOC was not stable among middle-aged Finnish men and a decline in SOC was associated with an increased hazard of all-cause mortality. In the fully adjusted model, a decrease of one standard deviation (SD) of the SOC mean difference increased the mortality hazard by about 35 %, two SDs decrease about 70 %, and 2.5 SDs about 100 %. Strengthening SOC showed a limited association with decreasing mortality hazards in the age-adjusted model. Policies, strategies, or plans, supporting SOC in the middle-age may help to decrease mortality and increase quality of life in later years.


Assuntos
Doenças Cardiovasculares , Senso de Coerência , Pessoa de Meia-Idade , Masculino , Humanos , Criança , Qualidade de Vida , Seguimentos , Fatores de Risco , Inquéritos e Questionários
7.
Nutr Metab Cardiovasc Dis ; 31(7): 2051-2057, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34090772

RESUMO

BACKGROUND AND AIMS: Both blood pressure and C-reactive protein (CRP) are individually associated with cardiovascular mortality risk. However, the combined effect of systolic blood pressure (SBP) and CRP on coronary heart disease (CHD) and cardiovascular disease (CVD) mortality risk, has not been studied. METHODS AND RESULTS: We evaluated the joint impact of SBP and CRP and the risk of mortality in the Kuopio Ischemic Heart Disease prospective cohort study of 1622 men aged 42-61 years at recruitment with no history of CVD. SBP and CRP were measured. SBP was categorized as low and high (cut-off 135 mmHg) and CRP as low and high (cut-off 1.54 mg/L) based on ROC curves. Multivariable adjusted hazard ratios (HRs) with confidence intervals (CI) were calculated. During a median follow-up of 28 years, 196 cases of CHD and 320 cases of CVD deaths occurred. Elevated SBP (>135 mmHg) combined with elevated (CRP >1.54 mg/L) were associated with CHD and CVD mortality (HR 3.41, 95% CI, 2.20-5.28, p < 0.001) and (HR 2.93, 95% CI, 2.11-4.06, p < 0.001) respectively after adjustment for age, examination year, smoking, alcohol consumption, BMI, Type 2 diabetes, energy expenditure, total cholesterol, serum HDL cholesterol, antihypertensive medication and use of aspirin. CONCLUSION: The combined effect of both high systolic blood pressure and high CRP is associated with increased risk of future CHD and CVD mortality as compared with both low SBP and low CRP levels in general male Caucasian population.


Assuntos
Pressão Sanguínea , Proteína C-Reativa/análise , Doença das Coronárias/mortalidade , Hipertensão/mortalidade , Mediadores da Inflamação/sangue , Inflamação/mortalidade , Adulto , Fatores Etários , Biomarcadores/sangue , Causas de Morte , Doença das Coronárias/sangue , Doença das Coronárias/diagnóstico , Doença das Coronárias/fisiopatologia , Finlândia/epidemiologia , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
8.
Int J Cardiol ; 326: 184-188, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33130259

RESUMO

BACKGROUND: Both blood pressure and C-reactive protein (CRP) are each independently related to mortality risk. However, the combined effect of systolic blood pressure (SBP) and CRP on sudden cardiac death (SCD) risk has not been studied. PATIENTS AND METHODS: We studied the joint impact of SBP and CRP and the risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of 1953 men aged 42-61 years with no history of ischemic heart disease. Baseline investigations were conducted between March 1984 and December 1989. SBP and CRP were measured. SBP was divided based on median values to low and high (median cutoffs 132 mmHg) and CRP as low and high (median cut-off 1.30 mg/L). Hazard ratios (HRs) with confidence intervals (CIs) were calculated after multivariate adjustment. RESULTS: Subjects were followed-up for 23.2 years, and 137 SCDs occurred. In this study, elevated SBP (>132 mmHg) combined with elevated (CRP >1.30 mg/L) were associated with SCD risk. Adjustment for age, examination year, alcohol consumption, BMI, energy expenditure during exercise, total cholesterol, HDL-cholesterol, type 2 diabetes, smoking, antihypertension medication and aspirin use, the risk of SCD remained statistically significant (HR, 2,73, 95% CI, 1.62-4.60, p < .001). Further adjustment for socio-economic status, years of education and history of cardiovascular disease in a family the results were only slightly changed (HR, 2.65, 95% CI, 1.57-4.49, p < .001). CONCLUSIONS: In our male cohort study, the joint effect of high SBP together with increased CRP levels is a risk predictor of SCD compared with low SBP and CRP.


