Digital health intervention during cardiac rehabilitation: A randomized controlled trial Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. Leisure time physical activity and long-term cardiovascular and cancer outcomes: the Busselton Health Study The relationship of fibrinogen and factors VII and VIII to incident cardiovascular disease and death in the elderly: results from the cardiovascular health study. High Diet Quality Is Associated with a Lower Risk of Cardiovascular Disease and All-Cause Mortality in Older Men123 Serial measures of circulating biomarkers of dairy fat and total and cause-specific mortality in older adults: the Cardiovascular Health Study. Dietary fried fish intake increases risk of CVD: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary Health Care project (SUPRIM). Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. What level of physical activity protects against premature cardiovascular death? The Caerphilly study Prognostic value of depression, anxiety, and anger in hospitalized cardiovascular disease patients for predicting adverse cardiac outcomes. Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms. Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: a nationwide cohort study. A cardiovascular disease policy model that predicts life expectancy taking into account socioeconomic deprivation Plasma total homocysteine: instigator or indicator of cardiovascular disease? Depression and cardiovascular sequelae in postmenopausal women. The Women's Health Initiative (WHI). Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50 225 walkers from 11 population British cohorts Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort. Sarcopenic Obesity and Risk of Cardiovascular Disease and Mortality: A Population-Based Cohort Study of Older Men Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study Influence of Lifestyle on Incident Cardiovascular Disease and Mortality in Patients With Diabetes Mellitus. Nut Consumption in Relation to Cardiovascular Disease Incidence and Mortality Among Patients With Diabetes Mellitus Microalbuminuria independently predicts all-cause and cardiovascular mortality in a British population: The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study. Hand function assessment in patients receiving haemodialysis. Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population. Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn Study Estimating the benefits of modifying risk factors of cardiovascular disease: a comparison of primary vs secondary prevention. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Potato consumption and risk of cardiovascular disease: 2 prospective cohort studies. Hyperhomocysteinaemia: a significant risk factor for cardiovascular disease in renal transplant recipients. Ready-to-Eat Cereal Consumption with Total and Cause-Specific Mortality: Prospective Analysis of 367,442 Individuals Serum parathyroid hormone in relation to all-cause and cardiovascular mortality: the Hoorn study. Depressive Symptoms and Mortality in Men: Results From the Multiple Risk Factor Intervention Trial
Background Digital health interventions ( DHI ) have been shown to improve intermediates of cardiovascular health , but their impact on cardiovascular ( CV ) outcomes has not been fully explored . The aim of this study was to determine whether DHI administered during cardiac rehabilitation ( CR ) would reduce CV‐related emergency department ( ED ) visits and rehospitalizations in patients after percutaneous coronary intervention ( PCI ) for acute coronary syndrome ( ACS ) . Methods We r and omized patients undergoing CR following ACS and PCI to st and ard CR ( n = 40 ) or CR + DHI ( n = 40 ) for 3 months with 3 patients withdrawing from CR prior to initiation in the treatment arm and 6 in the control group . The DHI incorporated an online and smartphone‐based CR platform asking the patients to report of dietary and exercise habits throughout CR as well as educational information toward patients ' healthy lifestyles . We obtained data regarding ED visits and rehospitalizations at 180 days , as well as other metrics of secondary CV prevention at baseline and 90 days . Results Baseline demographics were similar between the groups . The DHI + CR group had improved weight loss compared to the control group ( −5.1 ± 6.5 kg vs. −0.8 ± 3.8 kg , respectively , P = .02 ) . Those in the DHI + CR group also showed a non‐significant reduction in CV‐related rehospitalizations plus ED visits compared to the control group at 180 days ( 8.1 % vs 26.6 % ; RR 0.30 , 95 % CI 0.08‐1.10 , P = .054 ) . Conclusions The current study demonstrated that complementary DHI  significantly improves weight loss , and might offer a method to reduce CV‐related ED visits plus rehospitalizations in patients after ACS undergoing CR . The study suggests a role for DHI as an adjunct to CR to improve secondary prevention of CV disease . Trial registration This trial is registered at clinical trials.gov ( NCT01883050 ) Diets rich in fruits and vegetables have been of interest because of their potential health benefits against chronic diseases such as cardiovascular disease ( CVD ) and cancer . The aim of this work was to assess the association of the dietary intake of a food group that includes fruits , berries and vegetables with all-cause , CVD-related and non-CVD-related mortality .  The subjects were Finnish men aged 42 - 60 y examined in 1984 - 1989 in the prospect i ve Kuopio Ischaemic Heart Disease Risk Factor ( KIHD ) Study .  Dietary intakes were assessed by 4-d food intake record during the baseline phase of the KIHD Study . The risk of all-cause and non-CVD-related deaths was studied in 2641 men and the risk of CVD-related death in 1950 men who had no history of CVD at baseline . During a mean follow-up time of 12.8 y , cardiovascular as well as noncardiovascular and all-cause mortality were lower among men with the highest consumption of fruits , berries and vegetables . After adjustment for the major CVD risk factors , the relative risk for men in the highest fifth of fruit , berry and vegetable intake for all-cause death , CVD-related and non-CVD-related death was 0.66 [ 95 % confidence interval ( CI ) 0.50 - 0.88 ] , 0.59 ( 0.33 - 1.06 ) , and 0.68 ( 0.46 - 1.00 ) , respectively , compared with men in the lowest fifth . These data show that a high fruit , berry and vegetable intake is associated with reduced risk of mortality in middle-aged Finnish men . Consequently , the findings of this work indicate that diets that are rich in plant-derived foods can promote longevity Abstract The study aim ed to investigate whether meeting leisure time physical activity recommendations was associated with reduced incident and fatal cancer or cardiovascular disease ( CVD )  in a community-based cohort of middle- to late-aged adults with long-term follow-up . At baseline , 2,320 individuals were assessed on a large number of lifestyle and clinical parameters including their level of physical activity  per week , other risk factors ( e.g. smoking and alcohol use ) various anthropometric measures , blood tests and medical history . Individuals were linked to hospital and mortality registry data to identify future cancer and cardiovascular events ( fatal and non-fatal ) out to 15 years of follow-up . Cox regression analyses adjusted for relevant confounders identified a priori were used to estimate risk for all-cause , cancer-specific and CVD-specific mortality . In the full cohort an estimated 21 % decreased risk for all-cause mortality ( HR 0.79 ; 95 % CI 0.66–0.96 ) and 22 % decreased risk for fatal/non-fatal CVD events ( HR 0.78 ; 95 % CI 0.66–0.92 ) was associated with baseline self-reported physical activity levels of 150 min or more . After exclusion of those with chronic co-morbidities ( CVD , cancer , diabetes , chronic obstructive pulmonary disease , hypertension treatment ) at baseline , lower risk for fatal/non-fatal CVD events remained significantly associated with 150 min or more of physical activity ( HR 0.77 ; 95 % CI 0.62–0.96 ) . Results from this well established prospect i ve community-based cohort study support the role of leisure time physical activity in reducing all-cause mortality and CVD events ( fatal/nonfatal ) in the broader population studied . The data also suggest that physical activity associated reductions in risk for CVD events ( fatal/nonfatal ) were not overly impacted by prevalent key non-communicable diseases Little is known about the prospect i ve associations of fibrinogen , factor VII , or factor VIII with  cardiovascular disease ( CVD ) and mortality in the elderly . At baseline in the Cardiovascular Health Study ( 5888 white and African American men and women ; aged > /=65 years ) , we measured  fibrinogen , factor VIII , and factor VII .  