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1. Longitudinal association of grip strength with cardiovascular and all-cause mortality in older urban Lithuanian population

Author

Lolita Sileikiene, Abdonas Tamosiunas, Dalia Luksiene, Ricardas Radisauskas, Daina Kranciukaite-Butylkiniene, and Martin Bobak

Subjects
Grip strength, All-cause mortality, CVD mortality risk, Longitudinal study, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Ageing populations experience greater risks associated with health and survival. It increases the relevance of identifying variables associated with mortality. Grip strength (GS) has been identified as an important biomarker for all cause and cardiovascular mortality, however, its prognostic value has not been studied in Lithuania. The aim of the present study is to evaluate the relationship of GS to vital status in a representative sample of the Lithuanian 45–72-year-old urban population during the period of 12 years of follow-up and to explore associations of GS with all-cause mortality and mortality from cardiovascular diseases (CVD). Methods Within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) 7,115 men and women 45–72 years of age were examined in the baseline survey (2006 to 2008). Data from the Official Lithuanian Mortality Register were used to evaluate CVD and all-cause mortality from follow-up till 2020. Cox proportional hazards regression was used, and four models for all-cause and CVD mortality were assessed. Results The mean GS was significantly higher among survivors’ men and women as compared to individuals deceased from CVD and other causes of death. In survivor men and women groups, minimal values of GS in all terciles were higher as compared to all three deceased groups. In both men and women groups, the lowest GS (1st tercile) was associated with a significantly higher risk of all-cause and CVD mortality as compared to the highest levels of GS (3rd tercile) in three Cox regression models. In both men and women were found to have a 1.34- and 1.35-fold higher risk of all-cause mortality, respectively, at lower GS, but no significant difference in the risk of CVD mortality. When GS was treated in all models as decrement per 1 kg and decrement per 1 SD, in both men and women, the risk of all-cause mortality significantly increased with decreasing of GS. Conclusions The mean GS was significantly higher among survivors’ men and women as compared to deceased from CVD and other causes of death. Risk of all-cause mortality significantly increased with decreasing of GS.

Published
2024
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2. Enterobacterales Biofilm-Specific Genes and Antimicrobial and Anti-Inflammatory Biomarkers in the Blood of Patients with Ischemic Heart Disease

Author

Agne Giedraitiene, Vacis Tatarunas, Kornelija Kaminskaite, Ugne Meskauskaite, Svitlana Boieva, Yu Ajima, Ieva Ciapiene, Audrone Veikutiene, Vaidotas Zvikas, Nora Kupstyte-Kristapone, Valdas Jakstas, Dalia Luksiene, Abdonas Tamosiunas, and Vaiva Lesauskaite

Subjects
E. coli, bacterial DNA, biofilm, blood direct PCR, ischemic heart disease, cardiovascular diseases, Medicine (General), R5-920
Abstract

Background: Ischemic heart disease (IHD) is the most prevalent type of cardiovascular disease. The main cause of IHD is atherosclerosis, which is a multifactorial inflammatory disease of blood vessels. Studies show that bacteria might have a significant impact on the pathogenesis of atherosclerosis and plaque rupture. This study aimed to evaluate the complexity of interactions between bacteria and the human body concerning metabolites and bacterial genes in patients with ischemic heart disease. Methods: Bacterial 16S rDNA and wcaF, papC, and sdhC genes were detected in whole blood using a real-time PCR methodology. An enzyme-linked immunosorbent assay was used to measure the concentration of the LL-37 protein. An analysis of ARA in blood plasma was performed. Results: Bacterial 16S rDNA was detected in 31% of the study patients, and the genes wcaF and sdhC in 20%. Enterobacterales genes were detected more frequently in patients younger than 65 years than in patients aged 65 years and older (p = 0.018) and in patients with type 2 diabetes (p = 0.048). Concentrations of the human antimicrobial peptide LL-37 and 12S-HETE concentrations were determined to be higher if patients had 16S rDNA and biofilm-specific genes. Conclusions: The results of this study enhance the understanding that Enterobacterales bacteria may participate in the pathogenesis of atherosclerosis and IHD. Bacterial DNA and host metabolites in higher concentrations appear to be detected.

Published
2024
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3. Left ventricular hypertrophy: an ECG-based study of prevalence and risk factors in a multiethnic population

Author

Jaakko Tuomilehto, Paul Zimmet, Ulf Nilsson, Stefan Söderberg, Dianna J Magliano, Jonathan E Shaw, Abdonas Tamosiunas, Hina Taki, and Sudhir Kowlessur

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Left ventricular hypertrophy (LVH) is frequently seen in association with arterial hypertension and indicates poor prognosis. This study aimed to determine the prevalence of LVH and associated factors in a multiethnic population from Mauritius.Methods Population-based health surveys were performed in 2009 and 2015 and included in total 8961 individuals aged 35–75 years with recorded 12-lead ECG. LVH was defined according to three criteria: Sokolow-Lyon, Cornell voltage and Cornell product. Data were collected about health and lifestyle behaviour. Anthropometry and blood pressure were measured. Fasting levels of blood lipids and glucose were determined, oral glucose tolerance test was performed in people without glucose-lowering medications.Results The age-standardised prevalence of LVH was 9% (n=875) according to any of the three ECG criteria. Individuals with LVH were older, more likely to have hypertension, diabetes, known cardiovascular disease (CVD) and elevated levels of cholesterol and creatinine. Further, they were more likely to be of African descent (Creole) and have lower educational level. In a multivariable model, Creole (OR (95% CI)) (1.56 (1.33 to 1.83)), low educational level (1.49 (1.28 to 1.75)), hypertension (3.01 (2.55 to 3.56)), known CVD (1.42 (1.11 to 1.83)) and elevated creatinine (1.08 (1.03 to 1.14)) remained associated with LVH. Individuals with non-treated or uncontrolled hypertension had a higher risk for LVH (3.09 (95% CI 2.57 to 3.71) and 4.07 (95% CI 3.29 to 5.05), respectively), than individuals with well controlled hypertension or normotension.Conclusion LVH occurs more frequently in individuals with hypertension, as well as in individuals with African ancestry and/or low education level.

Published
2023
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4. All-cause and cardiovascular mortality in relation to lung function in the full range of distribution across four Eastern European cohorts

Author

Tatyana Sarycheva, Nadezda Capkova, Andrzej Pająk, Sofia Malyutina, Abdonas Tamosiunas, Martin Bobák, and Hynek Pikhart

Subjects
Medicine, Science
Abstract

Abstract It is unclear whether the dose–response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002–2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose–response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11–16 years of follow-up. Mortality rate increased in a dose–response manner from highest to lower FEV1/height3 deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18–1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29–2.63), 2.35 (1.67–3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.

Published
2022
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5. Predictive importance of the visceral adiposity index and atherogenic index of plasma of all-cause and cardiovascular disease mortality in middle-aged and elderly Lithuanian population

Author

Abdonas Tamosiunas, Dalia Luksiene, Daina Kranciukaite-Butylkiniene, Ricardas Radisauskas, Diana Sopagiene, and Martin Bobak

Subjects
visceral adiposity index, atherogenic index of plasma, cardiovascular diseases, mortality, gender, Public aspects of medicine, RA1-1270
Abstract

BackgroundTwo indices: visceral adiposity index (VAI) and atherogenic index of plasma (AIP) during several recent years were implemented into epidemiological studies for predicting of cardiovascular diseases (CVD) and mortality risk. Our study aimed to evaluate the association of VAI and AIP with the risk of all-cause and CVD mortality among the Lithuanian urban population aged 45–72 years.MethodsIn the baseline survey (2006–2008), 7,115 men and women 45–72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE). Six thousand six hundred and seventy-one participants (3,663 women and 3,008 men) were available for statistical analysis (after excluding 429 respondents with the missed information on study variables) and for them, VAI and AIP were calculated. The questionnaire evaluated lifestyle behaviors, including smoking and physical activity. All participants in the baseline survey were followed up for all-cause and CVD mortality events until December 31st, 2020. Multivariable Cox regression models were applied for statistical data analysis.ResultsAfter accounting for several potential confounders, higher levels of VAI (compared 5th quintile to 1st quintile) were associated with significantly higher CVD mortality in men [Hazards ratio (HR) = 1.38] and all-cause mortality in women (HR = 1.54) after 10-year follow-up. CVD mortality significantly increased in men with 0 the highest AIP quintile compared with that for the lowest quintile (HR = 1.40). In women, all-cause mortality was significantly higher for the 4th quintile of AIP as compared with the 1st quintile (HR = 1.36).ConclusionsHigh-risk VAI levels were statistically significantly associated with all-cause mortality risk in men and women groups. The higher AIP level (5th quintile vs. 1st quintile—in men and 4th quintile vs. 1st quintile—in women) was significantly associated with increased mortality from CVD in the men group and increased all-cause mortality in the women group.

Published
2023
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6. Impaired lung function and mortality in Eastern Europe: results from multi-centre cohort study

Author

Tatyana Sarycheva, Nadezda Capkova, Andrzej Pająk, Sofia Malyutina, Galina Simonova, Abdonas Tamosiunas, Martin Bobák, and Hynek Pikhart

Subjects
Forced expiratory volume in one second, Pulmonary function test, Cohort study, Mortality, Diseases of the respiratory system, RC705-779
Abstract

Abstract Background The association between impaired lung function and mortality has been well documented in the general population of Western European countries. We assessed the risk of death associated with reduced spirometry indices among people from four Central and Eastern European countries. Methods This prospective population-based cohort includes men and women aged 45–69 years, residents in urban settlements in Czech Republic, Poland, Russia and Lithuania, randomly selected from population registers. The baseline survey in 2002–2005 included 36,106 persons of whom 24,993 met the inclusion criteria. Cox proportional hazards models were used to estimate the hazard ratios of mortality over 11–16 years of follow-up for mild, moderate, moderate-severe and very severe lung function impairment categories. Results After adjusting for covariates, mild (hazard ratio (HR): 1.25; 95% CI 1.15‒1.37) to severe (HR: 3.35; 95% CI 2.62‒4.27) reduction in FEV1 was associated with an increased risk of death according to degree of lung impairment, compared to people with normal lung function. The association was only slightly attenuated but remained significant after exclusion of smokers and participants with previous history of respiratory diseases. The HRs varied between countries but not statistically significant; the highest excess risk among persons with more severe impairment was seen in Poland (HR: 4.28, 95% CI 2.14‒8.56) and Lithuania (HR: 4.07, 95% CI 2.21‒7.50). Conclusions Reduced FEV1 is an independent predictor of all-cause mortality, with risk increasing with the degree of lung function impairment and some country-specific variation between the cohorts.

Published
2022
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7. Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia, and associated risk factors in the Czech Republic, Russia, Poland and Lithuania: a cross-sectional study

Author

Wentian Lu, Hynek Pikhart, Abdonas Tamosiunas, Ruzena Kubinova, Nadezda Capkova, Sofia Malyutina, Andrzej Pająk, and Martin Bobak

Subjects
Blood pressure, Fasting plasma glucose, Total cholesterol, Dyslipidemia, Central and Eastern Europe, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Empirical evidence on the epidemiology of hypertension, diabetes and hypercholesterolemia is limited in many countries in Central and Eastern Europe. We aimed to estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia in the Czech Republic, Russia, Poland and Lithuania, and to identify the risk factors for the three chronic conditions. Methods We analysed cross-sectional data from the HAPIEE study, including adults aged 45–69 years in the Czech Republic, Russia, Poland and Lithuania, collected between 2002 and 2008 (total sample N = 30,882). Among prevalent cases, we estimated awareness, treatment, and control of hypertension, diabetes and hypercholesterolemia by gender and country. Multivariate logistic regression was applied to identify associated risk factors. Results In each country among both men and women, we found high prevalence but low control of hypertension, diabetes, and hypercholesterolemia. Awareness rates of hypertension were the lowest in both men (61.40%) and women (69.21%) in the Czech Republic, while awareness rates of hypercholesterolemia were the highest in both men (46.51%) and women (51.20%) in Poland. Polish participants also had the highest rates of awareness (77.37% in men and 79.53% in women), treatment (71.99% in men and 74.87% in women) and control (30.98% in men and 38.08% in women) of diabetes. The common risk factors for the three chronic conditions were age, gender, education, obesity and alcohol consumption. Conclusions Patterns of awareness, treatment and control rates of hypertension, diabetes and hypercholesterolemia differed by country. Efforts should be made in all four countries to control these conditions, including implementation of international guidelines in everyday practice to improve detection and effective management of these conditions.

Published
2022
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8. Lifestyle factors and psychological well-being: 10-year follow-up study in Lithuanian urban population

Author

Laura Sapranaviciute-Zabazlajeva, Lolita Sileikiene, Dalia Luksiene, Abdonas Tamosiunas, Ricardas Radisauskas, Irena Milvidaite, and Martin Bobak

Subjects
Lifestyle behaviour, Psychological well-being, Follow-up, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Several lifestyle behaviours, including physical activity, smoking, alcohol consumption, nutrition habits, and social activity have been associated with psychological well-being (PWB). However, their effect on PWB prospectively has been less studied. The aim of the present study was to evaluate the influence of lifestyle factors on higher future PWB during the 10-year follow-up of middle-aged and elderly urban population. Methods In the baseline survey (2006 to 2008), 7115 men and women 45–72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in the Eastern Europe (HAPIEE). In the follow-up survey (in 2016), which was performed among all 6210 participants who survived till that year, 4266 individuals participated responding to postal questionnaires. PWB was assessed by a CASP-12 questionnaire. The lifestyle behaviours, including smoking and nutrition habits, alcohol consumption, social and physical activity, were evaluated by the questionnaire. Multivariable logistic regression models were applied for statistical data analysis. Results After accounting for several potential confounders, healthy levels of lifestyle behaviours were associated with higher PWB after 10-year follow-up. Never-smokers in men and former smokers in women had higher PWB by 43 and 67% odds respectively in comparison with smokers. Physical activity in women and high social activity both in men in women was positively related to higher PWB. More frequent fresh vegetable and fruit consumption was associated with higher odds of higher PWB (odds ratio 1.57 in men and 1.36 in women, p

Published
2022
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9. Lowered cognitive function and the risk of the first events of cardiovascular diseases: findings from a cohort study in Lithuania

Author

Dalia Luksiene, Laura Sapranaviciute-Zabazlajeva, Abdonas Tamosiunas, Ricardas Radisauskas, and Martin Bobak

Subjects
Cognitive functions, Risk of first cardiovascular disease event, Cardiovascular mortality, Cohort study, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains predict the risk of first cardiovascular disease (CVD) events in middle-aged and older populations. Methods Seven thousand eighty-seven participants, men and women aged 45–72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008 in the city of Kaunas, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at the baseline survey) was evaluated. Cox proportional hazards regression models were applied to examine how cognitive function predicts the first events of CVD. Results During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased the risk of a first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score – by 17% in men and 24% in women; and a composite score of cognitive function – by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of a first cardiovascular event according to the categories of a composite score of cognitive function, revealed that a lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p

Published
2021
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10. Association between stroke occurrence and changes in atmospheric circulation

Author

Jone Vencloviene, Ricardas Radisauskas, Daina Kranciukaite-Butylkiniene, Abdonas Tamosiunas, Vidmantas Vaiciulis, and Daiva Rastenyte

Subjects
Ischaemic stroke, Haemorrhagic stroke, Atmospheric circulation, Arctic oscillation, North Atlantic oscillation, East Atlantic/West Russia indices, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. Methods The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. Results During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14–1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16–0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04–1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p

Published
2021
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11. Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project

