Chronic obstructive pulmonary disease is known to be associated with systemic inflammation. We examined the longitudinal association of C-reactive protein (CRP) and lung function in a cohort of ...18,110 men and women from the European Prospective Investigation Into Cancer in Norfolk who were 40–79 years of age at baseline (recruited in 1993–1997) and followed-up through 2011. We assessed lung function by measuring forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) at baseline, 4 years, and 13 years. Serum CRP levels were measured using a high-sensitivity assay at baseline and the 13-year follow up. Cross-sectional and longitudinal associations of loge-CRP and lung function were examined using multivariable linear mixed models. In the cross-sectional analysis, 1-standard-deviation increase in baseline loge-CRP (about 3-fold higher CRP on the original milligrams per liter scale) was associated with a −86.3 mL (95% confidence interval: −93.9, −78.6) reduction in FEV1. In longitudinal analysis, a 1-standard-deviation increase in loge-CRP over 13 years was also associated with a −64.0 mL (95% confidence interval: −72.1, −55.8) decline in FEV1 over the same period. The associations were similar for FVC and persisted among lifetime never-smokers. Baseline CRP levels were not predictive of the rate of change in FEV1 or FVC over time. In the present study, we found longitudinal observational evidence that suggested that increases in systemic inflammation are associated with declines in lung function.
Background
Forecasting dementia prevalence and the impact of preventive lifestyle interventions, requires accounting for the reduced risk of dementia and cardiovascular disease (CVD) and the ...concurrent increase in life‐expectancy and growing population susceptible to dementia. We aimed to forecast prevalence of dementia in Sweden, Spain, France and Poland in 2020 and 2050 assuming calendar trends in mortality rates and incidence of dementia and CVD continue the trajectories observed over the past two decades, and to estimate change in this number if elimination of cigarette‐smoking was successful.
Method
We developed a Monte‐Carlo Markov model with data derived from official statistics for population numbers and mortality rates and the Survey for Health, Ageing and Retirement in Europe for baseline prevalence estimates and transition probabilities. All input parameters were age‐ and sex‐specific and were projected to the future based on observed calendar trends. Relative risks of CVD, dementia, and mortality for smoking, obtained from meta‐analyses of published studies, were used to modify transition probabilities proportionate to the change in population attributable risk fractions if smoking is eliminated by 2025.
Result
Life‐expectancy at age 50 in Sweden was estimated at 31.1 years in 2020, increasing to 35.3 by 2050 if observed trajectories continue, and at 36.1 if smoking elimination was successful (Figure). Corresponding figures were 32.6, 41.7, and 44.0 years respectively for Spain; 32.5, 38.7, and 40.7 for France; and 30.3, 37.8, and 39.9 for Poland. Estimated numbers of people living with dementia in 2020 and 2050, and estimated numbers by 2050 if smoking was eliminated were 147,000 (age‐standardized prevalence 4.2%), 223,000 (4.1%) and 239,000 (4.2%) respectively in Sweden (Table); 1,090,000 (6.8%), 2,913,000 (6.4%) and 3,194,000 (6.6%) in Spain; 998,000 (4.8%), 2,128,000 (4.3%) and 2,400,000 (4.2%) in France; and 623,000 (3.9%), 1,254,000 (3.5%) and 1,442,000 (3.5%) in Poland.
Conclusion
Substantial increases in numbers with dementia by 2050 emphasize the importance of planning public health policies that meet the growing health‐ and social‐care needs of dementia patients in the next three‐decades. Although smoking cessation increases dementia‐free life‐years, it is unlikely to halt the increase in the numbers of dementia patients that result from concurrent increases in life‐expectancy.
Abstract
Background
Forecasting dementia prevalence and the impact of preventive lifestyle interventions, requires accounting for the reduced risk of dementia and cardiovascular disease (CVD) and the ...concurrent increase in life‐expectancy and growing population susceptible to dementia. We aimed to forecast prevalence of dementia in Sweden, Spain, France and Poland in 2020 and 2050 assuming calendar trends in mortality rates and incidence of dementia and CVD continue the trajectories observed over the past two decades, and to estimate change in this number if elimination of cigarette‐smoking was successful.
