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1.
J Affect Disord ; 264: 348-357, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32056771

RESUMO

BACKGROUND: Reported traditional gender role attitudes (GRAs) have been related to worse mental health in western countries. This study examined the link of GRAs with symptoms of depression and generalised anxiety disorder (GAD) in two Russian cities. METHODS: We used interview data from the cross-sectional Know Your Heart Study conducted among 5099 adults aged 35-69 in the Russian cities of Arkhangelsk and Novosibirsk between 2015 and 2017. Attitudes about gender inequality and division of labour between women and men at home or in the public sphere were measured by single items. Binary variables indicating presence of symptoms of depression and GAD were defined by a cut-off of ≥ 5 of the PHQ-9 and GAD-7 scores respectively. Multivariable logistic regression was used to determine crude and adjusted associations. RESULTS: There was evidence that all types of GRAs were associated with symptoms of depression and GAD consistent with a U-shape after controlling for confounding with stronger evidence for all relationships for depression than for GAD. Odds of depressive symptoms were elevated among participants strongly agreeing to gender inequality and gender division of labour. There was good evidence for effect measure modification by age. LIMITATIONS: The possibilities of measurement error of the exposure and outcomes, residual confounding and reverse causality are important limitations of this study. CONCLUSIONS: Agreeing to gender inequality and gender division of labour was associated with reporting symptoms of common mental disorders in Russia. This study adds evidence for a link of GRAs with mental health from a non-western context.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32040668

RESUMO

PURPOSE: Studies suggest that frequent contact with friends and relatives promote mental wellbeing in later life, but most evidence comes from Western populations. We investigated the prospective relationship between frequency of contact with friends and relatives and quality of life (QoL) among older Central and Eastern European (CEE) adults and whether depressive symptoms mediated the hypothesised longitudinal relationship. METHODS: Data from 6106 participants from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study were used. Frequency of contact with friends and relatives was measured at baseline. QoL, at baseline and follow-up, was measured by the Control, Autonomy, Self-realisation, and Pleasure (CASP) 12-item scale. After assessing the prospective association using multivariable linear regression, the mediational hypothesis was tested using path analysis. RESULTS: There was a significant prospective association between frequency of contact with friends and relatives and CASP-12 score (0-36) in fully adjusted models. Per every one unit increase in frequency of contact, there was a 0.12 (95% CI 0.06, 0.17) increase in CASP-12 score at follow-up, accounting for sociodemographic, health-related and baseline QoL. Pathway results showed that 81% of the longitudinal effect of frequency of contact on QoL was mediated through depressive symptoms. CONCLUSIONS: Frequent contact with friends and relatives improves QoL of older Central and Eastern European adults, partly through buffering against depressive symptoms. Interventions to improve QoL at older ages should incorporate effective management of common mental disorders such as depression.

3.
Hypertension ; 74(6): 1333-1342, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31630575

RESUMO

Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P≤0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension.

4.
JAMA ; 322(5): 409-420, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386134

RESUMO

Importance: Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes. Objective: To evaluate the association of BP indexes with death and a composite CV event. Design, Setting, and Participants: Longitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016). Exposures: Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings). Main Outcomes and Measures: Multivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC). Results: Among 11 135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P < .001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an AUC of 0.83 for mortality and 0.84 for the CV outcomes. Adding 24-hour or nighttime systolic BP to base models that included other BP indexes resulted in incremental improvements in the AUC of 0.0013 to 0.0027 for mortality and 0.0031 to 0.0075 for the composite CV outcome. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. These findings were consistent for diastolic BP. Conclusions and Relevance: In this population-based cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite CV outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. Thus, 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk, although statistically, model improvement compared with other blood pressure indexes was small.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/epidemiologia , Hipertensão/complicações , Adulto , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/etiologia , Ritmo Circadiano , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
5.
Soc Sci Med ; 237: 112454, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31376532