Author

Victoria Rosberg, Julie KK Vishram-Nielsen, Anna M. Dyrvig Kristensen, Manan Pareek, Thomas S.G. Sehested, Peter M Nilsson, Allan Linneberg, Luigi Palmieri, Simona Giampaoli, Chiara Donfrancesco, Frank Kee, Giuseppe Mancia, Giancarlo Cesana, Giovanni Veronesi, Guido Grassi, Kari Kuulasmaa, Veikko Salomaa, Tarja Palosaari, Susana Sans, Jean Ferrieres, Jean Dallongeville, Stefan Söderberg, Marie Moitry, Wojciech Drygas, Abdonas Tamosiunas, Annette Peters, Hermann Brenner, Ben Schöttker, Sameline Grimsgaard, Tor Biering-Sørensen, and Michael H Olsen

Subjects
Adipose tissue, Assessment, risk, Body mass index, Cardiovascular diseases, Cholesterol, Waist-hip ratio, Medicine
Abstract

To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (

Published
2022
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12. The Prognostic Value of Combined Status of Body Mass Index and Psychological Well-Being for the Estimation of All-Cause and CVD Mortality Risk: Results from a Long-Term Cohort Study in Lithuania

Author

Dalia Lukšienė, Abdonas Tamosiunas, Ricardas Radisauskas, and Martin Bobak

Subjects
body mass index, psychological well-being, all-cause mortality risk, cardiovascular diseases, Medicine (General), R5-920
Abstract

Background and Objectives: It is very important to analyze how body mass index (BMI) and psychological well-being (PWB) combination may be differentially associated with mortality risk. The aim of this study was to evaluate the additional prognostic value of the combined status of BMI and PWB for the estimation of all-cause and cardiovascular disease (CVD) mortality risk in the adult Lithuanian urban population. Materials and Methods: Initial data were collected within the framework of the international cohort HAPIEE study from 2006 to 2008. A random sample of 7115 individuals aged 45–72 years was screened. The response rate was 65%. Deaths were evaluated by the death register of Kaunas city (Lithuania) in a follow-up study until 31 December 2020. The mean (SD) duration of the follow-up for the endpoints period was 12.60 (2.79) years. PWB was evaluated by a CASP-12 questionnaire. Results: The findings from the Cox proportional hazards regression multivariable analysis showed that the combinations of underweight plus lower PWB and severe obesity plus lower PWB increased all-cause mortality risk in men (respectively hazard ratio (HR) = 5.65 and HR = 1.60) and in women (respectively HR = 6.02 and HR = 1.77); and increased the risk of mortality from CVD in men (respectively HR = 6.69 and HR = 2.19) compared with responders with normal weight plus higher PWB. The combination of severe obesity plus higher PWB significantly increased the risk of all-cause and CVD mortality risk in men. The combinations of normal weight plus lower PWB and overweight plus lower PWB significantly increased the risk of all-cause mortality risk in men. Conclusions: The combination of severe obesity independently on lower or higher PWB and the combination of underweight plus lower PWB is a strong predictor for all-cause and CVD mortality risk in men and a strong predictor for all-cause mortality risk in women.

Published
2022
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13. Phenome-wide association analysis of LDL-cholesterol lowering genetic variants in PCSK9

Author

Amand F. Schmidt, Michael V. Holmes, David Preiss, Daniel I. Swerdlow, Spiros Denaxas, Ghazaleh Fatemifar, Rupert Faraway, Chris Finan, Dennis Valentine, Zammy Fairhurst-Hunter, Fernando Pires Hartwig, Bernardo Lessa Horta, Elina Hypponen, Christine Power, Max Moldovan, Erik van Iperen, Kees Hovingh, Ilja Demuth, Kristina Norman, Elisabeth Steinhagen-Thiessen, Juri Demuth, Lars Bertram, Christina M. Lill, Stefan Coassin, Johann Willeit, Stefan Kiechl, Karin Willeit, Dan Mason, John Wright, Richard Morris, Goya Wanamethee, Peter Whincup, Yoav Ben-Shlomo, Stela McLachlan, Jackie F. Price, Mika Kivimaki, Catherine Welch, Adelaida Sanchez-Galvez, Pedro Marques-Vidal, Andrew Nicolaides, Andrie G. Panayiotou, N. Charlotte Onland-Moret, Yvonne T. van der Schouw, Giuseppe Matullo, Giovanni Fiorito, Simonetta Guarrera, Carlotta Sacerdote, Nicholas J. Wareham, Claudia Langenberg, Robert A. Scott, Jian’an Luan, Martin Bobak, Sofia Malyutina, Andrzej Pająk, Ruzena Kubinova, Abdonas Tamosiunas, Hynek Pikhart, Niels Grarup, Oluf Pedersen, Torben Hansen, Allan Linneberg, Tine Jess, Jackie Cooper, Steve E. Humphries, Murray Brilliant, Terrie Kitchner, Hakon Hakonarson, David S. Carrell, Catherine A. McCarty, Kirchner H. Lester, Eric B. Larson, David R. Crosslin, Mariza de Andrade, Dan M. Roden, Joshua C. Denny, Cara Carty, Stephen Hancock, John Attia, Elizabeth Holliday, Rodney Scott, Peter Schofield, Martin O’Donnell, Salim Yusuf, Michael Chong, Guillaume Pare, Pim van der Harst, M. Abdullah Said, Ruben N. Eppinga, Niek Verweij, Harold Snieder, Lifelines Cohort authors, Tim Christen, D. O. Mook-Kanamori, the ICBP Consortium, Stefan Gustafsson, Lars Lind, Erik Ingelsson, Raha Pazoki, Oscar Franco, Albert Hofman, Andre Uitterlinden, Abbas Dehghan, Alexander Teumer, Sebastian Baumeister, Marcus Dörr, Markus M. Lerch, Uwe Völker, Henry Völzke, Joey Ward, Jill P. Pell, Tom Meade, Ingrid E. Christophersen, Anke H. Maitland-van der Zee, Ekaterina V. Baranova, Robin Young, Ian Ford, Archie Campbell, Sandosh Padmanabhan, Michiel L. Bots, Diederick E. Grobbee, Philippe Froguel, Dorothée Thuillier, Ronan Roussel, Amélie Bonnefond, Bertrand Cariou, Melissa Smart, Yanchun Bao, Meena Kumari, Anubha Mahajan, Jemma C. Hopewell, Sudha Seshadri, the METASTROKE Consortium of the ISGC, Caroline Dale, Rui Providencia E. Costa, Paul M. Ridker, Daniel I. Chasman, Alex P. Reiner, Marylyn D. Ritchie, Leslie A. Lange, Alex J. Cornish, Sara E. Dobbins, Kari Hemminki, Ben Kinnersley, Marc Sanson, Karim Labreche, Matthias Simon, Melissa Bondy, Philip Law, Helen Speedy, James Allan, Ni Li, Molly Went, Niels Weinhold, Gareth Morgan, Pieter Sonneveld, Björn Nilsson, Hartmut Goldschmidt, Amit Sud, Andreas Engert, Markus Hansson, Harry Hemingway, Folkert W. Asselbergs, Riyaz S. Patel, Brendan J. Keating, Naveed Sattar, Richard Houlston, Juan P. Casas, and Aroon D. Hingorani

Subjects
Genetic association studies, Mendelian randomisation, LDL-cholesterol, Phenome-wide association scan, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background We characterised the phenotypic consequence of genetic variation at the PCSK9 locus and compared findings with recent trials of pharmacological inhibitors of PCSK9. Methods Published and individual participant level data (300,000+ participants) were combined to construct a weighted PCSK9 gene-centric score (GS). Seventeen randomized placebo controlled PCSK9 inhibitor trials were included, providing data on 79,578 participants. Results were scaled to a one mmol/L lower LDL-C concentration. Results The PCSK9 GS (comprising 4 SNPs) associations with plasma lipid and apolipoprotein levels were consistent in direction with treatment effects. The GS odds ratio (OR) for myocardial infarction (MI) was 0.53 (95% CI 0.42; 0.68), compared to a PCSK9 inhibitor effect of 0.90 (95% CI 0.86; 0.93). For ischemic stroke ORs were 0.84 (95% CI 0.57; 1.22) for the GS, compared to 0.85 (95% CI 0.78; 0.93) in the drug trials. ORs with type 2 diabetes mellitus (T2DM) were 1.29 (95% CI 1.11; 1.50) for the GS, as compared to 1.00 (95% CI 0.96; 1.04) for incident T2DM in PCSK9 inhibitor trials. No genetic associations were observed for cancer, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, or Alzheimer’s disease – outcomes for which large-scale trial data were unavailable. Conclusions Genetic variation at the PCSK9 locus recapitulates the effects of therapeutic inhibition of PCSK9 on major blood lipid fractions and MI. While indicating an increased risk of T2DM, no other possible safety concerns were shown; although precision was moderate.

Published
2019
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14. Trends in electrocardiographic abnormalities and risk of cardiovascular mortality in Lithuania, 1986–2015

Author

Abdonas Tamosiunas, Janina Petkeviciene, Ricardas Radisauskas, Gailute Bernotiene, Dalia Luksiene, Mindaugas Kavaliauskas, Irena Milvidaitė, and Dalia Virviciute

Subjects
Mortality, Electrocardiographic abnormalities, Risk factors, Trends, Cardiovascular disease, Middle-aged population, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background This study aimed to assess the trends in the prevalence of electrocardiographic (ECG) abnormalities from 1986 to 2015 and impact of ECG abnormalities on risk of death from cardiovascular diseases (CVD) in the Lithuanian population aged 40–64 years. Methods Data from four surveys carried out in Kaunas city and five randomly selected municipalities of Lithuania were analysed. A resting ECG was recorded and CVD risk factors were measured in each survey. ECG abnormalities were evaluated using Minnesota Code (MC). Trends in age-standardized prevalence of ECG abnormalities were estimated for both sexes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for coronary heart disease (CHD) and CVD mortality. Net reclassification index (NRI), integrated discrimination improvement and other indices were used for evaluation of improvement in the prediction of CVD and CHD mortality risk after addition of ECG abnormalities variable to Cox models. Results From1986 to 2008, the decrease in the prevalence of Q-QS MC was observed in both genders. The prevalence of high R waves increased in men, while the prevalence of ST segment and T wave abnormalities as well as arrhythmias decreased in women. Ischemic changes and possible MI were associated with a 2.5-fold and 4.4-fold higher risk of death from CVD in men and 1.51-fold and 2.56-fold higher mortality risk from CVD in women as compared to individuals with marginal or no ECG abnormalities. The addition of ECG abnormalities to traditional CVD risk factors improved Cox regression models performance. According to NRI, 18.6% of men were correctly reclassified in CVD mortality prediction model and 25.2% of men - in CHD mortality prediction model. Conclusions the decreasing trends in the prevalence of ischemia on ECG in women and increasing trends in the prevalence of left VH in men were observed. ECG abnormalities were associated with higher risk of CVD mortality. The addition of ECG abnormalities to the prediction models modestly improved the prediction of CVD mortality beyond traditional CVD risk factors. The use of ECG as routine screening to identify high risk individuals for more intensive preventive interventions warrants further research.

Published
2019
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15. Combined Influence of Waist and Hip Circumference on Risk of Death in a Large Cohort of European and Australian Adults

Author

Adrian J. Cameron, Helena Romaniuk, Liliana Orellana, Jean Dallongeville, Annette J. Dobson, Wojciech Drygas, Marco Ferrario, Jean Ferrieres, Simona Giampaoli, Francesco Gianfagna, Licia Iacoviello, Pekka Jousilahti, Frank Kee, Marie Moitry, Teemu J. Niiranen, Andrzej Pająk, Luigi Palmieri, Tarja Palosaari, Männistö Satu, Abdonas Tamosiunas, Barbara Thorand, Ulla Toft, Diego Vanuzzo, Salomaa Veikko, Giovanni Veronesi, Tom Wilsgaard, Kari Kuulasmaa, and Stefan Söderberg

Subjects
hip circumference, mortality, obesity, waist circumference, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Waist circumference and hip circumference are both strongly associated with risk of death; however, their joint association has rarely been investigated. Methods and Results The MONICA Risk, Genetics, Archiving, and Monograph (MORGAM) Project was conducted in 30 cohorts from 11 countries; 90 487 men and women, aged 30 to 74 years, predominantly white, with no history of cardiovascular disease, were recruited in 1986 to 2010 and followed up for up to 24 years. Hazard ratios were estimated using sex‐specific Cox models, stratified by cohort, with age as the time scale. Models included baseline categorical obesity measures, age, total and high‐density lipoprotein cholesterol, systolic blood pressure, antihypertensive drugs, smoking, and diabetes mellitus. A total of 9105 all‐cause deaths were recorded during a median follow‐up of 10 years. Hazard ratios for all‐cause death presented J‐ or U‐shaped associations with most obesity measures. With waist and hip circumference included in the same model, for all hip sizes, having a smaller waist was strongly associated with lower risk of death, except for men with the smallest hips. In addition, among those with smaller waists, hip size was strongly negatively associated with risk of death, with ≈20% more people identified as being at increased risk compared with waist circumference alone. Conclusions A more complex relationship between hip circumference, waist circumference, and risk of death is revealed when both measures are considered simultaneously. This is particularly true for individuals with smaller waists, where having larger hips was protective. Considering both waist and hip circumference in the clinical setting could help to best identify those at increased risk of death.

Published
2020
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16. Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry.

Author

Ricardas Radisauskas, Abdonas Tamosiunas, Daina Kranciukaite-Butylkiniene, Egle Milinaviciene, Vilija Malinauskiene, Gailute Bernotiene, Dalia Luksiene, Dalia Virviciute, and Daiva Rastenyte

Subjects
Medicine, Science
Abstract

BackgroundThere is a lack of reliable epidemiological data on long-term survival trends of first-ever stroke patients in Lithuanian population.AimsTo evaluate trends in long-term survival after stroke and to determine the influence of some sociodemographic and lifestyle factors, time and subtype of stroke, and stroke care on survival.MethodsAll stroke events included in Kaunas stroke register database were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2011. Death time was confirmed by the Office for National Death Statistics. Estimates of stroke long-term survival data and factors influencing survival changes were made by applying the Kaplan-Meier and Cox regression analysis.ResultsDuring the study period, 4,129 persons aged 25-64 years suffered from a first-ever stroke: 2,215 (53.6%) of them were men and 1,914 (46.4%)-women. Ischemic stroke was significantly more frequent in males than in females (80.6% and 78.6%, respectively, pConclusionsThis population-based study of patients with first-ever stroke demonstrated that the long-term survival was better in women than men, and improved significantly in both men and women during the past decade. Long-term survival was better of those with first-ever ischemic stroke and of younger age- 25 to 54 years.

Published
2019
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17. Possible Associations between Space Weather and the Incidence of Stroke

Author

Jone Vencloviene, Ricardas Radisauskas, Abdonas Tamosiunas, Dalia Luksiene, Lolita Sileikiene, Egle Milinaviciene, and Daiva Rastenyte

Subjects
geomagnetic activity, solar flares, solar proton event, ischemic stroke, hemorrhagic stroke, Meteorology. Climatology, QC851-999
Abstract

The aim of our study was to detect the possible association between daily numbers of ischemic strokes (ISs) and hemorrhagic strokes (HSs) and space weather events. The daily numbers of ISs, subarachnoid hemorrhages (SAHs), and intracerebral hemorrhages (ICHs) were obtained from Kaunas Stroke Register during the period of 1986 to 2010. We used time- and season-stratified multivariate Poisson regression. We analyzed data of 597 patients with SAH, 1147 patients with ICH, and 7482 patients with IS. Strong/severe geomagnetic storms (GSs) were associated with an increase in the risk of SAH (by 58%) and HS (by 30%). Only GSs occurring during 6:00–12:00 UT were associated with the risk of IS. Low geomagnetic activity (GMA) was associated with the risk of ICH, HS, and IS (Rate Ratios with 95% CI were 2.51 (1.50–4.21), 2.33 (1.50–3.61), and 1.36 (1.03–1.81), respectively). The days of ≥ X9 class solar flare (SF) were associated with a 39% higher risk of IS. The risk of HS occurrence was greater than two times higher on the day after the maximum of a strong/severe solar proton event (SPE). These results showed that GSs, very low GMA, and stronger SFs and SPEs may be associated with an increased risk of different subtypes of stroke.

