Introduction Data on omega-3 polyunsaturated fatty acids in relation to cardiovascular disease are limited in women. The aim of this study was to examine longitudinal relations of tuna and dark fish, ...α-linolenic acid, and marine omega-3 fatty acid intake with incident major cardiovascular disease in women. Methods This was a prospective cohort study of U.S. women participating in the Women’s Health Study from 1993 to 2014, during which the data were collected and analyzed. A total of 39,876 women who were aged ≥45 years and free of cardiovascular disease at baseline provided dietary data on food frequency questionnaires. Analyses used Cox proportional hazards models to evaluate the association between fish and energy-adjusted omega-3 polyunsaturated fatty acid intake and the risk of major cardiovascular disease, defined as a composite outcome of myocardial infarction, stroke, and cardiovascular death, in 38,392 women in the final analytic sample (96%). Results During 713,559 person years of follow-up, 1,941 cases of incident major cardiovascular disease were confirmed. Tuna and dark fish intake was not associated with the risk of incident major cardiovascular disease ( p -trend >0.05). Neither α-linolenic acid nor marine omega-3 fatty acid intake was associated with major cardiovascular disease or with individual cardiovascular outcomes (all p -trend >0.05). There was no effect modification by age, BMI, or baseline history of hypertension. Conclusions In this cohort of women without history of cardiovascular disease, intakes of tuna and dark fish, α-linolenic acid, and marine omega-3 fatty acids were not associated with risk of major cardiovascular disease.
Abstract Purpose We estimated the absolute risks of treatment termination and incidence of adverse liver outcomes among all commonly used oral antifungal treatments for superficial dermatophytosis ...and onychomycosis. Methods MEDLINE, EMBASE, and Cochrane Library were searched to identify randomized and nonrandomized controlled trials, case series, and cohort studies published before December 31, 2005. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. Treatment arms with the same regimen in terms of drug, type (continuous or intermittent), and dosage were combined to estimate the risk of an outcome of interest. Results We identified 122 studies with approximately 20,000 enrolled patients for planned comparison. The pooled risks (95% confidence intervals) of treatment discontinuation resulting from adverse reactions for continuous therapy were 3.44% (95% confidence interval CI, 2.28%-4.61%) for terbinafine 250 mg/day; 1.96% (95% CI, 0.35%-3.57%) for itraconazole 100 mg/day; 4.21% (95% CI, 2.33%-6.09%) for itraconazole 200 mg/day; and 1.51% (95% CI, 0%-4.01%) for fluconazole 50 mg/day. For intermittent therapy, the pooled risks were as follows: pulse terbinafine: 2.09% (95% CI, 0%-4.42%); pulse itraconazole: 2.58% (95% CI, 1.15%-4.01%); intermittent fluconazole 150 mg/week: 1.98% (95% CI, 0.05%-3.92%); and intermittent fluconazole 300 to 450 mg/week: 5.76% (95% CI, 2.42%-9.10%). The risk of liver injury requiring termination of treatment ranged from 0.11% (continuous itraconazole 100 mg/day) to 1.22% (continuous fluconazole 50 mg/day). The risk of having asymptomatic elevation of serum transaminase but not requiring treatment discontinuation was less than 2.0% for all treatment regimens evaluated. Conclusion Oral antifungal therapy against superficial dermatophytosis and onychomycosis, including intermittent and continuous terbinafine, itraconazole, and fluconazole, was associated with a low incidence of adverse events in an immunocompetent population.