RESUMO

RATIONALE: Two gaps in the literature arise on the relationship between social cohesion and depressive disorders. Firstly, there is a lack of studies comparing countries with diverse communal bonds and population-level differences in depression. Secondly, most work on explanatory mechanisms has overwhelmingly focussed on social network and social support pathways. OBJECTIVES: We compared the prospective association between perceived neighbourhood social cohesion and depressive symptoms among older adults in England, the Czech Republic, Poland and Russia; and examined whether psychological and health behavioural pathways mediated this association. METHODS: Harmonized data on 26,081 adults from the English Longitudinal Study of Ageing (ELSA), and the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) studies were analysed. Prospective associations between perceived neighbourhood social cohesion at baseline and depressive symptoms at follow-up were assessed using multivariable negative binomial regression. The psychological (through control of life, and control at home) and health behavioural (through smoking and drinking) pathways were tested using path analysis. RESULTS: Low cohesion predicted a higher number of depressive symptoms at follow-up among English (b = 0.106, p = 0.001), Czech (b=0.203, p < 0.001), Polish (0.115, p < 0.001) and Russian adults (b = 0.087, p < 0.001). Indirect effects via psychological mechanisms were strong and explained 64% (Poland), 82% (Russia), 84% (England) and 95% (Czech Republic) of the total indirect effects from low cohesion to elevated symptoms in these populations. Indirect effects via health behaviours were much weaker by comparison. CONCLUSIONS: Prospective associations between low social cohesion and increased depressive symptoms were largely congruent among older adults from England and three Central and Eastern European countries. These associations operated via a psychological, but not a health behavioural, pathway among ageing adults living in diverse parts of Europe.

6.
Hypertension ; 74(4): 776-783, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378104

RESUMO

The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.


Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Hipertensão/diagnóstico , Adulto , Idoso , American Heart Association , Monitorização Ambulatorial da Pressão Arterial/métodos , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos
7.
Biomolecules ; 9(7)2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31330999

RESUMO

The 9p21.3 chromosomal region is a marker of the risk of cardiovascular diseases. The aim of this study was to analyze single-nucleotide polymorphism rs1333049 (chr9:22125504) in the population of Western Siberia (Russia) and possible associations with clinical and biochemical parameters. The population included in the analyses was selected from a sample surveyed within the framework of the Health, Alcohol and Psychosocial Factors In Eastern Europe (HAPIEE) study (9360 participants, >90% white, aged 45-69, males: 50%). In total, 2729 randomly selected patients were included. Plasma lipid levels were determined by standard enzymatic assays. Rs1333049 was analyzed by RT-PCR (BioLabMix, Russia). Frequencies of rs1333049 genotypes C/C (homozygote), C/G (heterozygote), and G/G were 0.22, 0.51, and 0.27 in this population. The Allele G frequency was 0.53. We found an association of allele G with total cholesterol and low-density lipoprotein cholesterol levels among male participants (p = 0.004 and p = 0.002, respectively). Allele C was significantly associated with the risk of myocardial infarction among the male participants (odds ratio 1.96, 95% confidence interval 1.14-3.38, p = 0.017) and the study population (odds ratio 1.83, 95% confidence interval 1.23-2.72, p = 0.004). Thus, rs1333049 is associated with myocardial infarction in the white population of Western Siberia (Russia).

8.
Gene ; 707: 30-35, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31055022

RESUMO

BACKGROUND: Alcohol intake and tobacco smoking have significant negative health consequences and both are influenced by genetic predispositions. Some studies suggest that the FTO gene is associated with alcohol consumption. We investigated whether a tagging variant (rs17817449) within the FTO gene is associated with alcohol intake, problem drinking and smoking behaviour. METHODS: We analysed data from 26,792 Caucasian adults (47.2% of males; mean age 58.9 (±7.3) years), examined through the prospective cohort HAPIEE study. The primary outcomes were daily alcohol consumption, binge drinking, problem drinking (CAGE score 2+) and smoking status in relation to tagging variants within the FTO and ADH1B genes. RESULTS: We found no significant association of the FTO polymorphism with smoking status in either sex. The associations of the FTO polymorphism with drinking pattern were inconsistent and differed by gender. In men, GG homozygote carriers had lower odds of problem drinking (OR 0.85, 95% CI 0.75-0.96, p = 0.03). In women, the combination of the FTO/ADH1B GG/+A genotypes doubled the risk of binge drinking (OR 2.10, 95% CI 1.19-3.71, p < 0.05), and the risk was further increased among smoking women (OR 4.10, 95% CI 1.64-10.24, p = 0.008). CONCLUSIONS: In this large population study, the FTO gene appeared associated with binge and problem drinking, and the associations were modified by sex, smoking status and the ADH1B polymorphism.


