Heart rate and completed suicide: evidence from the IPC cohort study.

OBJECTIVE: Many suicide-related features such as affective disorders, impulsivity, and hostility have been associated with an aberrant regulation of heart rate (HR) and blood pressure (BP). Moreover, the neural bases of HR and BP regulation are similar to those of emotion regulation. The present study examined whether high resting HR or BP would be associated with an increased risk of suicide. METHODS: Resting HR and BP were measured among 204,600 men (mean [standard deviation] age = 44.5 [12.1] years) and 119,110 women (mean [standard deviation] age = 45.0 [14.0] years), together with depressive mood and perceived stress. Age, marital status, working status, socioeconomic status, physical activity, alcohol intake, and current medications were self-reported. Dates and causes of death were obtained from the French National Institute of Statistics and Economic Studies and the French National Cause-of-Death Registry, respectively. RESULTS: During a mean follow-up of 9.1 years, 133 participants (106 men) completed suicide. Resting HR, but not BP, was positively associated with suicide, together with depressive mood, perceived stress, low body mass index, male sex, status as a current smoker, and taking a psychotropic medication. Adjusting for these covariates, resting HR still independently predicted suicide. Ten additional beats per minute increased the risk of suicide by 19% in the unadjusted model and by 24% to 37% in the adjusted models. CONCLUSIONS: Resting HR and suicide risk may share some biologic determinants, such as genetic factors or neural bases. These results may inform further attempts to understand how suicide is mediated at a brain level.

Lung function impairment and metabolic syndrome: the critical role of abdominal obesity.

RATIONALE: Increased risk for cardiovascular morbidity and mortality has been related to both lung function impairment and metabolic syndrome. Data on the relationship between lung function and metabolic syndrome are sparse. OBJECTIVES: To investigate risk for lung function impairment according to metabolic syndrome traits. METHODS: This cross-sectional population-based study included 121,965 men and women examined at the Paris Investigations Préventives et Cliniques Center between 1999 and 2006. The lower limit of normal was used to define lung function impairment (FEV(1) or FVC < lower limit of normal). Metabolic syndrome was assessed according to the American Heart Association/National Heart, Lung, and Blood Institute statement. MEASUREMENTS AND MAIN RESULTS: We used a logistic regression model and principal component analysis to investigate the differential associations between lung function impairment and specific components of metabolic syndrome. Lung function impairment was associated with metabolic syndrome (prevalence = 15.0%) independently of age, sex, smoking status, alcohol consumption, educational level, body mass index, leisure-time physical activity, and cardiovascular disease history (odds ratio [OR] [95% confidence interval], 1.28 [1.20-1.37] and OR, 1.41 [1.31-1.51] for FEV(1) and FVC, respectively). Three factors were identified from factor analysis: "lipids" (low high-density lipoprotein cholesterol, high triglycerides), "glucose-blood pressure" (high fasting glycemia, high blood pressure), and "abdominal obesity" (large waist circumference). All factors were inversely related to lung function, but abdominal obesity was the strongest predictor of lung function impairment (OR, 1.94 [1.80-2.09] and OR, 2.11 [1.95-2.29], for FEV(1) and FVC, respectively). Similar results were obtained for women and men. CONCLUSIONS: We found a positive independent relationship between lung function impairment and metabolic syndrome in both sexes, predominantly due to abdominal obesity. Further studies are required to clarify the underlying mechanisms.

The metabolic syndrome: similar deleterious impact on all-cause mortality in hypertensive and normotensive subjects.