Published
2021
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18. Trends in major risk factors and mortality from main non-communicable diseases in Lithuania, 1985–2013

Author

Abdonas Tamosiunas, Jurate Klumbiene, Janina Petkeviciene, Ricardas Radisauskas, Olga Vikhireva, Dalia Luksiene, and Dalia Virviciute

Subjects
Mortality, Risk factors, Trends, Non-communicable diseases, Middle-aged population, Public aspects of medicine, RA1-1270
Abstract

Abstract Background This study aimed to assess the trends in the prevalence and levels of risk factors and mortality from main non-communicable diseases in the Lithuanian population aged 45–64 years during 1985 to 2013. Methods Data from four general population surveys conducted between 1985 and 2008 were used. All these surveys were carried out in Kaunas city and five randomly selected municipalities of Lithuania. Risk factors measured at each survey included regular smoking, overweight, obesity, arterial hypertension, and high levels of blood lipids. In total, data of 10,719 subjects (4,965 men and 5,754 women) aged 45–64 were analysed. Trends in standardized all-cause mortality and mortality from cardiovascular disease (CVD), coronary heart disease (CHD), and malignant neoplasms were estimated for both sexes by joinpoint regression analysis. Results In 1985–2013, some favourable trends were observed in the age-standardized mean levels and prevalence of risk factors and mortality from main non-communicable diseases in the Lithuanian middle-aged population. The mean values of blood lipids (with the exception of triglycerides) and the prevalence of dyslipidemias declined. In women, mean levels of systolic blood pressure and body mass index decreased, while in men, the levels of these factors increased. The prevalence of arterial hypertension and obesity increased in men. The proportion of obese women decreased. Smoking prevalence increased in both men and women. From 2007 to 2008, significant downward trends, which were steeper in women than in men, were observed in all-cause, CVD, and CHD mortality. Conclusions Despite the favourable changes in some risk factors and mortality rates, the prevalence of risk factors and mortality from main non-communicable diseases in Lithuania are still high. This indicates the importance of the ongoing primary and secondary prevention and optimal treatment of these diseases.

Published
2016
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19. Psychosocial and socioeconomic determinants of cardiovascular mortality in Eastern Europe: A multicentre prospective cohort study.

Author

Taavi Tillmann, Hynek Pikhart, Anne Peasey, Ruzena Kubinova, Andrzej Pajak, Abdonas Tamosiunas, Sofia Malyutina, Andrew Steptoe, Mika Kivimäki, Michael Marmot, and Martin Bobak

Subjects
Medicine
Abstract

BackgroundEastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations.MethodsParticipants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43-74 years and free of CVD at baseline examination during 2002-2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years.ResultsDuring the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14-1.40] and 1.81 [95% confidence interval 1.24-2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%-13%] to 22% [11%-31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature.ConclusionsSix psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.

Published
2017
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20. Long-Term Survival after Acute Myocardial Infarction in Lithuania during Transitional Period (1996–2015): Data from Population-Based Kaunas Ischemic Heart Disease Register

Author

Ricardas Radisauskas, Jolita Kirvaitiene, Gailutė Bernotiene, Dalia Virviciutė, Ruta Ustinaviciene, and Abdonas Tamosiunas

Subjects
acute myocardial infarction, long-term survival, sex, age, register, Medicine (General), R5-920
Abstract

Background and Objective: There is a lack of reliable epidemiological data on the long-term survival after acute myocardial infarction (AMI) in the Lithuanian population. The aim of the study was to evaluate the long-term (36 months) survival after AMI among persons aged 25−64 years, who had experienced AMI in four time-periods 1996, 2003−2004, 2008, and 2012. Material and Methods: The source of the data was Kaunas population-based Ischemic heart disease (IHD) register. Long-term survival after AMI (36 months) was evaluated using the Kaplan−Meier method. The survival curves significantly differed when p < 0.05. Hazard ratio for all-cause mortality and their 95% CIs, adjusted for baseline characteristics, were estimated with the Cox proportional hazards regression model. Results: The analysis of data on 36 months long-term survival among Kaunas population by sex and age groups showed that the survival rates among men and women were 83.4% and 87.6%, respectively (p < 0.05) and among 25−54 years-old and 55−64 years-old persons, 89.2% and 81.7%, respectively (p < 0.05). The rates of long-term survival of post-AMI Kaunas population were better in past periods than in first period. According to the data of the Kaplan-Meier survival analysis, long-term survival of 25 to 64-year-old post-AMI Kaunas population was without significantly difference in 1996, 2003−2004, 2008 and 2012 (Log-rank = 6.736, p = 0.081). The adjusted risk of all-cause mortality during 36 months among men and 25 to 54-year-old patients was on the average by 35% and 60% lower in 2012 than in 1996, respectively. Conclusion: It was found that 36 months survival post MI among women and younger (25−54 years) persons was significant better compared to men and older (55−64 years) persons. Long-term survival among 55 to 64-year-old post-AMI Kaunas population had a tendency to decrease during last period, while among 25−54 years old persons long-term survival was without significant changes. The results highlight the fact that AMI survivors, especially in youngest age, remain a high-risk group and reinforce the importance of primary and secondary prevention for the improvement of long-term prognosis of AMI patients.

Published
2019
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21. Trends in the Attack Rates, Incidence, and Mortality of Stroke during 1986-2012: Data of Kaunas (Lithuania) Stroke Registry.

Author

Ricardas Radisauskas, Vilija Malinauskiene, Egle Milinaviciene, Daina Kranciukaite-Butylkiniene, Abdonas Tamosiunas, Gailute Bernotiene, Dalia Luksiene, Zemyna Milasauskiene, Diana Sopagiene, and Daiva Rastenyte

Subjects
Medicine, Science
Abstract

BACKGROUND:There is a lack of reliable epidemiological data on longitudinal trends in stroke attack rates, incidence, and mortality in the countries of the Baltic region. AIMS:The aim of the present study was to explore the longitudinal trends of stroke in middle-aged urban population of Lithuania during the period of 1986 through 2012. METHODS:All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2012. Estimates of time-trends of the annual percentage change in stroke attack rates, incidence of stroke, and mortality from this condition were made by applying the Joinpoint regression analysis. RESULTS:During the study period, 9,992 stroke events were registered. The overall proportion of recurrent events was 25.7%. Overall, 18.9% of the events (20.0% in men, and 17.4% in women) were fatal within 28 days. During the period of 1986 to 2012, a flat trend in the incidence of stroke was observed among both male and female middle-aged inhabitants of Kaunas city, while attack rates were increasing due to the increase in recurrent strokes. Both mortality and 28-day case fatality of stroke declined significantly over the study period in both sexes. CONCLUSIONS:An increase both in the incidence and recurrence of stroke among middle-aged men residing in Kaunas city and in the recurrence of stroke among women denotes the inefficiency of measures applied both for primary and secondary prevention of stroke in Lithuania. The revision of current prevention strategies and the introduction of new ones are of paramount importance in order to fight the epidemic of stroke.

Published
2016
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22. The Prognostic Value of Family History for the Estimation of Cardiovascular Mortality Risk in Men: Results from a Long-Term Cohort Study in Lithuania.

Author

Abdonas Tamosiunas, Ricardas Radisauskas, Jurate Klumbiene, Gailute Bernotiene, Janina Petkeviciene, Dalia Luksiene, Dalia Virviciute, Vilija Malinauskiene, Olga Vikhireva, and Vilius Grabauskas

Subjects
Medicine, Science
Abstract

To evaluate the additional prognostic value of family history for the estimation of cardiovascular (CVD) mortality risk in middle-aged urban Lithuanian men.The association between family history of CVD and the risk of CVD mortality was examined in a population-based cohort of 6,098 men enrolled during 1972-1974 and 1976-1980 in Kaunas, Lithuania. After up to 40 years of follow-up, 2,272 deaths from CVD and 1,482 deaths from coronary heart disease (CHD) were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD and CHD mortality.After adjustment for traditional CVD risk factors, the HR for CVD mortality was 1.24 (95% CI 1.09-1.42) and for CHD mortality 1.20 (1.02-1.42) in men with first-degree relatives having a history of myocardial infarction (MI), compared to men without positive family history. A significant effect on the risk of CVD and CHD mortality was also observed for the family history of sudden cardiac death and any CVD. Addition of family history of MI, sudden death, and any CVD to traditional CVD risk factors demonstrated modest improvement in the performance of Cox models for CVD and CHD mortality.Family history of CVD is associated with a risk of CVD and CHD mortality significantly and independently of other risk factors in a middle-aged male population. Addition of family history to traditional CVD risk factors improves the prediction of CVD mortality and could be used for identification of high-risk individuals.

Published
2015
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23. Health factors and risk of all-cause, cardiovascular, and coronary heart disease mortality: findings from the MONICA and HAPIEE studies in Lithuania.

Author

Abdonas Tamosiunas, Dalia Luksiene, Migle Baceviciene, Gailute Bernotiene, Ricardas Radisauskas, Vilija Malinauskiene, Daina Kranciukaite-Butylkiniene, Dalia Virviciute, Anne Peasey, and Martin Bobak

Subjects
Medicine, Science
Abstract

AIMS:This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population. METHODS:Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45-64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD. RESULTS:Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006-2008 than in 1983-1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5-6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15-0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12-0.97) but not in women (HR 0.38, 95% CI 0.09-1.67). CONCLUSIONS:An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.

Published
2014
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24. Trends in prevalence of dyslipidaemias and the risk of mortality in Lithuanian urban population aged 45-64 in relation to the presence of the dyslipidaemias and the other cardiovascular risk factors.

Author

Dalia Luksiene, Abdonas Tamosiunas, Migle Baceviciene, Ricardas Radisauskas, Vilija Malinauskiene, Anne Peasey, and Martin Bobak

Subjects
Medicine, Science
Abstract

UNLABELLED:The aim of this study was to provide reliable information on dyslipidaemias, to estimate the trend of the prevalence of dyslipidaemias and other selected cardiovascular disease (CVD) risk factors at population level, and to evaluate the risk of all-cause and CVD mortality in relation to presence of mixed dyslipidaemias and other CVD risk factors. METHODS:Data from the five surveys (1983-2008) are presented. A random sample of 9,209 subjects aged 45-64 was selected for statistical analysis. During follow-up there were 1653 death cases from any cause, 864 deaths from CVD. Estimates of hazard ratios (HR) and 95% confidence intervals (CI) were based on the multivariate Cox proportional hazards regression for all-cause mortality and CVD mortality. RESULTS:During 25 year period the prevalence of normal total cholesterol level (

Published
2014
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25. Does inclusion of education and marital status improve SCORE performance in central and eastern europe and former soviet union? findings from MONICA and HAPIEE cohorts.

Author

Olga Vikhireva, Grazyna Broda, Ruzena Kubinova, Sofia Malyutina, Andrzej Pająk, Abdonas Tamosiunas, Zdena Skodova, Galina Simonova, Martin Bobak, and Hynek Pikhart

Subjects
Medicine, Science
Abstract

The SCORE scale predicts the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk version of SCORE is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), due to high CVD mortality rates in these countries. Given the pronounced social gradient in cardiovascular mortality in the region, it is important to consider social factors in the CVD risk prediction. We investigated whether adding education and marital status to SCORE benefits its prognostic performance in two sets of population-based CEE/FSU cohorts.The WHO MONICA (MONItoring of trends and determinants in CArdiovascular disease) cohorts from the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s (577 atherosclerotic CVD deaths among 14,969 participants with non-missing data). The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05 (395 atherosclerotic CVD deaths in 19,900 individuals with non-missing data).In MONICA and HAPIEE, the high-risk SCORE ≥5% at baseline strongly and significantly predicted fatal CVD both before and after adjustment for education and marital status. After controlling for SCORE, lower education and non-married status were significantly associated with CVD mortality in some samples. SCORE extension by these additional risk factors only slightly improved indices of calibration and discrimination (integrated discrimination improvement

Published
2014
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26. Prognostic Implications of Physical Activity on Mortality from Ischaemic Heart Disease: Longitudinal Cohort Study Data

Author

Bobak, Dalia Luksiene, Vilma Jasiukaitiene, Ricardas Radisauskas, Abdonas Tamosiunas, and Martin

Subjects
physical activity, mortality risk, ischaemic heart disease, longitudinal cohort study
Abstract

Background: The prevalence of physical inactivity has been rising in many countries in recent years, adding to the burden of non-communicable diseases and affecting overall health worldwide. The aim of this study was to determine the comprehensive assessment of the prognostic value of physical activity in leisure time on mortality from ischemic heart disease (IHD) by gender separately for those respondents who were diagnosed with IHD and for those who were not diagnosed with IHD in their baseline health survey. Methods: In the baseline survey (2006–2008), 7100 men and women ages 45–72 were examined within the framework of the international study Health, Alcohol, and Psychosocial Factors in Eastern Europe (HAPIEE). A total of 6770 participants were available for statistical analysis (after excluding 330 respondents due to missing information on study variables). Physical activity was determined by leisure-time physical activities (hours/week). All participants in the baseline survey were followed up for IHD mortality events until 31 December 2018. Results: Using multivariate Cox regression analysis, it was found that moderate and higher levels of physical activity significantly reduced the risk of IHD mortality (HR = 0.54,p = 0.016 and HR = 0.60, p = 0.031, respectively) in men who were not diagnosed with IHD at baseline compared with physically inactive subjects. It was found that among men and women who were diagnosed with IHD at baseline, physical activity reduced the risk of mortality from IHD compared with those who were physically inactive (HR = 0.54, p = 0.021 and HR = 0.41,p = 0.025, respectively). Using mediation analysis, it was found that physical activity directly predicted statistically lower IHD mortality (p < 0.05) in men and women. Conclusion: High physical activity was a significant factor that directly predicted statistically lower IHD mortality in men, regardless of whether subjects had IHD at baseline or not. However, only moderate physical activity was a significant factor that directly predicted statistically lower IHD mortality in the women group with IHD at baseline.

