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TIAZIDI
E IPERGLICEMIA IN RELAZIONE ALL'INDICE DI MASSA CORPOREA
[THE EFFECT OF BODY MASS INDEX ON FASTING BLOOD GLUCOSE AFTER INITIATION
OF THIAZIDE THERAPY IN HYPERTENSIVE PATIENTS. Am J Hypertens 2008;
21:438-442]
ABSTRACT
BACKGROUND The prevalence of obesity, hypertension, and type
2 diabetes mellitus is increasing in the United States. In this
setting, it is important to understand the effects of antihypertensives
on glucose metabolism. We therefore examined the association between
body mass index (BMI) (kg/m(2)) and fasting blood glucose (FBG)
in subjects in whom thiazide antihypertensive therapy had been initiated.
METHODS A retrospective observational study was carried out
on individuals with hypertension who had been started on thiazide
therapy. The subjects' age, thiazide dose, BMI, serum potassium,
FBG, new onset of diabetes mellitus, and concurrent use of other
antihypertensives were included in the analysis. Predictors of change
in FBG were analyzed using multiple linear regression analysis,
while predictors of new-onset diabetes mellitus were determined
using multiple logistic regression.
RESULTS A total of 2,624 individuals who had been started
on thiazide therapy for hypertension were divided into quartiles
of increasing BMI. FBG was found to be associated with baseline
BMI and, after thiazide initiation, there was a step-wise increase
in the magnitude of change in FBG with increasing BMI (P < 0.001
for both). Analysis using multiple linear regression found that
BMI and baseline FBG predicted the magnitude of FBG change in subjects
initiated on thiazide treatment (P < 0.001 for both). Analysis
with logistic regression found that, after thiazide initiation,
BMI, serum potassium baseline (P < 0.05 for both), and baseline
FBG (P < 0.001) predicted the development of diabetes mellitus.
CONCLUSIONS There is an overall increase in FBG in individuals
who are started on treatment with thiazides for hypertension. The
magnitude of change in FBG and the development of new-onset diabetes
mellitus after thiazide initiation were associated with increases
in BMI and baseline FBG.
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EFFETTI
RELATIVI DEI FARMACI PER L'OSTEOPOROSI NELLA PREVENZIONE DELLE FRATTURE
NON VERTEBRALI
[RELATIVE EFFECTIVENESS OF OSTEOPOROSIS DRUGS FOR PREVENTING NONVERTEBRAL
FRACTURE. Ann Int Med 2008; 148:637-646]
ABSTRACT
BACKGROUND Little information is available on the comparative
effectiveness of osteoporosis pharmacotherapies.
OBJECTIVE To compare the relative effectiveness of osteoporosis
treatments to reduce nonvertebral fracture risk among older adults.
DESIGN Cohort study.
SETTING Enrollees in 2 statewide pharmaceutical benefit programs
for persons age 65 years or older.
PATIENTS 43 135 new recipients of oral bisphosphonates, nasal
calcitonin, and raloxifene who began treatment from 2000 to 2005.
The mean age was 79 years (SD, 6.9), and 96% were women.
MEASUREMENTS The primary outcome was nonvertebral fracture
(hip, humerus, or radius or ulna) within 12 months of treatment
initiation. Cox proportional hazard models stratified by state and
adjusted for risk factors for fracture were used to compare fracture
rates. Alendronate was the reference category in all analyses.
RESULTS A total of 1051 nonvertebral fractures were observed
within 12 months (2.62 fractures per 100 person-years). No large
differences in fracture risk were found between risedronate (hazard
ratio [HR], 1.01 [95% CI, 0.85 to 1.21]) or raloxifene (HR, 1.18
[CI, 0.96 to 1.46]) and alendronate. However, among those with a
fracture history, raloxifene recipients experienced more nonvertebral
fractures within 12 months (HR, 1.78 [CI, 1.20 to 2.63]) compared
with alendronate recipients. Patients who received calcitonin experienced
more nonvertebral fractures than those who received alendronate
(HR, 1.40, [CI, 1.20 to 1.63]). Results were similar in sensitivity
analyses that examined different lengths of follow-up (6 months
and 24 months), were restricted to hip fracture as the outcome,
and were completed in various subgroups.
LIMITATION Confounder adjustment was limited to health care
utilization data, and the confidence bounds of some comparisons
were too wide to rule out potential clinically important differences
between agents.
CONCLUSION Differences in fracture risk between risedronate
or raloxifene and alendronate were small. Nasal calcitonin recipients
may have a higher risk for nonvertebral fractures compared with
alendronate recipients. Future studies that can better adjust for
possible confounding may further clarify these relationships.
