To assess whether body mass index (BMI) is associated with cognitive function and cognitive decline in healthy men and women.
In this prospective cohort study, we analyzed data from 2,223 healthy ...workers aged 32 to 62 years at baseline. Medical, psychosocial, and environmental data were collected in 1996 and in 2001. We tested cognitive functions at baseline and at follow-up with word-list learning (four recalls), a Digit-Symbol Substitution Test, and a selective attention test.
Cross-sectionally, a higher BMI was associated with lower cognitive scores after adjustment for age, sex, educational level, blood pressure, diabetes, and other psychosocial covariables. A higher BMI at baseline was also associated with a higher cognitive decline at follow-up, after adjustment for the above-cited confounding factors. This association was significant for word-list learning. For the changes in scores at word-list learning (delayed recall), regression coefficients were -0.008 +/- 0.13, -0.09 +/- 0.13, -0.17 +/- 0.14, and -0.35 +/- 0.14 (p for trend < 0.001) for the second, third, fourth, and fifth quintiles of BMI at baseline when compared with the first quintile. No significant association was found between changes in BMI and cognitive function.
Body mass index was independently associated both with cognitive function (word-list learning and Digit-Symbol Substitution Test) and changes in word-list learning in healthy, nondemented, middle-aged men and women.
To quantify the association between systemic levels of the chemokine regulated on activation normal T-cell expressed and secreted (RANTES/CCL5), interferon-γ-inducible protein-10 (IP-10/CXCL10), ...monocyte chemoattractant protein-1 (MCP-1/CCL2), and eotaxin-1 (CCL11) with future coronary heart disease (CHD) and ischemic stroke events and to assess their usefulness for CHD and ischemic stroke risk prediction in the PRIME Study.
After 10 years of follow-up of 9,771 men, 2 nested case-control studies were built including 621 first CHD events and 1,242 matched controls and 95 first ischemic stroke events and 190 matched controls. Standardized hazard ratios (HRs) for each log-transformed chemokine were estimated by conditional logistic regression.
None of the 4 chemokines were independent predictors of CHD, either with respect to stable angina or to acute coronary syndrome. Conversely, RANTES (HR = 1.70; 95% confidence interval CI 1.05-2.74), IP-10 (HR = 1.53; 95% CI 1.06-2.20), and eotaxin-1 (HR = 1.59; 95% CI 1.02-2.46), but not MCP-1 (HR = 0.99; 95% CI 0.68-1.46), were associated with ischemic stroke independently of traditional cardiovascular risk factors, hs-CRP, and fibrinogen. When the first 3 chemokines were included in the same multivariate model, RANTES and IP-10 remained predictive of ischemic stroke. Their addition to a traditional risk factor model predicting ischemic stroke substantially improved the C-statistic from 0.6756 to 0.7425 (p = 0.004).
In asymptomatic men, higher systemic levels of RANTES and IP-10 are independent predictors of ischemic stroke but not of CHD events. RANTES and IP-10 may improve the accuracy of ischemic stroke risk prediction over traditional risk factors.
Background and purpose
Up to 50% of ischaemic strokes in young adults are classified as cryptogenic despite extensive work‐up. We sought to evaluate the prevalence of non‐obstructive carotid ...atherosclerosis (NOCA) and its association with patent foramen ovale (PFO) in young adults with cryptogenic stroke (CS).
Methods
Patients aged 18–54 years, consecutively treated for first‐ever CS in an academic stroke service, were included. NOCA was assessed using carotid ultrasound examination and was defined as carotid plaque with <50% stenosis. PFO was diagnosed with transesophageal echocardiography.
Results
A total of 164 patients mean age (SD) = 43.7 (8.5) years; 104 men were included. A PFO was found in 79/164 (48.2%) patients. NOCA was demonstrated in 41/164 (25%) patients. NOCA was more common in patients without PFO 37.6% vs. 11.4%, P < 0.001; adjusted odds ratio (95% confidence interval), 0.24 (0.10–0.56). Older age (P = 0.046) and subcortical location of cerebral infarct (P = 0.015) were also associated with the absence of PFO, whereas hypertension, diabetes and smoking were not.
Conclusions
This study demonstrates that NOCA is common in young adults with CS. NOCA is negatively associated with PFO. Detecting NOCA is an important component of stroke investigation in young adults.
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Data on the possible association between depressive disorders and inflammatory markers are scarce and inconsistent. We investigated whether subjects with depressive mood had higher levels of a wide ...range of inflammatory markers involved in coronary heart disease (CHD) incidence and examined the contribution of these inflammatory markers and depressive mood to CHD outcome.