Assuntos
Proteína C-Reativa , Diabetes Mellitus Tipo 2 , Adulto , Pressão Sanguínea , Estudos de Coortes , Morte Súbita Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
9.
Ann Med ; 51(5-6): 306-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264909

RESUMO

Background: The burden of cardiovascular disease (CVD) prompted the American Heart Association to develop a cardiovascular health (CVH) metric as a measure to assess the cardiovascular status of the population. We aimed to assess the association between CVH scores and the risk of CVD mortality among a middle-aged Finnish population. Methods: We employed the prospective population-based Kuopio Ischemic Heart Disease cohort study comprising of middle-aged men (42-60 years). CVH scores were computed among 2607 participants at baseline and categorized as optimum (0-4), average (5-9), or inadequate (10-14) CVH. Multivariate cox regression models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) of CVH score for cardiovascular mortality. Results: During a median follow-up period of 25.8 years, 609 CVD mortality cases were recorded. The risk of CVD mortality increased gradually with increasing CVH score across the range 3-14 (p-value for non-linearity =.77). Men with optimum CVH score had HR (95% CI) for CVD mortality of 0.30 (CI 0.21 - 0.42, p < .0001) compared to those with inadequate CVH score after adjustment for conventional cardiovascular risk factors. Conclusions: CVH score was strongly and continuously associated with the risk of CVD mortality among middle-aged Finnish population and this was independent of other conventional risk factors. Key messages Achieving optimum cardiovascular health score reduces the risk of cardiovascular mortality. Adopting the American Heart Association's cardiovascular health metrics is a welcome approach for public health awareness and monitoring of cardiovascular health among Scandinavian population.


Assuntos
Doenças Cardiovasculares/epidemiologia , Saúde Pública/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Adulto , American Heart Association/organização & administração , Conscientização , Glicemia/análise , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Exercício Físico/fisiologia , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Saúde Pública/tendências , Fatores de Risco , Países Escandinavos e Nórdicos/epidemiologia , Fumar/epidemiologia , Estados Unidos
10.
Mayo Clin Proc ; 94(5): 833-841, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30935710

RESUMO

Cardiorespiratory fitness (CRF) is an established risk factor for cardiovascular disease outcomes. However, the relationship of CRF with risk of ventricular arrhythmias (VAs) is unknown. We aimed to assess the prospective association of CRF with the risk of serious VAs. Cardiorespiratory fitness, as measured by maximal oxygen uptake, was assessed using a respiratory gas exchange analyzer in 2299 middle-aged men in the Kuopio Ischemic Heart Disease prospective cohort. We corrected for within-person variability in CRF levels using data from repeated measurements 11 years apart. During median follow-up of 25.3 years (interquartile range, 18.7-27.2 years), 73 serious VAs were recorded. The age-adjusted regression dilution ratio of CRF was 0.58 (95% CI, 0.53-0.64). In analysis adjusted for age, the hazard ratio (HR) for serious VAs per 1-SD increase in CRF was 0.64 (95% CI, 0.49-0.84). The association persisted on additional adjustment for body mass index, systolic blood pressure, history of hypertension, prevalent coronary heart disease, smoking, history of diabetes, cholesterol level, alcohol consumption, and physical activity (HR, 0.67; 95% CI, 0.51-0.88). The corresponding adjusted HRs (95% CIs) were 0.29 (0.14-0.59) and 0.32 (0.15-0.65), respectively, comparing the top vs bottom tertiles. The associations were stronger on correction for regression dilution bias, remained consistent on exclusion of men with a history of coronary heart disease, and did not vary importantly in several relevant clinical subgroups. Cardiorespiratory fitness is inversely associated with future risk of serious VAs, independently of several cardiovascular disease risk factors. Further research is needed to assess the causal relevance of these findings.