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ACIDO
EICOSAPENTENOICO E GRAVITÀ DELLA SINTOMATOLOGIA DEPRESSIVA
[PLASMA EICOSAPENTAENOIC ACID IS INVERSELY ASSOCIATED WITH SEVERITY
OF DEPRESSIVE SYMPTOMATOLOGY IN THE ELDERLY: DATA FROM THE BORDEAUX
SAMPLE OF THE THREE-CITY STUDY. Am J Clin Nutr. 2008 May;87(5):1156-62]
ABSTRACT
BACKGROUND Depressive symptoms are commonly observed in elderly
people, and nutritional factors such as polyunsaturated fatty acids
(PUFAs) have been proposed as potential protective determinants
of depressive disorders.
OBJECTIVE The objective was to analyze the relation between
plasma fatty acids and severity of depressive symptomatology (DS)
in French elderly community dwellers.
DESIGN The study population (mean age: 74.6 y) consisted
of 1390 subjects from Bordeaux (France) included in the Three-City
Study cohort. DS was evaluated by using the Center for Epidemiologic
Studies Depression scale. The use of antidepressant drugs was recorded.
The proportion of each plasma fatty acid was determined. Cross-sectional
analysis of the association between plasma fatty acids and severity
of DS was performed by multilinear regression.
RESULTS Compared with control subjects, subjects with DS
were older, were more often women, were more often widowed or single,
were of lower income, were receiving antidepressant treatment more
frequently, had a lower incidence of hypercholesterolemia, and had
lower Mini-Mental State Examination scores (mean: -1.1 point; P
< 0.0001). Plasma eicosapentaenoic acid (EPA) was lower in the
subjects with DS than in the control subjects (0.85% compared with
1.01%; P = 0.001). There were no significant differences in any
other fatty acid. When adjusted for potential confounders, such
as sociodemographic characteristics and health indicators, plasma
EPA was inversely associated with the severity of DS (beta = -0.170,
P = 0.040) in subjects taking antidepressants.
CONCLUSION Higher plasma EPA was associated with a lower
severity of DS in elderly subjects, especially those taking antidepressants.
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EPIDEMIOLOGIA
DELLA VITAMINA B6 NELLA POPOLAZIONE AMERICANA
[PLASMA PYRIDOXAL 5'-PHOSPHATE IN THE US POPULATION: THE NATIONAL
HEALTH AND NUTRITION EXAMINATION SURVEY, 2003-2004. Am J Clin Nutr
2008; 87:1446-54]
ABSTRACT
BACKGROUND No large-scale, population-based study has considered
the descriptive epidemiology of vitamin B-6 status with use of plasma
pyridoxal 5'-phosphate (PLP), the indicator of vitamin B-6 adequacy
used to set the current Recommended Dietary Allowance, which is
< or = 2 mg/d for all subgroups.
OBJECTIVES We sought to examine the epidemiology of vitamin
B-6 status in the US population.
METHODS: In > 6000 participants aged > or = 1 y in
the National Health and Nutrition Examination Survey (2003-2004),
we considered relations between plasma PLP and various subject characteristics
and examined trends in plasma PLP and homocysteine with vitamin
B-6 intake, both overall and in selected subgroups.
RESULTS In males, plasma PLP decreased with age after adolescence
only in nonusers of supplemental vitamin B-6. Regardless of supplement
use, plasma PLP concentrations of women of childbearing age were
significantly lower than those of comparably aged men, and most
oral contraceptive users had plasma PLP < 20 nmol/L. The prevalence
of low plasma PLP was significantly > 3% at vitamin B-6 intakes
from 2 to 2.9 mg/d in all subgroups and at intakes from 3 to 4.9
mg/d in smokers, the elderly, non-Hispanic blacks, and current and
former oral contraceptive users. Intakes from 3 to 4.9 mg/d compared
with < 2 mg/d were associated with significant protection from
low plasma PLP in most subgroups and from hyperhomocysteinemia in
the elderly.
CONCLUSIONS Vitamin B-6 intakes of 3 to 4.9 mg/d appear consistent
with the definition of a Recommended Dietary Allowance for most
Americans. However, at that intake level, substantial proportions
of some population subgroups may not meet accepted criteria for
adequate vitamin B-6 status.
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PM10
E RICOVERI OSPEDALIERI PER MALATTIE RESPIRATORIE E CARDIOVASCOLARI
[COARSE PARTICULATE MATTER AIR POLLUTION AND HOSPITAL ADMISSIONS
FOR CARDIOVASCULAR AND RESPIRATORY DISEASES AMONG MEDICARE PATIENTS.