Abstract Background The prevalence of vascular risk factors, cardiovascular disease, and restless legs syndrome increases with age. Prior studies analyzing the associations between vascular risk ...factors, cardiovascular disease, and restless legs syndrome found controversial results. We therefore aim to evaluate the associations between prevalent vascular risk factors, prevalent cardiovascular disease, and restless legs syndrome. Methods We conducted a cross-sectional study among 22,786 participants of the US Physicians' Health Studies I and II. Restless legs syndrome was classified according to the 4 minimal diagnostic criteria. Vascular risk factors and restless legs syndrome symptoms were self-reported. Prevalent cardiovascular disease events, including major cardiovascular disease, stroke, and myocardial infarction, were confirmed by medical record review. Age- and multivariable-adjusted logistic regression models were used to evaluate the association among vascular risk factors, prevalent cardiovascular disease events, and restless legs syndrome. Results The mean age of the cohort was 67.8 years. The prevalence of restless legs syndrome was 7.5% and increased significantly with age. Diabetes significantly increased the odds of restless legs syndrome (odds ratio OR, 1.41; 95% confidence interval CI, 1.21-1.65), whereas frequent exercise (OR, 0.78; 95% CI, 0.67-0.91) and alcohol consumption of 1 or more drinks per day (OR, 0.80; 95% CI, 0.69-0.92) significantly reduced the odds of restless legs syndrome in multivariable-adjusted models. Prevalent stroke showed an increased multivariable-adjusted OR of 1.40 (1.05-1.86), whereas men with prevalent myocardial infarction had a decreased OR of 0.73 (0.55-0.97) for restless legs syndrome. Conclusions The restless legs syndrome prevalence among US male physicians is similar to that of men of the same age group in other western countries. A history of diabetes is the most consistent risk factor associated with restless legs syndrome. Prevalent stroke and myocardial infarction are related to restless legs syndrome prevalence.
Background Chronic kidney disease (CKD) and obesity are important public health concerns. We examined the association between anthropomorphic measures and incident CKD and mortality. Study Design ...Cohort study. Setting & Participants Individual patient data pooled from the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. Predictors Waist-to-hip ratio (WHR), body mass index (BMI). Outcomes & Measurements Incident CKD defined as serum creatinine level increase greater than 0.4 mg/dL with baseline creatinine level of 1.4 mg/dL or less in men and 1.2 mg/dL or less in women and final creatinine level greater than these levels, and, in separate analyses, estimated glomerular filtration rate (eGFR) decrease of 15 mL/min/1.73 m2 or greater with baseline eGFR of 60 mL/min/1.73 m2 or greater and final eGFR less than 60 mL/min/1.73 m2 . Multivariable logistic regression to determine the association between WHR, BMI, and outcomes. Cox models to evaluate a secondary composite outcome of all-cause mortality and incident CKD. Results Of 13,324 individuals, mean WHR was 0.96 in men and 0.89 in women and mean BMI was 27.2 kg/m2 in both men and women. During 9.3 years, 300 patients (2.3%) in creatinine-based models and 710 patients (5.5%) in eGFR-based models developed CKD. In creatinine-based models, each SD increase in WHR was associated with increased risk of incident CKD (odds ratio, 1.22; 95% confidence interval CI, 1.05 to 1.43) and the composite outcome (hazard ratio, 1.12; 95% CI, 1.06 to 1.18), whereas each SD increase in BMI was not associated with CKD (odds ratio, 1.05; 95% CI, 0.93 to 1.20) and appeared protective for the composite outcome (hazard ratio, 0.94; 95% CI, 0.90 to 0.99). Results of eGFR-based models were similar. Limitations Single measures of creatinine, no albuminuria data. Conclusions WHR, but not BMI, is associated with incident CKD and mortality. Assessment of CKD risk should use WHR rather than BMI as an anthropomorphic measure of obesity.
Abstract Background Previous studies evaluating the association of cardiovascular disease and vascular risk factors with restless legs syndrome showed inconsistent results, especially for the ...potential relation between various vascular risk factors and restless legs syndrome. We therefore aimed to analyze the relationships between vascular risk factors, prevalent cardiovascular disease, and restless legs syndrome. Methods This is a cross-sectional study of 30,262 female health professionals participating in the Women's Health Study (WHS). Restless legs syndrome was defined according to diagnostic criteria of the International Restless Legs Study Group. Information on vascular risk factors (diabetes, hypertension, hypercholesterolemia, body mass index BMI, alcohol, smoking, exercise, and family history of myocardial infarction) was self-reported. Cardiovascular disease events (coronary revascularization, myocardial infarction, and stroke) were confirmed by medical record review. Prevalent major cardiovascular disease was defined as nonfatal stroke or nonfatal myocardial infarction. Logistic regression models were used to evaluate the association between vascular risk factors, prevalent cardiovascular disease, and restless legs syndrome. Results Of the 30,262 participants (mean age: 63.6 years), 3624 (12.0%) reported restless legs syndrome. In multivariable-adjusted models, BMI (odds ratio OR for BMI ≥ 35 kg/m2 , 1.35; 95% confidence interval CI, 1.17-1.56), diabetes (OR, 1.19; 95% CI, 1.04-1.35), hypercholesterolemia (OR, 1.17; 95% CI, 1.09-1.26), smoking status (OR for ≥ 15 cigarettes/day, 1.41; 95% CI, 1.19-1.66), and exercise (OR for exercise ≥ 4 times/week, 0.84; 95% CI, 0.74-0.95) were associated with restless legs syndrome prevalence. We found no association between prevalent cardiovascular disease (major cardiovascular disease, myocardial infarction, and stroke) and restless legs syndrome prevalence. Women who underwent coronary revascularization had a multivariable-adjusted OR of 1.39 (1.10-1.77) for restless legs syndrome. Conclusions In this large cohort of female health professionals, various vascular risk factors are associated with the prevalence of restless legs syndrome. We could not confirm the results of previous reports indicating an association between prevalent cardiovascular disease and restless legs syndrome.