Assuntos
Arritmias Cardíacas/epidemiologia , Aptidão Cardiorrespiratória/fisiologia , Adulto , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco
11.
Nutr Diabetes ; 9(1): 1, 2019 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-30683848

RESUMO

BACKGROUND/OBJECTIVES: Molecular mechanisms linking fish and vegetable oil intakes to their healthy metabolic effects may involve attenuation of inflammation. Our primary aim was to examine in a randomized controlled setting whether diets enriched in fatty fish (FF), lean fish (LF) or ALA-rich camelina sativa oil (CSO) differ in their effects on the mRNA expression response of selected inflammation-related genes in peripheral blood mononuclear cells (PBMCs) and subcutaneous adipose tissue (SAT) in subjects with impaired fasting glucose. SUBJECTS/METHODS: Samples from 72 participants randomized to one of the following 12-week intervention groups, FF (n = 19), LF (n = 19), CSO (n = 17) or a control group (n = 17), were available for the PBMC study. For SAT, 39 samples (n = 8, n = 10, n = 9, n = 12, respectively) were available. The mRNA expression was measured at baseline and 12 weeks by TaqMan® Low Density Array. RESULTS: In PBMCs, LF decreased ICAM1 mRNA expression (P < 0.05), which was different (P = 0.06, Bonferroni correction) from the observed increase in the FF group (P < 0.05). Also, compared to the control group, LF decreased ICAM1 mRNA expression (P < 0.05). Moreover, the change in ICAM1 mRNA expression correlated positively with the intake of FF (P < 0.05) and negatively with the intake of LF (P < 0.05), independently of study group. A diet enriched in CSO, a rich source of alpha-linolenic acid (ALA), decreased PBMC IFNG mRNA expression (P < 0.01). The intake of CSO in the CSO group, but not the increase in plasma ALA proportions, correlated inversely with the IFNG mRNA expression in PBMCs (P = 0.08). In SAT, when compared with the control group, the effect of FF on decreasing IL1RN mRNA expression was significant (P < 0.03). CONCLUSION: We propose that CSO intake may partly exert its benefits through immuno-inflammatory molecular regulation in PBMCs, while modulation of ICAM1 expression, an endothelial/vascular-related gene, may be more dependent on the type of fish consumed.


Assuntos
Brassicaceae , Dieta , Peixes , Inflamação/dietoterapia , Tecido Adiposo/metabolismo , Adulto , Idoso , Animais , Feminino , Óleos de Peixe/administração & dosagem , Expressão Gênica , Humanos , Inflamação/sangue , Resistência à Insulina , Molécula 1 de Adesão Intercelular/genética , Molécula 1 de Adesão Intercelular/metabolismo , Leucócitos Mononucleares/metabolismo , Masculino , Pessoa de Meia-Idade , Óleos de Plantas/administração & dosagem , RNA Mensageiro/análise , Resultado do Tratamento
12.
Mayo Clin Proc ; 93(9): 1266-1270, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30082082

RESUMO

OBJECTIVE: To the association between metabolically healthy overweight/obesity and the risk of sudden cardiac death in middle-aged men. PARTICIPANTS AND METHODS: This prospective study was based on a population sample of 2185 men aged 42 to 60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study. Participants were divided into 4 groups on the basis of body mass index and metabolic health status. Metabolically healthy overweight/obesity was defined as body mass index 25 kg/m2 or greater without metabolic abnormalities, and metabolically unhealthy normal weight was defined as body mass index less than 25 kg/m2 with 1 or more metabolic abnormalities. RESULTS: During a median follow-up of 26 years (interquartile range, 18.7-28.1 years), 240 sudden cardiac deaths (11%) occurred. Compared with metabolically healthy normal weight men, metabolically unhealthy overweight/obese men had a higher risk of sudden cardiac death (hazard ratio, 1.99; 95% CI, 1.03-3.85) after adjusting for potential confounders. However, metabolically healthy overweight/obese men were not at increased risk of sudden cardiac death (hazard ratio, 0.95; 95% CI, 0.40-2.24) as compared with their metabolically healthy normal weight counterparts after adjusting for age, smoking, low-density lipoprotein cholesterol level, high-sensitivity C-reactive protein level, insulin level, history of myocardial infarction, and directly measured peak oxygen uptake. CONCLUSION: Our findings indicate that metabolically healthy normal weight men and metabolically healthy overweight/obese men were at comparable risk of sudden cardiac death over a 26-year follow-up period, suggesting that a baseline body mass index of 25 kg/m2 or greater per se does not adversely affect the risk of sudden cardiac death.


