Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: the Chicago Heart Association Detection Project in Industry

In a prospective cohort study, associations of resting heart rate with risk of coronary, cardiovascular disease, cancer, and all-cause mortality in age-specific cohorts of black and white men and women were examined over 22 years of follow-up. Participants were employees from 84 companies and organizations in the Chicago, Illinois, area who volunteered for a screening examination. Participants included 9,706 men aged 18-39 years, 7,760 men aged 40-59 years, 1,321 men aged 60-74 years, 6,928 women aged 18-39 years, 6,915 women aged 40-59 years, and 1,151 women aged 60-74 years at the baseline examination in 1967-1973. Vital status was ascertained through 1992. For fatal coronary disease, multivariate-adjusted relative risks associated with a 12 beats per minute higher heart rate (one standard deviation) were as follows: for men aged 18-39 years, relative risk (RR) = 1.27 (95% confidence interval (CI) 1.08-1.48); for men aged 40-59 years, RR = 1.13 (95% CI 1.05-1.21); for men aged 60-74 years, RR = 1.00 (95% CI 0.89-1.12); for women aged 40-59 years, RR = 1.21 (95% CI 1.07-1.36); and for women aged 60-74 years, RR = 1.16 (95% CI 0.99-1.37). Corresponding risks for all fatal cardiovascular diseases were similar to those for coronary death alone. Deaths from cancer were significantly associated with heart rate in men and women aged 40-59 years. All-cause mortality was associated with higher heart rate in men aged 18-39 years (RR = 1.11, 95% CI 1.01-1.20), men aged 40-59 years (RR = 1.16, 95% CI 1.11-1.21), and women aged 40-59 years (RR = 1.20, 95% CI 1.13-1.27). Heart rate was not associated with mortality in women aged 18-39 years. In summary, heart rate was a risk factor for mortality from coronary disease, all cardiovascular diseases, and all causes in younger men and in middle-aged men and women, and for cancer mortality in middle-aged men and women.     

Weight and mortality in Finnish women

Mortality in relation to body mass index (BMI) was studied in 17,159 healthy Finnish women aged 25-79 followed up for a median of 12 years. Mortality from all cases was related to BMI only in non-smokers aged 25-64, among whom the mortality pattern was "U"-shaped, with a minimum in the second quintile of BMI (the reference range), and about 1.5 times higher in quintiles I and V. Most of the excess risk of mortality among overweight women was due to cardiovascular diseases. During the first 7 years of follow-up, and high risk (relative risk (RR) = 1.7, 95% confidence interval (CI) = 1.0-2.9 for quintile V compared to quintile II) depended on the association of BMI with the initial blood pressure level, but in the later years, the relative risk of cardiovascular death, ranging from 1.6 (95% CI = 1.0-2.5) for women in quintile III up to 2.6 (95% Ci = 1.7-4.0) for those in quintile V, was largely independent of the baseline levels of the main biological risk factors. The excess mortality among thin women under the age of 65 was mainly due to non-cardiovascular diseases (RR = 1.7, 95% CI = 1.2-2.3 for quintile I compared to quintile II) and was not attributable to antecedent disease, smoking or the biological risk factors studied. Among women aged 65 and over, overall mortality varied little with BMI, but thinness seemed to predict deaths from cancers (RR = 1.6, 95% CI = 0.9-3.0).(ABSTRACT TRUNCATED AT 250 WORDS)     

Socioeconomic status and mortality in Swedish women: opposing trends for cardiovascular disease and cancer

We examined relations between socioeconomic status and cardiovascular disease, cancer, and diabetes mellitus in a 24-year prospective study of 1,462 Swedish women. Two socioeconomic indicators were used: the husband's occupational category for married women and a composite indicator combining women's educational level with household income for all women. The husband's occupational category was strongly associated with cardiovascular disease and cancer mortality in opposite directions, independent of age and other potential confounders. Women with husbands of lower occupational categories had an increased risk of cardiovascular disease mortality [relative risk (RR) = 1.60; 95% confidence interval (95% CI) = 1.09-2.33] while experiencing lower rates of all-site cancer mortality (RR = 0.69; 95% CI = 0.50-0.96). A similar relation was seen with the composite variable: women with low socioeconomic status had an increased risk of cardiovascular disease (RR = 1.37; 95% CI = 1.01-1.84) but a somewhat lower risk for cancer of all sites (RR = 0.86; 95% CI = 0.66-1.11). Finally, morbidity data (diabetes mellitus, stroke, and breast cancer) yielded results that were consistent with the mortality trends, and breast cancer appeared to account for a major part of the association between total cancer and high socioeconomic status. In summary, higher socioeconomic status was associated with decreased cardiovascular disease mortality and excess cancer mortality, in such a way that only a weak association was seen for all-cause mortality.     