OBJECTIVES: Few data are available on the impact of the metabolic syndrome on all-cause mortality risk according to the presence of hypertension. Our aim was to evaluate the 5-year impact of the metabolic syndrome, according to blood pressure status, on all-cause mortality risk in a large French population. METHODS: The study population included 39 998 men and 20 756 women with no personal history of cardiovascular disease, who had a health check-up at the IPC Center (Paris, France) between 1999 and 2002, and who were followed up for 4.7 +/- 1.2 years. The metabolic syndrome was defined according to the National Cholesterol Educational Program classification (2001). Cox regression models were used to evaluate risk of all-cause mortality after adjustment for age, sex, classical risk factors and socioeconomic categories. Subjects were classified according to blood pressure status: hypertensive subject (systolic blood pressure > or =140 mmHg and/or diastolic blood pressure > or =90 mmHg or treatment) and normotensive subject. RESULTS: The risk of all-cause mortality associated with the metabolic syndrome was 1.50 (1.24-1.82) [hazard ratio (HR) (95% confidence interval)]. The risk of all-cause mortality associated with the presence of hypertension was 1.60 (1.38-1.85). During the 4.7 years of follow-up, the impact of the metabolic syndrome was similar among normotensive and hypertensive subjects [HR: 1.09 (0.68-1.75) and 1.40 (1.13-1.74), respectively, P for interaction = 0.35]. CONCLUSION: The findings from this study show that, in a large middle-aged French population, the metabolic syndrome has the same deleterious impact on all-cause mortality in hypertensive subjects and normotensive subjects.

All-cause and cardiovascular mortality using the different definitions of metabolic syndrome.

The aim of the present study was to assess the risk of all-cause and cardiovascular disease (CVD) mortality in subjects identified as having metabolic syndrome (MS) using either the recent International Diabetes Federation (IDF) definition or the revised National Cholesterol Educational Program (NCEP-R) definition, but not the original NCEP (2001) definition. The study population was composed of 84,730 men and women without CVD aged > or =40 years who had a health checkup at the IPC Center. Follow-up for mortality was 4.7 +/-1.7 years. Prevalences of MS were 9.6%, 21.6%, and 16.5% according to the NCEP, IDF, and NCEP-R definitions, respectively. Compared with subjects without MS, risks of all-cause mortality associated with MS were 1.63 (95% confidence interval [CI] 1.38 to 1.93) with the NCEP, 1.25 (95% CI 1.09 to 1.45) with the IDF, and 1.32 (95% CI 1.13 to 1.53) with the NCEP-R, and risks of CVD mortality were 2.05 (95% CI 1.28 to 3.28), 1.77 (95% CI 1.18 to 2.64), and 1.64 (95% CI 1.08 to 2.50), respectively. In subjects with MS detected using the IDF and NCEP-R definitions, but not the NCEP definition, risks of all-cause mortality were 1.07 (95% CI 0.89 to 1.28) and 0.92 (95% CI 0.73 to 1.18) and 1.42 (95% CI 0.86 to 2.34) and 1.07 (95% CI 0.55 to 2.09) for CVD mortality, respectively. In conclusion, in a large French population, the recent definitions of MS almost double the prevalence compared with the original definition. Subjects identified as having MS using only the recent definitions and not the original definition did not have higher rates of all-cause and CVD mortality compared with subjects without MS during follow-up.

[Diabetes and socio-economic deprivation. A study in a large French population]. / Diabète et précarité. Etude d'une vaste population française.

Socio-economically deprived subjects are reported to have an increased risk of diabetes and related complications. The aim of this study was to confirm this relation in a large French population. The study subjects consisted of 32,435 men and 16,378 women aged from 35 to 80 years who had a free health checkup at the IPC Center (Investigations Preventives et Cliniques, Paris-Ile de France) between January 2003 and December 2006. Socio-economic deprivation was evaluated by using the EPICES approach (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé de France). Socio-economically deprived subjects were defined as those with scores in the 5th quintile. The prevalence of diabetes among deprived men and women was respectively 6% and 7% at age 35-59 years, and 18% and 15% at age 60-80 years. The prevalence of diabetes increased with level of deprivation. Compared to the 1st quintile of the EPICES score distribution, diabetes was three to eight times more frequent in the 5th quintile. After taking into account age, the body mass index, waist circumference, and anxiety and depression, the risk that deprived subjects would be diabetic (odds ratio) was respectively 4.2 and 5.2 for men and women aged 35-39 years, and 3.5 and 2.2 for those aged 60-80 years. The following cardiovascular risk markers were significantly higher or more frequent among deprived subjects: body mass, abdominal obesity, high blood pressure and the metabolic syndrome in women; and lower HDL cholesterol, higher triglyceride levels, proteinuria, a higher heart rate and additional ECG abnormalities in both men and women. Other indicators of poor health were also more frequent among deprived subjects, including anxiety and depression, smoking (among men), elevated gamma-GT and alkaline phosphatase levels, lung vital capacity, visual disorders, and dental plaque. Finally, deprived subjects also had more limited access to health care. Thus, socio-economic status markedly influences the risk of diabetes, independently of confounding factors. Several markers of cardiovascular risk and poor health were significantly more frequent among socio-economically deprived subjects, who also had more limited access to health care.