Method
We developed a Monte‐Carlo Markov model with data derived from official statistics for population numbers and mortality rates and the Survey for Health, Ageing and Retirement in Europe for baseline prevalence estimates and transition probabilities. All input parameters were age‐ and sex‐specific and were projected to the future based on observed calendar trends. Relative risks of CVD, dementia, and mortality for smoking, obtained from meta‐analyses of published studies, were used to modify transition probabilities proportionate to the change in population attributable risk fractions if smoking is eliminated by 2025.
Result
Life‐expectancy at age 50 in Sweden was estimated at 31.1 years in 2020, increasing to 35.3 by 2050 if observed trajectories continue, and at 36.1 if smoking elimination was successful (Figure). Corresponding figures were 32.6, 41.7, and 44.0 years respectively for Spain; 32.5, 38.7, and 40.7 for France; and 30.3, 37.8, and 39.9 for Poland. Estimated numbers of people living with dementia in 2020 and 2050, and estimated numbers by 2050 if smoking was eliminated were 147,000 (age‐standardized prevalence 4.2%), 223,000 (4.1%) and 239,000 (4.2%) respectively in Sweden (Table); 1,090,000 (6.8%), 2,913,000 (6.4%) and 3,194,000 (6.6%) in Spain; 998,000 (4.8%), 2,128,000 (4.3%) and 2,400,000 (4.2%) in France; and 623,000 (3.9%), 1,254,000 (3.5%) and 1,442,000 (3.5%) in Poland.
Conclusion
Substantial increases in numbers with dementia by 2050 emphasize the importance of planning public health policies that meet the growing health‐ and social‐care needs of dementia patients in the next three‐decades. Although smoking cessation increases dementia‐free life‐years, it is unlikely to halt the increase in the numbers of dementia patients that result from concurrent increases in life‐expectancy.
There is strong evidence from observational studies suggesting serum C-reactive protein (CRP) is associated with cardiovascular and all-cause mortality. However, less is known about whether there are ...differences in the association of CRP with all-cause or cause specific mortality by sex, smoking, body mass index (BMI), or physical activity. We aimed to investigate these interactions and also investigate and compare the association of CRP and other inflammation markers (i.e., fibrinogen and leukocyte count) with all-cause and cause-specific mortality. Men and women aged 40-79 were recruited in 1993–1997 in the EPIC-Norfolk cohort study. A total of 16,850 participants with high-sensitivity assayed CRP data who had no known cancer, myocardial infarction and stroke at baseline were entered in the analysis to test the association of CRP, fibrinogen and leukocyte count with risk of allcause and cause specific mortality. A total of, 2,603 allcause deaths (1,452 in men) including 823 cardiovascular and 1,035 cancer deaths, were observed after 231,000 person-years of follow-up (median 14.3 years). CRP was positively associated with risk of all-cause, cardiovascular, and non-cancer non-cardiovascular mortality independent of established risk factors. The hazard ratio of all-cause mortality (95 % CI) for participants with CRP in the range of 3–10 and>10 mg/1(vs.<0.5 mg/1) was 1.56(1.26–1.93) and 1.87 (1.43–2.43) respectively in men and 1.34 (1.07–1.68) and 1.98 (1.50–2.63) in women. The association was less positively graded in women with the increased risk being significant only at higher levels of the CRP distribution. The association persisted in never smokers and did not vary by levels of BMI or physical activity. Although fibrinogen and leukocyte count were also positively associated with mortality risk, only CRP remained a significant predictor of mortality when the inflammation markers were adjusted for one another in multivariable models. Serum CRP levels were a long-term predictor of risk of cardiovascular and noncardiovascular mortality independent of known risk factors, fibrinogen, and leukocyte count.
Abstract Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. In Sub-Saharan Africa, hypertension prevalence is higher and cardiovascular events ...occur at a younger age than in Europe or America. May Measurement Month (MMM) is a global campaign initiated by the International Society of Hypertension (ISH) aimed at raising awareness of high BP. In South Africa, the MMM campaign in 2017, 2018, and 2019 revealed that approximately one-third of adults had hypertension, only half of hypertensives were receiving antihypertensive therapy, and only a third of those with hypertension had controlled BP. These data highlight the need for continued BP screening and awareness campaigns in South Africa. From May to November 2021, a cross-sectional survey of volunteers aged ≥18 years was performed. Blood pressure measurements, definition of hypertension, and statistical analyses followed the MMM protocol. The screening sites targeted the general population mainly on university campuses and pharmacies in preference to hospitals and clinics, aiming to raise awareness and allow access to screening in those less likely to be aware of their BP status. Of the 2294 individuals (age 37.3 ± 16.9 years) screened, 30.8% had hypertension. Of those with hypertension, only 48.6% were aware and 43.5% were receiving treatment for hypertension. A large proportion (50.4%) of individuals receiving antihypertensive medication had uncontrolled BP (≥140/90 mmHg). In conclusion, the high prevalence of hypertension, despite the young adult age, and the high proportions of individuals unaware of their hypertension and with uncontrolled BP underscore the necessity for hypertension awareness campaigns and more rigorous management of hypertension.