JAMA 2008; 299:2172-9]
ABSTRACT
CONTEXT Health risks of fine particulate matter of 2.5 microm
or less in aerodynamic diameter (PM2.5) have been studied extensively
over the last decade. Evidence concerning the health risks of the
coarse fraction of greater than 2.5 microm and 10 microm or less
in aerodynamic diameter (PM10-2.5) is limited.
OBJECTIVE To estimate risk of hospital admissions for cardiovascular
and respiratory diseases associated with PM10-2.5 exposure, controlling
for PM2.5.
DESIGN, SETTING, AND PARTICIPANTS Using a database assembled
for 108 US counties with daily cardiovascular and respiratory disease
admission rates, temperature and dew-point temperature, and PM10-2.5
and PM2.5 concentrations were calculated with monitoring data as
an exposure surrogate from January 1, 1999, through December 31,
2005. Admission rates were constructed from the Medicare National
Claims History Files, for a study population of approximately 12
million Medicare enrollees living on average 9 miles (14.4 km) from
collocated pairs of PM10 and PM2.5 monitors.
MAIN OUTCOME MEASURES Daily counts of county-wide emergency
hospital admissions for primary diagnoses of cardiovascular or respiratory
disease.
RESULTS There were 3.7 million cardiovascular disease and
1.4 million respiratory disease admissions. A 10-microg/m3 increase
in PM10-2.5 was associated with a 0.36% (95% posterior interval
[PI], 0.05% to 0.68%) increase in cardiovascular disease admissions
on the same day. However, when adjusted for PM2.5, the association
was no longer statistically significant (0.25%; 95% PI, -0.11% to
0.60%). A 10-microg/m3 increase in PM10-2.5 was associated with
a nonstatistically significant unadjusted 0.33% (95% PI, -0.21%
to 0.86%) increase in respiratory disease admissions and with a
0.26% (95% PI, -0.32% to 0.84%) increase in respiratory disease
admissions when adjusted for PM2.5. The unadjusted associations
of PM2.5 with cardiovascular and respiratory disease admissions
were 0.71% (95% PI, 0.45%-0.96%) for same-day exposure and 0.44%
(95% PI, 0.06% to 0.82%) for exposure 2 days before hospital admission.
CONCLUSION After adjustment for PM2.5, there were no statistically
significant associations between coarse particulates and hospital
admissions for cardiovascular and respiratory diseases.
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IPERTENSIONE
E IPERLIPIDEMIA E RETINOPATIA VASCOLARE
[RETINAL VEIN OCCLUSION AND TRADITIONAL RISK FACTORS FOR ATHEROSCLEROSIS.
Arch Ophthalmol 2008; 126:692-699]
ABSTRACT
OBJECTIVE To determine whether retinal vein occlusion (RVO)
is related to systemic hypertension, diabetes mellitus, and hyperlipidemia.
METHODS We systematically retrieved all studies published
between January 1985 and July 2007 that compared cases with any
form of RVO, including central and branch RVO, with controls. We
generated pooled odds ratios (ORs) and estimates of the population-attributable
risk percentages for systemic hypertension, diabetes mellitus, and
hyperlipidemia.
RESULTS Of 21 studies, including 2916 cases and 28 646 controls,
both hypertension (OR, 3.5; 95% confidence interval [CI], 2.5-5.1)
and hyperlipidemia (OR, 2.5; 95% CI, 1.7-3.7) were significantly
associated with any form of RVO; the association was less pronounced
for diabetes mellitus (OR, 1.5; 95% CI, 1.1-2.0). Similar results
were found in cases with central RVO and branch RVO. The percentage
of cases with any form of RVO attributed to hypertension was 47.9%
(95% CI, 31.2%-63.1%), to diabetes mellitus was 4.9% (95% CI, 0.8%-11.5%),
and to hyperlipidemia was 20.1% (95% CI, 5.9%-43.8%).
CONCLUSIONS Hypertension and hyperlipidemia are common risk
factors for RVO in adults, and diabetes mellitus is less so. It
remains to be determined whether lowering blood pressure and/or
serum lipid levels can improve visual acuity or the complications
of RVO.
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CORONARY
CALCIUM COVERAGE SCORE E ATEROSCLEROSI
[CORONARY CALCIUM COVERAGE SCORE: DETERMINATION, CORRELATES, AND
PREDICTIVE ACCURACY IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS.
Radiology 2008; 247:669-678]
ABSTRACT
PURPOSE To develop a new calcium score for use with unenhanced
cardiac computed tomography (CT) that can be used to define the
percentage of coronary arteries affected by calcium and to correlate
this score with risk factors and cardiovascular events.
