The CARLA study (Cardiovascular Disease, Living and Ageing in Halle) is a population-based cohort study of the elderly general population of the city of Halle (Saale) aged 45-83 years. The aim is to ...investigate established cardiovascular risk factors and a reduced heart rate variability (HRV) as indicator of autonomous dysfunction. In total, 1779 probands (812 women and 967 men) were investigated at baseline. Of those, 1436 participants were re-examined at a 4-years follow-up. The corresponding response rates were 64.1% in the baseline and 92% in the follow-up investigation. In the cross-sectional analysis a clear decrease was found in all parameters of HRV with increasing age, but no consistent associations to cardiovascular classical risk factors and diseases could be shown. Compared to other German cohorts a striking risk constellation was found consisting of high prevalence of hypertension, frequent occurrence of central overweight (measured by waist-hip ratio) and high prevalence of diabetes mellitus. These findings will be further scrutinized in the ongoing analyses of the 4-year follow-up and the 10-years follow-up which will start in 2012.
BackgroundWalking is an important component of physical activity. It is commonly opined that the ‘walkability’ of someone’s environment encourages walking behaviour, but the evidence base for this is ...limited and there is no consensus on how to measure walkability. We have undertaken a small, proof-of-concept, cross-sectional observational study, the objectives of which were two-fold. Firstly, to examine the association between walkability of the area around participants’ homes and different aspects of physical activity as well as anthropometric measurements. Secondly we aimed to critique, test and extend existing methods of measuring walkability with GIS methods, in preparation for a larger multi-centre study.MethodsUsing GIS software we built a three-domain measure of walkability based on topography (the area accessible by walking points given road and footpath coverage), local amenities available in a short walk, and availability of public transit points. These measures were calculated for the homes of 1779 cohort study participants aged 45–83 years. Response variables were self-reported sports activities h/week, time spent walking or cycling, as well as walking and cycling as categorised as never, rarely, sometimes, often or mostly. We also captured BMI and waist circumference measured at follow-up. We estimated the association between walkability and our response variables using linear regression models that were adjusted for age and education.ResultsWe found few significant associations between any of our response variables and any of the dimensions of walkability. A very weak positive association between time spent walking and cycling with proximity of transit points was observed, however the effect sizes involved amounted to fewer than a few minutes exercise per week between high and low transit point density (ß 0.024, 95% Confidence Interval 0.006–0.041 for transit points within 500 m distance).DiscussionWe did not see a convincing association between walkability and our response variables in this study. This could be because there was insufficient heterogeneity in either our neighbourhoods or participants, an issue of statistical power, or because there really is no association. However we did demonstrate that we can get a sophisticated, sensitive and reproducible measure of walkability of environments for use in population based research. We will apply methods used here (slightly refined) in a large study involving six different cities across Germany. Our presentation will focus on the methodological aspects of this study and how we tackled some of the measurement issues and discuss the refinements we propose to use in the next phase.
Introduction/objectivesIndividual socioeconomic status (SES) is a determinant of cardiovascular risk factors (RF). Recent studies suggest an independent association of neighbourhood SES with ...cardiovascular RF, but the mechanisms have not fully been understood. Our aim was to assess the association of neighbourhood and individual SES with cardiovascular RF in an Eastern German population.MethodsWe used cross-sectional data of 1779 participants aged 45–83 years of the population-based CARLA study. We calculated linear mixed models to assess the age-adjusted influence of neighbourhood-specific unemployment rates and individual SES on smoking, systolic blood pressure (SBP), and body mass index (BMI). Spatial dependencies within and between neighbourhoods were adjusted for by using ICAR models.ResultsNeighbourhood-specific unemployment rates varied between 6.3 and 35.3%. Per 1% increase in the neighbourhood's unemployment rate, the number of cigarettes smoked/day increased by 0.11 in men (95% CI 0.09 to 0.12) and 0.05, (CI 0.04 to 0.07) in women. In women, SBP increased by 0.04 mm Hg with unemployment rate (CI 0.03 to 0.06), while there was no statistically significant association of SBP with SES in men. BMI was only in women significantly associated with unemployment (increase in BMI per 1% increase in unemployment rate 0.04 (CI 0.02 to 0.05)). Associations of RF with individual SES were stronger than with neighbourhood SES in multiple models.ConclusionsOur findings confirm the previously described association of neighbourhood SES with smoking independent of individual SES, while we found inconsistent associations with SBP and BMI. The neighbourhood environment may be more relevant for behavioural than for biomedical risk factors.