We used sex-stratified stepwise Cox survival analysis to determine relative risks ( RRs ) for CVD events and all-cause mortality ( up to 5 years of follow-up ) , both unadjusted and adjusted for CVD risk factors and sub clinical CVD . After adjustment , comparing the fifth quintile to the first , fibrinogen was significantly associated in men with coronary heart disease events ( RR=2.1 ) and stroke or transient ischemic attack ( RR=1.3 ) , and also with mortality within 2.5 years of follow-up ( RR=5.8 ) and later ( RR=1.7 ) . Factor VIII was significantly associated in men with coronary heart disease events ( RR=1.5 ) and mortality ( RR=1.8 ) , and in women with stroke/transient ischemic attack ( RR=1.4 ) . For both factors , values were higher in those who died , whether causes were CVD-related or non-CVD-related , but highest in CVD death . Factor VII exhibited associations with incident angina ( RR=1.44 ) in men and with death in women ( RR , middle quintile compared with first=0.66 ) . However , in general , factor VII was not consistently associated with CVD events in this population . We conclude that , if confirmed in other studies , the measurement of fibrinogen and /or factor VIII may help identify older individuals at higher risk for CVD events and mortality Although diet quality is implicated in cardiovascular disease ( CVD ) risk , few studies have investigated the relation between diet quality and the risks of  CVD and mortality in older adults . This study examined the prospect i ve associations between dietary scores and risk of CVD and all-cause mortality in older British men . A total of 3328 men ( aged 60–79 y ) from the British Regional Heart Study , free from CVD at baseline , were followed up for 11.3 y for CVD and mortality . Baseline food-frequency question naire data were used to generate 2 dietary scores :  the Healthy Diet Indicator ( HDI ) , based on WHO dietary guidelines , and the Elderly Dietary Index ( EDI ) , based on a Mediterranean-style dietary intake , with higher scores indicating greater compliance with dietary recommendations . Cox proportional hazards regression analyses assessed associations between quartiles of HDI and EDI and risk of all-cause mortality , CVD mortality , CVD events , and coronary heart disease ( CHD ) events . During follow-up , 933 deaths , 327 CVD deaths , 582 CVD events , and 307 CHD events occurred . Men in the highest compared with the lowest EDI quartile had significantly lower risks of all-cause mortality ( HR : 0.75 ; 95 % CI : 0.60 , 0.94 ; P-trend = 0.03 ) , CVD mortality ( HR : 0.63 ; 95 % CI : 0.42 , 0.94 ; P-trend = 0.03 ) , and CHD events ( HR : 0.66 ; 95 % CI : 0.45 , 0.97 ; P-trend = 0.05 ) but not CVD events ( HR : 0.79 ; 95 % CI : 0.60 , 1.05 ; P-trend = 0.16 ) after adjustment for sociodemographic , behavioral , and cardiovascular risk factors . The HDI was not significantly associated with any of the outcomes . The EDI appears to be more useful than the HDI for assessing diet quality in relation to CVD and morality risk  in older men . Encouraging older adults to adhere to the guidelines inherent in the EDI criteria may have public health benefits Background Controversy has emerged about the benefits compared with harms of dairy fat , including concerns over long-term effects . Previous observational studies have assessed self-reported estimates of consumption or a single biomarker measure at baseline , which may lead to suboptimal estimation of true risk . Objective The aim of this study was to investigate prospect i ve associations of serial measures of plasma phospholipid fatty acids pentadecanoic ( 15:0 ) , heptadecanoic ( 17:0 ) , and trans-palmitoleic ( trans-16:1n-7 ) acids with total mortality , cause-specific mortality  , and cardiovascular disease ( CVD ) risk among older adults . Design Among 2907 US adults aged ≥65 y and free of CVD at baseline , circulating fatty acid concentrations were measured serially at baseline , 6 y , and 13 y. Deaths and CVD events were assessed and adjudicated central ly . Prospect i ve associations were assessed by multivariate-adjusted Cox models incorporating time-dependent exposures and covariates . Results During 22 y of follow-up , 2428 deaths occurred , including 833 from CVD , 1595 from non-CVD causes , and 1301 incident CVD events . In multivariable models , circulating pentadecanoic , heptadecanoic , and trans-palmitoleic acids were not significantly associated with total mortality , with extreme-quintile HRs of 1.05 for pentadecanoic ( 95 % CI : 0.91 , 1.22 ) , 1.07 for heptadecanoic ( 95 % CI : 0.93 , 1.23 ) , and 1.05 for trans-palmitoleic ( 95 % CI : 0.91 , 1.20 ) acids . Circulating heptadecanoic acid was associated with lower CVD mortality ( extreme-quintile HR : 0.77 ; 95 % CI : 0.61 , 0.98 ) , especially stroke mortality , with a 42 % lower risk when comparing extreme quintiles of heptadecanoic acid concentrations ( HR : 0.58 ; 95 % CI : 0.35 , 0.97 ) . In contrast , heptadecanoic acid was associated with a higher risk of non-CVD mortality ( HR : 1.27 ; 95 % CI : 1.07 , 1.52 ) , which was not clearly related to any single subtype of non-CVD death . No significant associations of pentadecanoic , heptadecanoic , or trans-palmitoleic acids were seen for total incident CVD , coronary heart disease , or stroke . Conclusions Long-term exposure to circulating phospholipid pentadecanoic , heptadecanoic , or trans-palmitoleic acids was not significantly associated with total mortality or incident CVD among older adults . High circulating heptadecanoic acid was inversely associated with CVD and stroke mortality and potentially associated with higher risk of non-CVD death OBJECTIVE The objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality . DESIGN Prospect i ve cohort study among participants of the REasons for Geographic And Racial Differences in Stroke ( REGARDS ) study who resided in the USA . SETTING The primary outcome measures included the hazard ratios ( HR ) of incident CVD including first incident fatal or non-fatal ischaemic stroke or myocardial infa rct ion and all-cause mortality , based on cumulative average fish consumption ascertained at baseline . SUBJECTS Participants ( n 16 479 ) were enrolled between 2003 and 2007 , completed the self-administered Block98 FFQ and were free of CVD at baseline . RESULTS There were 700 cardiovascular events over a mean follow-up of 5·1 years . After adjustment for sociodemographic variables , health behaviours and other CVD risk factors , participants eating ≥2 servings fried fish/week ( v. < 1 serving/month ) were at a significantly increased risk of cardiovascular events ( HR=1·63 ; 95 % CI 1·11 , 2·40 ) . Intake of non-fried fish was not associated with risk of incident CVD . There was no association found with dietary fried or non-fried fish intake and cardiovascular or all-cause mortality . CONCLUSIONS Fried fish intake of two or more servings per week is associated with an increased risk of cardiovascular events . Given the increased intake of fried fish in the stroke belt and among African Americans , these data suggest that dietary fried fish intake may contribute to geographic and racial disparities in CVD BACKGROUND Psychosocial factors are independently associated with increased risk of cardiovascular disease ( CVD ) morbidity and mortality , but the effects of psychosocial factor intervention on CVD are uncertain . We performed a r and omized controlled clinical trial of cognitive behavioral therapy ( CBT ) to measure its effects on CVD recurrence . METHODS The study included 362 women and men 75 years or younger who were discharged from the hospital after a coronary heart disease event within the past 12 months . Patients were r and omized to receive traditional care  ( reference group , 170 patients ) or traditional care plus a CBT program ( intervention group , 192 patients ) , focused on stress management , with 20 two-hour sessions during 1 year . Median attendance at each CBT session was 85 % . Outcome variables were all-cause mortality , hospital admission for recurrent CVD , and recurrent acute myocardial infa rct ion . RESULTS During a mean 94 months of follow-up , the intervention group had a 41 % lower rate of fatal and nonfatal first recurrent CVD events ( hazard ratio [ 95 % confidence interval ] , 0.59 [ 0.42 - 0.83 ] ; P = .002 ) , 45 % fewer recurrent acute myocardial infa rct ions ( 0.55 [ 0.36 - 0.85 ] ; P = .007 ) , and a nonsignificant 28 % lower all-cause mortality ( 0.72 [ 0.40 - 1.30 ] ; P = .28 ) than the reference group after adjustment for other outcome -affecting variables . In the CBT group there was a strong dose-response effect between intervention group attendance and outcome . During the first 2 years of follow-up , there were no significant group differences in traditional risk factors . CONCLUSIONS A CBT intervention program decreases the risk of recurrent CVD and recurrent acute myocardial infa rct ion . This may have implication s for secondary preventive programs in patients with coronary heart disease . Trial Registration clinical trials.gov Identifier : NCT00888485 OBJECTIVE The association between hyperuricemia and cardiovascular events has been documented in high-risk groups , but is still undetermined in general population s , especially Chinese . This study assessed the temporal association between serum uric acid level , hyperuricemia , and cardiovascular mortality . METHODS A prospect i ve cohort study of 41,879 men and 48,514 women ages > or = 35 years was conducted using data from the MJ Health Screening Centers in Taiwan .  