Assuntos
Morte Súbita Cardíaca/etiologia , Sobrepeso/complicações , Adulto , Morte Súbita Cardíaca/epidemiologia , Finlândia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/mortalidade , Sobrepeso/mortalidade , Estudos Prospectivos , Fatores de Risco
13.
Atherosclerosis ; 269: 129-137, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29353228

RESUMO

BACKGROUND AND AIMS: We aimed to examine the association between socioeconomic status (SES) and subclinical atherosclerosis, as assessed by carotid intima-media-thickness (C-IMT) and to investigate whether the effect of social inequality on C-IMT is mediated by cardiovascular (CV) risk factors and whether it is dissimilar in men and women, and in different European countries. METHODS: We assessed the association of lifelong occupation and educational level with C-IMT in the IMPROVE study cohort including 3703 subjects (median age 64.4 years; 48% men) from Southern (Italy), Western (France and the Netherlands) and Northern Europe (Finland and Sweden). Three summary measures of C-IMT (IMTmean, IMTmax, IMTmean-max), obtained from four segments of both carotids, were considered. RESULTS: After adjusting for conventional CV risk factors, current employment status and diet, C-IMT was higher in manual workers than in white collars (+7.7%, +5.3%, +4.6% for IMTmax, IMTmean-max and IMTmean, respectively; all p<.0001). Similar results were obtained by stratification for educational level. The effect of occupation on C-IMT was comparable in men and women and in different age groups, and was only partially mediated by differences in CV risk factors. Of note, the association of C-IMT with occupation was significant in Western and Northern Europe but not in Italy, with a significant statistical interaction (p = .0005). CONCLUSIONS: Low SES was associated with subclinical atherosclerosis in subjects with at least three CV risk factors. Such association was stronger in Northern and Western Europe than in Italy. This difference was not completely explained by inequalities in CV risk factors and behavioural variables.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Escolaridade , Disparidades nos Níveis de Saúde , Ocupações , Determinantes Sociais da Saúde , Fatores Etários , Idoso , Doenças Assintomáticas , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Dieta/efeitos adversos , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais
14.
Mol Nutr Food Res ; 62(4)2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29272068

RESUMO

SCOPE: The aim of the study is to examine whether lean fish (LF), fatty fish (FF), and camelina sativa oil (CSO), a plant-based source of alpha-linolenic acid (ALA), differ in their metabolic effects in subjects with impaired glucose metabolism. METHODS AND RESULTS: Altogether 79 volunteers with impaired fasting glucose, BMI 25-36 kg m-2 , age 43-72 years, participated in a 12-week randomized controlled trial with four parallel groups, that is, the FF (four fish meals/week), LF (four fish meals/week), CSO (10 g d-1 ALA), and control (limited intakes of fish and sources of ALA) groups. The proportions of eicosapentaenoic acid and DHA increase in plasma lipids in the FF group, and the proportion of ALA increase in the CSO group (p < 0.0001 for all). In the CSO group, total and LDL-cholesterol (C) concentrations decrease compared with the FF and LF groups; LDL-C/HDL-C and ApoB/ApoA-I ratios decrease compared with the LF group. There are no significant changes in glucose metabolism or markers of low-grade inflammation. CONCLUSIONS: A diet enriched in CSO improves serum lipid profile as compared with a diet enriched in FF or LF in subjects with impaired fasting glucose, with no differences in glucose metabolism or concentrations of inflammatory markers.


Assuntos
Brassicaceae/química , Óleos de Peixe/farmacologia , Glucose/metabolismo , Lipídeos/sangue , Óleos de Plantas/farmacologia , Ácido alfa-Linolênico/farmacologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
PLoS One ; 12(3): e0173393, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28323823

RESUMO

BACKGROUND: The relation of a single risk factor with atherosclerosis is established. Clinically we know of risk factor clustering within individuals. Yet, studies into the magnitude of the relation of risk factor clusters with atherosclerosis are limited. Here, we assessed that relation. METHODS: Individual participant data from 14 cohorts, involving 59,025 individuals were used in this cross-sectional analysis. We made 15 clusters of four risk factors (current smoking, overweight, elevated blood pressure, elevated total cholesterol). Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) between clusters using those without any of the four risk factors as reference group. RESULTS: Compared to the reference, those with 1, 2, 3 or 4 risk factors had a significantly higher common CIMT: mean difference of 0.026 mm, 0.052 mm, 0.074 mm and 0.114 mm, respectively. These findings were the same in men and in women, and across ethnic groups. Within each risk factor cluster (1, 2, 3 risk factors), groups with elevated blood pressure had the largest CIMT and those with elevated cholesterol the lowest CIMT, a pattern similar for men and women. CONCLUSION: Clusters of risk factors relate to increased common CIMT in a graded manner, similar in men, women and across race-ethnic groups. Some clusters seemed more atherogenic than others. Our findings support the notion that cardiovascular prevention should focus on sets of risk factors rather than individual levels alone, but may prioritize within clusters.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Fatores Etários , Idoso , Colesterol/sangue , Análise por Conglomerados , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Modelos Lineares , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Sobrepeso/diagnóstico por imagem , Sobrepeso/epidemiologia , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia
16.
Ann Med ; 49(5): 404-410, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28166422