MATERIALS AND METHODS Institutional review boards at all
participating centers approved this HIPAA-compliant study, and all
participants gave written informed consent. Calcium coverage score
(CCS), which represents the percentage of coronary arteries affected
by calcific plaque, was calculated for 3252 participants in the
Multi-Ethnic Study of Atherosclerosis in whom calcific plaque was
detected with CT. Quasi-Poisson models were used to estimate associations
(assessed by using t tests with robust standard errors) between
CCS and risk factors. Associations between the CCS, Agatston, and
calcium mass scores (hereafter, mass scores) and outcomes were estimated
and assessed by using Cox proportional hazards models with Wald
tests. The predictive ability of these models was assessed by using
area under the receiver operating characteristic curves and bootstrap
t tests.
RESULTS After adjustments were made for age, race, ethnicity,
and sex in the quasi-Poisson model, CCS was associated with hypertension,
dyslipidemia, and diabetes (P < .001 for all diseases). After
adjustments for age and sex, a twofold increase in CCS was associated
with a 52% (95% confidence interval: 34%, 72%) increase in risk
for any coronary heart disease (CHD) event. When Agatston or mass
scores were included with CCS in a Cox model for prediction of CHD
events, neither Agatston score nor mass score was a significant
predictor, whereas CCS remained significantly associated with CHD
events. Although receiver operating characteristic curves suggested
that there was a difference between CCS score and Agatston and mass
scores in prediction of a cardiac event, no differences in prediction
of hard cardiac events (myocardial infarction, death) were found.
CONCLUSION Both spatial distribution and amount of calcified
plaque contribute to risk for CHD.
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OBESITÀ
E FATTORI DI RISCHIO CARDIOVASCOLARE E MALATTIE VASCOLARI SUBCLINICHE
[THE IMPACT OF OBESITY ON CARDIOVASCULAR DISEASE RISK FACTORS AND
SUBCLINICAL VASCULAR DISEASE. THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS.
Arch Intern Med 2008;168:928-935]
ABSTRACT
BACKGROUND To assess the importance of the obesity epidemic
on cardiovascular disease (CVD) risk, we determined the prevalence
of obesity and the relationship of obesity to CVD risk factors and
subclinical vascular disease.
METHODS The Multi-Ethnic Study of Atherosclerosis is an observational
cohort study involving 6814 persons aged 45 to 84 years who were
free of clinical CVD at baseline (2000-2002). The study assessed
the association between body size and CVD risk factors, medication
use, and subclinical vascular disease (coronary artery calcium,
carotid artery intimal medial thickness, and left ventricular mass).
RESULTS A large proportion of white, African American, and
Hispanic participants were overweight (60% to 85%) and obese (30%
to 50%), while fewer Chinese American participants were overweight
(33%) or obese (5%). Hypertension and diabetes were more prevalent
in obese participants despite a much higher use of antihypertensive
and/or antidiabetic medications. Obesity was associated with a greater
risk of coronary artery calcium (17%), internal carotid artery intimal
medial thickness greater than 80th percentile (32%), common carotid
artery intimal medial thickness greater than 80th percentile (45%),
and left ventricular mass greater than 80th percentile (2.7-fold
greater) compared with normal body size. These associations persisted
after adjustment for traditional CVD risk factors.
CONCLUSIONS These data confirm the epidemic of obesity in
most but not all racial and ethnic groups. The observed low prevalence
of obesity in Chinese American participants indicates that high
rates of obesity should not be considered inevitable. These findings
may be viewed as indicators of potential future increases in vascular
disease burden and health care costs associated with the obesity
epidemic.
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SINDROME
METABOLICA E MALATTIE CARDIOVASCOLARI E DIABETE NEGLI ANZIANI
[CAN METABOLIC SYNDROME USEFULLY PREDICT CARDIOVASCULAR DISEASE
AND DIABETES? OUTCOME DATA FROM TWO PROSPECTIVE STUDIES. Lancet,
pubblicato on line il 21 maggio 2008]
ABSTRACT
BACKGROUND Clinical use of criteria for metabolic syndrome
to simultaneously predict risk of cardiovascular disease and diabetes
remains uncertain. We investigated to what extent metabolic syndrome
and its individual components were related to risk for these two
diseases in elderly populations.
METHODS We related metabolic syndrome (defined on the basis
of criteria from the Third Report of the National Cholesterol Education
Program) and its five individual components to the risk of events
of incident cardiovascular disease and type 2 diabetes in 4812 non-diabetic
individuals aged 70-82 years from the Prospective Study of Pravastatin
in the Elderly at Risk (PROSPER). We corroborated these data in
a second prospective study (the British Regional Heart Study [BRHS])
of 2737 non-diabetic men aged 60-79 years.