Assuntos
Álcool Desidrogenase/genética , Consumo de Bebidas Alcoólicas/genética , Alcoolismo/genética , Bebedeira/genética , Polimorfismo de Nucleotídeo Único , Idoso , Dioxigenase FTO Dependente de alfa-Cetoglutarato/genética , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Interação Gene-Ambiente , Estudos de Associação Genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Fumar/genética
9.
J Hum Hypertens ; 33(9): 671-678, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30842546

RESUMO

Diet rich in fruits and vegetables (F&V) is an established protective factor for hypertension, but the available evidence regarding the impact of F&V consumption on age-related blood pressure change is limited. We examined whether systolic (SBP) and diastolic (DBP) blood pressure trajectories are influenced by F&V intakes in an ageing Russian cohort. Dietary data was available for 8997 men and women in the Health, Alcohol and Psychosocial Factors in Eastern Europe prospective cohort study. Blood pressure measurements were taken at three time-points over 12 years of follow-up, during which time the mean age of the sample changed from 58 to 69 years. The relationships between F&V intake and SBP and DBP were assessed using mixed-effect multilevel models. In the multivariable adjusted models, fruit intake was inversely related to both systolic and diastolic blood pressure at baseline (mean SBP and DBP was 3.5 mmHg and 1.4 mm Hg lower in the highest compared to the lowest intake tertiles, respectively (both p values < 0.001)). However, it was not associated with blood pressure change over time (difference in annual SBP and DBP change was 0.11 mmHg (p value = 0.138) and 0.01 mmHg (p value = 0.894), respectively). We found no significant link between vegetable intake and blood pressure, neither cross-sectionally nor longitudinally. In addition to the association with diet, we observed increasing SBP and mostly steady DBP over age, with deceleration and downward turn after the ages of 55-59 years. On the whole, this analysis found no consistent association between F&V intake and trajectories of blood pressure in older age.

10.
J Epidemiol Community Health ; 73(2): 117-122, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30385516

RESUMO

BACKGROUND: Social cohesion has a potential protective effect against depression, but evidence for Central and Eastern Europe is lacking. We investigated the prospective association between social cohesion and elevated depressive symptoms in the Czech Republic, Russia and Poland, and assessed whether alcohol drinking and smoking mediated this association. METHODS: Cohort data from 15 438 older urban participants from the Health, Alcohol and Psychosocial factors In Eastern Europe project were analysed. Baseline social cohesion was measured by five questions, and depressive symptoms were measured 3 years later by the 10-item Center for Epidemiological Depression (CES-D) Scale. Nested logistic regression models estimated ORs of elevated depressive symptoms (CES-D 10 score ≥4) by z-scores and tertiles of social cohesion. RESULTS: Per 1 SD decrease in social cohesion score, adjusted ORs of elevated depressive symptoms were 1.13 (95% CI 1.05 to 1.23) and 1.05 (95% CI 0.99 to 1.13) in men and women, respectively. Further adjustment for smoking and drinking did not attenuate these associations in either men (OR=1.13, 95% CI 1.05 to 1.22) or women (OR=1.05, 95% CI 0.99 to 1.13). Similarly, the fully adjusted ORs comparing the lowest versus highest social cohesion tertile were 1.33 (95% CI 1.10 to 1.62) in men and 1.18 (95% CI 1.01 to 1.39) in women. CONCLUSIONS: Lower levels of social cohesion was associated with heightened depressive symptoms after a 3-year follow-up among older Czech, Russian and Polish adults. These effects appeared stronger in men, and alcohol and smoking played no appreciable role in this association.

11.
Wellcome Open Res ; 3: 67, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30123849

RESUMO

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.

12.
Sci Rep ; 8(1): 16627, 2018 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-30413768

RESUMO

Previous studies suggest that reduced leukocyte telomere length (LTL) is related to higher risk of mortality and several chronic conditions, including coronary heart disease (CHD) and stroke. However, the consistency of this association differs across populations. We investigated the relationship of LTL with CHD, stroke and all-cause mortality together with non-fatal CHD and stroke events in a Russian cohort with a mean age of 58 years at baseline. Data from 1,144 individuals in the Russian subset of the Health Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) cohort study were used. The associations between LTL at baseline and fatal/non-fatal outcomes during 12 years of follow-up were assessed using multivariable Cox regression models, which yielded adjusted hazard ratios (HR). Compared to individuals in the shortest tertile, those in the longest tertile of LTL had a 42% lower risk of death from all-causes (HR 0.58; 95% CI: 0.39-0.88) and 58% lower risk of death from CHD (HR 0.42; 95%CI: 0.19-0.97). Similar patterns of association were identified for non-fatal and combined fatal/non-fatal CHD and stroke events but the associations were weaker. Consistent with results of previous studies in Western populations, this cohort of elderly Russian adults found an inverse association between LTL and CHD and all-cause mortality. These findings reinforce the hypothesis that LTL may play (or be a marker of) an aetiological role in human health across diverse populations.