Why socially deprived populations have a faster resting heart rate: impact of behaviour, life course anthropometry, and biology--the RECORD Cohort Study.

Although studies have shown that resting heart rate (RHR) is predictive of cardiovascular morbidity/mortality, few studies focused on the epidemiology and social aetiology of RHR. Using the RECORD Cohort Study (7158 participants, 2007-2008, Paris region, France), we investigated individual/neighbourhood socioeconomic variables associated with resting heart rate, and assessed which of a number of psychological factors (depression and stress), behaviour (sport-related energy expenditure, medication use, and alcohol, coffee, and tobacco consumption), life course anthropometric factors (body mass index, waist circumference, and leg length as a marker of childhood environmental exposures), and biologic factors (alkaline phosphatase and gamma-glutamyltransferase) contributed to the socioeconomic disadvantage-RHR relationship. Combining individual/neighbourhood socioeconomic factors in a socioeconomic score, RHR increased with socioeconomic disadvantage: +0.9 [95% credible interval (CrI): +0.2, +1.6], +1.8 (95% CrI: +1.0, +2.5), and +3.6 (95% CrI: +2.9, +4.4) bpm for the 3 categories reflecting increasing disadvantage, compared with the lowest disadvantage category. Twenty-one percent of the socioeconomic disadvantage-RHR relationship was explained by sport practise variables, 9% by waist circumference, 7% by gamma-glutamyltransferase, 5% by alkaline phosphatase, and 3% by leg length. Future research should further clarify the mechanisms through which socioeconomic disadvantage influences resting heart rate, as a pathway to social disparities in cardiovascular morbidity/mortality.

Individual/neighborhood social factors and blood pressure in the RECORD Cohort Study: which risk factors explain the associations?

Recent studies have started to suggest that, beyond effects of individual socioeconomic profiles, socioeconomic characteristics of residential neighborhoods are independently associated with blood pressure. However, mechanisms involved in these associations remain unknown. To distinguish between different mechanisms, we investigated whether specific risk factors of hypertension (physical inactivity, alcohol consumption, smoking, body mass index, waist circumference, and resting heart rate) intervene as mediators in the associations between individual or neighborhood socioeconomic characteristics and systolic blood pressure. We relied on data from the RECORD Cohort Study (Residential Environment and CORonary heart Disease) on 5941 participants recruited in 2007-2008, aged 30 to 79 years, residing in 1824 neighborhoods in the Paris metropolitan area. Systolic blood pressure increased independently and regularly with both decreasing individual education and decreasing residential neighborhood education. Body mass index/waist circumference and resting heart rate mediated an appreciable share of the associations between education and blood pressure and, adding validity to the finding, were the 2 most significant mediators for the effects of both individual education and neighborhood education. We found that 52% (95% CI: 25% to 79%) of the association between neighborhood education and blood pressure was mediated by body mass index/waist circumference and 20% (95% CI: 5% to 36%) by resting heart rate. Future research will have to clarify the exact mechanisms through which body weight and shape and resting heart rate intervene as mediators in the associations between individual/neighborhood education and blood pressure.

Impact of clinical, psychological, and social factors on decreased Tinetti test score in community-living elderly subjects: a prospective study with two-year follow-up.