RESUMO

BACKGROUND: We examined whether slow heart rate recovery (HRR) after exercise testing as an estimate of impaired autonomic function is related to coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis. METHODS: We evaluated 2088 men who participated in a health-screening program that included measures of CAC and peak or symptom-limited cardiopulmonary exercise testing. HRR was calculated as the difference between peak heart rate (HR) during exercise testing and the HR at 2 min of recovery after peak exercise. We measured CAC using multidetector computed tomography to calculate the Agatston coronary artery calcium score. Advanced CAC was defined as a mean CAC >75th percentile for each age group. RESULTS: HRR was negatively correlated with CAC (r = -.14, p < .01). After adjusting for conventional risk factors, participants in the lowest quartile of HRR (<38 bpm) were 1.59 times (95% CI: 1.17-2.18; p < .05) more likely to have advanced CAC than their counterparts in the highest quartile of HRR (>52 bpm). Each 1 bpm decrease in HRR was associated with 1% increase in advanced CAC after adjusting for potential confounders. CONCLUSIONS: An attenuated HRR after exercise testing is associated with advanced CAC, independent of coronary risk factors and other related hemodynamic response. KEY MESSAGES Slow heart rate recovery (HRR) after maximal exercise testing, indicating decreased autonomic function, is associated with an increased risk of cardiovascular event and mortality. Slow HRR has been linked with the occurrence of malignant ventricular arrhythmias, but it remains unclear whether slow HRR is associated with an increased risk of coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis. An attenuated HRR after exercise testing was associated with advanced CAC, independent of coronary risk factors and other potential hemodynamic confounder, supporting the hypothesis that slow HRR is related to the burden of atherosclerotic coronary artery disease.


Assuntos
Aterosclerose/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Teste de Esforço , Frequência Cardíaca/fisiologia , Calcificação Vascular/fisiopatologia , Idoso , Aterosclerose/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/fisiopatologia , Exercício Físico/fisiologia , Tolerância ao Exercício , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Calcificação Vascular/diagnóstico
17.
Am J Hum Biol ; 29(3)2017 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-27753165

RESUMO

OBJECTIVES: We investigated whether long-term changes in cardiorespiratory fitness (CRF) predict the risk of incident hypertension, independent of risk factors, in initially normotensive men. METHODS: This prospective study from the Kuopio Ischemic Heart Disease Study included 431 male participants without hypertension who underwent symptom-limited maximal cardiopulmonary exercise testing at baseline and during a second examination, 11-years later, who were re-evaluated for hypertension at 20-year follow-up. Changes in CRF (%) were calculated as the difference in directly measured maximal oxygen uptake (VO2max ) between the baseline and second examination, and classified into decreasing tertiles as percentages. Hypertension was defined as systolic and/or diastolic blood pressure ≥140/90 mmHg or hypertension that required antihypertensive medication as diagnosed by a physician. RESULTS: During a 10-year follow-up after the second examination, 165 men (38%) developed hypertension. Men who demonstrated the largest decline in CRF between evaluations (-62.1% to -20.2%) had a 4.33-fold (95% CI 2.32-8.07, P < .001) risk of incident hypertension compared to men with the smallest decrease or improvement in CRF (-8.8% to 82.0%), after adjusting for age, follow-up duration, alcohol consumption, cigarette smoking, serum low and high density lipoprotein cholesterol, body mass index, daily energy expenditure (kcal) via physical activity, glomerular filtration rate, and baseline systolic blood pressure and VO2max . CONCLUSIONS: The present findings indicate that more marked decreases in measured CRF over time are independently associated with the risk of incident hypertension in men, suggesting that CRF should be considered a causal risk factor to predict future hypertension.