Assuntos
Doença das Coronárias/mortalidade , Leucócitos/metabolismo , Acidente Vascular Cerebral/mortalidade , Homeostase do Telômero/genética , Telômero/genética , Idoso , Doença das Coronárias/etiologia , Doença das Coronárias/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Federação Russa , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Taxa de Sobrevida
13.
PLoS One ; 13(7): e0200460, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30001406

RESUMO

BACKGROUND: Unhealthy diet may increase the risk of impaired physical functioning in older age. Although poor diet and limited physical functioning both seem to be particularly common in Eastern Europe, no previous study has assessed the relationship between these two factors in this region. The current analysis examined the association between overall diet quality and physical functioning in Eastern European populations. METHODS: We used data on 25,504 persons (aged 45-69 years at baseline) who participated in the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Dietary assessment at baseline used food frequency questionnaire, and the overall diet quality was evaluated by the Mediterranean diet score (MDS). Physical functioning (PF) was measured by the physical functioning subscale (PF-10) of the 36-item Short-Form Health Survey at baseline and three subsequent occasions over a 10-year period. The cross-sectional and longitudinal relationships between the MDS and PF were examined simultaneously using growth curve models. RESULTS: Men and women with higher adherence to the Mediterranean diet had significantly better PF at baseline; after multivariable adjustment, the regression coefficient per 1-unit increase in the MDS was 0.39 (95% CI: 0.25, 0.52) in men and 0.50 (0.36, 0.64) in women. However, we found no statistically significant link between baseline MDS and the subsequent slope of PF decline in neither gender; the coefficients were -0.02 (-0.04, 0.00) in men and -0.01 (-0.03, 0.02) in women. DISCUSSION: Our results do not support the hypothesis that the Mediterranean diet has a substantial impact on the trajectories of physical functioning, although the differences existing at baseline may be related to dietary habits in earlier life.


Assuntos
Envelhecimento , Dieta Mediterrânea , Aptidão Física , Idoso , Estudos Transversais , Europa Oriental/epidemiologia , Comportamento Alimentar , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
14.
Blood Press ; 27(6): 341-350, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29909698

RESUMO

BACKGROUND: Guidelines on the required number of ambulatory blood pressure (ABP) readings focus on individual patients. Clinical researchers often face the dilemma of applying recommendations and discarding potentially valuable information or accepting fewer readings. METHODS: Starting from ABP recordings with ≥30/≥10 awake/asleep readings in 4277 participants enrolled in eight population studies in the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO), we randomly selected a certain number of readings (from 30 to 1 awake and 10 to 1 asleep readings) at a time over 1000 bootstraps at each step. We evaluated: (i) concordance of the ABP level; (ii) consistency of the cross-classification based on office blood pressure and ABP; and (iii) accuracy in predicting cardiovascular complications. For each criterion, we fitted a regression line joining data points relating outcome to the number of readings covering the ranges of 30-20/10-7 for awake/asleep readings. RESULTS: Reducing readings widened the SD of the systolic/diastolic differences between full (reference) and selected recordings from 1.7/1.2 (30 readings) to 14.3/10.3 mm Hg (single reading) during wakefulness, and from 1.9/1.4 to 10.3/7.7 mm Hg during sleep; lowered the κ statistic from 0.94 to 0.63, and decreased the hazard ratio associated with 10/5 mm Hg increments in systolic/diastolic ABP from 1.21/1.14 to 1.06/1.04 during wakefulness and from 1.26/1.17 to 1.14/1.08 during sleep. The first data points falling off these regression lines during wakefulness/sleep corresponded to 8/3 and 8/4 readings for criteria (i) and (iii) and to 5 awake readings for criterion (ii). CONCLUSIONS: 24-h ambulatory recordings with ≥8/≥4 awake/asleep readings yielded ABP levels similar to recordings including the guideline-recommended ≥20/≥7 readings. These criteria save valuable data in a research setting, but are not applicable to clinical practice.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Bases de Dados Factuais , Sono , Vigília , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
15.
Heart ; 104(15): 1263-1270, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29440183