FINDINGS In PROSPER, 772 cases of incident cardiovascular
disease and 287 of diabetes occurred over 3.2 years. Metabolic syndrome
was not associated with increased risk of cardiovascular disease
in those without baseline disease (hazard ratio 1.07 [95% CI 0.86-1.32])
but was associated with increased risk of diabetes (4.41 [3.33-5.84])
as was each of its components, particularly fasting glucose (18.4
[13.9-24.5]). Results were similar in participants with existing
cardiovascular disease. In BRHS, 440 cases of incident cardiovascular
disease and 105 of diabetes occurred over 7 years. Metabolic syndrome
was modestly associated with incident cardiovascular disease (relative
risk 1.27 [1.04-1.56]) despite strong association with diabetes
(7.47 [4.90-11.46]). In both studies, body-mass index or waist circumference,
triglyceride, and glucose cutoff points were not associated with
risk of cardiovascular disease, but all five components were associated
with risk of new-onset diabetes.
INTERPRETATION Metabolic syndrome and its components are
associated with type 2 diabetes but have weak or no association
with vascular risk in elderly populations, suggesting that attempts
to define criteria that simultaneously predict risk for both cardiovascular
disease and diabetes are unhelpful. Clinical focus should remain
on establishing optimum risk algorithms for each disease.
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ADERENZA
ALLA DIETA MEDITERRANEA E RISCHIO DI DIABETE
[ADHERENCE TO MEDITERRANEAN DIET AND RISK OF DEVELOPING DIABETES:
PROSPECTIVE COHORT STUDY. BMJ , pubblicato on line il 29 maggio
2008]
ABSTRACT
OBJECTIVE To assess the relation between adherence to a Mediterranean
diet and the incidence of diabetes among initially healthy participants.
DESIGN Prospective cohort study with estimates of relative risk
adjusted for sex, age, years of university education, total energy
intake, body mass index, physical activity, sedentary habits, smoking,
family history of diabetes, and personal history of hypertension.
SETTING Spanish university department.
PARTICIPANTS 13 380 Spanish university graduates without
diabetes at baseline followed up for a median of 4.4 years.
MAIN OUTCOME MEASURES Dietary habits assessed at baseline
with a validated 136 item food frequency questionnaire and scored
on a nine point index. New cases of diabetes confirmed through medical
reports and an additional detailed questionnaire posted to those
who self reported a new diagnosis of diabetes by a doctor during
follow-up. Confirmed cases of type 2 diabetes.
RESULTS Participants who adhered closely to a Mediterranean
diet had a lower risk of diabetes. The incidence rate ratios adjusted
for sex and age were 0.41 (95% confidence interval 0.19 to 0.87)
for those with moderate adherence (score 3-6) and 0.17 (0.04 to
0.75) for those with the highest adherence (score 7-9) compared
with those with low adherence (score <3). In the fully adjusted
analyses the results were similar. A two point increase in the score
was associated with a 35% relative reduction in the risk of diabetes
(incidence rate ratio 0.65, 0.44 to 0.95), with a significant inverse
linear trend (P=0.04) in the multivariate analysis.
CONCLUSION Adherence to a Mediterranean diet is associated
with a reduced risk of diabetes.
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FILTRAZIONE
GLOMERULARE, ALBUMINURIA E RISCHIO DI MORTALITÀ CARDIOVASCOLARE
E PER TUTTE LE CAUSE
[GLOMERULAR FILTRATION RATE, ALBUMINURIA, AND RISK OF CARDIOVASCULAR
AND ALL-CAUSE MORTALITY IN THE US POPULATION. Am J Epidemiol 2008;
167:1226-1234]
ABSTRACT
Decreased glomerular filtration rate (GFR) and albuminuria are used
in combination to define chronic kidney disease, but their separate
and combined effects on cardiovascular and all-cause mortality have
not been studied in the general population. The linked mortality
file of the Third National Health and Nutrition Examination Survey
includes data from 13 years of follow-up (1988-2000) for 14,586
US adults. The authors estimated GFR from standardized serum creatinine
levels. Albuminuria was defined by the urinary albumin:creatinine
ratio. Incidence rate ratios (IRRs) were adjusted for major cardiovascular
disease risk factors and C-reactive protein. Lower estimated GFR
was associated with higher risks of cardiovascular and all-cause
mortality overall and within every albuminuria category. Likewise,
increasing albuminuria was associated with higher risk of estimated
GFR overall and within every category. When estimated GFR and albuminuria
were examined simultaneously, a 10-ml/minute/1.73 m2 lower estimated
GFR (among persons with estimated GFR <60 ml/minute/1.73 m2)
was associated with an IRR of 1.29 (95% confidence interval: 1.06,
1.55) for cardiovascular mortality and a doubling of albuminuria
was associated with an IRR of 1.06 (95% confidence interval: 1.04,
1.08) for cardiovascular mortality. The authors conclude that moderately
decreased estimated GFR and albuminuria independently predict cardiovascular
and all-cause mortality in the general population. These data support
recent recommendations defining chronic kidney disease and stratifying
subsequent risks based on both decreased GFR and albuminuria.
