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6. Assessing Risk Prediction Models Using Individual Participant Data From Multiple Studies

Author

Pennells, Lisa, Kaptoge, Stephen, White, Ian R., Thompson, Simon G., Wood, Angela M., Tipping, Robert W., Folsom, Aaron R., Couper, David J., Ballantyne, Christie M., Coresh, Josef, Goya Wannamethee, S., Morris, Richard W., Kiechl, Stefan, Willeit, Johann, Willeit, Peter, Schett, Georg, Ebrahim, Shah, Lawlor, Debbie A., Yarnell, John W., Gallacher, John, Cushman, Mary, Psaty, Bruce M., Tracy, Russ, Tybjærg-Hansen, Anne, Price, Jackie F., Lee, Amanda J., McLachlan, Stela, Khaw, Kay-Tee, Wareham, Nicholas J., Brenner, Hermann, Schöttker, Ben, Müller, Heiko, Jansson, Jan-Håkan, Wennberg, Patrik, Salomaa, Veikko, Harald, Kennet, Jousilahti, Pekka, Vartiainen, Erkki, Woodward, Mark, DʼAgostino, Ralph B., Bladbjerg, Else-Marie, Jørgensen, Torben, Kiyohara, Yutaka, Arima, Hisatomi, Doi, Yasufumi, Ninomiya, Toshiharu, Dekker, Jacqueline M., Nijpels, Giel, Stehouwer, Coen D. A., Kauhanen, Jussi, Salonen, Jukka T., Meade, Tom W., Cooper, Jackie A., Cushman, Mary, Folsom, Aaron R., Psaty, Bruce M., Shea, Steven, Döring, Angela, Kuller, Lewis H., Grandits, Greg, Gillum, Richard F., Mussolino, Michael, Rimm, Eric B., Hankinson, Sue E., Manson, JoAnn E., Pai, Jennifer K., Kirkland, Susan, Shaffer, Jonathan A., Shimbo, Daichi, Bakker, Stephan J. L., Gansevoort, Ron T., Hillege, Hans L., Amouyel, Philippe, Arveiler, Dominique, Evans, Alun, Ferrières, Jean, Sattar, Naveed, Westendorp, Rudi G., Buckley, Brendan M., Cantin, Bernard, Lamarche, Benoît, Barrett-Connor, Elizabeth, Wingard, Deborah L., Bettencourt, Richele, Gudnason, Vilmundur, Aspelund, Thor, Sigurdsson, Gunnar, Thorsson, Bolli, Kavousi, Maryam, Witteman, Jacqueline C., Hofman, Albert, Franco, Oscar H., Howard, Barbara V., Zhang, Ying, Best, Lyle, Umans, Jason G., Onat, Altan, Sundström, Johan, Michael Gaziano, J., Stampfer, Meir, Ridker, Paul M., Michael Gaziano, J., Ridker, Paul M., Marmot, Michael, Clarke, Robert, Collins, Rory, Fletcher, Astrid, Brunner, Eric, Shipley, Martin, Kivimäki, Mika, Ridker, Paul M., Buring, Julie, Cook, Nancy, Ford, Ian, Shepherd, James, Cobbe, Stuart M., Robertson, Michele, Walker, Matthew, Watson, Sarah, Alexander, Myriam, Butterworth, Adam S., Angelantonio, Emanuele Di, Gao, Pei, Haycock, Philip, Kaptoge, Stephen, Pennells, Lisa, Thompson, Simon G., Walker, Matthew, Watson, Sarah, White, Ian R., Wood, Angela M., Wormser, David, and Danesh, John

Published
2014
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11. The Test Your Memory cognitive screening tool: sociodemographic and cardiometabolic risk correlates in a population‐based study of older British men

Author

Papachristou, E, Ramsay, SE, Papacosta, O, Lennon, LT, Iliffe, S, Whincup, PH, and Goya Wannamethee, S

Subjects
cognition, Male, Aging, Health Status, Blood Pressure, Neuropsychological Tests, Body Mass Index, Memory, Risk Factors, Humans, Prospective Studies, TYM, Life Style, Research Articles, Adiposity, Aged, Aged, 80 and over, Health Services, Middle Aged, United Kingdom, Socioeconomic Factors, ageing, Cardiovascular Diseases, Physical Fitness, Waist Circumference, cognitive impairments, Cognition Disorders, Research Article
Abstract