RESUMO

OBJECTIVE: Data on the contribution of ambulatory blood pressure (ABP) components to the risk of developing atrial fibrillation (AF) are limited. We prospectively tested the hypothesis that ABP may represent a potentially modifiable risk factor for the development of AF in a European population study. METHODS: We recorded daytime blood pressure (BP) in 3956 subjects randomly recruited from the general population in five European countries. Of these participants, 2776 (70.2%) underwent complete 24-hour ABP monitoring. Median follow-up was 14 years. We defined daytime systolic BP load as the percentage BP readings above 135 mm Hg. The incidence of AF was assessed from ECGs obtained at baseline and follow-up and from records held by general practitioners and/or hospitals. RESULTS: Overall, during 58 810 person-years of follow-up, 143 participants experienced new-onset AF. In adjusted Cox models, each SD increase in baseline 24 hours, daytime and night-time systolic BP was associated with a 27% (P=0.0056), 22% (P=0.023) and 20% (P=0.029) increase in the risk for incident AF, respectively. Conventional systolic BP was borderline associated with the risk of AF (18%; P=0.06). As compared with the average population risk, participants in the lower quartile of daytime systolic BP load (<3%) had a 51% (P=0.0038) lower hazard for incident AF, whereas in the upper quartile (>38%), the risk was 46% higher (P=0.0094). CONCLUSIONS: Systolic ABP is a significant predictor of incident AF in a population-based cohort. We also observed that participants with a daytime systolic BP load >38% had significantly increased risk of incident AF.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Hipertensão/complicações , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
16.
PLoS Med ; 14(12): e1002459, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29211726

RESUMO

BACKGROUND: Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations. METHODS: Participants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43-74 years and free of CVD at baseline examination during 2002-2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years. RESULTS: During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14-1.40] and 1.81 [95% confidence interval 1.24-2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%-13%] to 22% [11%-31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature. CONCLUSIONS: Six psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.


Assuntos
Doenças Cardiovasculares , Depressão , Solidão , Psicologia , Fatores Socioeconômicos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/psicologia , Comorbidade , República Tcheca/epidemiologia , Demografia , Depressão/epidemiologia , Depressão/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Prospectivos , Fatores de Risco , Federação Russa/epidemiologia
17.
BMJ ; 358: j3542, 2017 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-28855160

RESUMO

Objective To determine whether educational attainment is a causal risk factor in the development of coronary heart disease.Design Mendelian randomisation study, using genetic data as proxies for education to minimise confounding.Setting The main analysis used genetic data from two large consortia (CARDIoGRAMplusC4D and SSGAC), comprising 112 studies from predominantly high income countries. Findings from mendelian randomisation analyses were then compared against results from traditional observational studies (164 170 participants). Finally, genetic data from six additional consortia were analysed to investigate whether longer education can causally alter the common cardiovascular risk factors.Participants The main analysis was of 543 733 men and women (from CARDIoGRAMplusC4D and SSGAC), predominantly of European origin.Exposure A one standard deviation increase in the genetic predisposition towards higher education (3.6 years of additional schooling), measured by 162 genetic variants that have been previously associated with education.Main outcome measure Combined fatal and non-fatal coronary heart disease (63 746 events in CARDIoGRAMplusC4D).Results Genetic predisposition towards 3.6 years of additional education was associated with a one third lower risk of coronary heart disease (odds ratio 0.67, 95% confidence interval 0.59 to 0.77; P=3×10-8). This was comparable to findings from traditional observational studies (prevalence odds ratio 0.73, 0.68 to 0.78; incidence odds ratio 0.80, 0.76 to 0.83). Sensitivity analyses were consistent with a causal interpretation in which major bias from genetic pleiotropy was unlikely, although this remains an untestable possibility. Genetic predisposition towards longer education was additionally associated with less smoking, lower body mass index, and a favourable blood lipid profile.Conclusions This mendelian randomisation study found support for the hypothesis that low education is a causal risk factor in the development of coronary heart disease. Potential mechanisms could include smoking, body mass index, and blood lipids. In conjunction with the results from studies with other designs, these findings suggest that increasing education may result in substantial health benefits.