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SOFFIO
CAROTIDEO E RISCHIO DI INFARTO MIOCARDICO O MORTE CARDIOVASCOLARE
[CAROTID BRUITS AS A PROGNOSTIC INDICATOR OF CARDIOVASCULAR DEATH
AND MYOCARDIAL INFARCTION: A META-ANALYSIS. The Lancet 2008; 371:1587-1594]
SUMMARY
BACKGROUND Although carotid bruits are deemed to be markers
of generalised atherosclerosis, they are poor predictors of cerebrovascular
events. We investigated whether a carotid bruit predicts myocardial
infarction and cardiovascular death.
METHODS In this meta-analysis, we searched Medline (1966
to August, 2007) and Embase (1974 to August, 2007) with the terms
"carotid" and "bruit". Bibliographies of all
the retrieved articles were also searched. Articles were included
if they reported the incidence of myocardial infarction or cardiovascular
death in adults. Outcome variables were extracted in duplicate and
included the rate of myocardial infarction and cardiovascular mortality.
Quality of the articles was independently assessed with the Hayden
rating scheme. Data were pooled with a random effects model.
FINDINGS Of the 22 articles included, 20 (91%) used prospective
cohorts. Our analysis included 17.295 patients with 62.413·5
patient-years of follow-up, with a median sample size of 273 patients
(range 38-4736) followed up for 4 years (2-7). The rate of myocardial
infarction in patients with carotid bruits was 3·69 (95%
CI 2·97-5·40) per 100 patient-years (eight studies)
compared with 1·86 (0·24-3·48) per 100 patient-years
in those without bruits (two studies). Yearly rates of cardiovascular
death were also higher in patients with bruits (16 studies) than
in those without (four studies) (2·85 [2·16-3·54]
per 100 patient-years vs 1·11 [0·45-1·76] per
100 patient-years). In the four trials in which direct comparisons
of patients with and without bruits were possible, the odds ratio
for myocardial infarction was 2·15 (1·67-2·78)
and for cardiovascular death 2·27 (1·49-3·49).
INTERPRETATION Auscultation for carotid bruits in patients
at risk for heart disease could help select those who might benefit
the most from an aggressive modification strategy for cardiovascular
risk.
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MORBO
DI PARKINSON E MORTALITÀ
[PARKINSON DISEASE AND RISK OF MORTALITY: A PROSPECTIVE COMORBIDITY-MATCHED
COHORT STUDY. Neurology 2008; 70:1423-30]
ABSTRACT
OBJECTIVE To evaluate the association between Parkinson disease
(PD) and mortality after adjustment for comorbidities.
METHODS We conducted a matched cohort analysis among 22,071
participants in the Physicians' Health Study. Five hundred sixty
incident PD cases were identified by self-report. We used a modified
Charlson Comorbidity Index to calculate a comorbidity score. Each
PD case was matched by age to a comparator who was alive and had
an identical comorbidity score at the time of PD diagnosis of the
case. Both cohorts were followed for all-cause mortality. We used
proportional hazards models to calculate hazard ratios (HRs) for
mortality.
RESULTS A total of 330 participants died over a median follow-up
of 5.8 years, 200 (35.7%) in the PD group and 130 (23.2%) in the
reference group. After adjustment for smoking and age at PD onset,
the HR for mortality was 2.32 (95% CI 1.85-2.92). The mortality
risk remained significant with increasing age at onset, even in
those aged >or=80 years (HR = 2.10; 95% CI 1.44-3.00). The increased
risk was apparent for short PD duration (<2 years) and remained
stable with increasing duration. We found no different risk of mortality
associated with PD according to smoking status.
CONCLUSIONS In this large prospective cohort of men and after
matching on comorbidities, we found that Parkinson disease patients
had an increased risk of all-cause mortality. Mortality was increased
regardless of disease duration, did not diminish with increasing
age at onset, and was not influenced by smoking status.