Abstract May Measurement Month 2021 (MMM21) is the fourth edition of the global initiative in Poland initiated by the International Society of Hypertension (ISH) and aimed at raising awareness of ...hypertension and the need for blood pressure (BP) screening. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in 132 sites - between May and September 2021. Blood pressure was measured in 1699 subjects (mean age: 40.8 ± 17.0 years; 68.8% females). After multiple imputation, the age and sex standardized systolic and diastolic BP was 126.6/78.7 mmHg for the entire group, 133.8/81.9 mmHg in individuals on antihypertensive medication, and 125.4/78.6 mmHg in those not taking antihypertensive drugs. The proportion of subjects with high BP (≥140/90 mmHg) were: 30.9% for the entire group, 40.4% in subjects taking antihypertensive drugs, and 17.9% in those not taking antihypertensive drugs. Of all participants, 33.9% were in the age range of 18–29 years and we observed higher BP levels and more frequent BP elevation in males in this age group. These data provide unique insights into the hypertension rates during the COVID-19 pandemic. Due to the associated restrictions, only limited data could be obtained for older adults. Interestingly, among young Polish participants, the rate of hypertension and the level of BP were higher in males compared to females, suggestive perhaps of a higher susceptibility of males to experience a rise in BP during specific circumstances associated with a pandemic.
Dementia and cardiovascular disease generate enormous health and social-care costs and have shared risk factors. Following decades of cardiovascular disease mortality declines in England, ...improvements slowed after 2011. We investigated the potential economic implications of this slowdown.
We used the IMPACT better aging model—an open-cohort, stochastic Markov model. We synthesised trends in cardiovascular disease incidence and mortality, dementia, and disability (defined as reported diagnosis, functional impairment, or measured cognitive impairment) from the English Longitudinal Study of Ageing (ELSA) and Office for National Statistics data. We projected trends for adults aged 35–100 years in England and Wales from 2019–29. We modelled undiscounted health and social-care costs (primary outcome), and quality-adjusted life-years (QALYs) under the following two scenarios: age-specific cardiovascular disease incidence continues to decline, recommencing previous downward trends (scenario one); or age-specific cardiovascular disease incidence plateaus after 2006, continuing recent trends, assuming changes in mortality reflect incidence 5 years before (scenario two). We linked 85% of ELSA participants to their Hospital Episode Statistics (HES) data, which were costed and calibrated to national estimates. Age-related social-care costs were estimated by use of reported contact hours from ELSA combined with standard reference costs. Standard catalogues were used for QALY weights.
In scenario one, changes in population size and health were projected to increase health-care costs by around 12% between 2019 and 2029, from £93·0 billion to £104·6 billion per year (in 2019 prices). Social-care costs were projected to increase by around 27%, from £8·0 billion to £10·2 billion per year. In scenario two, health-care costs were projected to increase by around 15%, from £95·3 billion to £109·6 billion, and social-care costs by around 30%, from £8·2 billion to £10·7 billion, between 2019 and 2029. The overall net monetary cost of this slowdown in cardiovascular disease decline was £17·5 billion per year (made up of 200 000 QALYs and £5·5 billion in health and social-care costs).
We predict social-care costs will grow twice as fast as health-care costs over the next decade, even if cardiovascular disease occurrence continues to decline. Understanding the scale of the future health and social-care funding challenge might support proactive policy making. This study represents the first time ELSA data have been linked with HES data. However, we did not assess changes in health and social-care efficiency over time or the effect of spending on improving health.
British Heart Foundation
Previous estimates of the impact of public health interventions targeting hypertension usually focus on one health outcome. This study aims to consider the effects of change in future hypertension ...prevalence on mortality, dementia, and disability simultaneously.