Mortality from all causes , total cardiovascular disease ( CVD ) , ischemic stroke , congestive heart failure , hypertensive disease , and coronary heart disease were compared according to increasing serum uric acid levels . RESULTS A total of 1,151 ( 21.2 % ) events of 5,427 total deaths were ascribed to CVD ( mean followup 8.2 years ) . Hazard ratios ( HRs ) for hyperuricemia ( serum uric acid level > 7 mg/dl ) were estimated with Cox regression model after adjusting for age , sex , body mass index , cholesterol , triglycerides , diabetes , hypertension , heavy cigarette smoking , and frequent alcohol consumption . In all patients , HRs were 1.16 ( P < 0.001 ) for all-cause mortality , 1.39 ( P < 0.001 ) for total CVD , and 1.35 ( P = 0.02 ) for ischemic stroke . In subgroup analysis , the HRs for cardiovascular risk remained significant in patients with hypertension ( 1.44 , P < 0.001 ) and in patients with diabetes ( 1.64 , P < 0.001 ) . In addition , in a low metabolic risk subgroup , the HRs for all-cause mortality and total cardiovascular morbidity were 1.24 ( P = 0.02 ) and 1.48 ( P = 0.16 ) , respectively . CONCLUSION Hyperuricemia was an independent risk factor of mortality from all causes , total CVD , and ischemic stroke in the Taiwanese general population , in high-risk groups , and potentially in low-risk groups IMPORTANCE Sauna bathing is a health habit associated with better hemodynamic function ; however , the association of sauna bathing with cardiovascular and all-cause mortality is not known . OBJECTIVE To investigate the association of frequency and duration of sauna bathing with the risk of sudden cardiac death ( SCD ) , fatal coronary heart disease ( CHD ) , fatal cardiovascular disease ( CVD ) , and all-cause mortality . DESIGN , SETTING , AND PARTICIPANTS We performed a prospect i ve cohort study ( Finnish Kuopio Ischemic Heart Disease Risk Factor Study ) of a population -based sample of 2315 middle-aged ( age range , 42 - 60 years ) men from Eastern Finl and . Baseline examinations were conducted from March 1 , 1984 , through December 31 , 1989 . EXPOSURES Frequency and duration of sauna bathing assessed at baseline . RESULTS During a median follow-up of 20.7 years ( interquartile range , 18.1 - 22.6 years ) , 190 SCDs , 281 fatal CHDs , 407 fatal CVDs , and 929 all-cause mortality events occurred . A total of 601 , 1513 , and 201 participants reported having a sauna bathing session 1 time per week , 2 to 3 times per week , and 4 to 7 times per week , respectively . The numbers ( percentages ) of SCDs were 61 ( 10.1 % ) , 119 ( 7.8 % ) , and 10 ( 5.0 % ) in the 3 groups of the frequency of sauna bathing . The respective numbers were 89 ( 14.9 % ) , 175 ( 11.5 % ) , and 17 ( 8.5 % ) for fatal CHDs ; 134 ( 22.3 % ) , 249 ( 16.4 % ) , and 24 ( 12.0 % ) for fatal CVDs ; and 295 ( 49.1 % ) , 572 ( 37.8 % ) , and 62 ( 30.8 % ) for all-cause mortality events . After adjustment for CVD risk factors , compared with men with 1 sauna bathing session per week , the hazard ratio of SCD was 0.78 ( 95 % CI , 0.57 - 1.07 ) for 2 to 3 sauna bathing sessions per week and 0.37 ( 95 % CI , 0.18 - 0.75 ) for 4 to 7 sauna bathing sessions per week ( P for trend = .005 ) . Similar associations were found with CHD , CVD , and all-cause mortality ( P for trend ≤.005 ) . Compared with men having a sauna bathing session of less than 11 minutes , the adjusted hazard ratio for SCD was 0.93 ( 95 % CI , 0.67 - 1.28 ) for sauna bathing sessions of 11 to 19 minutes and 0.48 ( 95 % CI , 0.31 - 0.75 ) for sessions lasting more than 19 minutes ( P for trend = .002 ) ; significant inverse associations were also observed for fatal CHDs and fatal CVDs ( P for trend ≤.03 ) but not for all-cause mortality events . CONCLUSIONS AND RELEVANCE Increased frequency of sauna bathing is associated with a reduced risk of SCD , CHD , CVD , and all-cause mortality . Further studies are warranted to establish the potential mechanism that links sauna bathing and cardiovascular health CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with the metabolic syndrome and , consequently , with a potentially increased risk of cardiovascular disease ( CVD ) and related mortality later in life . Studies regarding CVD and mortality in PCOS women well into the postmenopausal age are lacking . OBJECTIVE Our objective was to examine whether postmenopausal PCOS women differ from controls regarding cardiovascular risk factors , myocardial infa rct ion ( MI ) , stroke and mortality . DESIGN AND SETTING We conducted , at a university hospital , a prospect i ve study of 35 PCOS women ( 61 - 79 yr ) and 120 age-matched controls . The study was performed 21 yr after the initial study . PARTICIPANTS Twenty-five PCOS women ( Rotterdam criteria ) and 68 controls participated in all examinations . Data on morbidity were based on 32 of 34 PCOS women and on 95 of 119 controls . INTERVENTIONS INTERVENTIONS included reexamination , interviews , and data from the National Board of Health and Welfare and from the Hospital Discharge Registry . MAIN OUTCOME MEASURES Blood pressure , glucose , insulin , triglycerides , total cholesterol , high- and low-density lipoprotein , apolipoprotein A1 and B , fibrinogen , and plasminogen activator inhibitor antigen were studied . Incidences of MI , stroke , hypertension , diabetes , cancer , cause of death , and age at death were recorded . RESULTS PCOS women had a higher prevalence of hypertension ( P = 0.008 ) and higher triglyceride levels ( P = 0.012 ) than controls . MI , stroke , diabetes , cancer , and mortality prevalence was similar in the two cohorts with similar body mass index . CONCLUSIONS The well-described cardiovascular/metabolic risk profile in pre- and perimenopausal PCOS women does not entail an evident increase in cardiovascular events during the postmenopausal period Objective : To examine the optimal intensity of leisure time physical activity ( LTPA ) to decrease the risk of all cause , cardiovascular disease ( CVD ) , and coronary heart disease ( CHD ) mortality in a population sample of middle aged British men . Design : Prospect i ve study of middle aged men with an 11 year follow up . Setting : A whole population sample of men from Caerphilly , South Wales , UK . Subjects : 1975 men aged 49–64 years without historical or clinical evidence of CHD at baseline examination . Main outcome measures : All cause , CVD , and CHD mortality . Results : Total ( cumulative ) LTPA had a grade d , significant relation with all cause , CVD , and CHD mortality but no trend with cancer deaths . When different intensities of activity were considered , light and moderate intensity LTPA had inconsistent and non-significant relations with all cause , CVD , or CHD mortality whether adjusted only for age or for other cardiovascular risk factors . In contrast a significant dose – response relation was found for heavy intensity LTPA for all cause , CVD , and CHD mortality fully adjusted for other risk factors . Conclusions : These data suggest that , in a population of men without evidence of CHD at baseline , only leisure exercise classified as heavy or vigorous was independently associated with reduced risk of premature death from CVD Although attention has recently been focused on the role of psychosocial factors in patients with cardiovascular disease ( CVD ) , the factors that have the greatest influence on prognosis have not yet been eluci date d. The aim of this study was to evaluate the effects of depression , anxiety , and anger on the prognosis of patients with CVD . Four hundred fourteen consecutive patients hospitalized with CVD were prospect ively enrolled .  Depression was evaluated using the Patient Health Question naire , anxiety using the Generalized Anxiety Disorder Question naire , and anger using the Spielberger Trait Anger Scale .  Cox proportional-hazards regression was used to examine the individual effects of depression , anxiety , and anger on a combined primary end point of cardiac death or cardiac hospitalization and on a combined secondary end point of all-cause death or hospitalization during follow-up ( median 14.2 months ) . Multivariate analysis showed that depression was a significant risk factor for cardiovascular hospitalization or death after adjusting for cardiac risk factors and other psychosocial factors ( hazard ratio 2.62 , p = 0.02 ) , whereas anxiety was not significantly associated with cardiovascular hospitalization or death after adjustment ( hazard ratio 2.35 , p = 0.10 ) . Anger was associated with a low rate of cardiovascular hospitalization or death ( hazard ratio 0.34 , p < 0.01 ) . In conclusion , depression in hospitalized patients with CVD is a stronger independent risk factor for adverse cardiac events than either anxiety or anger . Anger may help prevent adverse outcomes . Routine screening for depression should therefore be performed in patients with CVD , and the potential effects of anger in clinical practice should be reconsidered OBJECTIVES This study sought to estimate the extent to which behavioral and pathophysiological risk factors account for the association between  psychological distress  and incident cardiovascular events . BACKGROUND The intermediate processes through which psychological distress increases the risk of cardiovascular disease ( CVD ) are incompletely understood . An underst and ing of these processes is important for treating psychological distress in an attempt to reduce CVD risk . METHODS In a prospect i ve study of 6,576 healthy men and women ( ages 50.9 + /- 13.1 years ) , we measured psychological distress ( using the 12-item version of the General Health Question naire > or=4 ) and behavioral ( smoking , alcohol , physical activity ) and pathophysiological ( C-reactive protein , fibrinogen , total and high-density lipoprotein cholesterol , obesity , hypertension ) risk factors at baseline . The main outcome was CVD events ( hospitalization for nonfatal myocardial infa rct ion , coronary artery bypass , angioplasty , stroke , heart failure , and CVD-related mortality ) . RESULTS Cigarette smoking , physical activity , alcohol intake , C-reactive protein , and hypertension were independently associated with psychological distress . There were 223 incident CVD events ( 63 fatal ) over an average follow-up of 7.2 years . The risk of CVD increased in relation to presence of psychological distress in age- and sex-adjusted models ( hazard ratio : 1.54 , 95 % confidence interval : 1.09 to 2.18 , p = 0.013 ) . In models that were adjusted for potential mediators , behavioral factors explained the largest proportion of variance ( approximately 65 % ) , whereas pathophysiological factors accounted for a modest amount ( C-reactive protein approximately 5.5 % , hypertension , approximately 13 % ) . CONCLUSIONS The association between psychological distress and CVD risk is largely explained by behavioral processes . Therefore , treatment of psychological distress that aims to reduce CVD risk should primarily focus on health behavior change Objectives In many current guidelines , blood pressure (BP)-lowering drug treatment for primary prevention of cardiovascular disease ( CVD ) is based on absolute risk . However , in clinical practice , therapeutic decisions are often based on BP levels alone . We sought to investigate which approach was superior by conducting a post hoc analysis of the Australian National Blood Pressure ( ANBP ) cohort , a seminal study establishing the efficacy of BP lowering in ‘ mild hypertensive ’ persons . Design A post hoc subgroup analysis of the ANBP trial results by baseline absolute risk tertile . Setting and participants 3244 participants aged 35–69 years in a community-based r and omised placebo controlled trial of blood pressure-lowering medication . Interventions Chlorothiazide500 mg versus placebo . Primary outcome measures All-cause mortality and non-fatal events ( non-fatal CVD , congestive cardiac failure , renal failure , hypertensive retinopathy or encephalopathy ) . Results Treatment effects were assessed by HR , absolute risk reduction and number needed to treat . Participants had an average 5-year CVD risk in the intermediate range ( 10.5±6.5 ) with moderately elevated BP ( mean 159/103 mmHg ) and were middle aged ( 52±8 years ) . In a subgroup analysis , the relative effects ( HR ) and absolute effects ( absolute risk reduction and number needed to treat ) did not statistically differ across the three risk groups except for the absolute benefit in all-cause mortality ( p for heterogeneity=0.04 ) . With respect to absolute benefit , drug treatment significantly reduced the number of events in the high-risk group regarding any event with a number needed to treat of 18 ( 10 to 64 ) , death from any cause with 45 ( 25 to 196 ) and major CVD events with 23 ( 12 to 193 ) . Conclusion Our analysis confirms that the benefit of treatment was substantial only in the high-risk tertile , reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation OBJECTIVE To determine whether a  cardiovascular disease ( CVD ) health screening program is associated with CVD-related health conditions , incidence of cardiovascular events , mortality , healthcare utilization , and costs . METHODS Cohort study of a 3 % r and om sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted . A total 443,337 study participants were followed-up from January 1 , 2005 through December 31 , 2010 . RESULTS In primary analysis , the hazard ratios for CVD mortality , all-cause mortality , incident composite CVD events , myocardial infa rct ion , cerebral infa rct ion , and cerebral hemorrhage comparing participants who attended a screening exam during 2003 - 2004 compared to those who did not were 0.58 ( 95 % CI : 0.53 - 0.63 ) , 0.62 ( 95 % CI : 0.60 - 0.64 ) , 0.82 ( 95 % CI : 0.78 - 0.85 ) , 0.84 ( 95 % CI : 0.75 - 0.93 ) , 0.84 ( 95 % CI : 0.79 - 0.89 ) , and 0.73 ( 95 % CI : 0.67 - 0.80 ) , respectively . Screening attenders had higher rates of newly diagnosed hypertension , diabetes mellitus , and dyslipidemia , lower inpatient days of stay and cost , and lower outpatient cost compared to non-attenders . CONCLUSIONS Participation in CVD health screening was associated with lower rates of CVD , all-cause mortality , and CVD events , higher detection of CVD-related health conditions , and lower healthcare utilization and costs Objectives A policy model is a model that can evaluate the effectiveness and cost-effectiveness of interventions and inform policy decisions . In this study , we introduce a cardiovascular disease ( CVD ) policy model which can be used to model remaining life expectancy including a measure of socioeconomic deprivation as an independent risk factor for CVD . Design A state transition model was developed using the Scottish Heart Health Extended Cohort ( SHHEC ) linked to Scottish morbidity and death records . Individuals start in a CVD-free state and can transit to three CVD event states plus a non-CVD death state . Individuals who have a non-fatal first event are then followed up until death . Taking a competing risk approach , the cause-specific hazards of a first event are modelled using parametric survival analysis . Survival following a first non-fatal event is also modelled parametrically . We assessed discrimination , validation and calibration of our model . Results Our model achieved a good level of discrimination in each component ( c-statistics for men (women)—non-fatal coronary heart disease ( CHD ) : 0.70 ( 0.74 ) , non-fatal cerebrovascular disease ( CBVD ) : 0.73 ( 0.76 ) , fatal CVD : 0.77 ( 0.80 ) , fatal non-CVD : 0.74 ( 0.72 ) , survival after non-fatal CHD : 0.68 ( 0.67 ) and survival after non-fatal CBVD : 0.65 ( 0.66 ) ) . In general , our model predictions were comparable with observed event rates for a Scottish r and omised statin trial population which has an overlapping follow-up period with SHHEC . After applying a calibration factor , our predictions of life expectancy closely match those published in recent national life tables . Conclusions Our model can be used to estimate the impact of primary prevention interventions on life expectancy and can assess the impact of interventions on inequalities Abstract Cardiovascular disease ( CVD ) is a major cause of morbidity and mortality in developed countries . However , traditional risk factors can not fully account for this . In the last 20 years , there has been an explosion of interest in plasma total homocysteine ( tHcy ) as a potential modifiable risk factor for CVD . Recent meta-analyses of epidemiological studies support the concept that increased tHcy concentrations are associated with CVD . This has led to the ‘ homocysteine hypothesis ’ , which states that lowering plasma tHcy using folic acid and other B-vitamins will reduce the risk of CVD . In experimental studies , homocysteine has been shown to cause oxidative stress , endothelial cell dysfunction and promote thrombogenesis . However , data from recent large r and omized controlled trials have shown that there is no clinical benefit to lowering plasma tHcy concentrations with folic acid and other B-vitamins . This lack of effect of tHcy lowering strongly suggests that homocysteine is not an instigator but merely an indicator of CVD BACKGROUND Sub clinical depression , often clinical ly unrecognized , may pose increased risk of cardiovascular disease . Few studies have prospect ively investigated cardiovascular events related to depression in older women . We describe prevalence , cardiovascular correlates , and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women . METHODS The Women 's Health Initiative Observational Study followed up 93 676 women for an average of 4.1 years .  Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale .  Risks of cardiovascular disease ( CVD ) events were estimated from Cox proportional hazards models adjusting for multiple demographic , clinical , and risk factor covariates . RESULTS Current depressive symptoms above the screening cutoff point were reported by 15.8 % of women . Depression was significantly related to CVD risk and comorbidity ( odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina ) . Among women with no history of CVD , depression was an independent predictor of CVD death ( relative risk , 1.50 ) and all-cause mortality ( relative risk , 1.32 ) after adjustment for age , race , education , income , diabetes , hypertension , smoking , high cholesterol level requiring medication , body mass index , and physical activity . Taking antidepressant medications did not alter the depression-associated risks associated . CONCLUSIONS A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality , even after controlling for established CVD risk factors . Whether early recognition and treatment of sub clinical depression will lower CVD risk remains to be determined in clinical trials Background / objectives Walking pace is associated with risk of premature mortality . However , whether this relationship is independent of total volume of physical activity and highest physical activity intensity remains unclear . We examined the associations between  walking pace  and cause-specific mortality , investigating the potential modifying effect of factors such as total physical activity volume , highest physical activity intensity , age , sex and body mass index ( BMI ) . Methods Prospect i ve pooled analysis of 11 population -based baseline surveys in Engl and and Scotl and between 1994 and 2008 that were linked with mortality records . Multivariate-adjusted Cox proportional hazards models examined associations between  walking pace  ( slow , average , brisk/fast ) and all-cause , cancer and cardiovascular disease ( CVD ) mortality . Results 50 225 walkers were entered in the core analyses . Among participants who did not experience an event in the first 2 years of follow-up ( n=49 731 ) , walking at an average or brisk/fast pace was associated with a reduced risk of all-cause ( 20 % ( 95 % CI 12 % to 28 % ) and 24 % ( 95 % CI 13 % to 33 % ) , respectively ) and CVD mortality ( 24 % ( 95 % CI 9 % to 36 % ) and 21 % ( 95 % CI 1 % to 38 % ) , respectively ) , compared with reporting walking at a slow pace . In stratified analyses , such associations were evident among those over 50 years , those not meeting the physical activity recommendations and those who did not undertake vigorous-intensity activity . There were no interactions by sex or BMI . No associations were seen between pace and cancer mortality . Conclusion Walking benefits health . Assuming causality , these analyses suggest that increasing walking pace could reduce risk for all-cause and CVD mortality .  Walking pace could be emphasised in public health messages , especially in situations when increase in walking volume or frequency is less feasible BACKGROUND Studies suggest that moderate drinkers have lower cardiovascular disease ( CVD ) mortality than nondrinkers and heavy drinkers , but there have been no r and omized trials on this topic . Although most observational studies control for major cardiac risk factors , CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking . METHODS Data from the 2003 Behavioral Risk Factor Surveillance System , a population -based telephone survey of U.S. adults , was used to assess the prevalence of CVD risk factors and potential confounders among  moderate drinkers and nondrinkers . Moderate drinkers were defined as men who drank an average of two drinks per day or fewer , or women who drank one drink or fewer per day . RESULTS After adjusting for age and gender , nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors , social factors , behavioral factors , access to health care , and health-related conditions . Of the 30 CVD-associated factors or groups of factors that we assessed , 27 ( 90 % ) were significantly more prevalent among nondrinkers . Among factors with multiple categories ( e.g. , body weight ) , those in higher-risk groups were progressively more likely to be nondrinkers . Removing those with poor health status or a history of CVD did not affect the results . CONCLUSIONS These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding . Given their limitations , nonr and omized studies about the health effects of moderate drinking should be interpreted with caution , particularly since excessive alcohol consumption is a leading health hazard in the United States OBJECTIVE Limited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes . However , most of these were in population s with pre-existing cardiovascular diseases ( CVD ) and studies in general population are lacking . METHODS The study included 11,153 participants in a population -based , prospect i ve cohort study in Araihazar , Bangladesh .  Resting blood pressure was measured at baseline and every two years thereafter . Participants were followed up for an average of 6.5 years ( 2002 - 2009 ) . RESULTS Male gender , older age , baseline systolic blood pressure ( SBP ) , and absence of betel leaf use were independently positively associated with greater SBP variability over time . There was a significant association between SBP variability and the risk of death from overall CVD , especially from major CVD events . The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models . In addition , the hazard ratio ( HR ) of stroke mortality was greater for individuals with both high baseline and high SBP variability . Similar patterns of HRs were observed for all-cause and CVD mortalities . CONCLUSION In this rural Bangladeshi population , variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP Objectives To examine associations between sarcopenia , obesity , and sarcopenic obesity and risk of cardiovascular disease ( CVD ) and all-cause mortality in older men . Design Prospect i ve cohort study . Setting British Regional Heart Study . Participants Men aged 60–79 years ( n = 4,252 ) . Measurements Baseline waist circumference ( WC ) and midarm muscle circumference ( MAMC ) measurements  were used to classify participants into four groups : sarcopenic , obese , sarcopenic obese , or optimal WC and MAMC . The cohort was followed for a mean of 11.3 years for CVD and all-cause mortality . Cox regression analyses assessed associations between sarcopenic obesity groups and all-cause mortality , CVD mortality , CVD events , and coronary heart disease ( CHD ) events . Results There were 1,314 deaths , 518 CVD deaths , 852 CVD events , and 458 CHD events during follow-up . All-cause mortality risk was significantly greater in sarcopenic ( HR = 1.41 , 95 % CI = 1.22–1.63 ) and obese ( HR = 1.21 , 95 % CI = 1.03–1.42 ) men than in the optimal reference group , with the highest risk in sarcopenic obese ( HR = 1.72 , 95 % CI = 1.35–2.18 ) , after adjustment for lifestyle characteristics . Risk of CVD mortality was significantly greater in sarcopenic and obese but not sarcopenic obese men . No association was seen between sarcopenic obesity groups and CHD or CVD events . Conclusion Sarcopenia and central adiposity were associated with greater cardiovascular mortality and all-cause mortality . Sarcopenic obese men had the highest risk of all-cause mortality but not CVD mortality . Efforts to promote healthy aging should focus on preventing obesity and maintaining muscle mass Background Despite convincing evidence in the Mediterranean region , the cardiovascular benefit of the Mediterranean diet is not well established in non-Mediterranean countries and the optimal criteria for defining adherence are unclear . The population attributable fraction ( PAF ) of adherence to this diet is also unknown . Methods In the UK-based EPIC-Norfolk prospect i ve cohort , we evaluated habitual diets assessed at baseline ( 1993–1997 ) and during follow-up ( 1998–2000 ) using food-frequency question naires  ( n = 23,902 ) . We estimated a Mediterranean diet score ( MDS ) using cut-points projected from the Mediterranean dietary pyramid , and also three other pre-existing MDSs . Using multivariable-adjusted Cox regression with repeated measures of MDS and covariates , we examined prospect i ve associations between each MDS with incident cardiovascular diseases ( CVD ) by 2009 and mortality by 2013 , and estimated PAF for each outcome attributable to low MDS . Results We observed 7606 incident CVD events ( 2818/100,000 person-years ) and 1714 CVD deaths ( 448/100,000 ) . The MDS based on the Mediterranean dietary pyramid was significantly associated with lower incidence of the cardiovascular outcomes , with hazard ratios ( 95 % confidence intervals ) of 0.95 ( 0.92–0.97 ) per one st and ard deviation for incident CVD and 0.91 ( 0.87–0.96 ) for CVD mortality . Associations were similar for composite incident ischaemic heart disease and all-cause mortality . Other pre-existing MDSs showed similar , but more modest associations . PAF due to low dietary pyramid based MDS ( < 95th percentile ) was 3.9 % ( 1.3–6.5 % ) for total incident CVD and 12.5 % ( 4.5–20.6 % ) for CVD mortality . Conclusions Greater adherence to the Mediterranean diet was associated with lower CVD incidence and mortality  in the UK . This diet has an important population health impact for the prevention of CVD BACKGROUND Evidence is limited regarding the impact of healthy lifestyle practice s on the risk of subsequent cardiovascular events among patients with diabetes . OBJECTIVES The purpose of this study was to examine the associations of an overall healthy lifestyle , defined by eating a high- quality diet ( top two-fifths of Alternative Healthy Eating Index ) , nonsmoking , engaging in moderate- to vigorous-intensity physical activity ( ≥150 min/week ) , and drinking alcohol in moderation ( 5 to 15 g/day for women and 5 to 30 g/day for men ) , with the risk of developing cardiovascular disease ( CVD ) and CVD mortality among adults with type 2 diabetes ( T2D ) . METHODS This prospect i ve analysis included 11,527 participants with T2D diagnosed during follow-up ( 8,970 women from the Nurses ' Health Study and 2,557 men from the Health Professionals Follow-Up Study ) , who were free of CVD and cancer at the time of diabetes diagnosis .  