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INTERRUZIONE
DELL'ABITUDINE AL FUMO E MORTALITÀ
[SMOKING AND SMOKING CESSATION IN RELATION TO MORTALITY IN WOMEN.
JAMA 2008; 299:2037-2047]
ABSTRACT
CONTEXT Smoking is associated with an increased risk of total
and cause-specific death, but the rate of mortality risk reduction
after quitting compared with continuing to smoke is uncertain. There
is inadequate or insufficient evidence to infer the presence or
absence of a causal relationship between smoking and ovarian cancer
and colorectal cancer.
OBJECTIVE To assess the relationship between cigarette smoking
and smoking cessation on total and cause-specific mortality in women.
DESIGN, SETTING, AND PARTICIPANTS Prospective observational
study of 104 519 female participants in the Nurses' Health Study
with follow-up from 1980 to 2004.
MAIN OUTCOME MEASURE Hazard ratios (HRs) for total mortality,
further categorized into vascular and respiratory diseases, lung
cancer, other cancers, and other causes.
RESULTS A total of 12 483 deaths occurred in this cohort,
4485 (35.9%) among never smokers, 3602 (28.9%) among current smokers,
and 4396 (35.2%) among past smokers. Compared with never smokers,
current smokers had an increased risk of total mortality (HR, 2.81;
95% confidence interval [CI], 2.68-2.95) and all major cause-specific
mortality. The HR for cancers classified by the 2004 surgeon general's
report to be smoking-related was 7.25 (95% CI, 6.43-8.18) and 1.58
(95% CI, 1.45-1.73) for other cancers. Compared with never smokers,
the HR for colorectal cancer was 1.63 (95% CI, 1.29-2.05) for current
smokers and 1.23 (95% CI, 1.02-1.49) for former smokers. A significant
association was not observed for ovarian cancer. Significant trends
were observed for earlier age at initiation of smoking for total
mortality (P = .003), respiratory disease mortality (P = .001),
and all smoking-related cancer mortality (P = .001). The excess
risk for all-cause mortality decreases to the level of a never smoker
20 years after quitting, with different time frames for risk reduction
observed across outcomes. Approximately 64% of deaths among current
smokers and 28% of deaths among former smokers were attributable
to cigarette smoking.
CONCLUSIONS Most of the excess risk of vascular mortality
due to smoking in women may be eliminated rapidly upon cessation
and within 20 years for lung diseases. Postponing the age of smoking
initiation reduces the risk of respiratory disease, lung cancer,
and other smoking-related cancer deaths but has little effect on
other cause-specific mortality. These data suggest that smoking
is associated with an increased risk of colorectal cancer mortality
but not ovarian cancer mortality.
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INDICE
DI MASSA CORPOREA IN ADOLESCENZA E MORTALITÀ CAUSA-SPECIFICA
[BODY MASS INDEX IN ADOLESCENCE IN RELATION TO CAUSE-SPECIFIC MORTALITY:
A FOLLOW-UP OF 230,000 NORWEGIAN ADOLESCENTS. Am J Epidemiol, pubblicato
o n line il 13 maggio 2008]
ABSTRACT
The prevalence of obesity in childhood and adolescence has increased
worldwide. Long-term effects of adolescent obesity on cause-specific
mortality are not well specified. The authors studied 227,000 adolescents
(aged 14-19 years) measured (height and weight) in Norwegian health
surveys in 1963-1975. During follow-up (8 million person-years),
9,650 deaths were observed. Cox proportional hazards regression
was used to compare cause-specific mortality among individuals whose
baseline body mass index (BMI) was below the 25th percentile, between
the 75th and 84th percentiles, and above the 85th percentile in
a US reference population with that of individuals whose BMI was
between the 25th and 75th percentiles. Risk of death from endocrine,
nutritional, and metabolic diseases and from circulatory system
diseases was increased in the two highest BMI categories for both
sexes. Relative risks of ischemic heart disease death were 2.9 (95%
confidence interval (CI): 2.3, 3.6) for males and 3.7 (95% CI: 2.3,
5.7) for females in the highest BMI category compared with the reference.
There was also an increased risk of death from colon cancer (males:
2.1, 95% CI: 1.1, 4.1; females: 2.0, 95% CI: 1.2, 3.5), respiratory
system diseases (males: 2.7, 95% CI: 1.4, 5.2; females: 2.5, 95%
CI: 1.4, 4.8), and sudden death (males: 2.2, 95% CI: 1.2, 4.3; females:
2.7, 95% CI: 1.1, 6.6). Adolescent obesity was related to increased
mortality in middle age from several important causes.