We modelled three plausible scenarios based on observed trends of hypertension prevalence from 2003 to 2017 in England: observed trends continue (baseline scenario); 2017 prevalence remains unchanged; and 2017 prevalence decreases by 50% by 2060. We used a probabilistic Markov model to integrate calendar trends in incidence of cardiovascular disease, dementia, disability, and mortality to forecast their future occurrence in the population of England and Wales. Assuming the hypertension prevalence trend modifies health transition probabilities, we compared mortality outcomes and the burden of dementia and disability to 2060 for the scenarios.
If the decline in hypertension prevalence stops, there would be a slight increase in the number of additional deaths to 2060 (22·9 95% uncertainty interval 19·0–26·6 more deaths per 100 000 population), although the burdens of disability and dementia in absolute terms would change little. Alternatively, if the downward hypertension prevalence trend accelerates (with prevalence falling by 50% between 2017 and 2060), there would be a modest additional reduction in deaths (57·0 50·4–63·5 fewer deaths per 100 000 population), a small increase in dementia burden (9·0 5·1–13·2 more cases per 100 000 population), no significant effect on disability burden, and an 8% gain in healthy life expectancy at age 65 years from 2020 to 2060 (5·3 years vs 4·9 years) compared with the baseline scenario.
The major future impact of alternative hypertension prevention strategies appears to be on future life expectancy. The salutary effect of lower population blood pressure distribution on incidence of dementia and disability might not offset expansion of the susceptible population due to reduced mortality.
British Heart Foundation and UK Economic and Social Research Council.
Abstract Previous studies have shown that among Bangladeshi adults, one-fifth have hypertension. The National Heart Foundation of Bangladesh participated in May Measurement Month (MMM) campaigns in ...2017, 2018, 2019, as well as in 2021 as a part of a global initiative aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of nationwide screening programmes. This opportunistic screening of voluntary participants aged ≥18 years was carried out from May to July 2021. Data were collected from more than 150 screening sites in all 64 districts in Bangladesh. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Data on 28 355 individuals were finally analysed. Among the participants, 17 941 (63.3%) were female. After multiple imputation, 11 194 (39.5%) had hypertension. Among the 11 194 participants with hypertension, 78.8% were aware of having hypertension and 65.6% were on antihypertensive medication. Among 11 194 participants with hypertension, 7340 participants (65.6%) were on antihypertensive medication and 43.8% had controlled BP (<140/90 mmHg). Of those on antihypertensive medication, 66.8% had controlled BP. A voluntary BP screening programme can identify significant numbers of people with raised BP and thus contributes importantly to the prevention of cardiovascular diseases.
Smoking generates a huge burden of morbidity and mortality globally and in the UK. We aimed to estimate the impact of two smoking reduction scenarios on numbers of deaths to 2040 in England and ...Wales.
We developed a probabilistic Markov model, IMPACT-BAM, to integrate calendar trends in the incidence of cardiovascular disease, dementia, disability, and mortality to forecast future prevalence of these conditions in addition to numbers of deaths from cardiovascular and non-cardiovascular causes in the population of England and Wales. We used data from the English Longitudinal Study of Ageing and Office for National Statistics to inform the model. Systematic reviews and meta-analyses provided relative risks of cardiovascular disease, dementia, disability, and mortality among smokers by age and sex. We estimated the future numbers of cardiovascular and non-cardiovascular conditions and deaths in the England and Wales population to 2040 (baseline forecast). We then quantified the potential benefits of two contrasting tobacco policies.
If smoking prevalence remains at current levels of 19% in men (17% in women), between 2017 and 2040 there will be an estimated 950 000 deaths from cardiovascular causes (95% uncertainty interval UI 576 000–1 915 000) and about 10 770 000 deaths from non-cardiovascular causes (8 022 000–14 112 000) in the population aged 65 years and over. If smoking prevalence continues to decline by 0·7% per year (as observed over the past decade), by 2040 there will be an estimated 19 000 fewer deaths from cardiovascular causes (95% UI 3700–58 000) and 170 000 fewer deaths from non-cardiovascular causes (89 000–289 000). If smoking prevalence is reduced to 9% by 2020 and 5% by 2025, there will be 34 000 fewer deaths from cardiovascular disease (95% UI 8200–111 000) and 349 000 fewer deaths from non-cardiovascular causes (188 000–574 000).
Public health programmes targeting tobacco smoking could potentially prevent over a third of a million cardiovascular and non-cardiovascular deaths by 2040.
British Heart Foundation (grants RG/13/2/30098, RG/16/11/32334).
PDF