Assuntos
Aptidão Cardiorrespiratória , Hipertensão/epidemiologia , Adulto , Teste de Esforço , Finlândia/epidemiologia , Humanos , Hipertensão/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
J Atheroscler Thromb ; 24(6): 600-608, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27784848

RESUMO

AIM: Low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c), which are components of total cholesterol, have each been suggested to be linked to the risk of sudden cardiac death (SCD). However, the relationship between LDL-c/HDL-c ratio and the risk of SCD has not been previously investigated. We aimed to assess the associations of LDL-c, HDL-c, and the ratio of LDL-c/HDL-c with the risk of SCD. METHODS: Serum lipoprotein concentrations were assessed at baseline in the Finnish Kuopio Ischemic Heart Disease prospective cohort study of 2,616 men aged 42-61 years at recruitment. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed. RESULTS: During a median follow-up of 23.0 years, a total of 228 SCDs occurred. There was no significant evidence of an association of LDL-c or HDL-c with the risk of SCD. In analyses adjusted for age, examination year, body mass index, systolic blood pressure, smoking, alcohol consumption, physical activity, years of education, diabetes, previous myocardial infarction, family history of coronary heart disease, and serum high sensitivity C-reactive protein, there was approximately a two-fold increase in the risk of SCD (HR 1.94, 95% CI 1.21-3.11; p=0.006), comparing the top (>4.22) versus bottom (≤2.30) quintile of serum LDL-c/HDL-c ratio. CONCLUSION: In this middle-aged male population, LDL-c or HDL-c was not associated with the risk of SCD. However, a high serum LDL-c/HDL-c ratio was found to be independently associated with an increased risk of SCD. Further research is warranted to understand the mechanistic pathways underlying this association.


Assuntos
HDL-Colesterol/sangue , LDL-Colesterol/sangue , Morte Súbita Cardíaca , Isquemia Miocárdica/sangue , Adulto , Índice de Massa Corporal , Proteína C-Reativa/análise , Doença das Coronárias/sangue , Seguimentos , Humanos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , População Rural , População Urbana
19.
Am Heart J ; 184: 55-61, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27892887

RESUMO

BACKGROUND: To examine the prognostic value of cardiorespiratory fitness (CRF) with risk of first major nonfatal myocardial infarction (MI), stroke, and heart failure (HF) events. METHODS: Cardiorespiratory fitness, as measured by maximal oxygen uptake, was assessed at baseline in a prospective cohort of 2,089 men aged 42 to 61years. RESULTS: During a mean (SD) follow-up of 19.1(8.4) years, 522 nonfatal acute MI events, 198 acute all-cause nonfatal stroke events, and 221 nonfatal HF events were recorded. The hazard ratio per 1-metabolic-equivalent increase in CRF was 0.93 (95% CI 0.88-0.97) for nonfatal MI, 0.94 (95% CI0.87-1.01) for nonfatal stroke, and 0.84 (95% CI 0.78-0.91) for nonfatal HF events after adjustment for cardiovascular risk factors (age, systolic blood pressure, body mass index, history of cardiovascular disease, diabetes, smoking, alcohol use, serum creatinine, low-density lipoprotein levels, physical activity, and socioeconomic status). Further adjustment for left ventricular hypertrophy and resting heart rate did not attenuate these associations. Addition of CRF to conventional cardiovascular disease risk factors significantly improved both discrimination (C index) and category free net reclassification index (cf-NRI) for nonfatal MI (change in C index, 0.015 [95% CI 0.010-0.020] and change in cf-NRI 0.27, P<.01) and HF (change in C index 0.040 [95% CI 0.010-0.060] and change in cf-NRI 0.88, P<.01). CONCLUSION: In this Finnish population, there is a strong, inverse, and independent association between CRF and acute nonfatal MI and HF risk.


Assuntos
Aptidão Cardiorrespiratória , Insuficiência Cardíaca/epidemiologia , Infarto do Miocárdio/epidemiologia , Consumo de Oxigênio , Acidente Vascular Cerebral/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Coortes , Creatinina/sangue , Diabetes Mellitus/epidemiologia , Exercício Físico , Teste de Esforço , Finlândia/epidemiologia , Seguimentos , Humanos , Lipoproteínas LDL/sangue , Masculino , Equivalente Metabólico , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fumar/epidemiologia
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