Published
2023
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27. Prognostic Implications of Physical Activity on Mortality from Ischaemic Heart Disease: Longitudinal Cohort Study Data

Author

Dalia Luksiene, Vilma Jasiukaitiene, Ricardas Radisauskas, Abdonas Tamosiunas, and Martin Bobak

Abstract

Background: The prevalence of physical inactivity has been rising in many countries in recent years, adding to the burden of non-communicable diseases and affecting overall health worldwide. The aim of this study is to determine the impact of physical activity on mortality from ischemic heart disease (IHD) separately for those respondents who were diagnosed with IHD and for those who were not diagnosed with IHD in their baseline health survey. Methods: In the baseline survey (2006–2008), 7100 men and women ages 45–72 were examined within the framework of the international study Health, Alcohol, and Psychosocial Factors in Eastern Europe (HAPIEE). 6770 participants were available for statistical analysis (after excluding 330 respondents due to missing information on study variables). Physical activity was determined by leisure-time physical activities (hours/week). All participants in the baseline survey were followed up for IHD mortality events until December 31, 2018. Results: Using multivariate Cox regression analysis, it was found that moderate and higher levels of physical activity significantly reduced the risk of IHD mortality (HR=0.54 and HR=0.60 respectively) in men who were not diagnosed with IHD at baseline compared with physically inactive subjects. It was found that among men and women who were diagnosed with IHD at baseline, physical activity reduced the risk of mortality from IHD compared with those who were physically inactive (HR=0.54 and HR=0.41 respectively). Using mediation analysis, was found that physical activity directly predicted statistically lower IHD mortality (P

Published
2023

28. Unsupervised Learning for Large Scale Data

Author

Petros Barmpas, Sotiris Tasoulis, Aristidis G. Vrahatis, Panagiotis Anagnostou, Spiros Georgakopoulos, Matthew Prina, José Luis Ayuso-Mateos, Jerome Bickenbach, Ivet Bayes, Martin Bobaki, Francisco Félix Caballero, Somnath Chatterji, Laia Egea-Cortés, Esther García-Esquinas, Matilde Leonardi, Seppo Koskinen, Ilona Koupil, Andrzej Pająk, Martin Prince, Warren Sanderson, Sergei Scherbov, Abdonas Tamosiunas, Aleksander Galas, Josep MariaHaro, Albert Sanchez-Niubo, Vassilis P. Plagianakos, and Demosthenes Panagiotakos

Published
2022

30. Lowered cognitive function and the risk of the first events of cardiovascular diseases: findings from a cohort study in Lithuania

Author

Ričardas Radišauskas, Martin Bobak, Dalia Luksiene, Laura Sapranaviciute-Zabazlajeva, and Abdonas Tamosiunas

Subjects
Male, medicine.medical_specialty, Cardiovascular mortality, Disease, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cognition, Risk of first cardiovascular disease event, Risk Factors, Epidemiology, Medicine, Humans, Europe, Eastern, Prospective Studies, Cities, Prospective cohort study, Survival analysis, Aged, Proportional Hazards Models, business.industry, Research, Public Health, Environmental and Occupational Health, Lithuania, Middle Aged, Cognitive functions, Cardiovascular Diseases, Female, Biostatistics, Public aspects of medicine, RA1-1270, business, Cohort study, Psychosocial, 030217 neurology & neurosurgery, Demography, Follow-Up Studies
Abstract

Background The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains predict the risk of first cardiovascular disease (CVD) events in middle-aged and older populations. Methods Seven thousand eighty-seven participants, men and women aged 45–72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008 in the city of Kaunas, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at the baseline survey) was evaluated. Cox proportional hazards regression models were applied to examine how cognitive function predicts the first events of CVD. Results During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased the risk of a first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score – by 17% in men and 24% in women; and a composite score of cognitive function – by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of a first cardiovascular event according to the categories of a composite score of cognitive function, revealed that a lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p Conclusions The findings of this follow-up study suggest that men and women with lower cognitive functions have an increased risk for a first event of CVD compared to participants with a higher level of cognitive functions.

Published
2021

31. Associations between Quasi-biennial Oscillation phase, solar wind, geomagnetic activity, and the incidence of acute myocardial infarction

Author

Jone Vencloviene, Vidmantas Vaičiulis, Deivydas Kiznys, Gailute Bernotiene, Abdonas Tamosiunas, Ričardas Radišauskas, and Daina Kranciukaite-Butylkiniene

Subjects
Atmospheric Science, 010504 meteorology & atmospheric sciences, Health, Toxicology and Mutagenesis, Population, Myocardial Infarction, Wind, Space weather, Rate ratio, 01 natural sciences, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Humans, Medicine, Poisson regression, Solar Activity, education, Weather, 0105 earth and related environmental sciences, 030203 arthritis & rheumatology, Geomagnetic storm, Quasi-biennial oscillation, education.field_of_study, Ecology, business.industry, Incidence, Incidence (epidemiology), Lithuania, Earth's magnetic field, symbols, business, Demography
Abstract

An increase in the daily rate of acute myocardial infarction (AMI) has been observed during days of geomagnetic storm (GS). However, the analysis of associations between the daily number of AMI and geomagnetic activity (GMA) over longer periods sometimes yields controversial results. The study aimed to detect the complex association between the daily numbers of AMI and weather, the Quasi-biennial Oscillation (QBO) phase, GMA, and solar wind variables. We used data of Kaunas population-based Ischemic Heart Disease Register of residents of Kaunas city (Lithuania) for 2000-2012. The associations between weather and space weather variables and the daily number of AMI were evaluated by applying the multivariate Poisson regression. A higher risk of AMI was positively associated with active-stormy local GMA (rate ratio (RR) = 1.06 (95% CI 1.01-1.10)), solar wind dynamic pressure with a lag of 4 days (RR = 1.02 (1.01-1.04) per 1 nPa increase), and solar wind speed with a lag of 3-7 days (RR = 1.03 (1.01-1.05) per 100 km/s increase). A positive association was found between the west QBO phase and the risk of AMI during winter (RR = 1.08 (1.01-1.16)), and a negative association was observed between them during March-November (RR = 0.93 (0.90-0.97)). The risk of AMI positively associated with the GS due to stream interaction regions with a lag of 0-2 days during the east QBO phase (RR = 1.10, p = 0.046) and was negatively associated with them during the west QBO phase (RR = 0.82, p = 0.024). These results may help understand the population's sensitivity under different weather and space weather conditions. The QBO phase may modify the effect of GS.

Published
2020

32. Alcohol intake and total mortality in 142 960 individuals from the MORGAM Project:a population-based study

Author

Wojciech Drygas, B Thorand, Salim Dabboura, Satu Männistö, Kari Kuulasmaa, Jean Ferrières, Yuri Nikitin, Benedikt Schrage, Frank Kee, Licia Iacoviello, Inger Njølstad, Dirk Westermann, Jean Dallongeville, Giovanni de Gaetano, Abdonas Tamosiunas, Patrick McElduff, Stefan Blankenberg, Simona Costanzo, Marco M Ferrario, Giovanni Veronesi, Stefan Söderberg, Guido Grassi, Augusto Di Castelnuovo, Veikko Salomaa, Tanja Zeller, Emanuela Pettenuzzo, Marialaura Bonaccio, Marie Moitry, Maria Benedetta Donati, Hermann Brenner, Allan Linneberg, Di Castelnuovo, A, Costanzo, S, Bonaccio, M, Mcelduff, P, Linneberg, A, Salomaa, V, Mannisto, S, Moitry, M, Ferrieres, J, Dallongeville, J, Thorand, B, Brenner, H, Ferrario, M, Veronesi, G, Pettenuzzo, E, Tamosiunas, A, Njolstad, I, Drygas, W, Nikitin, Y, Soderberg, S, Kee, F, Grassi, G, Westermann, D, Schrage, B, Dabboura, S, Zeller, T, Kuulasmaa, K, Blankenberg, S, Donati, M, de Gaetano, G, and Iacoviello, L

Subjects
Population, Medicine (miscellaneous), SDG 3 - Good Health and Well-being, cardiovascular mortality, HDL cholesterol, Environmental health, cancer mortality, cohort study, Medicine, Alcohol intake, education, Beroendelära, Alcohol Intake, Cancer Mortality, Cardiovascular Mortality, Cohort Study, Hdl Cholesterol, Mortality, education.field_of_study, business.industry, Substance Abuse, Public Health, Global Health, Social Medicine and Epidemiology, medicine.disease, mortality, Total mortality, Substance abuse, Population based study, Psychiatry and Mental health, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Observational study, business, Alcohol consumption, Cohort study
Abstract

Aim: To test the association of alcohol consumption with total and cause-specific mortality risk. Design: Prospective observational multi-centre population-based study. Setting: Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project. Participants: A total of 142 960 individuals (mean age 50±13 years, 53.9% men). Measurements: Average alcohol intake by food frequency questionnaire, total and cause-specific mortality. Findings: In comparison with life-time abstainers, consumption of alcohol less than 10 g/day was associated with an average 11% [95% confidence interval (CI)=7–14%] reduction in the risk of total mortality, while intake >20 g/day was associated with a 13% (95% CI=7–20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. With regard to cancer, drinking up to 10 g/day was not associated with either mortality risk reduction or increase, while alcohol intake >20 g/day was associated with a 22% (95% CI=10–35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that high-density lipoprotein cholesterol explained 2.9 and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively. Conclusions: In comparison with life-time abstainers, consuming less than one drink per day (nadir at 5 g/day) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than two drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality.

Published
2022

33. A divisive hierarchical clustering methodology for enhancing the ensemble prediction power in large scale population studies : the ATHLOS project

Author

Petros Barmpas, Sotiris Tasoulis, Aristidis G. Vrahatis, Spiros V. Georgakopoulos, Panagiotis Anagnostou, Matthew Prina, José Luis Ayuso-Mateos, Jerome Bickenbach, Ivet Bayes, Martin Bobak, Francisco Félix Caballero, Somnath Chatterji, Laia Egea-Cortés, Esther García-Esquinas, Matilde Leonardi, Seppo Koskinen, Ilona Koupil, Andrzej Paja̧k, Martin Prince, Warren Sanderson, Sergei Scherbov, Abdonas Tamosiunas, Aleksander Galas, Josep Maria Haro, Albert Sanchez-Niubo, Vassilis P. Plagianakos, and Demosthenes Panagiotakos

Subjects
General Medicine
Abstract

The ATHLOS cohort is composed of several harmonized datasets of international groups related to health and aging. As a result, the Healthy Aging index has been constructed based on a selection of variables from 16 individual studies. In this paper, we consider additional variables found in ATHLOS and investigate their utilization for predicting the Healthy Aging index. For this purpose, motivated by the volume and diversity of the dataset, we focus our attention upon data clustering, where unsupervised learning is utilized to enhance prediction power. Thus we show the predictive utility of exploiting hidden data structures. In addition, we demonstrate that imposed computation bottlenecks can be surpassed when using appropriate hierarchical clustering, within a clustering for ensemble classification scheme, while retaining prediction benefits. We propose a complete methodology that is evaluated against baseline methods and the original concept. The results are very encouraging suggesting further developments in this direction along with applications in tasks with similar characteristics. A straightforward open source implementation for the R project is also provided (https://github.com/Petros-Barmpas/HCEP).The online version contains supplementary material available at 10.1007/s13755-022-00171-1.

Published
2022

34. Lifestyle factors and psychological well-being: 10-year follow-up study in Lithuanian urban population

Author

Laura Sapranaviciute-Zabazlajeva, Lolita Sileikiene, Dalia Luksiene, Abdonas Tamosiunas, Ricardas Radisauskas, Irena Milvidaite, and Martin Bobak

Subjects
Male, Alcohol Drinking, Urban Population, Vegetables, Public Health, Environmental and Occupational Health, Humans, Female, Lithuania, Middle Aged, Life Style, Aged, Follow-Up Studies
Abstract

Background Several lifestyle behaviours, including physical activity, smoking, alcohol consumption, nutrition habits, and social activity have been associated with psychological well-being (PWB). However, their effect on PWB prospectively has been less studied. The aim of the present study was to evaluate the influence of lifestyle factors on higher future PWB during the 10-year follow-up of middle-aged and elderly urban population. Methods In the baseline survey (2006 to 2008), 7115 men and women 45–72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in the Eastern Europe (HAPIEE). In the follow-up survey (in 2016), which was performed among all 6210 participants who survived till that year, 4266 individuals participated responding to postal questionnaires. PWB was assessed by a CASP-12 questionnaire. The lifestyle behaviours, including smoking and nutrition habits, alcohol consumption, social and physical activity, were evaluated by the questionnaire. Multivariable logistic regression models were applied for statistical data analysis. Results After accounting for several potential confounders, healthy levels of lifestyle behaviours were associated with higher PWB after 10-year follow-up. Never-smokers in men and former smokers in women had higher PWB by 43 and 67% odds respectively in comparison with smokers. Physical activity in women and high social activity both in men in women was positively related to higher PWB. More frequent fresh vegetable and fruit consumption was associated with higher odds of higher PWB (odds ratio 1.57 in men and 1.36 in women, p Conclusions Lifestyle factors such as never smoking and former smoking, high social activity, and more frequent fresh vegetable and fruit consumption increased the odds of higher PWB over 10 years of follow-up in men and women groups. The increase of the protective health behaviour score was directly associated with the odds of higher PWB.