应用超额死亡法探讨新型冠状病毒肺炎疫情防控期间居民死亡情况的变化趋势

目的 分析新型冠状病毒肺炎疫情防控期间镇江市户籍居民主要死亡原因分布变化情况,探讨此期间相关防控措施的实施及生活方式改变对居民健康的影响。方法 2020年1月26日—3月27日为镇江市新冠疫情防控一级、二级卫生应急响应期,选取2018—2020年同期镇江市户籍居民死亡数据,应用超额死亡理论中的事例分析法,对新冠疫情防控卫生应急响应期内超额死亡情况进行分析。结果 新冠疫情防控卫生应急响应期间,镇江市户籍居民死亡人数显著低于对照期水平（RR = 0.91,95%CI:0.87～0.95）,超额死亡情况主要体现在男性（RR = 0.86,95%CI:0.81～0.92）和65岁及以上年龄组（RR = 0.91,95%CI:0.87～0.96）人群。分病种超额死亡情况分析显示,男性心脑血管疾病死亡人数显著低于对照期水平（RR = 0.88,95%CI:0.82～0.95）,超额死亡情况主要体现在45～64岁（RR = 0.72,95%CI:0.53～0.98）和65岁及以上年龄组（RR = 0.85,95%CI:0.76～0.96）人群;急性、慢性呼吸系统疾病死亡人数显著低于对照期水平（RR = 0.52,95%CI:0.36～0.74）、（RR = 0.58,95%CI:0.49～0.68）,超额死亡情况主要体现在65岁及以上年龄组（RR = 0.53,95%CI:0.36～0.77）、（RR = 0.57,95%CI:0.49～0.68）;男性45～65岁年龄组伤害的死亡人数显著低于对照期水平（RR = 0.56,95%CI:0.35～0.88）;女性45～65岁年龄组恶性肿瘤的死亡人数显著高于对照期水平（RR = 1.40,95%CI:1.05～1.86）。不同特征人群超额死亡情况对比分析显示,男性的超额死亡情况显著低于女性（RRR = 1.13,95%CI:1.04～1.22）,与恶性肿瘤超额死亡情况相比,心脑血管疾病（RRR = 1.19,95%CI:1.09～1.30）、急性呼吸系统疾病（RRR = 2.04,95%CI:1.67～2.40）、慢性呼吸系统疾病（RRR = 1.82,95%CI:1.65～2.00）的超额死亡情况显著降低。结论 新型冠状病毒肺炎疫情应急响应期间,相关防护措施及政策的实施改变了居民的日常生活行为方式,对居民的健康产生了间接影响。     

Non-communicable disease mortality rates using the verbal autopsy in a cohort of middle aged and older populations in Beirut during wartime, 1983-93

STUDY OBJECTIVES: Health priorities in middle to low income countries, such as Lebanon, have traditionally been assumed to follow those of a "typical" developing country, with a focus on the young and on communicable diseases. This study was carried out to quantify the magnitude of communicable and non-communicable disease mortality and to examine mortality pattern among middle aged and older populations in an urban setting in Lebanon. DESIGN AND PARTICIPANTS: A representative cohort of 1567 men and women (>/=50 years) who had participated in a cross sectional multi-dimensional health survey in Beirut, Lebanon in 1983 and were followed up 10 years later. Vital status was ascertained and causes of death were obtained through verbal autopsy. RESULTS: Total mortality rates were estimated at 33.7 and 25.2/1000 person years among men and women respectively. In both sexes, the leading causes of death were non-communicable, mainly circulatory diseases (60%) and cancer (15%). For all cause mortality, men had significantly higher risk than women (age adjusted rate ratio, RR=1.42, 95% confidence intervals (CI) = 1.16, 1.72) especially at younger ages. Except for cerebrovascular diseases, renal problems and injuries attributable to falls and fractures, men were also at higher cause specific mortality risk than women, in particular, for ischaemic heart disease (RR = 2.24, 95% CI = 1.62, 3.12). Comparison with earlier death certificate data in Lebanon and current estimates from other regions in the world showed the magnitude of cardiovascular disease over time. CONCLUSIONS: The results from this first cohort study in the Arab region show, in contrast with popular perception, a mortality pattern more like a developed country than a developing one. Strategies of public health activities, in particular for countries in transition, need to be continuously re-assessed in light of empirical epidemiological data and other health indicators for evidence-based decision making.     

