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Aims/hypothesis: The aim of this work was to investigate whether measurement of the mean common carotid intima-media thickness (CIMT) improves cardiovascular risk prediction in individuals with diabetes. Methods: We performed a subanalysis among 4,220 individuals with diabetes in a large ongoing individual participant data meta-analysis involving 56,194 subjects from 17 population-based cohorts worldwide. We first refitted the risk factors of the Framingham heart risk score on the individuals without previous cardiovascular disease (baseline model) and then expanded this model with the mean common CIMT (CIMT model). The absolute 10 year risk for developing a myocardial infarction or stroke was estimated from both models. In individuals with diabetes we compared discrimination and calibration of the two models. Reclassification of individuals with diabetes was based on allocation to another cardiovascular risk category when mean common CIMT was added. Results: During a median follow-up of 8.7 years, 684 first-time cardiovascular events occurred among the population with diabetes. The C statistic was 0.67 for the Framingham model and 0.68 for the CIMT model. The absolute 10 year risk for developing a myocardial infarction or stroke was 16% in both models. There was no net reclassification improvement with the addition of mean common CIMT (1.7%; 95% CI −1.8, 3.8). There were no differences in the results between men and women. Conclusions/interpretation: There is no improvement in risk prediction in individuals with diabetes when measurement of the mean common CIMT is added to the Framingham risk score. Therefore, this measurement is not recommended for improving individual cardiovascular risk stratification in individuals with diabetes. [ABSTRACT FROM AUTHOR]

Objective:We wanted to explore if FTO genotype interacts with fat intake, or leisure-time physical activity, on fat mass, lean mass and mortality.Subjects and methods:Among 22 799 individuals (44-74 years) in the population-based Malmö diet and cancer cohort that were genotyped for rs9939609 in FTO and had information on dietary intake (from a modified diet history method) and no history of diabetes, cancer or cardiovascular disease, 2255 deaths (including 1100 cancer and 674 cardiovascular deaths) occurred during 12.0 years of follow-up. Leisure-time physical activity was determined from a list of 17 different physical activities in a questionnaire. Body composition was measured using bioelectric impedance method.Results:FTO genotype associated strongly with both fat mass and lean mass (Ptrend<1 × 10−16 for both) but we found only significant interactions with fat intake, or physical activity, on fat mass (Pinteraction=0.01 and 0.004). No significant interaction between FTO genotype and fat intake (Pinteraction=0.72), or leisure-time physical activity (Pinteraction=0.07), on total mortality were observed. However, we observed a significant interaction between leisure-time physical activity and FTO genotype on cardiovascular mortality (Pinteraction=0.03). The highest vs lowest quintile of physical activity was associated with 46% (95% confidence interval, 17-64%) reduced cardiovascular mortality among TT-carriers (Ptrend=0.004), and 11% reduced cardiovascular mortality among A-allele carriers (Ptrend=0.68).Conclusion:Our results indicate that FTO genotype associates with both fat mass and lean mass, but the level of fat intake and physical activity only modify the association with fat mass. In addition, FTO genotype may modify the association between physical activity and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate if two different physical activity (PA) questionnaires have similar ability to rank individuals, and to examine associations with cardiovascular-metabolic risk factors, compared to an objective measure. In a random sample (n=369, age: 65±6 years) from the population-based ‘Malmö Diet and Cancer’ (MDC) cohort, PA was measured by a leisure-time comprehensive questionnaire (MDC-score), a simple leisure-time questionnaire and by accelerometer-monitoring (CSA). Moderate correlations were observed between MDC-score and CSA in men and women (r=0.35 and 0.24, respectively). In men, both questionnaires and CSA were inversely associated with waist circumference, insulin resistance and metabolic syndrome. In women, the MDC-score was positively associated with high-density lipoprotein-cholesterol, and the simple questionnaire inversely associated with anthropometric indexes, but no association was seen between PA estimates and cardiovascular components. We conclude that both PA questionnaires distinguish health risks associated with anthropometric-metabolic risk factors, particularly in men. [ABSTRACT FROM AUTHOR]