Published
2021

35. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author

Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. Nogueira, Marcia Scazufca, Katharina Maruszczak, Natascia Rinaldo, Paulo A. Lotufo, Nuno Lunet, Thor Aspelund, Caroline H.D. Fall, Antonio Cabrera de León, Ahmad Faudzi Yusoff, Holger Theobald, Beatriz D'Agord Schaan, Pedro Marques-Vidal, William A. Neal, Mihai Gafencu, Tandi E. Matsha, Ana B. Crujeiras, Ahmad Reza Dorosty, Alain Morejon, Weili Yan, Dominique Hange, Bekbolat Zholdin, Frédéric Gottrand, Jorge Mota, Jana Námešná, Stevo Popovic, Louise Eriksen, Line Lund Kårhus, Cihangir Erem, Juergen Breckenkamp, Mathilde Kersting, Yi Song, Martin McKee, Aleksandra Gomula, Rafaela Rosário, Enzo Manzato, S. Goya Wannamethee, Sounnia Mediene Benchekor, Azim Nejatizadeh, Krishna Kumar Aryal, Juan P. González-Rivas, Vedrana Sember, Stephen T. McGarvey, Jukka T. Salonen, Patrick Pasquet, Patricia Varona-Pérez, Amelia C. Crampin, Ramin Heshmat, Violeta Iotova, Juvenal Soares Dias-da-Costa, Oye Gureje, Aletta E. Schutte, João Luiz Bastos, Anelise Reis Gaya, Konrad Jamrozik, Dalia Luksiene, Amina Barkat, Maria Paula Santos, José Camolas, Azli Baharudin, Diego Vanuzzo, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, Albertino Damasceno, Davood Khalili, Simona Bo, Martina Müller-Nurasyid, Dominique Cottel, Markku Peltonen, Fikru Tullu, Ana Isabel Rito, Angélica Ochoa-Avilés, Annette J. Dobson, Christopher T. Cowell, Charumathi Sabanayagam, Rildo de Souza Wanderley Júnior, Oanh T. H. Trinh, Farahnaz Joukar, Mostafa K. Mohamed, Mostafa Qorbani, Jeongseon Kim, Helmut Schröder, Machi Suka, Natasja M. van Schoor, Jussi Kauhanen, Teresa Haugsgjerd, Goodarz Danaei, M. Fernanda Lima-Costa, Yong Tao, Elisabetta L. Romeo, Grazyna Jasienska, Victor Guillermo Sequera, Kazem Mohammad, Yanina Zócalo, Fernanda Cunha Soares, Jianfeng Wu, Mohammad Esmaeel Motlagh, María Elena Díaz-Sánchez, Monika Zuziak, Eldridge Ferrer, Anette Varbo, Leila Beltrami Moreira, Jeremy M. Jacobs, Kenneth James, Elena Sacchini, Pascal Bovet, Mahboubeh Parsaeian, Tania Lopez, Ya Xing Wang, Wojciech Drygas, Jody C Miller, Svetlana A. Shalnova, Maria Elisa Zapata, Chung T Nguyen, Nimmathota Arlappa, Edwige Landais, Thorkild I. A. Sørensen, Jeannette Klimont, Amirabbas Momenan, Erik J. Timmermans, Mari-Liis Tammesoo, Jost B. Jonas, Stefania Toselli, Maria Teresa Anselmo Olinto, Bahman Cheraghian, Kouamelan Doua, Esteban Carmuega, Marjeta Mišigoj-Duraković, Bo Werner, M. Arfan Ikram, Breige A. McNulty, Christa Meisinger, Clara Homs, Namuna Shrestha, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Alicia Matijasevich, Alison J Price, Ala'a Alkerwi, Kristine H. Allin, Lorenza Pilotto, Mohannad Al Nsour, Ingunn Holden Bergh, Marianna Noale, Heba Fouad, Vilnis Dzerve, Novie O. Younger-Coleman, Peter Willeit, Andrea R. V. R. Horimoto, Freda Pitakaka, Habiba Ben Romdhane, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Cristina Padez, Sarah P. Garnett, Maria del Cristo Rodriguez-Perez, Michala Lustigová, Tien Yin Wong, Rosa Haghshenas, Jonathan Giovannelli, Christina Howitt, Marleen E. Hendriks, Fadia AlBuhairan, Huashuai Chen, Gretchen A Stevens, Luís B. Sardinha, David Goltzman, Jenny M. Kindblom, Karina Mary de Paiva, Yousef Khader, Eric Monterrubio-Flores, Rajendra Pradeepa, Yi-Ting Lin, Martin Neovius, Juan Francisco Miquel, Ellis Owusu-Dabo, Anil Poudyal, Marzieh Katibeh, Tanja Stocks, Veronica Mocanu, Ulla Roggenbuck, Robespierre Ribeiro, Gabriele Eiben, Mary Simon, Christine Cameron, Hamid Hakimi, Kamel Ajlouni, Jakub Stokwiszewski, Iulia Jurca Simina, Pietro Amedeo Modesti, Frederick C. W. Wu, Peter Kristensen, Charles Mondo, Felix Gutzwiller, Mariana Sbaraini, Martijn Huisman, Betina H. Thuesen, Queenie Chan, Antonisamy Belavendra, Artur Mazur, Ulf Ekelund, Laura A. Rodríguez-Villamizar, Marcos André Moura-dos-Santos, Jean Ferrières, Farhad Zamani, Shina Avi, Yves Kameli, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Thomas Meinertz Dantoft, Hossein Poustchi, Farid Najafi, Giovanni de Gaetano, Azaliia M Tuliakova, Vera Lanska, Tint Swe Latt, Matthias Bopp, Abbas Rezaianzadeh, Rod Jackson, Johan Van der Heyden, Reecha Sofat, Koen Van Herck, Allan G. Hill, Con Burns, Emanuela Pettenuzzo, Ming-Dong Wang, Stela McLachlan, Ulrike Gehring, Ranko Stevanovic, Nagalla Balakrishna, Lekhraj Rampal, Marjolijn C. E. Bragt, Saeid Eslami, Napoleón Pérez-Farinós, G. K. Mini, Viktoria Anna Kovacs, Rosemarie Martin, Nahla Hwalla, Wei Zheng, Hoang Van Minh, Edward D Janus, Laetitia Huiart, Farhad Pourfarzi, Sudha Ramachandra Rao, Fred Paccaud, Marcia Makdisse, Aye Aye Sein, Enrique Gutiérrez-González, Yang Yang, Anneke Blokstra, Henrike Galenkamp, Jaume Marrugat, Nazan Yardim, Wan Nazaimoon Wan Mohamud, Jesús Ibarluzea, Julio Zuñiga Cisneros, Laura Lauria, Argyro Karakosta, Dragana P Jovic, Jun Hata, Elio Riboli, Piotr Bandosz, Xun Tang, Parvina Mukhtorova, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Aleksandra Piwońska, Dusan Grafnetter, Mette Rasmussen, Daniel Weghuber, Sherali Rakhmatulloev, Martine Vrijheid, Johann Willeit, Motahareh Kheradmand, Małgorzata Mossakowska, Lechaba Tshepo, Dongfeng Gu, Hyeon Chang Kim, Vilmundur Gudnason, Maria Forsner, Peter Bjerregaard, Leon A. Simons, Rachael McLean, Japhet Killewo, Ramón Suárez-Medina, Y Nikitin, Eng Joo Tan, Jean Claude Mbanya, Aroor Bhagyalaxmi, Renata Kuciene, Kairat Davletov, Jose Eugenio Lozano, Afshin Ostovar, Niloofar Peykari, Guy De Backer, Soheir H Ahmed, Nicholas J. Wareham, Sai Yin Ho, Constanta Huidumac Petrescu, Maria Hassapidou, Iris Pigeot, Myriam Galfo, Susana Cararo Confortin, Blanca Sandra Ruiz-Betancourt, W. M. Monique Verschuren, Catterina Ferreccio, Fabio Galvano, Leila Houti, Daniel Bia, Annika Rosengren, Marcin Rutkowski, Biruta Velika, Joana Araújo, Fernando Rigo, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Marie Kunešová, Boban Mugoša, Sania Nishtar, Mangesh S. Pednekar, Shahla AlDhukair, Helle-Mai Loit, Antonis Zampelas, Altan Onat, Maciej Banach, Shohreh Naderimagham, Hajer Aounallah-Skhiri, Maja Bæksgaard Jørgensen, Yin Guo, Ewelina Czenczek-Lewandowska, Parasmani Dasgupta, Elvis Oa Wambiya, Inge Huybrechts, Raimund Erbel, Jari Jokelainen, Ana P. Ortiz, Stefan Kiechl, Emmanuel Cohen, Caleb Ochimana, Shynar Abdrakhmanova, Laura Censi, Iqbal Bata, Geetha R Menon, Snehalatha Chamukuttan, Pedro Plans-Rubio, Domenico Palli, Ana Azevedo, Slawomir Koziel, Benoît Salanave, Parinaz Mehdipour, Shu Ti Chiou, Lela Sturua, Lubica Ticha, Felipe Vogt Cureau, Jin Soo Moon, Ming-Hui Zhao, Urho M. Kujala, Nathalie Michels, Ertugrul Celikcan, Jaakko Tuomilehto, Judith Benedics, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, Andrea Rodriguez-Martinez, Tai Hing Lam, Yn-Tz Sung, Jürgen König, Kodavanti Mallikharjuna Rao, Hazzaa M. Al-Hazzaa, Karen Morgan, Bogdan Wojtyniak, Cynthia M. Pérez, Ilse Khouw, Manoli Garcia-de-la-Hera, Dong Wook Shin, Genc Burazeri, Ausra Petrauskiene, Charles Sossa Jérome, Kenisha Russell Jonsson, José Boggia, Daniela Galeone, Alice Bonilla-Vargas, Han Cg Kemper, Rahman Shiri, Stefaan Demarest, Else Karin Grøholt, San-Lin You, Adelheid Weber, Juha Auvinen, Aida Pilav, Sibel Gogen, Suzanne N Morin, Wan Mohamad Wan Bebakar, Viviane Cunha Cardoso, Kavumpurathu Raman Thankappan, Hana Zamrazilová, Frank Claessens, Karien Stronks, Helen Gonçalves, Tahir Aris, Luis Revilla, Sérgio Viana Peixoto, Zhamilya Battakova, Jing Liu, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Priscilla Duboz, Sandjaja, Tiina Laatikainen, Rafel Ramos, Sareh Eghtesad, Judith Simons, Orn Olafsson, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Aung Soe Htet, Bente Sparboe-Nilsen, Paul Elliott, Soon-Woo Park, Angel R. Gonzalez, Ying-Wei Wang, Rob M. van Dam, Ryutaro Ohtsuka, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Lynell V Maniego, Fariborz Mansour-Ghanaei, Maria Dorobantu, Giovanni Viegi, Xiaoguang Yang, Honor Bixby, Prakash C. Gupta, Ofra Kalter-Leibovici, Eugene Sobngwi, Ričardas Radišauskas, Jurate Medzioniene, Roy A Wong-McClure, Kim F. Michaelsen, Antonia Trichopoulou, Tania Tello, Francesco Branca, Johanna Gunnlaugsdottir, Els Clays, Wei-Yen Lim, Suzanne C. Ho, Toomas Veidebaum, Rebecca Goldsmith, Margot González-León, Matthias Nauck, Alibek Mereke, Marta Buoncristiano, Jakob Tarp, Rosalba Rojas-Martínez, Maya Tanrygulyyeva, Reza Malekzadeh, Abdonas Tamosiunas, Dimitrios Poulimeneas, Pedro Ordunez, Isabelle Herter-Aeberli, Khanh Le Nguyen Bao, Anne Juolevi, Vassilis Zafiropulos, Emanuela Gualdi-Russo, Jordi Sunyer, Manu Raj, Chaoqiang Jiang, Sofia Malyutina, Efthymios Kapantais, Maria Lazo-Porras, Maung Maung Than Htike, Michael Hobbs, Ranjit Mohan Anjana, Merike Liivak, Johan G. Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. Tebar, Yingfeng Zheng, Eha Nurk, Bhawesh Koirala, Ana Jelakovic, Suhad Bahijri, Freja B Kampmann, Qi Sheng You, Marika Ferrari, María-Elena González-Villalpando, Aline Wagner, Olfa Saidi, Anwar Batieha, Eduardo Capuano, Coimbatore Subramaniam Shanthirani, Dong Wook Kim, Albina A Fakhretdinova, Tom Wilsgaard, Maria Avdicova, Moesijanti Soekatri, Chiara Donfrancesco, Salim Mohanna, Paola Russo, Uruwan Yamborisut, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Khairil Si-Ramlee, Kirsten Mehlig, Christina Mavrogianni, Raluca Pop, Lèlita Santos, Graziella Bruno, Valentina Peterkova, Iná S. Santos, Georg Lappas, Alberto Palloni, Malay K. Mridha, Andrzej Pajak, Marta García-Solano, Stefaan De Henauw, Daniel Ferrante, Rute Santos, Anders Grøntved, Lucjan Szponar, Mihaela Vladulescu, Chien-An Sun, Jan A. Staessen, Paula Duarte de Oliveira, Norazizah Ibrahim Wong, Maria Nordendahl, Elaine M. Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. Sepanlou, Adolfo Rubinstein, Francis Delpeuch, Julianne Williams, Abbas Dehghan, Leanne M. Riley, Heloisa Bettiol, Gabriele Nagel, Ellisiv B. Mathiesen, Ekaterina Stoyanova, Alisha N. Wade, Zhamyila Usupova, Arnaud Chiolero, Oonagh Markey, Jacqueline Ramke, Elena Bogova, Niveen M E Abu-Rmeileh, Nguyen D Nguyen, Tomasz Zdrojewski, Marjo-Riitta Järvelin, Jose Sanchez-Abanto, Rômulo Araújo Fernandes, Lourdes Ribas-Barba, Nalan Uysal, Mohamad Hasnan Ahmad, Krista Fischer, Maria Wany Louzada Strufaldi, Ramiro Guerrero, Farnam Mohebi, Tran Quoc Bao, Flávio Danni Fuchs, Salim Berkinbayev, Enisa Kujundzic, Sari Voutilainen, Farzad Hadaegh, Robert Lundqvist, Saeid Safiri, Iraj Mohebbi, George Luiz Lins Machado-Coelho, Annette Peters, Gonzalo Valdivia, Magdalena Korzycka, Rajiv T Erasmus, Masanori Iwasaki, Charmaine A. Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. Casajús, Guang Ning, Lutgart Braeckman, Dirk Vanderschueren, Jochanan Stessman, Ivana Radic, Yi Zeng, Hans Concin, Damaskini Valvi, Sari Hantunen, Catherine Kyobutungi, Diego Augusto Santos Silva, Wenhua Zhao, Sok King Ong, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Mattias Johansson, Samuel C. Dumith, Magdalena Muc, Sabine Schipf, Idowu O Senbanjo, Jim Mann, Rajaa Al-Raddadi, Yih Chung Tham, Kay-Tee Khaw, Joseph Cacciottolo, Ana Henriques, Sahar Saeedi Moghaddam, Reza Mohammadpourhodki, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Camilla T. Damsgaard, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Constance Schultsz, Santiago F. Gomez, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Pierre Traissac, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. 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Patel, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Son Thai Pham, Simona Giampaoli, Dong Zhao, Indah Suci Widyahening, Merete Osler, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, Giota Touloumi, Janice Luisa Lukrafka, Adela Chirita-Emandi, Maryam Kavousi, Sanja Musić Milanović, Jean-Michel Gaspoz, Jalila El Ati, Sauli Herrala, Liang Xu, Pilar Guallar-Castillón, Bee Koon Poh, Luis Serra-Majem, Jonathan E. Shaw, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Yuki Fujita, Tiffany K. Gill, Nish Chaturvedi, Erkin M. Mirrakhimov, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Deepak Amarapurkar, Deepa Weerasekera, Diana A. 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Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut 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Ltd, Orebro University, University of London, Universitas Indonesia, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Children’s Hospital of Fudan University, University of Cyprus, Niigata University, International Medical University, Iran University of Medical Sciences, Center for Diabetes and Endocrine Care, Peking University First Hospital, Jiangsu Provincial Center for Disease Control and Prevention, Sun Yat-sen University, West Kazakhstan Medical University, Inner Mongolia Medical University, University of Ghana, Maria Lc Iurilli , Bin Zhou , James E Bennett , Rodrigo M Carrillo-Larco , Marisa K Sophiea , Andrea Rodriguez-Martinez , Honor Bixby , Bethlehem D Solomon , Cristina Taddei , Goodarz Danaei , Mariachiara Di Cesare , Gretchen A Stevens , Leanne M Riley , Stefan Savin , Melanie J Cowan , Pascal Bovet , Albertino Damasceno , Adela Chirita-Emandi , Alison J Hayes , Nayu Ikeda , Rod T Jackson , Young-Ho Khang , Avula Laxmaiah , Jing 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Mišigoj-Durakovic , Antonio Mistretta , Veronica Mocanu , Pietro A Modesti , Sahar Saeedi Moghaddam , Bahram Mohajer , Mostafa K Mohamed , Shukri F Mohamed , Kazem Mohammad , Zahra Mohammadi , Noushin Mohammadifard , Reza Mohammadpourhodki , Viswanathan Mohan , Salim Mohanna , Muhammad Fadhli Mohd Yusoff , Iraj Mohebbi , Farnam Mohebi , Marie Moitry , Drude Molbo , Line T Møllehave , Niels C Møller , Dénes Molnár , Amirabbas Momenan , Charles K Mondo , Michele Monroy-Valle , Eric Monterrubio-Flores , Kotsedi Daniel K Monyeki , Jin Soo Moon , Mahmood Moosazadeh , Leila B Moreira , Alain Morejon , Luis A Moreno , Karen Morgan , Suzanne N Morin , Erik Lykke Mortensen , George Moschonis , Malgorzata Mossakowska , Aya Mostafa , Anabela Mota-Pinto , Jorge Mota , Mohammad Esmaeel Motlagh , Jorge Motta , Marcos André Moura-Dos-Santos , Malay K Mridha , Kelias P Msyamboza , Thet Thet Mu , Magdalena Muc , Boban Mugoša , Maria L Muiesan , Parvina Mukhtorova , Martina Müller-Nurasyid , Neil Murphy 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Thai Pham , Rafael N Pichardo , Daniela Pierannunzio , Iris Pigeot , Hynek Pikhart , Aida Pilav , Lorenza Pilotto , Francesco Pistelli , Freda Pitakaka , Aleksandra Piwonska , Andreia N Pizarro , Pedro Plans-Rubió , Bee Koon Poh , Hermann Pohlabeln , Raluca M Pop , Stevo R Popovic , Miquel Porta , Georg Posch , Anil Poudyal , Dimitrios Poulimeneas , Hamed Pouraram , Farhad Pourfarzi , Akram Pourshams , Hossein Poustchi , Rajendra Pradeepa , Alison J Price , Jacqueline F Price , Rui Providencia , Jardena J Puder , Iveta Pudule , Soile E Puhakka , Maria Puiu , Margus Punab , Radwan F Qasrawi , Mostafa Qorbani , Tran Quoc Bao , Ivana Radic , Ricardas Radisauskas , Salar Rahimikazerooni , Mahfuzar Rahman , Mahmudur Rahman , Olli Raitakari , Manu Raj , Ellina Rakhimova , Sherali Rakhmatulloev , Ivo Rakovac , Sudha Ramachandra Rao , Ambady Ramachandran , Jacqueline Ramke , Elisabete Ramos , Rafel Ramos , Lekhraj Rampal , Sanjay Rampal , Vayia Rarra , Ramon A Rascon-Pacheco , Mette Rasmussen , Cassiano Ricardo Rech , Josep Redon , Paul Ferdinand M Reganit , Valéria Regecová , Luis Revilla , Abbas Rezaianzadeh , Lourdes Ribas-Barba , Robespierre Ribeiro , Elio Riboli , Adrian Richter , Fernando Rigo , Natascia Rinaldo , Tobias F Rinke de Wit , Ana Rito , Raphael M Ritti-Dias , Juan A Rivera , Cynthia Robitaille , Romana Roccaldo , Daniela Rodrigues , Fernando Rodríguez-Artalejo , María Del Cristo Rodriguez-Perez , Laura A Rodríguez-Villamizar , Ulla Roggenbuck , Rosalba Rojas-Martinez , Nipa Rojroongwasinkul , Dora Romaguera , Elisabetta L Romeo , Rafaela V Rosario , Annika Rosengren , Ian Rouse , Joel Gr Roy , Adolfo Rubinstein , Frank J Rühli , Jean-Bernard Ruidavets , Blanca Sandra Ruiz-Betancourt , Maria Ruiz-Castell , Emma Ruiz Moreno , Iuliia A Rusakova , Kenisha Russell Jonsson , Paola Russo , Petra Rust , Marcin Rutkowski , Charumathi Sabanayagam , Elena Sacchini , Harshpal S Sachdev , Alireza Sadjadi , Ali Reza Safarpour , Saeid Safiri , Nader Saki , Benoit Salanave , Eduardo Salazar Martinez , Diego Salmerón , Veikko Salomaa , Jukka T Salonen , Massimo Salvetti , Margarita Samoutian , Jose Sánchez-Abanto , Sandjaja , Susana Sans , Loreto Santa Marina , Diana A Santos , Ina S Santos , Lèlita C Santos , Maria Paula Santos , Osvaldo Santos , Rute Santos , Sara Santos Sanz , Jouko L Saramies , Luis B Sardinha , Nizal Sarrafzadegan , Thirunavukkarasu Sathish , Kai-Uwe Saum , Savvas Savva , Mathilde Savy , Norie Sawada , Mariana Sbaraini , Marcia Scazufca , Beatriz D Schaan , Angelika Schaffrath Rosario , Herman Schargrodsky , Anja Schienkiewitz , Sabine Schipf , Carsten O Schmidt , Ida Maria Schmidt , Peter Schnohr , Ben Schöttker , Sara Schramm , Stine Schramm , Helmut Schröder , Constance Schultsz , Aletta E Schutte , Aye Aye Sein , Rusidah Selamat , Vedrana Sember , Abhijit Sen , Idowu O Senbanjo , Sadaf G Sepanlou , Victor Sequera , Luis Serra-Majem , Jennifer Servais , Ludmila Ševcíková , Svetlana A Shalnova , Teresa Shamah-Levy , 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Kazakbaeva, Gyulli M, Keil, Ulrich, Boker, Lital Keinan, Keinänen-Kiukaanniemi, Sirkka, Kelishadi, Roya, Kelleher, Cecily, Kemper, Han CG, Kengne, Andre P, Keramati, Maryam, Kerimkulova, Alina, Kersting, Mathilde, Key, Timothy, Khader, Yousef Saleh, Khalili, Davood, Khaw, Kay-Tee, Kheiri, Bahareh, Kheradmand, Motahareh, Khosravi, Alireza, Khouw, Ilse MSL, Kiechl-Kohlendorfer, Ursula, Kiechl, Stefan, Killewo, Japhet, Kim, Dong Wook, Kim, Hyeon Chang, Kim, Jeongseon, Kindblom, Jenny M, Klakk, Heidi, Klimek, Magdalena, Klimont, Jeannette, Klumbiene, Jurate, Knoflach, Michael, Koirala, Bhawesh, Kolle, Elin, Kolsteren, Patrick, König, Jürgen, Korpelainen, Raija, Korrovits, Paul, Korzycka, Magdalena, Kos, Jelena, Koskinen, Seppo, Kouda, Katsuyasu, Kovacs, Viktoria A, Kowlessur, Sudhir, Koziel, Slawomir, Kratenova, Jana, Kratzer, Wolfgang, Kriemler, Susi, Kristensen, Peter Lund, Krokstad, Steiner, Kromhout, Daan, Kruger, Herculina S, Kubinova, Ruzena, Kuciene, Renata, Kujala, Urho M, Kujundzic, Enisa, Kulaga, Zbigniew, Kumar, R Krishna, Kunešová, Marie, Kurjata, Pawel, Kusuma, Yadlapalli S, Kuulasmaa, Kari, Kyobutungi, Catherine, La, Quang Ngoc, Laamiri, Fatima Zahra, Laatikainen, Tiina, Lachat, Carl, Laid, Youcef, Lam, Tai Hing, Lambrinou, Christina-Paulina, Landais, Edwige, Lanska, Vera, Lappas, Georg, Larijani, Bagher, Latt, Tint Swe, Lauria, Laura, Lazo-Porras, Maria, Le Coroller, Gwenaëlle, Le Nguyen Bao, Khanh, Le Port, Agnè, Le, Tuyen D, Lee, Jeannette, Lee, Jeonghee, Lee, Paul H, Lehmann, Nil, Lehtimäki, Terho, Lemogoum, Daniel, Levitt, Naomi S, Li, Yanping, Liivak, Merike, Lilly, Christa L, Lim, Wei-Yen, Lima-Costa, M Fernanda, Lin, Hsien-Ho, Lin, Xu, Lin, Yi-Ting, Lind, Lar, Linneberg, Allan, Lissner, Lauren, Litwin, Mieczyslaw, Liu, Lijuan, Lo, Wei-Cheng, Loit, Helle-Mai, Long, Khuong Quynh, Lopes, Lui, Lopes, Oscar, Lopez-Garcia, Esther, Lopez, Tania, Lotufo, Paulo A, Lozano, José Eugenio, Lukrafka, Janice L, Luksiene, Dalia, Lundqvist, Annamari, Lundqvist, Robert, Lunet, Nuno, Lunogelo, Charle, Lustigová, Michala, Łuszczki, Edyta, Ma, Guansheng, Ma, Jun, Ma, Xu, Machado-Coelho, George LL, Machado-Rodrigues, Aristides M, Macieira, Luisa M, Madar, Ahmed A, Maggi, Stefania, Magliano, Dianna J, Magnacca, Sara, Magriplis, Emmanuella, Mahasampath, Gowri, Maire, Bernard, Majer, Marjeta, Makdisse, Marcia, Mäki, Päivi, Malekzadeh, Fatemeh, Malekzadeh, Reza, Malhotra, Rahul, Rao, Kodavanti Mallikharjuna, Malyutina, Sofia K, Maniego, Lynell V, Manios, Yanni, Mann, Jim I, Mansour-Ghanaei, Fariborz, Manzato, Enzo, Margozzini, Paula, Markaki, Anastasia, Markey, Oonagh, Ioannidou, Eliza Markidou, Marques-Vidal, Pedro, Marques, Larissa Pruner, Marrugat, Jaume, Martin-Prevel, Yve, Martin, Rosemarie, Martorell, Reynaldo, Martos, Eva, Maruszczak, Katharina, Marventano, Stefano, Mascarenhas, Luis P, Masoodi, Shariq R, Mathiesen, Ellisiv B, Mathur, Prashant, Matijasevich, Alicia, Matsha, Tandi E, Mavrogianni, Christina, Mazur, Artur, Mbanya, Jean 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Mohebbi, Iraj, Mohebi, Farnam, Moitry, Marie, Molbo, Drude, Møllehave, Line T, Møller, Niels C, Molnár, Déne, Momenan, Amirabba, Mondo, Charles K, Monroy-Valle, Michele, Monterrubio-Flores, Eric, Monyeki, Kotsedi Daniel K, Moon, Jin Soo, Moosazadeh, Mahmood, Moreira, Leila B, Morejon, Alain, Moreno, Luis A, Morgan, Karen, Morin, Suzanne N, Mortensen, Erik Lykke, Moschonis, George, Mossakowska, Malgorzata, Mostafa, Aya, Mota-Pinto, Anabela, Mota, Jorge, Motlagh, Mohammad Esmaeel, Motta, Jorge, Moura-dos-Santos, Marcos André, Mridha, Malay K, Msyamboza, Kelias P, Mu, Thet Thet, Muc, Magdalena, Mugoša, Boban, Muiesan, Maria L, Mukhtorova, Parvina, Müller-Nurasyid, Martina, Murphy, Neil, Mursu, Jaakko, Murtagh, Elaine M, Musa, Kamarul Imran, Milanovic, Sanja Music, Musil, Vera, Mustafa, Norlaila, Nabipour, Iraj, Naderimagham, Shohreh, Nagel, Gabriele, Naidu, Balkish M, Najafi, Farid, Nakamura, Harunobu, Námešná, Jana, Ei K Nang, Ei, Nangia, Vinay B, Nankap, Martin, Narake, Sameer, Nardone, Paola, Nauck, Matthia, Neal, William A, Nejatizadeh, Azim, Nekkantti, Chandini, Nelis, Keiu, Nelis, Lii, Nenko, Ilona, Neovius, Martin, Nervi, Flavio, Nguyen, Chung T, Nguyen, Nguyen D, Nguyen, Quang Ngoc, Nieto-Martínez, Ramfis E, Nikitin, Yury P, Ning, Guang, Ninomiya, Toshiharu, Nishtar, Sania, Noale, Marianna, Noboa, Oscar A, Nogueira, Helena, Norat, Teresa, Nordendahl, Maria, Nordestgaard, Børge G, Noto, Davide, Nowak-Szczepanska, Natalia, Al Nsour, Mohannad, Nuhoglu, Irfan, Nurk, Eha, O'Neill, Terence W, O'Reilly, Dermot, Obreja, Galina, Ochimana, Caleb, Ochoa-Avilés, Angélica M, Oda, Eiji, Oh, Kyungwon, Ohara, Kumiko, Ohlsson, Clae, Ohtsuka, Ryutaro, Olafsson, Örn, Olinto, Maria Teresa A, Oliveira, Isabel O, Omar, Mohd Azahadi, Onat, Altan, Ong, Sok King, Ono, Lariane M, Ordunez, Pedro, Ornelas, Rui, Ortiz, Ana P, Ortiz, Pedro J, Osler, Merete, Osmond, Clive, Ostojic, Sergej M, Ostovar, Afshin, Otero, Johanna A, Overvad, Kim, Owusu-Dabo, Elli, Paccaud, Fred Michel, Padez, Cristina, Pagkalos, Ioanni, Pahomova, Elena, de Paiva, Karina Mary, Pajak, Andrzej, Palli, Domenico, Palloni, Alberto, Palmieri, Luigi, Pan, Wen-Harn, Panda-Jonas, Songhomitra, Pandey, Arvind, Panza, Francesco, Papandreou, Dimitrio, Park, Soon-Woo, Park, Suyeon, Parnell, Winsome R, Parsaeian, Mahboubeh, Pascanu, Ionela M, Pasquet, Patrick, Patel, Nikhil D, Pecin, Ivan, Pednekar, Mangesh S, Peer, Nasheeta, Pei, Gao, Peixoto, Sergio Viana, Peltonen, Markku, Pereira, Alexandre C, Peres, Marco A, Pérez-Farinós, Napoleón, Pérez, Cynthia M, Peterkova, Valentina, Peters, Annette, Petersmann, Astrid, Petkeviciene, Janina, Petrauskiene, Ausra, Pettenuzzo, Emanuela, Peykari, Niloofar, Pham, Son Thai, Pichardo, Rafael N, Pierannunzio, Daniela, Pigeot, Iri, Pikhart, Hynek, Pilav, Aida, Pilotto, Lorenza, Pistelli, Francesco, Pitakaka, Freda, Piwonska, Aleksandra, Pizarro, Andreia N, Plans-Rubió, Pedro, Poh, Bee Koon, Pohlabeln, Hermann, Pop, Raluca M, Popovic, Stevo R, Porta, Miquel, Posch, Georg, Poudyal, Anil, Poulimeneas, Dimitrio, Pouraram, Hamed, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J, Price, Jacqueline F, Providencia, Rui, Puder, Jardena J, Pudule, Iveta, Puhakka, Soile E, Puiu, Maria, Punab, Margu, Qasrawi, Radwan F, Qorbani, Mostafa, Bao, Tran Quoc, Radic, Ivana, Radisauskas, Ricarda, Rahimikazerooni, Salar, Rahman, Mahfuzar, Rahman, Mahmudur, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina, Rakhmatulloev, Sherali, Rakovac, Ivo, Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramke, Jacqueline, Ramos, Elisabete, Ramos, Rafel, Rampal, Lekhraj, Rampal, Sanjay, Rarra, Vayia, Rascon-Pacheco, Ramon A, Rasmussen, Mette, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M, Regecová, Valéria, Revilla, Lui, Rezaianzadeh, Abba, Ribas-Barba, Lourde, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, Rinaldo, Natascia, de Wit, Tobias F Rinke, Rito, Ana, Ritti-Dias, Raphael M, Rivera, Juan A, Robitaille, Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)