Associations between white blood cell count and risk for cerebrovascular disease mortality: NHANES II Mortality Study, 1976-1992

PURPOSE: To examine associations between elevated white blood cell count (WBC) and cerebrovascular disease (CeVD) mortality independent of cigarette smoking and by gender. METHODS: We used Cox regression analyses of data from 8459 adults (3982 men; 4477 women) aged 30 to 75 years in the NHANES II Mortality Study (1976-1992) to estimate the relative risk of death from CeVD across quartiles of WBC. RESULTS: During 17 years of follow-up, there were 192 deaths from CeVD (93 men; 99 women). Compared with those with WBC (cells/mm(3))<5700, adults with WBC>8200 were at increased risk of CeVD mortality (relative risk [RR], 2.1; 95% confidence interval [CI], 1.2-3.7) after adjustment for smoking and other cardiovascular disease risk factors. Similar results were observed among never smokers (RR, 2.0; 95% CI, 1.0-3.8). The adjusted relative risk of CeVD mortality comparing those with WBC>8200 to those with WBC<5700 was 1.5 (95% CI, 0.7-3.5) among men and 2.7 (95% CI, 1.4-5.0) among women. CONCLUSIONS: Elevated WBC may predict CeVD mortality even after considering the effects of smoking and other cardiovascular disease risk factors.     

Lifestyle characteristics and 3-year total mortality of Japanese with self-reported diabetes

Despite the significant adverse health consequences of diabetes, data on lifestyle characteristics and mortality among the Japanese with diabetes are limited. Our objective was to investigate the lifestyles of Japanese community residents with self-reported diabetes and their 3-year total mortality. Our cohort was 7178 randomly selected residents aged 30-79 years in Nihonmatsu City, Fukushima Prefecture, Japan; 5187 responded to the survey (72% response rate) and were followed for 3 years. Baseline data were collected using questionnaires in December 2002, and deaths were monitored monthly. Only 19% of women and 4% of men followed six to seven of Breslow's seven health practices. The percentage of people with self-reported diabetes was 4.2%[95% confidence interval (CI), 3.4-5.1%] for women and 7.9% (95% CI, 6.8-9.1%) for men, and the 3-year total mortality was 1.4% (95% CI, 1.0-1.9%) for women and 3.1% (95% CI, 2.4-3.8%) for men. Factors associated with 3-year mortality were fair or poor subjective health [odds ratio (OR) = 3.1, 95% CI 1.7-5.5] and self-reported diabetes (OR = 2.3, 95% CI 1.1-4.9) in a logistic regression controlling for age and gender. In stratified analyses, 3-year mortality of those with diabetes was significantly higher than those without the disease among men and those aged under 65. Those with diabetes were more likely to have self-reported comorbidities, high blood pressure and report poor subjective health regardless of age and gender, and healthier lifestyles among the women and those aged under 65. Our results support the need for community-based primary prevention measures to improve the lifestyles of residents, along with secondary prevention approaches to monitor those with diabetes for complications and to give them lifestyle instructions.     