The research on heterogeneity among obese individuals has identified the metabolically healthy, but obese (MHO) phenotype as a distinct group that does not experience the typical ...cardiovascular-related diseases (CVD). It is unclear if this group differs with regard to preconditions for CVDs. Our aim was to assess differences in echocardiographic parameters and inflammatory biomarkers between MHO and metabolically healthy, normal weight individuals (MHNW).
The analyses used data from 1412 elderly participants from a German population-based cohort study (CARLA), which collected detailed information on demographic, biochemical, and echocardiographic variables. Participants were subdivided into four groups (MHNW, MHO, MUNW (metabolically unhealthy, normal weight) and MUO (metabolically unhealthy, obese)) based on BMI≥30 kg/m
(obese or normal weight) and presence of components of the metabolic syndrome. The clinical characteristics of the 4 groups were compared with ANOVA or Chi-Square test, in addition to two linear regression models for 16 echocardiographic parameters. The difference in inflammatory biomarkers (hsCRP, IL-6 and sTNF-RI) between the groups was examined with a multinomial logistic regression model.
The MHO individuals were on average 64.2±8.4 years old, with a higher proportion of women (71.6%), low percentage of smokers, larger waist circumference (109.3±10.5 cm vs 89.1±10.8 cm, p<0.0001) and higher odds ratios for hsCRP, IL-6 and sTNF-RI compared to MHNW individuals. Linear regression models revealed greater left atrial (LA) diameter (2.73 (95% CI: 1.35-4.11) mm), LA volume (7.86 (95% CI: 2.88-12.83) mL), and left ventricular mass index (LVMI) (11.82 (95% CI: 4.43-19.22) g/m
) in the MHO group compared to the MHNW group.
The MHO phenotype is associated with echocardiographic markers of cardiac remodeling (LA diameter, volume and LVMI) and higher odds ratios for inflammatory biomarkers.
IntroductionIn Germany, regional data on the prevalence of type 2 diabetes mellitus (T2DM) are lacking for use in healthcare planning. We analysed regional differences in the prevalence of T2DM and ...treatment with antidiabetic agents.MethodsData from five regional population-based studies and the German National Health Interview and Examination Survey (GNHIES98) conducted between 1997 and 2006 were analysed. Estimates of self-reported diabetes, treatment, and onset of diabetes were compared. T2DM prevalence (95% CI) for the five regional studies was directly standardised to the German adult population (31 December 2007).ResultsFrom 11 688 participants aged 45–74 years, 1008 had prevalent T2DM, corresponding to a prevalence of 8.6% (8.1%–9.1%). For the GNHIES98 a prevalence of 8.2% (7.3%–9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9%–10.4%) than in women (7.6%; 6.9%–8.3%). The age-standardised regional prevalence was highest in the East with 12.0% (10.3%–13.7%) and lowest in the South with 5.8% (4.9%–6.7%). The mean age of onset of T2DM was lower in Northeast (53+9SD) than in West-Germany (57+10SD). Treatment with oral antidiabetic agents was more frequently reported in the South (56.9%) than in the Northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the Northeast (21.6%) than in the South (16.4%).ConclusionThe prevalence of T2DM showed a Northeast and Southwest gradient within Germany with the highest standardised prevalence in the East, which is in accordance with regional differences in the distribution of risk factors for T2DM. Furthermore, the treatment with antidiabetic agents showed regional differences.
Background/objectivesSocio-economic status (SES) has long been recognized as determinant of cardiovascular risk factors and disease. Recent studies suggest an association of neighbourhood SES with ...risk factors independent of the individual's own SES, but the mechanisms have not fully been understood. Our aim was to assess the association of neighbourhood and individual SES with cardiovascular risk factors in an Eastern German population with exceptionally high cardiovascular mortality and unemployment rates.MethodsWe used cross-sectional data of 1779 inhabitants of the city of Halle (Saale), aged 45–83 years, who participated in the population-based CARLA study. We calculated linear mixed models to assess the age-adjusted influence of neighbourhood SES (defined as neighbourhood-specific unemployment rates for 39 administrative districts of the city) and individual SES (defined as number of education years) on smoking (defined as number of currently smoked cigarettes/day), systolic blood pressure (SBP), and body mass index (BMI). Spatial dependencies within and between neighbourhoods were adjusted for by using ICAR models.ResultsThe unemployment rate ranged from 6.3 to 35.3% between neighbourhoods. For smoking, there was a statistically significant increase of 0.11 cigarettes smoked/day per 1% increase in the neighbourhood's unemployment rate in men (95% CI 0.09 to 0.12), and a decrease of 0.59 per increase in education years (CI −0.62 to −0.56), but a weaker association in women (regression coefficients (β) for unemployment rate and education years 0.054 (CI 0.039 to 0.067), and −0.21 (CI −0.24 to −0.19)). There was no statistically significant association of SBP with SES in men (β=−0.07 (CI −0.22 to 0.08) for unemployment rate, and −0.15 (CI −0.69 to 0.38) for education years), while in women, there was a statistically significant decrease in SBP of 0.79 mmHg per increase in education years (CI −0.82 to −0.76), and an increase with unemployment rate (β=0.04, CI 0.03 to 0.06). BMI was statistically significantly associated with education in men and women (0.11 decrease in BMI per increase in education years in men (CI −0.14 to −0.08), and 0.35 in women (CI −0.38 to −0.33)), but only for women with unemployment (increase in BMI per 1% increase in unemployment rate 0.008 (CI −0.008 to 0.02) in men, and 0.036 (CI −0.38 to −0.33) in women. Spatial correlations within and between neighbourhoods were small for all of the assessed outcomes.ConclusionsOur findings confirm the previously described association of neighbourhood SES with smoking independent of individual SES, while we found inconsistent associations with SBP and BMI. The neighbourhood environment may be more relevant for behavioural than for biomedical risk factors.