OBJECTIVE: This study aimed to examine the association of Test Your Memory (TYM)-defined cognitive impairment groups with known sociodemographic and cardiometabolic correlates of cognitive impairment in a population-based study of older adults. METHODS: Participants were members of the British Regional Heart Study, a cohort across 24 British towns initiated in 1978-1980. Data stemmed from 1570 British men examined in 2010-2012, aged 71-92 years. Sociodemographic and cardiometabolic factors were compared between participants defined as having TYM scores in the normal cognitive ageing, mild cognitive impairment (MCI) and severe cognitive impairment (SCI) groups, defined as ≥46 (45 if ≥80 years of age), ≥33 and

Published
2015

12. Self-reported sleep duration and napping, cardiac risk factors and markers of subclinical vascular disease: cross-sectional study in older men

Author

Zonoozi, Shahrzad, Ramsay, Sheena E, Papacosta, Olia, Lennon, Lucy, Ellins, Elizabeth A, Halcox, Julian P J, Whincup, Peter H, and Goya Wannamethee, S

Subjects
Blood Glucose, Male, Time Factors, Epidemiology, subclinical atherosclerosis, Disorders of Excessive Somnolence, Pulse Wave Analysis, Carotid Intima-Media Thickness, Vascular Stiffness, Risk Factors, Forced Expiratory Volume, Natriuretic Peptide, Brain, von Willebrand Factor, Humans, Insulin, Aged, Aged, 80 and over, Glycated Hemoglobin, Heart Failure, Research, sleep patterns, Atherosclerosis, Peptide Fragments, Troponin, Cross-Sectional Studies, Asymptomatic Diseases, Self Report, cardiac function, Sleep, Biomarkers
Abstract

STUDYOBJECTIVES: Daytime sleep has been associated with increased risk of cardiovascular disease and heart failure (HF), but the mechanisms remain unclear. We have investigated the association between daytime and night-time sleep patterns and cardiovascular risk markers in older adults including cardiac markers and subclinical markers of atherosclerosis (arterial stiffness and carotid intima-media thickness (CIMT)). METHODS: Cross-sectional study of 1722 surviving men aged 71-92 examined in 2010-2012 across 24 British towns from a prospective study initiated in 1978-1980. Participants completed a questionnaire and were invited for a physical examination. Men with a history of heart attack or HF (n=251) were excluded from the analysis. RESULTS: Self-reported daytime sleep duration was associated with higher fasting glucose and insulin levels (p=0.02 and p=0.01, respectively) even after adjustment for age, body mass index, physical activity and social class. Compared with those with no daytime sleep, men with daytime sleep >1 hour, defined as excessive daytime sleepiness (EDS), had a higher risk of raised N-terminal pro-brain natriuretic peptide of ≥400 pg/mL, the diagnostic threshold for HF (OR (95% CI)=1.88 (1.15 to 3.1)), higher mean troponin, reduced lung function (forced expiratory volume in 1 s) and elevated von Willebrand factor, a marker of endothelial dysfunction. However, EDS was unrelated to CIMT and arterial stiffness. By contrast, night-time sleep was only associated with HbA1c (short or long sleep) and arterial stiffness (short sleep). CONCLUSIONS: Daytime sleep duration of >1 hour may be an early indicator of HF.

Published
2017

13. Dietary patterns and the risk of cardiovascular disease and all-cause mortality in older British men

Author

Atkins, Janice L, Whincup, Peter H, Morris, Richard, Lennon, Lucy T, Papacosta, Olia, and Goya Wannamethee, S

Subjects
Older adults, Principal component analysis, food and beverages, a posteriori dietary patterns, Mortality, Cardiovascular disease
Abstract

Dietary patterns are a major risk factor for cardiovascular morbidity and mortality, but few studies have examined this relationship in older adults. We examined prospective associations between dietary patterns and the risk of CVD and all-cause mortality in 3226 older British men, aged 60-79 years and free from CVD at baseline, from the British Regional Heart Study. Baseline food frequency questionnaire data were used to generate 34 food groups. Principal component analysis identified dietary patterns which were categorised into quartiles, with higher quartiles representing higher adherence to the dietary pattern. Cox proportional hazards examined associations between dietary patterns and risk of all-cause mortality and cardiovascular outcomes. Three interpretable dietary patterns were identified: ‘high fat/low fibre’ (high in red meat, meat products, white bread, fried potato, eggs), ‘prudent’ (high in poultry, fish, fruit, vegetables, legumes, pasta, rice, wholemeal bread, eggs,olive oil) and ‘high sugar’ (high in biscuits, puddings, chocolate, sweets, sweet spreads, breakfast cereal). During 11 years of follow-up, 899 deaths, 316 CVD deaths, 569 CVD events and 301 coronary heart disease (CHD) events occurred. The ‘high fat/low fibre’ dietary pattern was associated with an increased risk of all-cause mortality only, after adjustment for confounders (highest vs. lowest quartile; HR:1.44, 95% CI:1.13-1.84). Adherence to a ‘high sugar’ diet was associated with a borderline significant trend for an increased risk of CVD and CHD events. The ‘prudent’ diet did not show a significant trend with cardiovascular outcomes or mortality. Avoiding ‘high fat/low fibre’ and ‘high sugar’ dietary components may reduce the risk of cardiovascular events and all-cause mortality in older adults.