银川市日内温差与居民心血管病死亡人数的时间序列研究

目的 探讨银川市日内温差（daily temperature range,DTR）与居民心血管病（cardiovascular disease,CVD）死亡的关系。方法 收集2010年1月1日~2015年12月31日银川市居民死亡及气象资料,采用分布滞后非线性模型（distributed lag non-linear model,DLNM）分析DTR与CVD死亡的暴露-反应关系。结果 DTR与CVD死亡呈"J"型关系,以20℃为拐点,随着DTR的增大,死亡效应增加。全年中,极高DTR对CVD死亡效应持续2 d,滞后1 d时最大（RR=1.054,95%CI:1.006~1.104）,男性和<65岁者更易受极高DTR影响。在温暖季节,极大DTR总效应在滞后2 d时最大（RR=1.105,95%CI:1.034~1.182）,男性和各年龄人群均易受DTR影响。在寒冷季节,极高DTR只对<65岁者有危险效应（RR=1.144,95%CI:1.005~1.303）。结论 银川市DTR的心血管病死亡效应呈非线性关系,且存在滞后效应。当DTR接近20℃时,心血管病死亡增加。男性和<65岁人群对极高DTR更敏感,应制定干预策略,有针对性的保护易感人群,以防止高DTR暴露的影响。     

Effects of temperature and snowfall on mortality in Pennsylvania.

The relation between exposure to severe cold weather and mortality is examined in a retrospective study of deaths occurring during the month of January from 1991 to 1996 in Pennsylvania. Using division-days as units of observation (n = 1,560) aggregated from death certificates and geographic divisions, the authors estimated mortality rates for total deaths and deaths due to ischemic heart disease, cerebrovascular diseases, and respiratory diseases by analyses based on generalized estimating equations. Total mortality increased on days of "extreme" climatic conditions, that is, when snowfall was greater than 3 cm and when temperatures were below -7 degrees C (rate ratio (RR) = 1.27, 95 percent confidence interval (CI) 1.12-1.44). On days of extreme conditions, mortality due to ischemic heart diseases tripled among males aged 35-49 years (RR = 3.54, 95 percent CI 2.35-5.35), increased for men aged 50-64 years (RR = 1.77, 95 percent CI 1.32-2.38), and rose for males aged 65 years and older (RR = 1.58, 95 percent CI 1.37-1.82), when compared with milder conditions. Among females, mortality for those aged 65 years and older increased for respiratory causes (RR = 1.68, 95 percent CI 1.28-2.21) and cerebrovascular causes (RR = 1.47, 95 percent CI 1.13-1.91). Cold and snow exposure may be hazardous among men as young as 35 years.     

Relation between self-reported physical functional health and chronic disease mortality in men and women in the European Prospective Investigation into Cancer (EPIC-Norfolk): a prospective population study

PURPOSE: To explore the relationship between self-reported physical functional health and mortality. METHODS: A cohort of 17,777 men and women aged 41-80 years who completed the anglicised 36-item short-form questionnaire (UK SF-36) in 1996-2000 were followed prospectively until 2004, average 6.5 years, for mortality from all causes, from cardiovascular disease, from cancer, and from all other causes. RESULTS: During 115,527 person-years of follow-up, 1065 deaths occurred. After adjusting for age, body mass index, systolic blood pressure, cholesterol, smoking, diabetes, and social class, the relative risks (RR) for all cause mortality were 2.15 (95% CI: 1.54, 2.99) and 2.42 (1.57, 3.74), cardiovascular mortality were RR = 2.71 (1.47, 4.98) and 3.09 (1.30, 7.33), and death from other causes excluding cancer RR = 2.88 (1.43, 5.79) and 5.22 (1.21, 22.53) in men and women respectively for those who were in the lowest compared to top quintile of SF-36 scores. These associations remained unchanged after exclusion of deaths during the first two years of follow-up and were also consistent in different age groups. CONCLUSIONS: Poor self-reported physical functional health in men and women without known instances of prevalent cardiovascular disease or cancer predicts total and cardiovascular disease mortality in the general population independently of known risk factors.     