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INDICE
DI MASSA CORPOREA E CIRCONFERENZA VITA E RISCHIO DI CANCRO AL POLMONE
[BODY MASS INDEX AND WAIST CIRCUMFERENCE IN RELATION TO LUNG CANCER
RISK IN THE WOMEN'S HEALTH INITIATIVE. Am J Epidemiol, pubblicato
on line il 15 maggio 2008]
ABSTRACT
Investigators in several epidemiologic studies have observed an
inverse association between body mass index (BMI) and lung cancer
risk, while others have not. The authors used data from the Women's
Health Initiative to study the association of anthropometric factors
with lung cancer risk. Over 8 years of follow-up (1998-2006), 1,365
incident lung cancer cases were ascertained among 161,809 women.
Cox proportional hazards models were used to estimate hazard ratios
adjusted for covariates. Baseline BMI was inversely associated with
lung cancer in current smokers (highest quintile vs. lowest: hazard
ratio (HR) = 0.62, 95% confidence interval (CI): 0.42, 0.92). When
BMI and waist circumference were mutually adjusted, BMI was inversely
associated with lung cancer risk in both current smokers and former
smokers (HR = 0.40 (95% CI: 0.22, 0.72) and HR = 0.61 (95% CI: 0.40,
0.94), respectively), and waist circumference was positively associated
with risk (HR = 1.56 (95% CI: 0.91, 2.69) and HR = 1.50 (95% CI:
0.98, 2.31), respectively). In never smokers, height showed a borderline
positive association with lung cancer. These findings suggest that
in smokers, BMI is inversely associated with lung cancer risk and
that waist circumference is positively associated with risk.
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LDL
OSSIDATE E SINDROME METABOLICA
[ASSOCIATION BETWEEN CIRCULATING OXIDIZED LOW-DENSITY LIPOPROTEIN
AND INCIDENCE OF THE METABOLIC SYNDROME. JAMA 2008; 299:2287-2293]
ABSTRACT
CONTEXT Experimental data support the hypothesis that oxidized
low-density lipoprotein (LDL) is associated with the metabolic
syndrome. However, this hypothesis has not been tested in humans.
OBJECTIVE To establish the relation of oxidized LDL with
metabolic syndrome in the general community.
DESIGN, SETTING, AND PARTICIPANTS The Coronary Artery Risk
Development in Young Adults (CARDIA) study is a population-based,
prospective, observational study. We studied 1889 participants
who were between the ages of 18 and 30 years at the time of recruitment
in 1985 and 1986 and living in 1 of 4 US metropolitan areas (41%
African American; 56% women) and were seen both at year 15 (2000-2001,
ages 33-45 years) and year 20 examinations (2005-2006).
MAIN OUTCOME MEASURE The longitudinal association of oxidized
LDL and incident metabolic syndrome. Oxidized LDL was measured
with a monoclonal antibody-based enzyme-linked immunosorbent assay.
The metabolic syndrome was defined according to the Adult Treatment
Panel III of the National Cholesterol Education Program.
RESULTS Incident metabolic syndrome was diagnosed at the
year 20 follow-up in 12.9% (243 of 1889) of participants who did
not have metabolic syndrome at the 15-year follow-up. The odds
ratios (ORs) for incident metabolic syndrome after 5 years' follow-up
and adjusted for age, sex, race, study center, cigarette smoking,
body mass index, physical activity, and LDL cholesterol levels
by quintiles of oxidized LDL were 2.1 (95% confidence interval
[CI], 1.1-3.8) for the second quintile (55.4-69.1 U/L); 2.4 (95%
CI, 1.3-4.3) for the third quintile (69.2-81.2 U/L); 2.8 (95%
CI, 1.5-5.1) for the fourth quintile (81.3-97.3 U/L); and 3.5
(95% CI, 1.9-6.6) for the fifth quintile ( 97.4 U/L). The adjusted
ORs for incidence of dichotomous components of metabolic syndrome
in the highest vs the lowest quintile of oxidized LDL were 2.1
(95% CI, 1.2-3.6) for abdominal obesity, 2.4 (95% CI, 1.5-3.8)
for high fasting glucose, and 2.1 (95% CI, 1.1-4.0) for high triglycerides.
Low-density lipoprotein cholesterol was not associated with incident
metabolic syndrome or with any of its components in the fully
adjusted model containing oxidized LDL.
CONCLUSION Higher concentration of oxidized LDL was associated
with increased incidence of metabolic syndrome overall, as well
as its components of abdominal obesity, hyperglycemia, and hypertriglyceridemia.
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