Objective To investigate the association between inflammation and selective echocardiographic parameters (EP) characteristic for ventricular hypertrophy in cross-sectional and longitudinal ...population-based analyses. Methods Baseline (711 men, 659 women: 45–83 years) and 4-year follow-up data (622 men, 540 women) of the prospective, population-based CARdio-vascular disease, Living and Ageing in Halle (CARLA)study after exclusion of participants with cardiacvascular diseases were analysed. Inflammation parameters: soluble tumour necrosis factor receptor 1 (sTNF-R1), high-sensitivity C reactive protein (hsCRP) and interleukin 6 (IL-6). EPs: left ventricular mass (LVM), left atrial systolic dimension (LADS), interventricular septum diameter (IVSD), posterior wall dimension (PWD), left ventricular diastolic diameter (LVDD), ejection fraction according to Teichholz (EF). For the longitudinal analyses baseline to follow-up differences were considered. Effect sizes were determined by using multiple linear regression and mixed models. Missing values were replaced by means of multiple imputations. Results Men had higher sTNF-R1 levels; means of hsCRP and IL-6 were similar in men and women. In multiple regression models, sTNF-R1 was associated with LADS (1.4 mm/1000 pg/mL sTNF-R1, 95% CI 0.6 to 2.1) in men. Respecting confounder hsCRP was associated with LVM (5.2 g/10 mg/L hsCRP, 95% CI 1.6 to 8.8), IVSD (0.2 mm/10 mg/L hsCRP, 95% CI 0 to 0.3) and PWD (0.2 mm/10 mg/L hsCRP, 95% CI 0.1 to 0.3) in women, while there were no relevant effects in analysis of IL-6 in both sexes. The baseline to follow-up change in EPs was not relevantly associated with sTNF-R1, hsCRP or IL-6. Conclusions STNF-R1, hsCRP and IL-6 were inadequate predictors for structural changes of the heart at follow-up, while weak cross-sectional associations are restricted to certain EPs and depend on sex.
Purpose
Hypertension is one of the most relevant risk factors for cardiovascular disease; however, little is known about differences in hypertension by occupation. The aim of this study was to ...explore the association between occupational group and prevalent hypertension.
Methods
Cross-sectional data of the CARLA study were used, a representative sample of an East German population aged 45–83. Job titles of the current or last held occupation of 967 men and 808 women were coded using the German classification of occupation. Hypertension was defined as blood pressure of ≥140 mmHg (systolic), ≥90 mmHg (diastolic) or use of antihypertensives. Sex-stratified, age-adjusted prevalence risk ratios (PR) with 95% confidence intervals (CI) were calculated for 31 occupational groups.
Results
Hypertension was prevalent in 79% of the population. In men, highest age-adjusted prevalence ratios were observed in metal-processing workers, carpenters/painters, and electricians with PRs of 1.31 (CI 1.04–1.65), 1.28 (CI 1.00–1.64), and 1.21 (0.95–1.53), respectively, compared to office clerks. In women, highest PRs were found in technicians/forewomen, scrutinisers/storekeepers, and food-processing occupations with PR 1.28 (1.09–1.49), 1.23 (0.99–1.51), and 1.22 (1.01–1.48), respectively. Adjustment for education, smoking, body mass index, and current work hours did not fully explain occupational differences. Excluding currently non-working subjects lead to decreased PRs in men and to increased PR in women.
Conclusions
Differences in the prevalences of hypertension by occupational group were only partly explained by conventional risk factors and may require workplace interventions targeted at high-risk occupations. Longitudinal data with large cohorts and work-related exposure assessment are needed to confirm a temporal relationship between occupation and incident hypertension.
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