Age at natural menopause and cause-specific mortality

Several studies have suggested that a young age at menopause may be associated with increased risk of all-cause mortality. Few studies have examined the influence of age at menopause on specific causes of death other than coronary heart disease. Data from a prospective cohort study of US adults were used to examine the relation between age at natural menopause and all-cause and cause-specific mortality among women who never used hormone replacement therapy, who never smoked, and who experienced natural menopause between the ages of 40 and 54 years. After 20 years of follow-up between 1982 and 2002, 23,067 deaths had occurred among 68,154 women. Results from Cox proportional hazards models showed that all-cause mortality rates were higher among women who reported that menopause occurred at age 40-44 years compared with women who reported that menopause occurred at age 50-54 years (rate ratio (RR) = 1.04, 95% confidence interval (CI): 1.00, 1.08). This increased risk was largely due to higher mortality rates from coronary heart disease (RR = 1.09, 95% CI: 1.00, 1.18), respiratory disease (RR = 1.19, 95% CI: 1.02, 1.39), genitourinary disease (RR = 1.39, 95% CI: 1.07, 1.82), and external causes (RR = 1.56, 95% CI: 1.21, 2.02). These findings suggest that mortality from other diseases, as well as coronary heart disease, may contribute to the increased mortality associated with a younger age at menopause.     

Total Physical Activity,Exercise Intensity,and Walking Speed as Predictors of All-Cause and Cause-Specific Mortality Over 7 Years in Older Men: The Concord Health and Aging in Men Project

Objective

The study aimed to examine the contemporaneous temporal association between changes in total physical activity, sports intensity, muscle strengthening exercise, and walking speed as predictors of all-cause, cardiovascular, cancer and other cause-specific mortality in older men.

Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.     

2009—2019年中国老年人心血管疾病死亡趋势及预测分析

目的 了解2009—2019年我国老年人心血管疾病总体死亡趋势并进行趋势预测的分析,为制定适合我国老年人心血管疾病整体防治策略提供相关理论基础。方法 利用2009—2019年《中国死因监测数据集》,采用joinpoint回归模型分析老年人心血管疾病死亡率的平均年度变化百分比(AAPC),应用GM(1,1)对我国2020—2030年老年人心血管疾病死亡粗率进行预测。结果 与2009年相比,2019年我国老年人心血管疾病平均死亡粗率降至2 039.99/10万,年龄标化死亡率则降至2 172.24/10万;我国总老年人群、老年男性和女性、城市和乡村老年人心血管疾病标化死亡率AAPC分别为-2.400%、-2.843%、-2.049%、-1.368%、-3.298%,均呈长期下降趋势,P<0.05;老年男性的死亡率下降速度快于老年女性,但2009—2019年老年男性心血管病标化死亡率始终较女性高;农村的下降速度快于城市,但2009—2019年农村老年人心血管病标化死亡率始终较城市高;随着年龄的增长,中国65岁以上老年人心血管疾病的死亡率逐渐上升,在≥85岁组死亡率达到最高,各年龄组AA...     

Mortality among women and men relative to unemployment, part time work, overtime work, and extra work: a study based on data from the Swedish twin registry

OBJECTIVE—To examine mortality before 70 years of age among women and men relative to unemployment, part time work, overtime work, and extra work. Age, marital status, children, smoking and alcohol habits, use of sleeping pills and tranquilisers, stress, shift work, personality factors, and long lasting or serious illness were taken into account as potential confounding factors.
METHODS—The study group comprised a subcohort of the Swedish twin registry, people born in 1926-58. Data were based on a postal questionnaire of 1973 and on information from the Swedish Causes of Death Registry. All subjects reporting a main occupation were selected, 9500 women and 11 132 men, and mortality from all causes during 1973-96 was analysed. The subjects were treated as a sample from the general population regardless of the twinning.
RESULTS—Unemployment in 1973 among both women and men showed an association with increased mortality. The adjusted relative risk (RR) (95% confidence interval (95% CI)) was 1.98 (1.16 to 3.38), for women and 1.43 (0.91 to 2.25) for men. For the first 5 years of follow up, a threefold increase in risk was found for men (RR (95% CI) 3.29 (1.33 to 8.17)). The RR declined by time, but remained increased throughout the 24 year study period. In women overtime work of more than 5 hours a week was followed by an increased mortality rate (RR (95% CI) 1.92 (1.13 to 3.25)). A protective effect of moderate overtime work of a maximum 5 hours a week was shown for men (RR (95% CI) 0.58 (0.43 to 0.80)), whereas an increased mortality was indicated for part time work (RR (95% CI) 1.58 (0.91 to 2.77)) and extra work (work outside employment) of more than 5 hours a week (RR (95% CI) 1.29 (0.99 to 1.69)).
CONCLUSION—Unemployment and some time aspects of work were associated with subsequent mortality, even when controlling for social, behavioural, work, and health related factors. The idea that losing a job may have less importance for women than for men is not supported by this study.