Published
2016

14. Natriuretic peptides and integrated risk assessment for cardiovascular disease. an individual-participant-data meta-analysis

Author

Peter, Willeit, Stephen Kaptoge, Paul Welsh, Adam S, Butterworth, Rajiv, Chowdhury, Sarah, A. Spackman, Lisa, Pennells, Pei, Gao, Stephen, Burgess, Daniel F, Freitag, Michael, Sweeting, Angela M, Wood, Nancy, R. Cook, Suzanne, Judd, Stella, Trompet, Vijay, Nambi, Michael, Hecht Olsen, Brendan, M. Everett, Frank, Kee, Johan, Ärnlöv, Veikko, Salomaa, Daniel, Levy, Jussi, Kauhanen, Jari A. Laukkanen, Maryam Kavousi, Toshiharu, Ninomiya, Juan Pablo, Casas, Lori B, Daniels, Lars, Lind, Caroline, N. Kistorp, Jens, Rosenberg, Thomas, Mueller, Rubattu, Speranza Donatella, Demosthenes, B. Panagiotakos, Oscar, H. Franco, James A, de Lemos, Andreas, Luchner, Jorge R, Kizer, Stefan, Kiechl, Jukka, T. Salonen, Goya Wannamethee, S, Rudolf, A. de Boer, Børge G, Nordestgaard, Jonas, Andersson, Torben, Jørgensen, Olle, Melander, Christie M, Ballantyne, Christopher, Defilippi, Paul M, Ridker, Mary, Cushman, Wayne, D. Rosamond, Simon G, Thompson, Vilmundur, Gudnason, Naveed, Sattar, John, Danesh, and DI ANGELANTONIO, Emanuele

Subjects
iternal medicine, endocrinology, diabetes and metabolism
Published
2016

15. Physical activity in older men: longitudinal associations with inflammatory and hemostatic biomarkers, N-terminal pro-brain natriuretic peptide, and onset of coronary heart disease and mortality

Author

Jefferis, BJ, Whincup, PH, Lennon, LT, Papacosta, O, and Goya Wannamethee, S

Abstract

OBJECTIVES: To examine associations between habitual physical activity (PA) and changes in PA and onset of coronary heart disease (CHD) and the pathways linking PA to CHD.\ud \ud DESIGN: British Regional Heart Study population-based cohort; men completed questionnaires in 1996 and 1998 to 2000, attended rescreen in 1998 to 2000, and were followed up to June 2010.\ud \ud SETTING: Community.\ud \ud PARTICIPANTS: Of 4,252 men recruited from primary care centers (77% of those invited and eligible) who were rescreened in 1998 to 2000, 3,320 were ambulatory and free from CHD, stroke, and heart failure and participated in the current study.\ud \ud MEASUREMENTS: Usual PA (regular walking and cycling, recreational activity and sport). Outcome was first fatal or nonfatal myocardial infarction.\ud \ud RESULTS: In 3,320 ambulatory men, 303 first and 184 fatal CHD events occurred during a median of 11 years of follow-up; 9% reported no usual PA, 23% occasional PA, and 68% light or more-intense PA. PA was inversely associated with novel risk markers C-reactive protein, D-dimer, von Willebrand Factor and N-terminal pro-brain natriuretic peptide (NT-proBNP). Compared with no usual PA, hazard ratios (HRs) for CHD events, adjusted for age and region, were 0.52 (95% confidence interval (CI) = 0.34-0.79) for occasional PA, 0.47 (95% CI = 0.30-0.74) for light PA, 0.51 (95% CI = 0.32-0.82) for moderate PA, and 0.44 (95% CI = 0.29-0.65) for moderately vigorous or vigorous PA (P for linear trend =.004). Adjustment for established and novel risk markers somewhat attenuated HRs and abolished linear trends. Compared with men who remained inactive, men who maintained at least light PA had an HR for CHD events of 0.73 (95% CI = 0.53-1.02) and men whose PA level increased had an HR of 0.86 (95% CI = 0.55-1.35).\ud \ud CONCLUSION: Even light PA was associated with significantly lower risk of CHD events in healthy older men, partly through inflammatory and hemostatic mechanisms and cardiac function (NT-proBNP).