Diet and lifestyle factors before and after T2D diagnosis were repeatedly assessed every 2 to 4 years . RESULTS There were 2,311 incident CVD cases and 858 CVD deaths during an average of 13.3 years of follow-up . After multivariate adjustment of covariates , the low-risk lifestyle factors after diabetes diagnosis were each associated with a lower risk of CVD incidence and CVD mortality . The multivariate-adjusted hazard ratios for participants with 3 or more low-risk lifestyle factors compared with 0 were 0.48 ( 95 % confidence interval [ CI ] : 0.40 to 0.59 ) for total CVD incidence , 0.53 ( 95 % CI : 0.42 to 0.66 ) for incidence of coronary heart disease , 0.33 ( 95 % CI : 0.21 to 0.51 ) for stroke incidence , and 0.32 ( 95 % CI : 0.22 to 0.47 ) for CVD mortality ( all p trend < 0.001 ) . The population -attributable risk for poor adherence to the overall healthy lifestyle ( <3 low-risk factors ) was 40.9 % ( 95 % CI : 28.5 % to 52.0 % ) for CVD mortality . In addition , greater improvements in healthy lifestyle factors from pre-diabetes to post-diabetes diagnosis were also significantly associated with a lower risk of CVD incidence and CVD mortality . For each number increment in low-risk lifestyle factors there was a 14 % lower risk of incident total CVD , a 12 % lower risk of coronary heart disease , a 21 % lower risk of stroke , and a 27 % lower risk of CVD mortality ( all p < 0.001 ) . Similar results were observed when analyses were stratified by diabetes duration , sex/cohort , body mass index at diabetes diagnosis , smoking status , and lifestyle factors before diabetes diagnosis . CONCLUSIONS Greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of CVD incidence and CVD mortality  among adults with T2D . These findings further support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of cardiovascular complications in patients with T2D Rationale : The evidence regarding the potential health benefits of nut consumption among individuals with type 2 diabetes mellitus is limited . Objective : To examine intake of total and specific types of nuts , including tree nuts and peanuts , in relation to subsequent risk of cardiovascular disease ( CVD ) , including coronary heart disease and stroke , and all-cause and cause-specific mortality among individuals with diabetes mellitus . Methods and Results : This prospect i ve analysis included 16 217 men and women with diabetes mellitus at baseline or diagnosed during follow-up ( Nurses ’ Health Study : 1980–2014 , Health Professionals Follow-Up Study : 1986–2014 ) .  Nut consumption was assessed using a vali date d food frequency question naire and up date d every 2 to 4 years . During 223 682 and 254 923 person-years of follow-up , there were 3336 incident CVD cases and 5682 deaths , respectively . Higher total nut consumption was associated with a lower risk of CVD incidence and mortality . The multivariate-adjusted hazard ratios ( 95 % CIs ) for participants who consumed 5 or more servings of total nuts per week ( 1 serving=28 g ) , compared with those who consumed < 1 serving per month , were 0.83 ( 0.71–0.98 ; P trend=0.01 ) for total CVD incidence , 0.80 ( 0.67–0.96 ; P trend=0.005 ) for coronary heart disease incidence , 0.66 ( 0.52–0.84 ; P trend < 0.001 ) for CVD mortality , and 0.69 ( 0.61–0.77 ; P trend < 0.001 ) for all-cause mortality .  Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality . For specific types of nuts , higher tree nut consumption was associated with lower risk of total CVD , coronary heart disease incidence , and mortality because of CVD , cancer , and all causes , whereas peanut consumption was associated with lower all-cause mortality only ( all P trend < 0.001 ) . In addition , compared with participants who did not change the consumption of total nuts from pre- to post-diabetes mellitus diagnosis , participants who increased consumption of total nuts after diabetes mellitus diagnosis had an 11 % lower risk of CVD , a 15 % lower coronary heart disease risk , a 25 % lower CVD mortality , and a 27 % lower all-cause mortality . The associations persisted in subgroup analyses stratified by sex/cohort , body mass index at diabetes mellitus diagnosis , smoking status , diabetes mellitus duration , nut consumption before diabetes mellitus diagnosis , or diet quality . Conclusions : Higher consumption of nuts , especially tree nuts , is associated with lower CVD incidence and mortality among participants with diabetes mellitus . These data provide novel evidence that supports the recommendation of incorporating nuts into healthy dietary patterns for the prevention of CVD complications and premature deaths among individuals with diabetes mellitus BACKGROUND In patients with diabetes or hypertension , raised albuminuria is independently associated with an increased risk of all mortality , cardiovascular morbidity and mortality , and renal insufficiency . The role of albuminuria in the general population is still controversial . We therefore undertook this study to examine the relationship between albuminuria and all-cause , cardiovascular disease ( CVD ) and non-CVD mortality in the general population . METHODS Prospect i ve population -based cohort study of 20 911 individuals aged 40 - 79 years recruited in 1993 - 1997 for the EPIC-Norfolk Study ( UK ) and followed-up for an average of 6.3 years . R and om spot urine specimens were collected at baseline and the albumin-to-creatinine ratio measured . Participants were categorized into normoalbuminuria , microalbuminuria , and macroalbuminuria ordered groups . At follow-up , vital status and cause of death were obtained from the UK Office for National Statistics . RESULTS During follow-up , 934 deaths were registered . Age-adjusted all-cause mortality rate increased significantly across categories of baseline albuminuria ( 5.3 , 5.2 , and 6.3/1000 person years ( pyrs ) across tertiles of normoalbuminuria , 8.7/1000 pyrs for microalbuminuria , and 18.4/1000 pyrs for macroalbuminuria , P < 0.001 for trend ) ; CVD , 1.6 , 1.7 , 2.1 , 4.3 , 12.6/1000 pyrs ( P < 0.001 ) ; and non-CVD , 3.7 , 3.5 , 4.2 , 4.4 , 5.8/1000 pyrs ( P = 0.052 ) respectively . The multivariate hazard ratio for all-cause mortality associated with microalbuminuria was 1.48 ( 95 % CI : 1.20 , 1.79 ) , and CVD 2.03 ( 95 % CI : 1.55 , 2.67 ) . The association with non-CVD mortality was only significant in men . CONCLUSIONS The significant increased risk of all-cause mortality especially from CVD associated with microalbuminuria , suggest that this may be a useful indicator in identifying those in the population at greatest absolute risk of fatal CVD events alongside conventional CVD risk factors OBJECTIVE To assess the usefulness of Duruöz 's H and Index ( DHI ) in patients undergoing haemodialysis . METHODS Patients receiving haemodialysis for more than 2 months were recruited r and omly . Demographic , clinical and functional characteristics of patients were evaluated . Functional assessment was performed with  DHI , H and Functional Index ( HFI ) ,  Health Assessment Question naire ( HAQ ) ,  Purdue Pegboard  , grip strength and 3 kinds of pinch strengths . DHI was correlated ( Spearman 's ) with the other functional parameters in assessing the convergent validity and with non-functional parameters in assessing the divergent validity . RESULTS Sixty patients with a mean age of 50.05 were recruited . The average duration of haemodialysis was 55.02 months . DHI is significantly correlated with HAQ , HFI , Purdue Pegboard scores , grip strength and 3 types of pinch strengths while no significant correlation was found with non-functional parameters . CONCLUSIONS DHI is a practical scale which is efficient in assessing accurately the functional disability of the h and in patients receiving haemodialysis We examined the associations of intake of vegetables , legumes and fruit with all-cause and cause-specific mortality in a population with prevalent diabetes in Europe . A cohort of 10,449 participants with self-reported diabetes within the European Prospect i ve Investigation into Cancer and Nutrition study was followed for a mean of 9 y. Intakes of vegetables , legumes , and fruit were assessed at baseline between 1992 and 2000 using vali date d country-specific question naires . A total of 1346 deaths occurred . Multivariate relative risks ( RR ) for all-cause mortality were estimated in Cox regression models and RR for cause-specific mortality were derived in a competing risk model . An increment in intake of total vegetables , legumes , and fruit of 80 g/d was associated with a RR of death from all causes of 0.94 [ 95 % CI 0.90 - 0.98 ] . Analyzed separately , vegetables and legumes were associated with a significantly reduced risk , whereas nonsignificant inverse associations for fruit intake were observed . Cardiovascular disease ( CVD ) mortality and mortality due to non-CVD/non-cancer causes were significantly inversely associated with intake of total vegetables , legumes , and fruit ( RR 0.88 [ 95 % CI 0.81 - 0.95 ] and 0.90 [ 0.82 - 0.99 ] , respectively ) but not cancer mortality ( 1.08 [ 0.99 - 1.17 ] ) . Intake of vegetables , legumes , and fruit was associated with reduced risks of all-cause and CVD mortality in a diabetic population . The findings support the current state of evidence from general population studies that the protective potential of vegetable and fruit intake is larger for CVD than for cancer and suggest that diabetes patients may benefit from a diet high in vegetables and fruits Purpose Existing data from prospect i ve cohort studies on dairy consumption and cardiovascular diseases are inconsistent . Even though the association between total dairy and cardiovascular diseases has been studied before , little is known about the effect