Abstract Purpose While a healthy lifestyle has been associated with reduced risk of developing ischemic stroke, less is known about its effect on stroke severity. Methods We performed a prospective ...cohort study among 37,634 women without stroke or missing risk factor data at baseline. The healthy lifestyle index was composed of smoking, physical activity, body mass index, alcohol consumption, and diet (range 0-20, with 20 representing healthiest lifestyle). Possible functional outcomes were no stroke or stroke with modified Rankin Scale (mRS) score of 0-1 (mild), 2-3 (moderate), or 4-6 (severe). Multinomial logistic regression was used to analyze the association between healthy lifestyle and functional outcomes from stroke. Results Over 17.2 years of follow-up, 867 total strokes were confirmed. Compared to the lowest category (0-4), the highest category (17-20) was associated with reductions in risk of total stroke with mild (OR=0.43; 95% CI: 0.20-0.90), moderate (OR=0.53; 95% CI: 0.27-1.06) and severe (OR=0.48; 95% CI: 0.20-1.18) functional outcomes. Even a modest healthy lifestyle index (5-8 points) was associated with significant decreases in total stroke with severe and moderate functional outcomes. Similar results were seen for ischemic but not hemorrhagic strokes. Conclusions Highest versus lowest scores on the healthy lifestyle index were associated with reductions in risk of total and ischemic strokes with mild, moderate, and severe functional outcomes among women. The evidence that even modest healthy lifestyle index scores reduced risks of total and ischemic stroke with moderate and severe functional outcomes suggests modest lifestyle changes may reduce risk of disabling stroke events.
Abstract Background Restless legs syndrome has been speculated to be linked to cognitive impairment through vascular risk factors or through its effect on sleep deprivation. Previous studies on the ...association between restless legs syndrome and cognitive function have been inconclusive. We performed a cross-sectional analysis of the association between restless legs syndrome and cognitive function using data from a large population-based study of elderly individuals residing in France. Methods We used information from 2070 individuals from the Dijon, France center of the Three-City study who had available information on restless legs syndrome and cognitive functioning measures. Restless legs syndrome was assessed using the 4 minimal diagnostic criteria of the International Restless Legs Study Group. During the same wave in which restless legs syndrome status was assessed, cognitive functions also were assessed using 4 tests: Isaacs' test of verbal/category fluency, the Benton Visual Retention Test, the Trail Making Test B, and the Mini-Mental State Examination. We created a summary global cognitive score by summing the z scores for the 4 tests and used analysis of covariance to explore the association between restless legs syndrome and cognitive function. Results We did not observe any statistically significant differences in any cognitive z -score between those with restless legs syndrome and those without restless legs syndrome. The mean global z -score after multivariate adjustment was −0.003 (SE 0.173) for those with restless legs syndrome and −0.007 (SE 0.129) for those without restless legs syndrome ( P -value = .98). Conclusion Data from this large, population-based study do not suggest that restless legs syndrome is associated with prevalent cognitive deficits in elderly individuals.
Development of a Risk Score for Colorectal Cancer in Men Driver, Jane A., MD, MPH; Gaziano, J. Michael, MD, MPH; Gelber, Rebecca P., MD, MPH ...