Subjects
Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed

Published
2021

36. Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium

Author

Seppo Koskinen, Laia Egea-Cortés, Matthew Prina, Yu-Tzu Wu, Albert Sanchez-Niubo, Francisco Félix Caballero, Sergei Scherbov, Jerome Bickenbach, Ilona Koupil, Holger Arndt, Ivet Bayes-Marin, Carlos G. Forero, Javier de la Fuente, Fernando Rodríguez-Artalejo, Demosthenes B. Panagiotakos, Matilde Leonardi, Iago Gine-Vazquez, Alberto Raggi, Alejandro de la Torre-Luque, Andrzej Pająk, Beatriz Olaya, Martin Bobak, Esther García-Esquinas, Abdonas Tamosiunas, Elena Critselis, Warren C. Sanderson, Josep Maria Haro, Martin Prince, Somnath Chatterji, José Luis Ayuso-Mateos, Blanca Mellor-Marsá, Beata Tobias-Adamczyk, Stefanos Tyrovolas, and Christina Daskalopoulou

Subjects
Aging, Epidemiology, Health Status, Envejecimiento, 030204 cardiovascular system & hematology, Logistic regression, Item response theory, Cohort Studies, Integración de datos, 0302 clinical medicine, Equating, 030212 general & internal medicine, Functional ability, Teoría de respuesta a ítems, Aging activities of daily living, General Medicine, scale, Healthy aging, Convergent validity, Scale (social sciences), Capacitat intrínseca, Intrinsic capacity, Data integration, Psychology, functional ability, Concurrent validity, intrinsic capacity, Teoria de resposta a ítems, 03 medical and health sciences, Envelliment, Healthy ageing, Functional capacity, Capacidad funcional, Humans, AcademicSubjects/MED00860, Envejecimiento saludable, Reproducibility of Results, Capacidad intrínseca, Differential item functioning, data integration, Ageing, item response theory, Capacitat funcional, Envelliment saludable, Integració de dades, Activitats d’envelliment de la vida diària, Actividades de envejecimiento de la vida diaria, Demography
Abstract

Background Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts. Methods In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10. Results A common scale was created for 343 915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality. Conclusions The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing.