of different types of dairy products on cardiovascular diseases ( CVD ) . The objective of this study was to examine the relationship between ( type of ) dairy intake and CVD mortality and all-cause mortality  in a Dutch population . Methods We examined the relationship between  dairy intake and CVD mortality and all-cause mortality in 1956 participants of the Hoorn Study ( aged 50–75 years ) , free of CVD at baseline . Hazard ratios with 95 % CIs were obtained for CVD mortality and all-cause mortality per st and ard deviation ( SD ) of the mean increase in dairy intake , with adjustment for age , sex , BMI , smoking , education , total energy intake , alcohol consumption , physical activity , and dietary intakes . Results During 12.4 years of follow-up , 403 participants  died , of whom 116 had a fatal CVD event . Overall dairy intake was not associated with CVD mortality or all-cause mortality . Each SD increase in high-fat dairy intake was associated with a 32 % higher risk of CVD mortality ( 95 % CI ; 7–61 % ) . Conclusion In this prospect i ve cohort study , the intake of high-fat dairy products was associated with an increased risk of CVD mortality OBJECTIVES To compare the potential years of life saved ( YOLS ) associated with risk factor modification in the primary and secondary prevention of cardiovascular disease ( CVD ) . METHODS The CVD life expectancy model estimates the risk of death due to coronary disease , stroke , and other causes based on the levels of independent risk factors ( such as age , blood pressure , and blood lipid levels ) found in the cohort of the Lipid Research Clinics . The model was vali date d by comparing its predictions with the observed fatal outcomes of 9 r and omized clinical trials . We then estimated the YOLS associated with treating hyperlipidemia or hypertension among hypothetical patient groups with and without CVD at baseline . We defined high-risk patients as those with 3 risk factors ( hyperlipidemia , cigarette smoking , and hypertension ) and low-risk patients as those with isolated hypertension or hyperlipidemia . RESULTS The fatal events predicted by the model were consistent with the clinical trial results . Among men and women with hyperlipidemia without CVD , the forecasted benefits of lipid therapy  were substantially greater among high-risk groups vs low-risk groups ( 4.74 - 0.78 YOLS vs 2.50 - 0.25 YOLS , respectively ) . Among those with CVD , the forecasted benefits of treatment were similar for both high-risk and low-risk groups ( 4.65 - 0.65 YOLS vs 3.84 - 0.58 YOLS , respectively ) . The results for  hypertension  therapy also demonstrated greater benefits for high-risk vs low-risk patients undergoing primary prevention therapy ( 1.34 - 0.29 YOLS vs 0.85 - 0.13 YOLS , respectively ) , and the forecasted benefits in secondary prevention were similar ( 1.26 - 0.23 YOLS vs 1.00 - 0.23 YOLS , respectively ) . CONCLUSIONS The clinical approach to risk factor modification in primary prevention should be different from that in secondary prevention . The forecasted benefits of therapy among patients without CVD are greatest in the presence of other risk factors . Among those with CVD , the benefits of therapy are equivalent , thereby obviating the need to target high-risk patients Objective To investigate the association between active commuting and  incident cardiovascular disease ( CVD ) , cancer , and all cause mortality .  Design Prospect i ve population based study . Setting UK Biobank . Participants 263 450 participants ( 106 674 ( 52 % ) women ; mean age 52.6 ) , recruited from 22 sites across the UK . The exposure variable was the mode of transport used ( walking , cycling , mixed mode v non-active ( car or public transport ) ) to commute to and from work on a typical day . Main outcome measures Incident ( fatal and non-fatal ) CVD and cancer , and deaths from CVD , cancer , or any causes . Results 2430 participants died ( 496 were related to CVD and 1126 to cancer ) over a median of 5.0 years ( interquartile range 4.3 - 5.5 ) follow-up . There were 3748 cancer and 1110 CVD events . In maximally adjusted models , commuting by cycle and by mixed mode including cycling were associated with lower risk of all cause mortality ( cycling hazard ratio 0.59 , 95 % confidence interval 0.42 to 0.83 , P=0.002 ; mixed mode cycling 0.76 , 0.58 to 1.00 , P<0.05 ) , cancer incidence ( cycling 0.55 , 0.44 to 0.69 , P<0.001 ; mixed mode cycling 0.64 , 0.45 to 0.91 , P=0.01 ) , and cancer mortality ( cycling 0.60 , 0.40 to 0.90 , P=0.01 ; mixed mode cycling 0.68 , 0.57 to 0.81 , P<0.001 ) . Commuting by cycling and walking were associated with a lower risk of CVD incidence ( cycling 0.54 , 0.33 to 0.88 , P=0.01 ; walking 0.73 , 0.54 to 0.99 , P=0.04 ) and CVD mortality ( cycling 0.48 , 0.25 to 0.92 , P=0.03 ; walking 0.64 , 0.45 to 0.91 , P=0.01 ) . No statistically significant associations were observed for walking commuting and all cause mortality or cancer outcomes . Mixed mode commuting including walking was not noticeably associated with any of the measured outcomes . Conclusions Cycle commuting was associated with a lower risk of CVD , cancer , and all cause mortality .  Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors . Initiatives to encourage and support active commuting could reduce risk of death and the burden of important chronic conditions CONTEXT For women , impact of cardiovascular risk factors measured in young adulthood , particularly favorable ( low-risk ) profile , on mortality has been difficult to assess due to low short-term death rates . OBJECTIVE To assess the relationship of baseline coronary risk factor status to mortality from coronary heart disease ( CHD ) , cardiovascular diseases ( CVDs ) , and all causes in young women . DESIGN Prospect i ve cohort study . SETTING AND PARTICIPANTS A total of 7302 women aged 18 to 39 years without prior CHD or major electrocardiographic abnormalities screened between 1967 and 1973 for the Chicago Heart Association Detection Project in Industry . Risk groups were defined using national guidelines for values of systolic and diastolic blood pressure , serum cholesterol level , body mass index , presence of diabetes , and smoking status . Participants were divided into 4 groups : low risk , 0 risk factors high but 1 or more unfavorable , 1 only risk factor high , and 2 or more risk factors high . MAIN OUTCOME MEASURES All-cause mortality , CHD mortality , and CVD mortality ; hazard ratio of outcome measures comparing low-risk group with other groups . RESULTS Only 20 % met low-risk criteria ; 59 % had high levels of 1 or more risk factors . During an average follow-up of 31 years , there were 47 CHD deaths , 94 CVD deaths , and 469 deaths from all causes . The age-adjusted CVD death rate per 10,000 person-years was lowest for low-risk women and increased with the number of risk factors , ie , 1.5 , 1.7 , 5.0 , and 9.1 for low-risk ; 0 , 1 , and 2 or more risk factors high , respectively . Multivariate-adjusted CVD mortality hazard ratio for low-risk women was 0.19 ( 95 % confidence interval , 0.08 - 0.45 ) compared with women with 2 or more risk factors high . Similar patterns were observed for CHD and all-cause mortality and for both blacks and whites . CONCLUSION For women with favorable levels for all 5 major risk factors at younger ages , CHD and CVD are rare ; long-term and all-cause mortality are much lower compared with others Overweight and obesity are major contributors to both type 2 diabetes and cardiovascular disease ( CVD ) . Moreover , individuals with type 2 diabetes who are overweight or obese are at particularly high risk for CVD morbidity and mortality . Although short-term weight loss has been shown to ameliorate obesity-related metabolic abnormalities and CVD risk factors , the long-term consequences of intentional weight loss in overweight or obese individuals with type 2 diabetes have not been adequately examined . The primary objective of the Look AHEAD clinical trial is to assess the long-term effects ( up to 11.5 years ) of an intensive weight loss program delivered over 4 years in overweight and obese individuals with type 2 diabetes . Approximately 5000 male and female participants who have type 2 diabetes , are 45 - 74 years of age , and have a body mass index > or=25 kg/m(2 ) will be r and omized to one of the two groups . The intensive lifestyle intervention is design ed to achieve and maintain weight loss through decreased caloric intake and increased physical activity . This program is compared to a control condition given diabetes support and education . The primary study outcome is time to incidence of a major CVD event . The study is design ed to provide a 0.90 probability of detecting an 18 % difference in major CVD event rates between the two groups . Other outcomes include components of CVD risk , cost and cost-effectiveness , diabetes control and complications , hospitalizations , intervention processes , and quality of life BACKGROUND Whether consumption of potatoes , which are rich in potassium and have a high glycemic index and glycemic load , is associated with the risk of cardiovascular disease ( CVD ) is unknown . OBJECTIVE The aim was to examine the association between potato consumption and risk of total and specific CVD events as well as mortality from CVD in 2 prospect i ve cohorts of Swedish adults , a population with a high consumption of potatoes .  