We built a nested case-referent study within the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study of healthy middle-aged men from Belfast and France. We considered the baseline plasma sample from 335 future cases (angina pectoris, nonfatal myocardial infarction, coronary death) and 670 matched controls (2 controls per case). Depressive mood characterized men whose baseline depression score (13-item modification of the Welsh depression subscale) was in the fourth quartile (mean score, 5.75; range, 4 to 12). On average, men with depressive mood had 46%, 16%, and 10% higher C-reactive protein, interleukin-6, and intercellular adhesion molecule-1 levels, respectively, independently of case-control status, social characteristics, and classic cardiovascular risk factors; no statistical difference was found for fibrinogen. The odds ratios of depressive mood for CHD were 1.35 (95% CI, 1.05 to 1.73) in univariate analysis and 1.50 (95% CI, 1.04 to 2.15) after adjustment for social characteristics and classic cardiovascular risk factors. The latter odds ratio remained unchanged when each inflammatory marker was added separately, and in this analysis, each inflammatory marker contributed significantly to CHD event risk.
These data support an association of depressive mood with inflammatory markers and suggest that depressive mood is related to CHD even after adjustment for these inflammatory markers.
The distribution of risk factors for cardiovascular disease in patients aged 35–44 years who were treated for human immunodeficiency virus type 1 (HIV-1) infection was compared with that for a ...population-based cohort. HIV-1-infected men treated with a protease inhibitor-containing regimen (n = 223), compared with HIV-1-uninfected men (n = 527), were characterized by a lower prevalence of hypertension, a lower mean high-density lipoprotein cholesterol level, a higher prevalence of smoking, a higher mean waist-to-hip ratio, and a higher mean triglyceride level. No difference was found for total plasma or low-density cholesterol levels, nor for the prevalence of diabetes. Similar trends were observed among female subjects. The predicted risk of coronary heart disease was greater among HIV-1-infected men (relative risk RR, 1.20) and women (RR, 1.59; P < 10-6 for both), compared with the HIV-1-uninfected cohort. The estimated attributable risks due to smoking were 65% and 29% for HIV-1-infected men and women, respectively. Because most HIV-1-infected people will ultimately need antiretroviral therapy, risk factors for cardiovascular disease should be determined at the initiation of treatment, and interventions should be considered for all patients who have them.
Abstract Aim This study assessed the independent relationships of daily sitting time, levels of work and leisure-time physical activity (PA), and dietary patterns of patients with the metabolic ...syndrome (MetS). Methods This population-based, cross-sectional study included 3090 French subjects aged 35–64 years. Daily time spent sitting and PA levels were assessed by an interview-administered questionnaire, while dietary patterns were identified using the factorial method of principal component analysis. Independent associations of lifestyle behaviours with the MetS were assessed by multivariable logistic-regression models adjusted for age, centre, educational level, smoking status, total calorie intake, heart rate and menopausal status. Results The multivariable-adjusted ORs 95% CI for MetS in the fourth quartile of sitting time and leisure-time PA were 1.65 1.11–2.44 ( P for trend < 0.01) and 0.58 0.40–0.84 ( P for trend < 0.001), respectively, for men, and 2.35 1.41–3.92 ( P for trend < 0.01) and 0.52 0.33–0.82 ( P for trend < 0.01), respectively, for women. Work PA was not favourably related to the MetS, particularly in women. An ‘energy-dense’ dietary pattern was independently associated with higher ORs for the MetS in both genders. However, accounting for body mass index (BMI) weakened the associations, which otherwise remained significant for leisure-time PA and the energy-dense dietary pattern in men, suggesting that BMI may be a potential mediator of these relationships. Conclusion This study demonstrated a dose–response association between sitting time, an energy-dense dietary pattern and the MetS, together with a graded inverse association between leisure-time PA and the MetS. In addition to the usual advice for PA and healthy eating, limiting the amount of time spent sitting should also be promoted through public-health initiatives.
The omega-3 index (the summed percentage content of eicosapentaenoic and docosahexaenoic acids in red blood cells) is associated with a lower risk of fatal coronary heart disease and sudden cardiac ...death. We aimed to determine which socio-demographic, behavioural or clinical factors are independently associated with the omega-3 index and the extent to which seafood consumption mediates the index's association with socio-economic status (SES).
As part of the cross-sectional MONA LISA-NUT survey (2005-2007), gas chromatography was used to analyse the red blood cell fatty acid composition in 503 French subjects aged 35-64 years. Dietary data were collected by trained dieticians via a validated food frequency questionnaire and a prospective 3-day food record. Risk factors were estimated with standardised measurements and questionnaires. SES was assessed through the self-reported educational and income tax levels.
The mean ± s.d. omega-3 index was 6.02 ± 1.75%. In the best parsimonious predictive model (which explained 32% of the variability in the omega-3 index), age, educational level and seafood servings were significantly and positively associated with the index. In contrast, waist circumference and smoking were inversely associated with the index. In a mediation analysis that took account of all these factors, seafood servings explained about 40% of the association between educational level and the omega-3 index. Similar results were obtained for the income tax level.