Published
2021

37. Psychological well-being and mortality: longitudinal findings from Lithuanian middle-aged and older adults study

Author

Dalia Luksiene, Laura Sapranaviciute-Zabazlajeva, Dalia Virviciute, Abdonas Tamosiunas, and Anne Peasey

Subjects
Male, medicine.medical_specialty, Health (social science), Social Psychology, Epidemiology, Longevity, Poison control, Suicide prevention, Psychological well-being, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Cause of Death, Surveys and Questionnaires, Injury prevention, medicine, Humans, 030212 general & internal medicine, Longitudinal Studies, Mortality, Life Style, Aged, Original Paper, Marital Status, business.industry, Mental Disorders, Confounding, Lithuania, Middle Aged, 3. Good health, 030227 psychiatry, Psychiatry and Mental health, Mental Health, Cardiovascular Diseases, Marital status, Female, business, Demography, Social status, Follow-Up Studies
Abstract

Background The study aimed to examine whether after confounding by possible socio-demographic and other risk factors, psychological well-being is independently associated with reduced all-cause and cardiovascular mortality. Methods Initial data were collected within the framework of the international project HAPIEE in 2006–2008. A random sample of 7115 individuals aged 45–72 years was screened. Deaths were evaluated by death register of Kaunas city (Lithuania) in a follow-up study till 2016. Psychological well-being was evaluated by a CASP-12 questionnaire. Socio-demographic, lifestyle, biologic factors and depressive symptoms were evaluated. Results Age-adjusted survival curves revealed that psychological well-being predicts longevity in men and women (p

Published
2019

38. Gender, marital and educational inequalities in mid-to late-life depressive symptoms: Cross-cohort variation and moderation by urbanicity degree

Author

Martijn Huisman, Abdonas Tamosiunas, Martin Bobak, Ruzena Kubinova, Rita Wissa, Dany Doiron, Aliou Sarr, Parminder Raina, Basile Chaix, Sofia Malyutina, Nazmul Sohel, Erik J. Timmermans, Milagros Ruiz, Frank J. van Lenthe, Asli Gurer, Mariëlle A. Beenackers, Steinar Krokstad, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Sociology, The Social Context of Aging (SoCA), Public Health, University College of London [London] (UCL), Erasmus University Medical Center [Rotterdam] (Erasmus MC), McGill University Health Center [Montreal] (MUHC), McMaster University [Hamilton, Ontario], VU University Medical Center [Amsterdam], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Vrije Universiteit Amsterdam [Amsterdam] (VU), Norwegian University of Science and Technology (NTNU), National Institute of Public Health [Prague], Novosibirsk State University (NSU), Utrecht University [Utrecht], Gestionnaire, Hal Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)

Subjects
Canada, Inequality, Epidemiology, [SDV]Life Sciences [q-bio], media_common.quotation_subject, Social epidemiology, Affect (psychology), Population density, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Humans, Medicine, 030212 general & internal medicine, Depression (differential diagnoses), Original Research, media_common, urbanisation, Depression, business.industry, Public Health, Environmental and Occupational Health, Ageing, depression, social epidemiology, SDG 10 - Reduced Inequalities, Middle Aged, Moderation, 030227 psychiatry, [SDV] Life Sciences [q-bio], Cross-Sectional Studies, Cohort, Educational Status, Marital status, Female, business, Demography
Abstract

Background Although ageing populations are increasingly residing in cities, it is unknown whether depression inequalities are moderated by urbanicity degree. We estimated gender, marital and educational inequalities in depressive symptoms among older European and Canadian adults, and examined whether higher levels of urbanicity, captured by population density, heightened these inequalities. Methods Harmonised cross-sectional data on 97 826 adults aged ≥50 years from eight cohorts were used. Prevalence ratios (PRs) were calculated for probable depression, depressed affect and depressive symptom severity by gender, marital status and education within each cohort, and combined using random-effects meta-analysis. Using a subsample of 73 123 adults from six cohorts with available data on population density, we tested moderating effects measured by the number of residents per square kilometre. Results The pooled PRs for probable depression by female gender, unmarried or non-cohabitating status and low education were 1.48 (95% CI 1.28 to 1.72), 1.44 (95% CI 1.29 to 1.61) and 1.29 (95% CI 1.18 to 1.41), respectively. PRs for depressed affect and high symptom severity were broadly similar. Except for one Dutch cohort with findings in an unexpected direction, there was no evidence that population density modified depressive symptom inequalities. Conclusions Despite cross-cohort variation in gender, marital status and educational inequalities in depressive symptoms, there was weak evidence that these inequalities differed by levels of population density.

Published
2021

39. Unsupervised Learning for Large Scale Data: The ATHLOS Project

Author

Jerome Bickenbach, Laia Egea-Cortés, Aristidis G. Vrahatis, Albert Sanchez-Niubo, Sergei Scherbov, Petros Barmpas, Matilde Leonardi, Seppo Koskinen, Francisco Félix Caballero, Somnath Chatterji, Martin Prince, Vassilis P. Plagianakos, José Luis Ayuso-Mateos, Andrzej Pająk, Ivet Bayes, Martin Bobak, Warren C. Sanderson, Spiros V. Georgakopoulos, Ilona Koupil, Panagiotis Anagnostou, Abdonas Tamosiunas, Matthew Prina, Aleksander Galas, Josep MariaHaro, Sotiris K. Tasoulis, Esther García-Esquinas, and Demosthenes B. Panagiotakos

Subjects
Computer science, business.industry, Dimensionality reduction, Big data, Large scale data, Machine learning, computer.software_genre, Data type, Visualization, Unsupervised learning, Artificial intelligence, Cluster analysis, business, Categorical variable, computer
Abstract

1AbstractRecent technological advancements in various domains, such as the biomedical and health, offer a plethora of big data for analysis. Part of this data pool is the experimental studies that record various and several features for each instance. It creates datasets having very high dimensionality with mixed data types, with both numerical and categorical variables. On the other hand, unsupervised learning has shown to be able to assist in high-dimensional data, allowing the discovery of unknown patterns through clustering, visualization, dimensionality reduction, and in some cases, their combination. This work highlights unsupervised learning methodologies for large-scale, high-dimensional data, providing the potential of a unified framework that combines the knowledge retrieved from clustering and visualization. The main purpose is to uncover hidden patterns in a high-dimensional mixed dataset, which we achieve through our application in a complex, real-world dataset. The experimental analysis indicates the existence of notable information exposing the usefulness of the utilized methodological framework for similar high-dimensional and mixed, real-world applications.

Published
2021

40. Lowered Cognitive Function and the Risk of the First Events of Cardiovascular Diseases: Findings from the Cohort Study in Lithuania

Author

Dalia Luksiene, Laura Sapranaviciute-Zabazlajeva, Abdonas Tamosiunas, Ricardas Radisauskas, and Martin Bobak

Abstract

Background: The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains predict the risk of first cardiovascular diseases (CVD) events in the middle-aged and older population.Methods: 7,087 participants, men and women aged 45-72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008 in Kaunas city, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at baseline survey) was evaluated. Results: During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors, and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased risk of the first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score – by 17% in men and 24% in women; and a composite score of cognitive function – by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of the first cardiovascular event according to the categories of a composite score of cognitive function, revealed that the lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p < 0.05).Conclusions: The findings of this follow-up study suggest that men and women with lower cognitive functions have an increased risk for the first event of CVD compared to participants with a higher level of cognitive functions.

Published
2021

41. Possible Associations between Space Weather and the Incidence of Stroke

Author

Lolita Sileikiene, Dalia Luksiene, Egle Milinaviciene, Jone Vencloviene, Ričardas Radišauskas, Daiva Rastenyte, and Abdonas Tamosiunas

Subjects
Atmospheric Science, medicine.medical_specialty, 010504 meteorology & atmospheric sciences, solar flares, Environmental Science (miscellaneous), Space weather, Hemorrhagic strokes, lcsh:QC851-999, 01 natural sciences, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Internal medicine, medicine, ischemic stroke, hemorrhagic stroke, Poisson regression, cardiovascular diseases, Stroke, geomagnetic activity, 0105 earth and related environmental sciences, solar proton event, Solar proton, business.industry, Incidence (epidemiology), Ischemic strokes, medicine.disease, Increased risk, symbols, Cardiology, lcsh:Meteorology. Climatology, business, 030217 neurology & neurosurgery
Abstract

The aim of our study was to detect the possible association between daily numbers of ischemic strokes (ISs) and hemorrhagic strokes (HSs) and space weather events. The daily numbers of ISs, subarachnoid hemorrhages (SAHs), and intracerebral hemorrhages (ICHs) were obtained from Kaunas Stroke Register during the period of 1986 to 2010. We used time- and season-stratified multivariate Poisson regression. We analyzed data of 597 patients with SAH, 1147 patients with ICH, and 7482 patients with IS. Strong/severe geomagnetic storms (GSs) were associated with an increase in the risk of SAH (by 58%) and HS (by 30%). Only GSs occurring during 6:00–12:00 UT were associated with the risk of IS. Low geomagnetic activity (GMA) was associated with the risk of ICH, HS, and IS (Rate Ratios with 95% CI were 2.51 (1.50–4.21), 2.33 (1.50–3.61), and 1.36 (1.03–1.81), respectively). The days of ≥ X9 class solar flare (SF) were associated with a 39% higher risk of IS. The risk of HS occurrence was greater than two times higher on the day after the maximum of a strong/severe solar proton event (SPE). These results showed that GSs, very low GMA, and stronger SFs and SPEs may be associated with an increased risk of different subtypes of stroke.

Published
2021

42. A Hybrid Machine Learning Framework for Enhancing the Prediction Power in Large Scale Population Studies: The ATHLOS Project

Author

Aleksander Galas, Matthew Prina, Esther García-Esquinas, J.L. Ayuso-Mateos, Martin Prince, S. Chatterji, Barmpas P, Ilona Koupil, Andrzej Pająk, Matilde Leonardi, Jerome Edmond Bickenbach, Sotiris K. Tasoulis, Warren C. Sanderson, Josep Maria Haro, Abdonas Tamosiunas, Martin Bobak, Plagianakos, Laia Egea-Cortés, Aristidis G. Vrahatis, Albert Sanchez-Niubo, Sergei Scherbov, Seppo Koskinen, Félix Caballero F, Ivet Bayes, and Demosthenes B. Panagiotakos

Subjects
Scheme (programming language), education.field_of_study, Scale (ratio), business.industry, Computer science, Population, Machine learning, computer.software_genre, Hierarchical clustering, Unsupervised learning, Artificial intelligence, Cluster analysis, business, education, Baseline (configuration management), computer, Selection (genetic algorithm), computer.programming_language
Abstract

The ATHLOS cohort is composed of several harmonized datasets of international cohorts related to health and aging. The healthy aging scale has been constructed based on a selection of particular variables from 16 individual studies. In this paper, we consider a selection of additional variables found in ATHLOS and investigate their utilization for predicting the healthy aging. For this purpose motivated by the dataset’s volume and diversity we focus our attention upon the clustering for prediction scheme, where unsupervised learning is utilized to enhance prediction power, showing the predictive utility of exploiting structure in the data by clustering. We show that imposed computation bottlenecks can be surpassed when using appropriate hierarchical clustering within a clustering for ensemble classification scheme while retaining prediction benefits. We propose a complete methodology which is evaluated against baseline methods and the original concept. The results are very encouraging suggesting further developments in this direction along with applications in tasks with similar characteristics. A strait-forward open source implementation is provided for the R project.

Published
2021

43. Predictive Importance of Blood Pressure Characteristics With Increasing Age in Healthy Men and Women: The MORGAM Project

Author

Matti Savallampi, Wojciech Drygas, Tarja Palosaari, Sameline Grimsgaard, Giancarlo Cesana, Marie Moitry, Simona Giampaoli, Peter M. Nilsson, Susana Sans, Kari Kuulasmaa, Sara V. Greve, Annette Peters, Anna Meta Dyrvig Kristensen, Luigi Palmieri, Jean Ferrières, Giovanni Veronesi, Manan Pareek, Hermann Brenner, Abdonas Tamosiunas, Stefan Söderberg, Frank Kee, Jean Dallongeville, Stephane Laurent, Veikko Salomaa, Chiara Donfrancesco, Giuseppe Mancia, Michael H. Olsen, Julie K K Vishram-Nielsen, Guido Grassi, Allan Linneberg, Vishram-Nielsen, J, Kristensen, A, Pareek, M, Laurent, S, Nilsson, P, Linneberg, A, Greve, S, Palmieri, L, Giampaoli, S, Donfrancesco, C, Kee, F, Mancia, G, Cesana, G, Veronesi, G, Grassi, G, Kuulasmaa, K, Salomaa, V, Palosaari, T, Sans, S, Ferrieres, J, Dallongeville, J, Söderberg, S, Moitry, M, Drygas, W, Tamosiunas, A, Peters, A, Brenner, H, Grimsgaard, S, Savallampi, M, and Olsen, M

Subjects
Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Global Health, Risk Assessment, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Vascular Stiffness, cardiovascular disease, Internal medicine, blood pressure, myocardial infarction, prognosis, risk factor, Cause of Death, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Risk factor, Mortality, Correlation of Data, Aged, business.industry, Age Factors, Blood Pressure Monitoring, Ambulatory, Middle Aged, medicine.disease, Prognosis, Blood pressure, Cardiovascular Diseases, Heart Disease Risk Factors, Hypertension, Cardiology, Blood Pressure, Cardiovascular Disease, Myocardial Infarction, Risk Factor, Female, business, prognosi
Abstract

It remains unclear which blood pressure (BP) characteristics best predict cardiovascular risk in different age groups and between sexes. We leveraged data from the MORGAM (MONICA [Monitoring of Trends and Determinants in Cardiovascular Disease], Risk, Genetics, Archiving and Monograph) Project to investigate determinants of BP characteristics and their prognostic importance, in younger and older (P interaction P P P P =0.03), enhanced continuous net reclassification improvement (0.150 [95% CI, 0.087–0.215]) and improved the prognostic value of the European Society of Cardiology/European Society of Hypertension hypertension definition (categorical net reclassification improvement=0.0255, P =0.005). In conclusion, diastolic BP may provide additional prognostic utility beyond systolic BP, in predicting composite cardiovascular events among younger individuals.

Published
2021

44. Association between stroke occurrence and changes in atmospheric circulation

Author

Ričardas Radišauskas, Vidmantas Vaičiulis, Daina Kranciukaite-Butylkiniene, Daiva Rastenyte, Jone Vencloviene, and Abdonas Tamosiunas

Subjects
Male, medicine.medical_specialty, Haemorrhagic stroke, 010504 meteorology & atmospheric sciences, Atmospheric circulation, 01 natural sciences, Russia, 03 medical and health sciences, symbols.namesake, El Niño-southern oscillation, 0302 clinical medicine, Epidemiology, medicine, Humans, Poisson regression, cardiovascular diseases, Stroke, Ischaemic stroke, Weather, 0105 earth and related environmental sciences, business.industry, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Lithuania, medicine.disease, Arctic oscillation, El Niño, East Atlantic/West Russia indices, North Atlantic oscillation, symbols, Female, business, 030217 neurology & neurosurgery, Teleconnection, Demography, Research Article
Abstract

Background The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. Methods The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. Results During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14–1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16–0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04–1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p Conclusions The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.