DESIGN Information on potato consumption was available from 69,313 men and women , free of CVD and diabetes , in the Cohort of Swedish Men and the Swedish Mammography Cohort .  Nonfatal and fatal cases of CVD diagnosed over 13 y of follow-up were identified by linkage with the Swedish National Patient and Cause of Death Registers . Analyses were conducted by using a Cox proportional hazards regression model , controlled for potential confounders . RESULTS We ascertained 10,147 major CVD events [ myocardial infa rct ion ( MI ) , heart failure ( HF ) , and stroke ] and 4003 deaths due to CVD . Total potato consumption was not associated with the risk of major CVD events , specific CVD endpoints , or CVD mortality in either men or women . Multivariable HRs ( 95 % CIs ) per an increment of 3 servings/wk of total potato consumption ( boiled potatoes , fried potatoes , and French fries ) were 1.00 ( 0.97 , 1.02 ) for major CVD events , 1.01 ( 0.97 , 1.04 ) for MI , 0.97 ( 0.93 , 1.02 ) for HF , 1.01 ( 0.97 , 1.05 ) for stroke , and 0.99 ( 0.95 , 1.03 ) for CVD mortality . There were no significant trends between the consumption of boiled potatoes , fried potatoes , or French fries and risk of any CVD outcome . CONCLUSION Potato consumption was not associated with the risk of CVD  in this population . The Swedish Mammography Cohort and the Cohort of Swedish Men are registered at clinical trials.gov as NCT01127698 and NCT01127711 , respectively Moderate hyperhomocysteinaemia has been shown to constitute an independent risk factor for cardiovascular disease ( CVD ) , a frequent cause of morbidity and mortality in renal transplant recipients ( RTR ) . In these patients few data regarding both total homocysteine levels and their influence on cardiovascular risk have been reported . We therefore studied serum homocysteine levels in deep-frozen sera from 42 kidney transplant recipients with a follow-up of 11 + /- 4.5 years ( mean + /- SD ) after transplantation . Eighteen patients had one or more ischaemic events ( CVD ( + ) ) and 24 patients had none ( CVD ( - ) ) . Serum sample s had been drawn 1 - 6 months prior to the first vascular event in CVD ( + ) patients and serum storage time was comparable in both CVD ( - ) and CVD ( + ) patients . Serum homocysteine levels were measured using a radioenzymatic method .  Mean homocysteine level was significantly higher in 42 RTR males and females ( 15.5 + /- 6.3 , 13.5 + /- 5.5 microM respectively ) compared with 35 control subjects matched for age and sex ( 8.7 + /- 1.9 , 7.5 + /- 1.9 microM , P < 0.001 ) . The difference in serum homocysteine levels between CVD ( + ) and CVD ( - ) RTR nearly reached statistical significance in male patients ( 18.6 + /- 7.8 versus 13.1 + /- 3.4 microM , P < 0.06 ) but not in female patients ( P = NS ) . In the CVD ( + ) group 11/18 patients had homocysteine levels > 14 microM ( the upper limit in healthy controls ) versus 7/24 in the CVD ( - ) group ( P = 0.04 ) . In these patients we simultaneously measured in the same serum sample s , serum triglycerides , and total and HDL cholesterol , and calculated LDL cholesterol . By stepwise discriminant analysis and by logistic regression analysis in this relatively small patient population , only serum triglycerides and homocysteine were selected as risk factors associated with CVD . We conclude that significant hyperhomocysteinaemia is present in renal transplant recipients and represents a potential risk factor for cardiovascular disease in these patients Background : Intakes of ready-to-eat cereal ( RTEC ) have been inversely associated with risk factors of chronic diseases such as cardiovascular disease ( CVD ) , type 2 diabetes , and certain cancers ; however , their relations with total and cause-specific mortality remain unclear . Objective : To prospect ively assess the associations of RTEC intakes with all causes and disease-specific mortality risk . Design : The study included 367,442 participants from the prospect i ve National Institutes of Health (NIH)–AARP Diet and Health Study . Intakes of RTEC were assessed at baseline . Results : Over an average of 14 years of follow-up , 46,067 deaths were documented . Consumption of RTEC was significantly associated with reduced risk of mortality from all-cause mortality and death from CVD , diabetes , all cancer , and digestive cancer ( all p for trend < 0.05 ) . In multivariate models , compared to nonconsumers of RTEC , those in the highest intake of RTEC had a 15 % lower risk of all-cause mortality and 10%–30 % lower risk of disease-specific mortality . Within RTEC consumers , total fiber intakes were associated with reduced risk of mortality from all-cause mortality and deaths from CVD , all cancer , digestive cancer , and respiratory disease ( all p for trend < 0.005 ) . Conclusions : Consumption of RTEC was associated with reduced risk of all-cause mortality and mortality from specific diseases such as CVD , diabetes , and cancer . This association may be mediated via greater fiber intake CONTEXT Higher PTH concentrations have been associated with fatal cardiovascular diseases ( CVDs ) , but data in the general population are scarce . OBJECTIVE We investigated whether higher PTH concentrations are prospect ively associated with all-cause and CVD mortality . DESIGN , SETTING , PARTICIPANTS This study used data from the Hoorn Study , a prospect i ve population -based cohort with baseline measurements between 2000 and 2001 . We included 633 participants , mean age 70.1 ± 6.6 years , 51 % female .  Serum intact PTH was measured using a 2-site immunoassay . MAIN OUTCOME MEASURES Outcomes were all-cause and CVD mortality based on clinical files and coded according to the International Classification of Diseases , ninth revision . We used Kaplan-Meier plots to estimate survival curves and Cox regression to estimate hazard ratios ( HRs ) using season-specific PTH quartiles . RESULTS During a median follow-up of 7.8 years , 112 participants died , of which 26 deaths ( 23 % ) were cardiovascular . Survival curves by PTH quartiles differed for all-cause mortality ( log-rank P = .054 ) and CVD mortality ( log-rank P = .022 ) . In a multivariate model , the highest PTH quartile was associated with all-cause mortality ; HR = 1.98 ( 1.08 , 3.64 ) . Kidney function slightly attenuated the PTH risk association , but risk persisted ; HR = 1.93 ( 1.04 , 3.58 ) . The results for CVD mortality showed a similar pattern , although the association was significant only in a threshold model ( quartile 4 vs quartile 1 - 3 ) ; HR = 2.56 ( 1.11 , 5.94 ) . CONCLUSIONS Among a general older population , higher PTH concentrations were associated with higher all-cause mortality risk , mostly explained by fatal CVD events . We suggest to evaluate whether individuals with high PTH concentrations benefit from therapeutic approaches targeted to decrease PTH concentrations Background and Purpose — Depression may be a risk factor for cardiovascular disease ( CVD ) mortality . We evaluated long-term mortality risk associated with depressive symptoms measured at middle age among men at high risk for coronary heart disease ( CHD ) . Methods — 12 866 men without definite evidence of CHD at study entry but who had above average risk of CHD based on blood pressure , blood cholesterol levels , and /or cigarette smoking were recruited into the Multiple Risk Factor Intervention Trial ( MRFIT ) . Survivors at the end of the trial were followed-up for mortality for an additional 18 years . Men who had completed the  Center for Epidemiologic Studies Depression ( CES-D ) scale  near the end of the trial ( n=11 216 ) were used in a prospect i ve analysis of post-trial all-cause and cause-specific mortality during 18-year follow-up after CES-D assessment . Results — Greater depressive symptoms measured at the end of the trial were associated with significantly higher risk of all-cause mortality and for cause-specific death , a higher risk of CVD , and , more specifically , stroke mortality ( all P values < 0.02 ) but not CHD mortality ( P=0.48 ) in linear trend analyses . The significant associations were strongest for those reporting the greatest depression : hazard ratio (HR)=1.15 ( 95 % CI , 1.03 to 1.28 ; P<0.01 ) for all-cause mortality for those in the highest depressive symptom quintile , HR=1.21 for CVD mortality ( 95 % CI , 1.03 to 1.41 ; P<0.05 ) , and HR=2.03 for stroke mortality ( 95 % CI , 1.20 to 3.44 ; P<0.01 ) compared with those in the lowest quintile . These associations were adjusted for age , intervention group , race , educational attainment , smoking at baseline and visit 6 , trial averaged systolic blood pressure , alcohol consumption , and fasting cholesterol , as well as the occurrence of nonfatal cardiovascular events during the trial . Conclusions — Greater depressive symptoms are associated with an increase in the risk of all-cause and , more specifically , CVD mortality in men . Stroke but not CHD was the form of CVD with which depressive symptoms were associated
Overall , these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a positive impact on risk factors for CVD
OBJECTIVE To assess the potential benefit of digital health interventions ( DHIs ) on  cardiovascular disease ( CVD ) outcomes ( CVD events , all-cause mortality , hospitalizations ) and risk factors compared with non-DHIs .