BACKGROUND: Balance and gait are essential to maintain physical autonomy, particularly in elderly people. Thus the detection of risk factors of balance and gait impairment appears necessary in order to prevent falls and dependency. The objective of this study was to analyze the impact of demographic, social, clinical, psychological, and biological parameters on the decline in balance and gait assessed by the Tinetti test (TT) after a two-year follow-up. MATERIAL/METHODS: This prospective study was conducted among community-living, young elderly volunteers in the centre "Investigations Preventives et Cliniques" and "Observatoire De l'Age" (Paris, France). Three hundred and forty-four participants aged 63.5 on average were enrolled and performed the TT twice, once at inclusion and again two years later. After the two-year follow-up, two groups were constituted according to whether or not there was a decrease in the TT score: the "TT no-deterioration" group comprised subjects with a decrease of less than two points and the "TT deterioration" group comprised those with a decrease of two points or more. Selected demographic, social, clinical, psychological, and biological parameters for the two groups were then compared. RESULTS: Statistical analysis showed that female sex, advanced age, high body mass index, osteoarticular pain, and a high level of anxiety all have a negative impact on TT score. CONCLUSIONS: Knowledge of predictive factors of the onset or worsening of balance and gait disorders could allow clinicians to detect young elderly people who should benefit from a specific prevention program.

Recent advances in metabolic syndrome and cardiovascular disease.

Metabolic syndrome is defined as an association of central obesity and several other cardiometabolic risk factors. Dysfunctional visceral adipose tissue and inflammatory status appear to be involved in its genesis. New definitions have decreased the threshold for glycaemia and one has lowered the threshold for waist circumference, leading to an increase in the prevalence of metabolic syndrome. However, the impact on mortality with these new definitions is lower than with the National Cholesterol Education Program-Adult Treatment Panel III 2001 definition. An increase in waist circumference, along with increased glycaemia, triglycerides and/or blood pressure is more highly associated with an increased risk of mortality than are other associations, while a decrease in high density lipoprotein cholesterol increases risk of coronary heart disease. The risk of sudden death and stroke is particularly notable with metabolic syndrome. Metabolic syndrome is associated with an increase in heart rate, pulse pressure, arterial stiffness and left ventricular hypertrophy, impairment of diastolic function, enlargement of the left atrium and atrial fibrillation. In the 2007 European recommendations for the management of high blood pressure, metabolic syndrome is now taken into consideration for both risk stratification and in selecting the optimal therapeutic strategy for arterial hypertension.

All-cause mortality associated with specific combinations of the metabolic syndrome according to recent definitions.

OBJECTIVE: The aim was to evaluate the impact of specific component combinations of the metabolic syndrome on all-cause mortality risk in a large French cohort. RESEARCH DESIGN AND METHODS: The population was composed of 39,998 men (aged 52.6 +/- 8.3 years) and 20,756 women (aged 54.7 +/- 9.2 years) who were examined at the Investigations Préventives et Cliniques Center from 1999 to 2002. Mean follow-up was 3.57 +/- 1.12 years. Metabolic syndrome was defined according to three definitions: the National Cholesterol Educational Program (NCEP 2001), the revised NCEP (NCEP-R; American Heart Association/National Heart, Lung, and Blood Institute 2005), and the International Diabetes Federation (IDF 2005). Subjects with metabolic syndrome were compared with subjects without metabolic syndrome and with subjects with no metabolic syndrome components using Cox regression models. RESULTS: The prevalence of metabolic syndrome increased from 10.3% (NCEP) to 17.7% (NCEP-R) and 23.4% (IDF). After adjustment for age, sex, classical risk factors, and socioprofessional categories, and compared with subjects without metabolic syndrome, the risk of all-cause mortality was 1.79 (95% CI 1.35-2.38), 1.46 (1.14-1.88), and 1.32 (1.04-1.67) with the NCEP, NCEP-R, and IDF definitions, respectively. Among the combinations significantly associated with all-cause mortality, the following three-component combinations and the four-component combination were more highly significant than other combinations (P < 0.05): elevated waist circumference plus elevated glucose, plus either elevated blood pressure or elevated triglycerides, and the combination of all four of these. CONCLUSIONS: In a large middle-aged French population, four specific components of metabolic syndrome are associated with a much higher mortality risk. These results may have a significant impact on detecting high-risk subjects suffering from metabolic disorders and underline the fact that metabolic syndrome is a nonhomogeneous syndrome.