Hypertension has been associated with raised plasma levels of complement factor 3 and 4 (C3 and C4). The nature of this association is unclear. This population-based longitudinal study explored whether C3 or C4 is associated with development of hypertension. Blood pressure and plasma levels of C3 and C4 were determined in 2178 healthy men, aged 35–50 years, initially without treatment for hypertension. Incidence of hypertension and blood pressure increase over 15.7 (±2.2) years follow-up was studied in relation to C3 and C4 at baseline. Among men with initially normal blood pressure (<160/95 mm Hg), incidence of hypertension (160/95 mm Hg or treatment) was 32, 42, 37 and 47%, respectively, for men with C3 in the first, second, third and fourth quartile (trend: P=0.001). This relationship remained significant after adjustment for confounding factors. Among men without blood pressure treatment, systolic BP increase (mean+standard error, adjusted for age, initial blood pressure and follow-up time) was 17.5+0.8, 19.6+0.9, 19.8+0.8 and 20.8+0.8 mm Hg, respectively, in the C3 quartiles (trend: P=0.004). C3 was not associated diastolic blood pressure at follow-up. Although C4 was associated with blood pressure at the baseline examination, there was no relationship between C4 and development of hypertension or future blood pressure increase. It is concluded that C3 in plasma is associated with future blood pressure increase and development of hypertension.Journal of Human Hypertension (2007) 21, 276–282. doi:10.1038/sj.jhh.1002129; published online 14 December 2006 [ABSTRACT FROM AUTHOR]

This study investigated the profile of long-term blood pressure (BP)-lowering medication in a population-based cohort, and whether treatment effects on BP control or risk of cardiovascular disease (CVD) differed between the types or patterns of BP-lowering regimes. In treated hypertensive patients, only 11.3% had a BP<140/90mm Hg. Inadequate drug combination and underestimation of global risk score seemed to be the possible reasons for poor BP control. Neither CVD morbidity nor mortality showed any significant difference in relation to treatment types or patterns. [ABSTRACT FROM AUTHOR]

Coronary heart disease remains an important cause of morbidity and mortality. Much data support the view that social support is associated with coronary heart disease. Participants of the study 'Men born in 1914,' (414 men) were followed from a baseline measurement in 1982/83 until the end of 1996. At baseline, the men answered a questionnaire on social support and participated in a stressful test where their behavior was categorized as adaptive or maladaptive. This study examined whether social support had a prospective impact on the incidence of myocardial infarction and all-cause mortality when behavior in the stressful task was taken into consideration. The conclusion of the study was that unsatisfactory levels of social support is associated with an increased risk of incident myocardial infarction (HR 2.40, CI 1.36-4.25, p = .003) and premature death (HR 1.99, CI 1.32-3.00, p = .001) but only in men who had shown maladaptive behavior in the test. [ABSTRACT FROM AUTHOR]

Objective:Body mass index (BMI) is associated with increased incidence of cardiovascular disease (CVD). However, the risk could be very different for individuals with the same body mass. The present study explored whether regional fat distribution, as measured by waist–hip ratio (WHR), could modify the impact of BMI on the risk of CVD in men and women.Design:Prospective population-based study.Subjects:A total of 10 369 men and 16 638 women, 45–73 years old, from general population in Malmö, Sweden.Measurements:All subjects were followed over 7 years for the incidences of first-ever cardiac event (CE) and ischemic stroke in relation to BMI category (<25.0, 25.0–29.9, 30.0) and WHR.Results:The prevalence of overweight and obesity was 39.4 and 13.0%, respectively. During follow-up, 1280 subjects suffered a CVD event (750 CE, 530 ischemic stroke). The risk of CVD in women increased with increasing levels of WHR, irrespective of BMI category. In men, WHR (per 1 s.d. increase) was associated with increased incidence of CVD in those with normal weight (relative risk (RR)=1.24; 95% CI: 1.13–1.37) after adjustments for confounding factors. However, WHR was not related to CVD in overweight men (RR=1.06; 95%CI: 0.94–1.20) or obese men (RR=1.04; 95%CI: 0.87–1.24). A significant interaction was observed between sex and WHR on the CVD risk.Conclusion:The effect of WHR on incidence of CVD is modified by the overall body weight and by gender. WHR adds prognostic information on the cardiovascular risk in women at all levels of BMI, and in men with normal weight.International Journal of Obesity (2006) 30, 1775–1781. doi:10.1038/sj.ijo.0803339; published online 11 April 2006 [ABSTRACT FROM AUTHOR]