The American journal of medicine,
03/2007, Letnik:
120, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Abstract Background Colorectal cancer is a common and preventable disease for which screening rates remain unacceptably low. Methods We developed a risk scoring system for the development of ...colorectal cancer among participants in the Physician’s Health Study, a prospective cohort of 21,581 US male physicians who were all free of cancer. Predictors of colorectal cancer were self-reported and identified from the baseline questionnaire. Logistic regression was used to determine the independent predictors of incident colorectal cancer over the follow-up period. Risk scores were created from the sum of the odds ratios of the final predictors and used to divide the cohort into categories of increasing relative risk. Results During 20 years of follow-up, 381 cases of colon cancer and 104 cases of rectal cancer developed in the cohort. Age, alcohol use, smoking status, and body mass index were independent significant predictors of colorectal cancer. The point scores were used to define 10 risk groups. Those in the highest risk group (9-10 points) had an odds ratio of 15.29 (6.19-37.81) for colorectal cancer compared with those with the lowest risk. We further stratified scores into 3 risk classes. Compared with those at the lowest relative risk, the odds ratio for colorectal cancer was 3.07 (2.46-3.83) in the intermediate risk group and 5.75 (4.44-7.44) in the highest risk group. Conclusions We developed a simple scoring system for colorectal cancer that identifies men at increased relative risk on the basis of age and modifiable factors. This tool should be validated in other populations.
Few prospective studies have explored the association between renal function and risk for incident atrial fibrillation (AF) in apparently healthy populations. A total of 24,746 women participating in ...the Women's Health Study who were free of cardiovascular disease and AF and provided blood samples at baseline were prospectively followed for incident AF from 1993 to 2010. AF events were confirmed by medical chart review. Estimated glomerular filtration rate (eGFR) was calculated from baseline creatinine using the Chronic Kidney Disease Epidemiology (CKD-EPI) equation. Cox models were used to estimate hazard ratios and 95% confidence intervals (CIs) for incident AF across eGFR categories controlling for AF risk factors. During a median of 15.4 years of follow-up, 786 incident AF events occurred. The multivariate-adjusted hazard ratios for incident AF across eGFR categories (<60, 60 to 74.9, 75 to 89, and ≥90 ml/min/1.73 m2 ) were 1.36 (95% CI 1.00 to 1.84), 0.90 (95% CI 0.71 to 1.14), 0.99 (95% CI 0.84 to 1.18) and 1.00, respectively, without evidence of a linear association (P for trend = 0.48). Similarly, there was no significant curvilinear association (quadratic p = 0.10) in multivariate analysis across categories. Compared to women with eGFRs ≥60 ml/min/1.73 m2 , the 1,008 women with eGFRs <60 ml/min/1.73 m2 had a multivariate-adjusted hazard ratio for AF of 1.39 (95% CI 1.04 to 1.86, p = 0.03). In conclusion, no significant linear or curvilinear relation was observed between incident AF and less severe impairment of renal function in this large prospective cohort of women. However, a significant elevation in AF risk was observed at a threshold eGFR of <60 ml/min/1.73 m2.
Background Chronic kidney disease is a risk factor for heart failure (HF). Although cystatin C can detect early kidney dysfunction, limited data are available on the association between cystatin C ...and HF. Methods In a prospective nested case-control study design, we examined whether cystatin C is associated with an increased risk of HF in the PHS and whether such an association is stronger in hypertensive subjects. We selected 220 cases of incident HF and 220 controls, matched on age, year of birth, and time of blood collection. Plasma cystatin C was measured using an immunonephelometry method. We used conditional logistic regression to estimate relative risks (RRs). Results Compared with the lowest tertile, the multivariable adjusted RR (95% CI) for HF was 1.15 (0.69-1.89) and 1.78 (1.01-3.13) for the second and third tertiles of cystatin C, respectively. Additional adjustment for systolic blood pressure and history of hypertension attenuated this association (RR = 1.0, 1.23 0.73-2.09, and 1.61 0.90-2.88 from the lowest to the highest tertile, respectively). Furthermore, we observed a 4-fold increased risk of HF in the second and third tertiles of cystatin C among hypertensive individuals and no meaningful effects of cystatin C on HF among nonhypertensive subjects. Conclusions Our data demonstrated that higher levels of cystatin C are associated with an increased risk of HF and that such association may be limited to hypertensive individuals. Additional studies are warranted to further examine the relationship between hypertension and cystatin C on the risk of HF.
PDF