Keywords: mortality; unemployment; overtime work     

Diabetes mellitus, coronary heart disease incidence, and death from all causes in African American and European American women: The NHANES I epidemiologic follow-up study

Few data are available on risk for coronary heart disease in African American women with diabetes mellitus, a well-established coronary risk factor in European American women. This study tests the hypothesis that medical history of diabetes predicts coronary heart disease incidence in African American women in a national cohort. Participants in the NHANES I Epidemiologic Follow-up Study in this analysis were 1035 African American and 5732 European American women aged 25-74 years without a history of coronary heart disease. Average follow-up for survivors was 19 years (maximum 22 years). Risk of incident coronary heart disease by baseline diabetes status was estimated. Proportional hazards analyses for African American women aged 25-74 revealed significant associations of coronary heart disease risk with diabetes after adjusting for age (RR = 2.40; 95% CI, 1.58-3.64, P < 0.01). After adjusting for age, smoking, and low education, there was an elevated risk in diabetics age 25-74 (RR = 2. 34; 95% CI, 1.54-3.56, P < 0.01); this association did not differ significantly from that for European American women. Excess coronary incidence in African American compared to European American women aged 25-64 was statistically explained by controlling for diabetes history, age, education, and smoking but only partly explained by age and diabetes history. In African American women aged 25-74, diabetes was also associated with increased coronary heart disease, cardiovascular, and all-cause mortality. The population attributable risk of coronary heart disease incidence associated with a medical history of diabetes was 8.7% in African American women and 6.1% in European American women. Medical history of diabetes was a significant predictor of coronary heart disease incidence and mortality in African American women and explained some of the excess coronary incidence in younger African American compared to European American women.     

Apolipoprotein E genotypes and the incidence of Alzheimer's disease among persons aged 75 years and older: variation by use of antihypertensive medication?

The authors examined the impact of the apolipoprotein E (APOE)(*)epsilon4 allele on Alzheimer's disease incidence in relation to use of antihypertensive medication. A population-based (Kungsholmen Project) cohort of 985 nondemented Swedish subjects aged >/=75 years was followed for an average of 3 years (1990-1992); 164 dementia (122 Alzheimer's disease) cases were identified. Compared with (*)epsilon3/(*)epsilon3, the APOE(*)epsilon4 allele increased the risk of developing dementia (relative risk (RR) = 1.5, 95% confidence interval (CI): 1.1, 2.1) and Alzheimer's disease (RR = 1.7, 95% CI: 1.2, 2.5). Subjects using antihypertensive medication at baseline (n = 432, 80% used diuretics) had a decreased risk of dementia (RR = 0.6, 95% CI: 0.5, 0.9) and Alzheimer's disease (RR = 0.5, 95% CI: 0.3, 0.8) after adjustment for several variables, including APOE. The effect of antihypertensive medication use was more pronounced among (*)epsilon4 carriers. For those not using antihypertensive medication, the relative risks of dementia and Alzheimer's disease for carriers were 2.2 (95% CI: 1.4, 3.4) and 2.3 (95% CI: 1.4, 3.7), respectively. The corresponding relative risks for those using antihypertensive medication were 0.9 (95% CI: 0.5, 1.6) and 1.1 (95% CI: 0.6, 2.2). The APOE(*)epsilon4 allele is an important predictor of dementia and Alzheimer's disease incidence. Further studies are needed to clarify whether use of antihypertensive medication, especially diuretics, modifies the effect of the allele.     