Hypertension has been associated with increased case-fatality rates among individuals who subsequently suffer from acute coronary events. It is unknown whether inflammation modifies this relationship. This population-based study explored the effects of inflammation and hypertension on incidence of coronary event, and on the fatality of the future events. Blood pressure (BP) and five inflammation-sensitive plasma proteins (ISPs, fibrinogen, orosomucoid, α1-antitrypsin, haptoglobin and ceruloplasmin) were determined in 6071 healthy men. During the mean follow-up of 19 years, 679 men had a first coronary event (non-fatal myocardial infarction or death from coronary heart disease). Of them, 197 (29%) were fatal cases (death during the first day). As expected, hypertension was associated with increased incidence of coronary events and increased proportion of fatal cases. At all levels of BP, high ISPs (2 ISPs in top quartile) significantly added to the incidence of events. Men with high ISPs had the highest case-fatality rates. The difference in case-fatality rate between men with and without high ISPs was, however, significant only in men with normal BP (<130/85 mm Hg) (33 vs 19%, P<0.05), and not in men with moderate or severe hypertension (160/100 mm Hg) (40 vs 35%, P=0.32). High ISPs add to the incidence of coronary events at all levels of BP. Hypertension and inflammation are both independently associated with increased case-fatality in subjects who later have an acute coronary event. The influence of ISPs on the case-fatality rate seems to be most important in men with normal BP.Journal of Human Hypertension (2006) 20, 581–586. doi:10.1038/sj.jhh.1002037; published online 4 May 2006 [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Mice that are deficient for complement factor 3 (C3) have shown resistance to weight gain, despite increased food intake. Cross-sectional studies of humans have reported correlations between C3 and obesity. This longitudinal study explored whether C3 predicts a large weight gain in middle-aged men. Methods: Plasma concentrations of C3 and complement factor 4 (C4) were measured in 2,706 non-diabetic healthy men aged between 38 and 50 years, who were re-examined after a mean period of 6.1 years. Results: After adjustments for initial weight, age, height and follow-up time, the odds of incurring large weight gain (75th percentile, ≥3.8 kg) were 1.00 (reference), 0.96 (95% CI:0.7–1.2), 1.1 (CI:0.9–1.5) and 1.4 (CI: 1.1–1.8), respectively, among men with C3 levels in the first, second, third and fourth quartiles (p for trend= 0.01) respectively. This relationship remained significant after further adjustments for lifestyle factors (physical inactivity, alcohol, smoking), metabolic factors (glucose or homeostasis model assessment values, cholesterol, triglycerides), inflammatory markers (fibrinogen, haptoglobin, ceruloplasmin, orosomucoid, α1-antitrypsin) and for C4. C4 was associated with weight gain after adjustments for initial weight, height, follow-up time and lifestyle factors, but not after adjustments for C3. Conclusions/interpretation: C3 is a risk factor for incurring large weight gain in middle-aged men. [ABSTRACT FROM AUTHOR]

Assesses to what extent the incidence of coronary events and death related to smoking, hypertension, hyperlipidemia and diabetes is modified by obesity. Increase in the risk associated with obesity by exposure to other atherosclerotic risk factors of which smoking seems to be the most important; Need to evaluate the preventive potential of the associations in controlled trials.

The Serial Color Word Test was administered at baseline to 253 hypertensive men participating in the prospective cohort study of cardiovascular diseases 'Men born in 1914' in Malmo, Sweden. This test ofpsychological adaptation to a stressful encounter was used to investigate whether susceptibility to stress moderates the risk of a cardiac event in association with hypertension. Adaptive behavior, as measured by test performance, can be categorized in two dimensions. The regression dimension refers to linear change of time spent in the test session whereas the variability dimension refers to nonlinear change. Both dimensions consist of four different patterns. At follow-up (mean time = 8.2 +/- 3.5 years), the risk of a cardiac event varied between men with different adaptive patterns. One pattern, the Cumulative-Dissociative pattern of the variability dimension, characterized by a discontinuous and fluctuating time-consumption, was associated to an almost three-fold risk of a cardiac event during follow-up (relative risk [RR], 2.99; 95% confidence interval [CI],1.33 -6.70,p= .010) after adjustment for medical-, socioeconomic-, and lifestyle-related factors. No association existed between adaptive patterns and overall mortality. [ABSTRACT FROM AUTHOR]

Objectives: An increased risk of all-cause and cardiovascular mortality in users of anxiolytic-hypnotic drugs (AHD) has been reported, and use of analgesics may be an additional factor. Therefore, we examined the association of AHD and analgesic use, alone and in combination, with all-cause and ischaemic heart disease (IHD) mortality. Methods: Multivariate 10-year survival analysis in a population based cohort of 500 men born in 1914. Relative risks (RR) were adjusted by relevant confounders (blood pressure, serum cholesterol, diabetes mellitus, smoking habit, high alcohol consumption, history of previous IHD, cancer, and other diseases). Results: The RR of both all-cause and IHD mortality were significantly increased among those using both AHD and analgesics compared to those who took neither of these drugs: RR=1.8 for all-cause mortality, and RR=2.7 for IHD mortality. Conclusion: Although the number of cases was small, warranting interpretative caution, the current study suggests that the combined use of AHD (mainly benzodiazepines) and analgesics seems to be associated with an increase in all-cause and IHD mortality in elderly men. [ABSTRACT FROM AUTHOR]