Published
2021

45. Author response: Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author

Zahra Mohammadi, Abdul Basit, Helena I. S. Nogueira, Soile E. Puhakka, Hongsheng Bi, Ari Voutilainen, Davood Khalili, Bin Zhou, Dermot O'Reilly, Natascia Rinaldo, Paulo A. Lotufo, Bahareh Kheiri, Thein Thein Htay, Simona Giampaoli, Goodarz Danaei, M. Fernanda Lima-Costa, Simona Bo, Peter Schnohr, Jerzy Chudek, Francesco Panza, Ling Yang, Katia Vergetti Bloch, Vincenzo Capuano, Holly E. Syddall, Dong Zhao, Indah Suci Widyahening, Maria Lorenza Muiesan, Leng Huat Foo, Mohsen Azimi-Nezhad, Merete Osler, Laura Torres-Collado, Manu Raj, Adroaldo Cesar Araujo Gaya, Susi Kriemler, Ali Akbar Shayesteh, Aneta Grajda, Anette Varbo, Kazem Mohammad, Leila Beltrami Moreira, Shu Ti Chiou, Iuliia A Rusakova, Jyh Eiin Wong, Torben Jørgensen, Lela Sturua, Lubica Ticha, Hamid Hakimi, Hazzaa M. Al-Hazzaa, Yanina Zócalo, Freda Pitakaka, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Marie Kunešová, Johanna M. Geleijnse, Elysée Claude Bika Lele, Yannis Manios, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Sibel Gogen, Viviane Cunha Cardoso, Kristine H. Allin, Ana Azevedo, Line Tang Møllehave, Vincent Jr DeGennaro, Novie O. Younger-Coleman, Gretchen A Stevens, Dickman Gareta, Holger Theobald, Anja Schienkiewitz, Bekbolat Zholdin, Janice Luisa Lukrafka, Adela Chirita-Emandi, Ulla Roggenbuck, Kenisha Russell Jonsson, Robespierre Ribeiro, Gabriele Eiben, Eero Kajantie, Sounnia Mediene Benchekor, Fariborz Mansour-Ghanaei, Mary Simon, Prakash C. Gupta, Mohammad Esmaeel Motlagh, Emanuela Gualdi-Russo, María Elena Díaz-Sánchez, Pilar Guallar-Castillón, Bee Koon Poh, Cristina Padez, Azaliia M Tuliakova, Sarah P. Garnett, William R. Tebar, Yingfeng Zheng, Suhad Bahijri, Christina Mavrogianni, Mihaela Vladulescu, Jan A. Staessen, Paula Duarte de Oliveira, Rui Ornelas, Michael Sjöström, Charles Agyemang, Slawomir Koziel, Shohreh Naderimagham, Jari Jokelainen, Stephen T. McGarvey, Patrick Pasquet, Farnam Mohebi, Nader Saki, Aida Pilav, Azim Nejatizadeh, Marianna Noale, Habiba Ben Romdhane, Luís B. Sardinha, Laura Lauria, Jun Hata, Kodanda R Kanala, Gert B. M. Mensink, Nils Lehmann, Elio Riboli, Carolina Tarqui-Mamani, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Luis Serra-Majem, Martina Müller-Nurasyid, Felipe Vogt Cureau, Lekhraj Rampal, Zhamilya Battakova, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Fikru Tullu, Aung Soe Htet, Angel R. Gonzalez, Annette J. Dobson, Kavumpurathu Raman Thankappan, Hélène Delisle, Francisco J. Félix-Redondo, Ramón Suárez-Medina, Annika Rosengren, Sania Nishtar, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Maria Cecília Formoso Assunção, Kazi M. Jamil, Stefano Marventano, Wenbin Wei, Norsyamlina Che Abdul Rahim, Shukri F. Mohamed, Bente Sparboe-Nilsen, Soon-Woo Park, Ana Isabel Rito, David Goltzman, W. M. 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Pérez, Vera Lanska, Tint Swe Latt, Dominique Hange, João Luiz Bastos, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Maya Tanrygulyyeva, Reza Malekzadeh, Dimitrios Poulimeneas, Pedro Ordunez, Thomas Waldhör, Ioannis Pagkalos, Carlo M. Barbagallo, Abla M. Sibai, Peter Vollenweider, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Santosh K. Bhargava, Patrick Kolsteren, Aya Mostafa, Fangfang Chen, Flavio Nervi, Imre Janszky, Arvind Pandey, Renata Cifkova, Alexandre C. Pereira, Alejandro Diaz, Alireza Ansari-Moghaddam, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Rusidah Selamat, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paul Korrovits, Paola Nardone, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Alberto Barceló, Camilla T. Damsgaard, Constance Schultsz, Frank J Rühli, Santiago F. Gomez, Tara Coppinger, Muhammad Islam, Pierre Traissac, Eleonora d'Orsi, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Daniela Pierannunzio, Cristina Taddei, Wen-Harn Pan, Gregor Starc, Abdullah Alkandari, Saeed Dastgiri, Lien Braeckevelt, Gustavo Velasquez-Melendez, Sudhir Kowlessur, Bagher Larijani, Cynthia Robitaille, Mohamed M. Ali, Steiner Krokstad, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Abhijit Sen, Sergej M. Ostojic, Silvana Donoso, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Hanan F. Abdul Rahim, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Bethlehem D. Solomon, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Miquel Porta, Vesna Jureša, Alexander D. Deev, Son Thai Pham, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, David Faeh, Antonio Bernabe-Ortiz, Giota Touloumi, Maryam Kavousi, Sanja Musić Milanović, Jalila El Ati, Sauli Herrala, Liang Xu, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Yi Song, Jianfeng Wu, Jeannette Klimont, Jean Ferrières, Farhad Zamani, Shina Avi, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Reecha Sofat, Koen Van Herck, Hoang Van Minh, Enrique Gutiérrez-González, Martine Vrijheid, Susana Cararo Confortin, Antonis Zampelas, Bogdan Wojtyniak, Ausra Petrauskiene, Juha Auvinen, Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Young-Ho Khang, Ellina Rakhimova, Magdalena Klimek, Luís Lopes, Erkin M. Mirrakhimov, Maria Lc Iurilli, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Rainford J. Wilks, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Li Juan Wu, Adrian Richter, Licia Iacoviello, Hanno Ulmer, Deepak Amarapurkar, Mohsen Ibrahim, Hamed Pouraram, Massimo Salvetti, Hung-Kwan So, Yonghua Hu, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Sabina Zambon, Angelika Schaffrath Rosario, Lauren Lissner, Kamarul Imran Musa, Deepa Weerasekera, Bihungum Bista, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Irene G. M. van Valkengoed, Anna Fijałkowska, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Nasheeta Peer, Radka Taxová Braunerová, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Eliza Cinteza, Ha Tp Do, and Alison J. Hayes

Subjects
education.field_of_study, business.industry, Population, Distribution (economics), medicine.disease, Obesity, Geography, medicine, Underweight, medicine.symptom, education, business, Body mass index, Demography
Published
2020

46. Changes in physical activity and mortality risk among an adult Lithuanian urban population: results from a cohort study

Author

Dalia Luksiene, Abdonas Tamosiunas, V. Jasiukaitiene, and Daina Kranciukaite-Butylkiniene

Subjects
Adult, Male, Urban Population, Population, Physical activity, Disease, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Cox proportional hazards regression, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, education, Exercise, Aged, Proportional Hazards Models, education.field_of_study, business.industry, 030503 health policy & services, Hazard ratio, Public Health, Environmental and Occupational Health, Lithuania, General Medicine, Middle Aged, Physical activity level, Cardiovascular Diseases, Female, 0305 other medical science, business, Demography, Cohort study
Abstract

Objectives The purpose of this study was to investigate changes in physical activity and the association of these changes with the risk of all-cause mortality and mortality from cardiovascular disease (CVD) among an adult and elderly Lithuanian urban population. Study design Prospective cohort study. Methods Data from four surveys are presented. In total, there were 2416 participants (1071 men and 1345 women) who took part in one of the initial three surveys in the framework of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study since 1986 and also in the follow-up survey in 2006 (with follow-up over 15 years). Study participants were followed-up for mortality events from 2006 until 31 December 2017. The mean duration of the follow-up for endpoints period was 10.55 (standard deviation 2.33) years. Results Over 15 years of follow-up, 50.9% of men and 56.7% of women were physically active at initial and follow-up surveys, and approximately 10.0% of respondents were physically inactive. Over this period, 22.8% of men and 24.8% of women increased their physical activity level, and 14.1% of men and 10.1% of women decreased their physical activity level. The findings from the Cox proportional hazards regression multivariable analysis showed that a decrease in physical activity level during the follow-up period was related to a higher risk for all-cause mortality and mortality from CVD risk in women (hazard ratio [HR] = 1.82, P = 0.039; and HR = 5.40, P = 0.014, respectively). In men, a clear association of physical inactivity was ascertained only to all-cause mortality risk and only for non-smokers (HR = 2.07, P = 0.013). Conclusions A decrease in physical activity levels in women is a strong predictor for all-cause mortality risk and mortality from CVD risk. Physical inactivity in male non-smokers is a strong predictor for all-cause mortality risk.

Published
2020

47. Combined Influence of Waist and Hip Circumference on Risk of Death in a Large Cohort of European and Australian Adults

Author

Stefan Söderberg, Kari Kuulasmaa, Annette J. Dobson, Salomaa Veikko, Wojciech Drygas, Adrian J. Cameron, Luigi Palmieri, Abdonas Tamosiunas, Barbara Thorand, Jean Ferrières, Jean Dallongeville, Simona Giampaoli, Männistö Satu, Frank Kee, Licia Iacoviello, Liliana Orellana, Giovanni Veronesi, Tarja Palosaari, Helena Romaniuk, Francesco Gianfagna, Marco M Ferrario, Pekka Jousilahti, Teemu J. Niiranen, Diego Vanuzzo, Marie Moitry, Ulla Toft, Tom Wilsgaard, and Andrzej Pająk

Subjects
Male, obesity, Epidemiology, Disease, 0302 clinical medicine, Risk Factors, Cause of Death, Cardiovascular Disease, Medicine, Cardiac and Cardiovascular Systems, 030212 general & internal medicine, Prospective Studies, Adiposity, Original Research, media_common, Kardiologi, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, Incidence, Hazard ratio, Middle Aged, Circumference, Prognosis, waist circumference, Europe, Cardiovascular Diseases, Cohort, Female, Risk of death, Cardiology and Cardiovascular Medicine, hip circumference, mortality, Adult, medicine.medical_specialty, Waist, 030209 endocrinology & metabolism, Lower risk, Risk Assessment, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Predictive Value of Tests, Internal medicine, Humans, media_common.cataloged_instance, European union, Aged, Hip Circumference, Waist-Hip Ratio, business.industry, Proportional hazards model, Australia, Fat distribution, Protective Factors, medicine.disease, Obesity, Large cohort, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, Demography
Abstract

Background: Waist circumference (WC) and hip circumference (HC) are both strongly associated with risk of death, however their joint association has rarely been investigated. This study aimed to assess the combined influence of WC and HC, as well as a range of other obesity measures, with the risk of all-cause and cardiovascular disease (CVD) death. Methods: This study uses participant data from 30 cohorts of the MORGAM Project conducted in 11 countries; 90,487 males and females aged 30-74 years, predominantly Caucasian, with no history of CVD, recruited in 1986-2010, and followed-up for up to 24 years. Hazard ratios were estimated using sex specific Cox models stratified by cohort with age as the time scale. Models included baseline categorical obesity measures, age, total and HDL cholesterol, systolic blood pressure, antihypertensive drugs, smoking and diabetes. Findings: 9105 all-cause deaths were recorded during a median follow up of 10 years. Hazard ratios for all-cause death presented J- or U-shaped associations with most obesity measures. When WC and HC were included in the same model, in both men and women, for all hip sizes, having a smaller waist was found to be strongly associated with lower risk of death, except for males with the smallest hip size. In addition, among those with smaller waists, hip size was strongly negatively associated with risk of death, with around 20% more people identified as being at increased risk compared to WC alone. Interpretation: A more complex relationship between HC, WC and risk of death is revealed when both measures are considered simultaneously. This is particularly true for individuals with smaller waists, where having larger hips was protective. Considering both WC and HC in the clinical setting could help to best identify those at increased risk of death. Funding Statement: The MORGAM Project received funding from Medical Research Council London grant G0601463 (80983) and European Union FP7 project BiomarCaRE (HEALTH-F2-2011-278913). The activities of the MORGAM Data Centre have been sustained also by recent funding from European Union FP 7 project CHANCES (HEALTH-F3-2010-242244). AJC, HR and LO were supported by Deakin University. AJC is the recipient of an Australian Research Council Discovery Early Career Researcher Awards (project number DE160100141). SS was supported by the Swedish Heart-Lung Foundation, the County Council of Vasterbotten (ALF, VLL-548791), and Umea University. Declaration of Interests: No conflicts of interest exist in relation to this work. Ethics Approval Statement: Each MORGAM participating centre was responsible for ethical approval and patient consent, according to local rules at the time of study enrollment.

Published
2020

48. The role of apolipoprotein E (rs7412 and rs429358) in age-related macular degeneration

Author

Alvita Vilkeviciute, Dalia Zaliuniene, Vaiva Lesauskaite, Alina Smalinskiene, Janina Petkeviciene, Abdonas Tamosiunas, and Rasa Liutkeviciene

Subjects
Male, 0301 basic medicine, Apolipoprotein E, medicine.medical_specialty, Genotyping Techniques, genetic structures, Visual impairment, Drusen, Polymorphism, Single Nucleotide, Apolipoproteins E, Macular Degeneration, 03 medical and health sciences, 0302 clinical medicine, Gene Frequency, Age related, Ophthalmology, Odds Ratio, medicine, Humans, Pathological, Genetics (clinical), Aged, Aged, 80 and over, business.industry, Middle Aged, Macular degeneration, medicine.disease, eye diseases, 030104 developmental biology, Pediatrics, Perinatology and Child Health, 030221 ophthalmology & optometry, Female, sense organs, Gene polymorphism, medicine.symptom, business
Abstract

Background: Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment in the developed countries. The main pathological change in AMD is the formation of drusen containing 40% of lipids, dominated by esterified cholesterol (EC) and phosphatidylcholine (PC), and protein. Haplotype ε4 of apolipoprotein E (ApoE) acts as a ligand for the low-density lipoprotein receptor and is involved in the maintenance and repair of neuronal cell membranes. Purpose: This study aimed to evaluate the association of AMD with ApoE gene polymorphism variants (rs7412 and rs429358). Methodology: A total of 2133 subjects were enrolled in our research. The study group comprised patients with early AMD (n = 413) and exudative AMD (n = 307), and the control group enrolled randomly selected persons (n = 1413). The genotyping of ApoE (rs7412 and rs429358) was performed using the real-time polymerase chain reaction (PCR) method. Results: Statistical analysis revealed that ApoE 4/2 genotype was less frequently observed in in older patients with exudative AMD compared to older healthy controls (0.4% vs. 4.0%, p = 0.003). Conclusion: Our data demonstrated that ApoE 4/2 genotype was less frequently observed in old patients (65 years and more) with exudative AMD compared to old healthy controls. It leads to hypothesis on the protective effect of ApoE 4/2 to develop AMD in the elderly.

Published
2018

50. Associations of environmental variables with different types of stroke

Author

Ričardas Radišauskas, Jone Vencloviene, Abdonas Tamosiunas, Vidmantas Vaičiulis, Daina Kranciukaite-Butylkiniene, and Daiva Rastenyte

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, business.industry, Intracranial Hemorrhages, Public Health, Environmental and Occupational Health, medicine.disease, Stroke risk, medicine.anatomical_structure, Meteorological Concept, Internal medicine, Ischemic stroke, medicine, Cardiology, business, Stroke, Hypothalamic–pituitary–adrenal axis
Abstract

Background Air temperature (T) and atmospheric pressure (AP) are among the most closely studied weather variables; increases, decreases, and fluctuations in both have been significantly linked to numerous stroke subtypes. We decided to detect the association between daily numbers of ischaemic stroke (IS) and haemorrhagic stroke (HS) and daily North Atlantic Oscillation (NAO) and Arctic Oscillation (AO) indices and monthly indices of Quasi-Biennal Oscillation (QBO). Methods The study was conducted in Kaunas city from 2000 to 2010. Kaunas stroke register presented daily numbers of IS, subarachnoid haemorrhages (SAH), and intracerebral haemorrhages (ICH). We evaluated the association between these types of stroke and NAO, AO, and QBO indices (NAOI, AOI, and QBOI) by applying Poisson regression, adjusting for month and other weather variables. Results During the study period, we analysed 3,992 cases (2,205 men and 1,787 women) with stroke. IS composed 3,199 (80.1%), ICH 533 (13.4%), and SAH - 260 (6.5%). A change in mean daily atmospheric pressure (AP) of > 3.9 hPa and QBOI 0 was associated with HS (RR = 1.29 (1.03-1.62)), and a negative association between NAOI and IS (RR = 0.91 (0.84-0.98)) was found. Conclusions The results of our study provided new evidence that the NAO, AO, and QBO pattern may affect the risk of stroke. The impact of these teleconnection indices is not identical for different types of stroke. Key messages This abstract is part of publication, which will be published later on. In some cases, environmental impact is not essential, but quite often determines the course of various diseases, especially of the circulatory system.

Published
2019

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