Published
2014

17. Objectively measured physical activity and kidney function in older men; a cross-sectional population-based study.

Author

PARSONS, TESSA J., SARTINI, CLAUDIO, ASH, SARAH, LENNON, LUCY T., GOYA WANNAMETHEE, S., I.-MIN LEE, WHINCUP, PETER H., and JEFFERIS, BARBARA J.

Subjects
ACTIGRAPHY, CONFIDENCE intervals, CREATININE, GLOMERULAR filtration rate, REGRESSION analysis, CYSTATINS, CROSS-sectional method, PHYSICAL activity, DESCRIPTIVE statistics, ODDS ratio, BLOOD, OLD age
Abstract

Background: kidney function declines in older adults and physical activity levels are low. We investigated whether higher levels of physical activity and lower levels of sedentary behaviour were associated with lower odds of low kidney function in older men. Methods: cross-sectional study of 1,352 men from the British Regional Heart Study, mean (standard deviation) age 78.5 (4.6) year. Physical activity and sedentary behaviour were measured using Actigraph GT3X accelerometers. Kidney function was measured by estimated Glomerular filtration rate (eGFR) using the chronic kidney disease-EPI creatinine-cystatin equation. Associations between physical (in)activity and kidney function were investigated using regression models. Results: higher levels of physical activity and lower levels of sedentary behaviour were associated with reduced odds ratios (ORs) for lower eGFR (<45 versus ≥45 ml/min per 1.73 m²) after adjustment for covariates. Each additional 1,000 steps, 30 min of light physical activity and 10 min of moderate/vigorous physical activity per day were associated with a lower Objectively measured physical activity and kidney function in older men odds (95% confidence interval (CI)) of a low eGFR; OR 0.81 (0.73, 0.91), OR 0.87 (0.78, 0.97) and OR 0.84 (0.76, 0.92), respectively. Each additional 30 min of sedentary behaviour per day was associated with a higher odds of a low eGFR (1.16 95% CI 1.06, 1.27). Associations between moderate/vigorous physical activity and lower kidney function persisted after adjustment for light physical activity or sedentary behaviour. Conclusion: physical activity is associated with kidney function in older men and could be of public health importance in this group who are at increased risk of poor kidney function and low physical activity. More evidence is needed on whether the association is causal. [ABSTRACT FROM AUTHOR]

Published
2017
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20. The Test Your Memory cognitive screening tool: sociodemographic and cardiometabolic risk correlates in a population-based study of older British men.

Author

Papachristou, Efstathios, Ramsay, Sheena E., Papacosta, Olia, Lennon, Lucy T., Iliffe, Steve, Whincup, Peter H., and Goya Wannamethee, S.

Subjects
MEMORY testing, SOCIODEMOGRAPHIC factors, MILD cognitive impairment, OBESITY, PULMONARY function tests, CONFIDENCE intervals, ADIPOSE tissue physiology, COGNITION disorders diagnosis, AGING, BLOOD pressure, HUMAN body composition, CARDIOVASCULAR diseases, COGNITION disorders, COMPARATIVE studies, HEALTH status indicators, LONGITUDINAL method, NEUROPSYCHOLOGICAL tests, RESEARCH methodology, MEDICAL care, MEDICAL cooperation, MEMORY, PHYSICAL fitness, RESEARCH, RESEARCH funding, SOCIOECONOMIC factors, EVALUATION research, BODY mass index, LIFESTYLES, WAIST circumference, DISEASE complications
Abstract

Objective: This study aimed to examine the association of Test Your Memory (TYM)-defined cognitive impairment groups with known sociodemographic and cardiometabolic correlates of cognitive impairment in a population-based study of older adults.Methods: Participants were members of the British Regional Heart Study, a cohort across 24 British towns initiated in 1978-1980. Data stemmed from 1570 British men examined in 2010-2012, aged 71-92 years. Sociodemographic and cardiometabolic factors were compared between participants defined as having TYM scores in the normal cognitive ageing, mild cognitive impairment (MCI) and severe cognitive impairment (SCI) groups, defined as ≥46 (45 if ≥80 years of age), ≥33 and <33, respectively.Results: Among 1570 men, 636 (41%) were classified in the MCI and 133 (8%) in the SCI groups. Compared with participants in the normal cognitive ageing category, individuals with SCI were characterized primarily by lower socio-economic position (odds ratio (OR) = 6.15, 95% confidence interval (CI) 4.00-9.46), slower average walking speed (OR = 3.36, 95% CI 2.21-5.10), mobility problems (OR = 4.61, 95% CI 3.04-6.97), poorer self-reported overall health (OR = 2.63, 95% CI 1.79-3.87), obesity (OR = 2.59, 95% CI 1.72-3.91) and impaired lung function (OR = 2.25, 95% CI 1.47-3.45). A similar albeit slightly weaker pattern was observed for participants with MCI.Conclusion: Sociodemographic and lifestyle factors as well as adiposity measures, lung function and poor overall health are associated with cognitive impairments in late life. The correlates of cognitive abilities in the MCI and SCI groups, as defined by the TYM, resemble the risk profile for MCI and Alzheimer's disease outlined in current epidemiological models. [ABSTRACT FROM AUTHOR]