Assuntos
Doença das Coronárias/genética , Escolaridade , Estudo de Associação Genômica Ampla , Análise da Randomização Mendeliana , Doença das Coronárias/prevenção & controle , Europa (Continente)/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Estudos Observacionais como Assunto , Fatores de Risco , Classe Social
18.
Maturitas ; 103: 37-44, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28778331

RESUMO

OBJECTIVES: To evaluate, among the elderly, the association of self-rated health (SRH) with mortality, and to identify determinants of self-rating health as "at-least-good". STUDY DESIGN: Individual data on SRH and important covariates were obtained for 424,791 European and United States residents, ≥60 years at recruitment (1982-2008), in eight prospective studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios, HRs) in relation to SRH were calculated and subsequently combined with random-effect meta-analyses. MAIN OUTCOME MEASURES: All-cause, cardiovascular and cancer mortality. RESULTS: Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH "fair" or "poor" vs. "at-least-good" was associated with increased mortality: HRs 1.46 (95% CI 1·23-1.74) and 2.31 (1.79-2.99), respectively. These associations were evident: for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently, for medical history explained only a modest amount of the unadjusted associations. Factors favourably associated with SRH were: sex (males), age (younger-old), education (high), marital status (married/cohabiting), physical activity (active), body mass index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence). CONCLUSION: SRH provides a quick and simple tool for assessing health and identifying groups of elders at risk of early mortality that may be useful also in clinical settings. Modifying determinants of favourably rating health, e.g. by increasing physical activity and/or by eliminating obesity, may be important for older adults to "feel healthy" and "be healthy".


Assuntos
Doenças Cardiovasculares/mortalidade , Nível de Saúde , Neoplasias/mortalidade , Autorrelato , Europa (Continente)/epidemiologia , Humanos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estados Unidos/epidemiologia
19.
J Epidemiol Community Health ; 71(8): 771-778, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28515210

RESUMO

BACKGROUND: Inverse associations between perceived control and cardiovascular disease (CVD) have been reported in studies from Western Europe and the USA. To assess this relationship across different populations, we investigated the association between perceived control and all-cause and CVD mortality in three population-based cohorts of Eastern European countries. METHODS: We analysed data from a prospective cohort study in random population samples in Krakow (Poland), Novosibirsk (Russia) and six Czech towns. Baseline survey included structured questionnaire and objective examination in a clinic. Perceived control was assessed using an 11-item scale developed by the MacArthur Foundation Programme on Successful Midlife. Information on vital status was obtained from death registers. Effect of perceived control on mortality was assessed using Cox proportional hazards models. RESULTS: A total of 2377 deaths (1003 from CVD) occurred among 27 249 participants over a median 7-year follow-up. In the Czech and Polish cohorts, perceived control was inversely associated with mortality; the adjusted HRs for the lowest versus highest control quintiles were 1.71 (1.34 to 2.19) in men and 1.63 (1.14 to 2.35) in women for all-cause mortality and 2.31 (1.48 to 3.59) and 5.50 (2.14 to 14.13) for CVD deaths. There was no association between perceived control and mortality in Russia; the adjusted HRs for all-cause mortality were 1.03 (0.79 to 1.34) in men and 1.29 (0.82 to 2.02) in women. CONCLUSIONS: Low perceived control was associated with increased risk of all-cause and CVD mortality in Czech and Polish cohorts but not in Russia. It is possible that this inconsistency may partly reflect a different sociocultural understanding of the concept of control in Russia.


Assuntos
Doenças Cardiovasculares/mortalidade , Causas de Morte , Comportamento de Redução do Risco , População Urbana , Idoso , Tchecoslováquia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Federação Russa/epidemiologia , Inquéritos e Questionários
20.
Hypertension ; 70(1): 50-58, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28483916

RESUMO

Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%-86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%-66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%-74.1%) and 38.6% (10.1%-55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%-71.9%) and 45.6% (18.6%-64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%-56.2%). Masked hypertension (conventional BP <140/90 mm Hg and ambulatory BP ≥130/80 mm Hg) occurred in 16.9% (8.8%-30.5%) of 3320 untreated subjects who were normotensive on conventional measurement. Exclusion of participants with diabetes mellitus, obesity, hypercholesterolemia, or history of cardiovascular complications resulted in a <9% reduction in the conventional and 24-hour ambulatory hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Idoso , Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/estatística & dados numéricos , Estudos de Coortes , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Vida Independente/estatística & dados numéricos , Cooperação Internacional , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos
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