Background Cohort studies evaluating increased uric acid level as a cardiovascular disease (CVD) risk factor have shown variable results; studies are particularly lacking in lower risk populations. ...Study Design Prospective cohort study. Setting & Participants 484,568 adults participating in a medical screening program in Taiwan since 1994 were followed up for a median of 8.5 years. Two subgroups were constructed: the first (n = 246,697; 51%) excluded participants with either overt CVD or overt CVD risk factors (including hypertension, diabetes, obesity, and hypertriglyceridemia) and the second (n = 157,238; 32%) further excluded individuals with early-stage CVD risk factors (including prehypertension, prediabetes, overweight, and borderline hypertriglyceridemia). Predictor Serum uric acid. Outcomes & Measurements All-cause and CVD mortality risk assessed using Cox proportional hazards models for categorical and continuous serum uric acid levels. As applicable, models adjusted for 14 variables. Population-attributable fraction was applied to compare contributions to mortality between high uric acid level and other CVD risk factors. Results In the total cohort, mean age was 41.4 ± 14.0 years and 26.2% had serum uric acid levels ≥7 mg/dL. Through 2007, there were 16,246 deaths (3.4% of all participants), with 35.2% of deaths occurring in individuals with hyperuricemia. Adjusted HRs associated with serum uric acid levels ≥7 mg/dL for all-cause and CVD mortality were 1.10 (95% CI, 1.04-1.17) and 1.38 (95% CI, 1.20-1.58), respectively. In individuals with hyperuricemia, 64.3% had overt CVD risk factors and 82.5% had either overt or early-stage CVD risk factors. Individuals with serum uric acid levels ≥8 mg/dL without overt CVD risk factors constituted 13.5% of the total study population with hyperuricemia; in analyses excluding those with overt CVD risk factors, serum uric acid level ≥8 mg/dL was significantly associated with all-cause and CVD mortality, with HRs of 1.37 (95% CI, 1.18-1.60) and 2.30 (95% CI, 1.51-3.49), respectively. In the subgroup of those with serum uric acid levels ≥8 mg/dL but who lacked both overt and early-stage CVD risk factors, the HRs for all-cause and CVD mortality were also significant and were 1.39 (95% CI, 1.08-1.78) and 2.38 (95% CI, 1.24-4.54), respectively. HRs for individuals with the same risk profiles but with serum uric acid of 7.0-7.9 mg/dL were not significant. In all groups, inclusion of proteinuria and glomerular filtration rate in models substantially attenuated the association between uric acid level and outcomes. High uric acid levels contributed a relatively insignificant portion to mortality (1.2%) and CVD deaths (4.5%) in this population. Limitations A single measurement of uric acid was used. Conclusion Increased serum uric acid level is a minor, but significant, risk factor for all-cause and CVD mortality. However, except for a small proportion (13.5%), increased serum uric acid level is more a risk marker than a target for treatment and is not an independent risk. Determining appropriate groups to target in clinical trials for uric acid–lowering therapy is critical.
Background Effects of decreased estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) mortality are uncertain in Chinese general populations. Study Design Prospective cohort ...study. Setting & Participants 17,026 adults 50 years and older in Taiwan. A subset of 7,968 had repeated measurements. Predictor Decreased eGFR and its progression. eGFR was calculated from serum creatinine level by using the Modification of Diet in Renal Disease Study equation. Outcomes Mortality from all causes and CVD, including coronary heart disease (CHD) and stroke, from the National Death Registry. Measurements Hazard ratios (HRs) and Kaplan-Meier survival curves were calculated for participants with a moderate to severe decrease in eGFR (<60 mL/min/1.73 m2 ) compared with those with normal eGFR (≥90 mL/min/1.73 m2 ). HR of a rapid decrease (≥20%) in eGFR was also calculated. Results Mean age of all participants was 57.2 ± 5.2 (SD) years. We observed 1,682 deaths in 15 years of follow-up. Participants with a moderate to severe decrease in eGFR had increased HRs for mortality from all causes (1.44; 95% confidence interval CI, 1.22 to 1.70), CVD (1.90; 95% CI, 1.36 to 2.65), CHD (2.07; 95% CI, 1.26 to 3.41), and stroke (2.16; 95% CI, 1.29 to 3.62) after adjusting for confounders. Decreased eGFR was associated with ischemic stroke, but not hemorrhagic stroke. No significant interaction between decreased eGFR and anemia, diabetes, or smoking was found. There were 660 participants with a 20% or greater decrease in eGFR from baseline during 18 months of follow-up. They had increased HRs for all causes (1.45; 95% CI, 1.13 to 1.86), CVD (2.48; 95% CI, 1.58 to 3.89), CHD (2.14; 95% CI, 1.07 to 4.29), and stroke (2.79; 95% CI, 1.45 to 5.36) compared with those with less than a 20% decrease in eGFR during the same period. Limitations Data for proteinuria were not available. Creatinine assay was not calibrated. Conclusions A moderate to severe or fast decrease in eGFR was associated with all-cause and CVD mortality in this ethnic Chinese cohort.
Minimal Amount of Exercise to Prolong Life Wen, Chi Pang, MD, DrPH; Wai, Jackson Pui Man, PhD; Tsai, Min Kuang, MS ...
Journal of the American College of Cardiology,
08/2014, Letnik:
64, Številka:
5
Journal Article
Recenzirano
Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise can save it and preserve it.--Plato 400 B.C. (1,2)For man to assume great ...responsibility, God tested his mental commitment, labored his muscles and bones, and starved his body.--Mencius 300 B.C. (3) Most agree that physical activity is beneficial, but a large proportion of the global population, ranging from 40% to 80%, remains sedentary. ...the concern for sudden death from running is so miniscule that the risk could be ignored--reported as 4 per 1 million (13) compared with an average coronary heart risk of 20% to 30% in the lifetime of an inactive individual.
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