The inverse association between SES and omega-3 index is largely explained (40%) by an insufficient seafood intake. It remains to be seen which other factors mediate this association.
Abstract Objectives The aim of our study was to determine the effect of the menopause on various coronary heart disease (CHD) risk factors and on the global risk of CHD in a population based sample ...of women, making the difference between menopause and age related effects. Study design The Third French MONICA cross-sectional survey on cardiovascular risk included 1730 randomly selected women, aged 35–64 years, representative from the general population. Main outcome measures Women were defined as post-menopausal (postM; n = 696), peri-menopausal (periM; n = 183) or pre-menopausal (preM; n = 659) based on the date of last menses. Socio-demographic, clinical and biological data were collected. Analyses of variance were used to compare means. Results PostM women had significantly higher age-adjusted levels of total cholesterol (6.0 mmol/L in postM vs. 5.7 mmol/L in preM, p < 0.05) and LDL cholesterol (3.9 mmol/L vs. 3.6 mmol/L, p < 0.05). There was no difference in HDL cholesterol or triglyceride levels, glycemia or blood pressure. Further adjustment on body mass index and hormonal treatments did not modify the results. No risk factor was significantly different between periM and postM. However, the Framingham 10-year risk of CHD was higher in postM, as compared with periM (5.1% vs. 5.0%, p < 0.05). In postM women, lipids and the Framingham risk were not associated with elapsed time since menopause. Conclusions The CHD risk increases during the sixth decade could be explained not only by estrogen deprivation but also by an effect on lipid profile, which is likely to occur in the peri-menopause period.
Abstract Objective Insulin-like growth factor-1 (IGF-1) has been associated with cardiovascular risk factors and atherosclerosis. The aim of the present study was to evaluate the prognostic value of ...IGF-1 concentrations with respect to occurrence of well-defined coronary syndromes. Methods The PRIME study is a prospective cohort having included 10,600 subjects from Northern Ireland and France. Detailed information on cardiovascular risk factors, socioeconomic and behavioural variables were collected and a cardiologic examination was performed. At 5-year follow-up, 317 incident cases of coronary events were recorded according to strict protocols. They were matched to 634 age- and centre-paired controls from the same cohort, free of coronary disease. Baseline IGF-1 concentrations were measured, together with variables of lipid and glucose metabolism and markers of vascular and systemic inflammation. Results Baseline IGF-1 concentration was lower in subjects developing an acute coronary syndrome than in unaffected controls. IGF-1 levels correlated negatively with age, waist circumference, tobacco consumption and markers of inflammation. Subjects in the highest quartile of IGF-1 distribution had a 55% reduction in the relative risk of developing myocardial infarction and a 45% decrease for all-combined acute coronary syndromes. A similar trend, although non-significant, was noted for angina pectoris. Multiple adjustments on classical risk factors and inflammation markers did not affect IGF-1 results. Elevated levels of both IGF-1 and apo A-I conferred a significantly greater risk reduction than either one alone. However, interaction between the two markers was not significant. Conclusion Like HDL markers, high levels of IGF-1 confer protection against coronary artery disease.
Long-term observational cohorts provide the opportunity to investigate the potential impact of dietary patterns on death. We aimed to investigate all-cause death according to the consumption of ...selected food groups, and then to identify those independently associated with reduced mortality.
Population survey of middle-aged men randomly selected in the period 1995-1997 from the general population of three French areas and followed over a median of 14.8 years. Dietary data were collected through a 3-day food record. Cox modeling was used to assess the risk of death according to selected foods groups after extensive adjustment for confounders, including a diet quality index.
The study population comprised 960 men (mean age 55.5 ±6.2 years). After a median follow-up of 14.8 (interquartile range 14.3-15.2) years, 150 (15.6%) subjects had died. Food groups that remained independently predictive of a lower risk of death after extensive adjustment were an above-median consumption of milk (adjusted relative risk: 0.61, 95% confidence interval (CI): 0.43-0.86, P-value=0.005), fruits and vegetables (0.68, 0.46-0.98, P-value=0.041) and a moderate consumption of yogurts and cottage cheese (0.50, 95% CI: 0.31-0.81, P-value=0.005), other cheeses (0.62, 0.39-0.97, P-value=0.036) and bread (0.57, 0.37-0.89, P-value=0.014). Besides, there was a nonsignificant trend for a higher risk of death associated with highest sodium intakes.
Consumption of food groups that largely match recommendations is associated with a reduced risk of all-cause death in men. A diet providing moderate amounts of diverse food groups appears associated with the highest life expectancy.
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