Effect of body mass on the association between estrogen replacement therapy and mortality among elderly US women

In observational studies, estrogen replacement therapy is associated with decreased cardiovascular disease rates and increased breast cancer rates. Recent evidence suggests that the impact of estrogen use on disease outcomes may vary by body mass. In a prospective study of 290,827 postmenopausal US women with no history of cancer or cardiovascular disease at enrollment in 1982, the authors examined the association between postmenopausal estrogen use and all-cause, coronary heart disease, stroke, all-cancer, and breast cancer death rates and whether these associations differed by body mass. After 12 years of follow-up, results from Cox proportional hazards models showed that all-cause death rates were lower among baseline estrogen users than never users (rate ratio (RR) = 0.82, 95% confidence interval (CI): 0.78, 0.87). The lowest relative risk was found for coronary heart disease (RR = 0.66, 95% CI: 0.58, 0.77). The inverse association between estrogen use and coronary heart disease mortality was strongest for thin women (body mass index <22 kg/m2) (RR = 0.49, p for interaction = 0.02). Breast cancer mortality did not increase with estrogen use overall, and no increased risk was observed for thin or heavy women. In this population, the reduction in coronary heart disease mortality among estrogen users was greatest for thinner women. Additional studies are needed to confirm or refute these results.     

The impacts of health examinations and smoking on disease mortality risk in Japan: a longitudinal cohort of 720,611 Japanese life insured persons

Objectives To evaluate the impacts of health examinations (HE) and smoking on disease mortality risk in Japan. Methods By using the large cohort database of a Japanese life insurance company, 720,611 subjects aged 20 to 80 years, who had contracted for life insurance between April 1, 1995 and March 31, 1998, were followed up until September 30, 1999. Cox’s proportional hazard model was used to estimate age-adjusted relative risk (RR) for disease death. Results After adjusting for age, disease mortality in smokers was significantly higher than that in non-smokers (men, RR 1.51, 95% CI: 1.25–1.81; women, RR 1.54, 95% CI: 1.12–2.11). Meanwhile, disease mortality in HEees (those who had got HE within the past 2 years) was significantly lower than that in non-HEees (men, RR 0.70, 95% CI: 0.56–0.88; women, RR 0.71, 95% CI: 0.54–0.92). The magnitude of the impact of HE on disease mortality risk varied according to smoking status. Non-smokers showed a significantly lower risk associated with HE, whereas smokers did not. Conclusions HE may allow an appreciable reduction in disease mortality, however, the reduction effect may be limited to non-smokers. Smoking cessation may be essential to improve the preventive effects of HE.     

Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men.

BACKGROUND: There is a well-established inverse relation between education and mortality from cardiovascular disease and cancer. The reasons for this are still in part unclear. We aimed to investigate whether differences in traditional vascular risk factors, adult height, physical activity, and biomarkers of fatty acid and antioxidant intake, could explain this association. METHODS: In all, 2301 50-year-old men in Uppsala, Sweden (82% of the background population) were examined with regard to educational level, blood pressure, blood glucose, body mass index, serum lipids, smoking, body height, physical activity, serum beta carotene, alpha tocopherol, selenium, and serum fatty acids in cholesterol esters. Cause-specific mortality was registered 25 years later. RESULTS: Low education was associated with a higher rate of mortality from cardiovascular disease (crude relative risk [RR] = 1.67, 95% CI : 1.17-2.39), and from cancer (crude RR = 1.94, 95% CI : 1.21-3.10), compared to high educational attainment. Men with high education had an overall more beneficial risk factor profile concerning traditional cardiovascular risk factors, physical activity, and biomarkers of dietary intake of antioxidants and fat. After adjustment for all examined risk factors, the inverse gradient between education and cardiovascular mortality disappeared (RR in low education = 1.01. 95% CI : 0.67-1.52). Controlling for smoking, physical activity and dietary biomarkers explained less than half of the excess cancer mortality in the lower educational groups. Smoking (adjusted RR = 1.89, 95% CI : 1.37-2.61), and high proportions of palmitoleic acid in serum cholesterol esters (adjusted RR per 1 SD = 1.39, 95% CI : 1.07-1.82) predicted cancer mortality, independently of all other factors. There were no independent relations between serum antioxidants and mortality. CONCLUSIONS: These data indicate that modifiable lifestyle factors mediate the inverse gradient between education and death from cerebro- and cardiovascular disease. Smoking, physical activity and dietary factors explained half of the excess cancer mortality in lower educated groups. Further studies are needed to explore the proposed association between palmitoleic acid, a marker of high intake of animal and dairy fat, and cancer.