Published
2016
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23. Diurnal patterns of objectively measured physical activity and sedentary behaviour in older men.

Author

Sartini, Claudio, Goya Wannamethee, S., Iliffe, Steve, Morris, Richard W., Ash, Sarah, Lennon, Lucy, Whincup, Peter H., and Jefferis, Barbara J.

Subjects
*HEALTH of older men, *PHYSICAL activity measurement, *SEDENTARY behavior, *HEALTH of older people, *DEMOGRAPHIC characteristics, *ACCELEROMETERS
Abstract

Background: Physical activity (PA) levels among older adults are generally low and sedentary behaviour (SB) very common; increasing PA and reducing SB levels could have appreciable health benefits. Quantifying PA and SB patterns through the day could help in defining strategies for change. We examined within day variations in PA and SB and whether these varied by demographic factors and health status. Methods: Men aged 71-91 years participating in an established UK population-based cohort study were invited to wear a GT3x Actigraph accelerometer over the hip for one week in 2010-12. Percentages of time spent in sedentary (SB, <100 counts per minute [CPM]); in light (LIPA, 100-1040 CPM) and in moderate to vigorous PA (MVPA, >1040 CPM) were derived. Multilevel models were used to estimate the associations between demographic factors and health status and SB, LIPA and MVPA. Results: 1455 of 3137 men invited (46.4 %) participated and provided adequate data. Men spent 73 % of the day in SB, 23 % in LIPA and 4.5 % in MVPA (619, 197 and 39 min per day respectively). The percentage of time spent in MVPA was highest in the morning, peaking at 10-11 am (8.4 %), and then declining until the evening, with the exception of a small increase at 2-3 pm. LIPA followed a similar pattern. Conversely, SB levels were lowest in the morning and increased throughout the day, peaking at 9 pm (88 %). Men who were older, did not use active transport, had mobility limitations, were obese, depressed, had more chronic health conditions, and were smokers had lower levels of MVPA. The impacts of older age, obesity, mobility limitations and chronic diseases on LIPA,MVPA and SB were more marked in the morning than in the afternoon and evening. Conclusions: Levels of MVPA and LIPA are highest in the morning (peak at 10-11 am) and decrease during the day. SB increases through the course of the day to peak in the evening. Interventions to encourage older men to be physically active may need to take account of current PA patterns, aiming to prolong active morning bouts of PA and/or reducing SB in the afternoon and evening hours. [ABSTRACT FROM AUTHOR]

Published
2015
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25. Adherence to physical activity guidelines in older adults, using objectively measured physical activity in a population-based study.

Author

Jefferis, Barbara J., Sartini, Claudio, I-Min Lee, Minkyoung Choi, Amuzu, Antoinette, Gutierrez, Christina, Casas, Juan Pablo, Ash, Sarah, Lennnon, Lucy T., Goya Wannamethee, S., and Whincup, Peter H.

Subjects
HEALTH of older people, PHYSICAL activity, DISEASE prevalence, COHORT analysis, MENTAL depression, HEALTH promotion, SELF-efficacy
Abstract

Background Physical activity (PA) levels in older adults decline with age. The prevalence and correlates of adherence to current UK PA guidelines in older adults has not been studied using objectively measured PA, which can examine precisely whether PA is carried out in bouts of specified length and intensity. Methods Free living men and women aged 70-93 years from 25 towns in the United Kingdom, participating in parallel an on-going population based cohort studies were invited (by post) to wear a GT3x accelerometer over the hip for one week in 2010-12. Adherence to UK PA guidelines was defined as ⩾150 minutes/week of moderate or vigorous PA (MVPA) in bouts of ⩾10 minutes; the effect of different intensities and durations were examined. Results 1593 men and 857 women participated (responses 51% and 29% respectively). 15% men and 10% women achieved ⩾150 minutes/week of MVPA (defined as >1040 cpm) in bouts lasting ⩾10 minutes. With MVPA defined as >1952 cpm, prevalences were 7% and 3% respectively. Those adhering to guidelines were younger, had fewer chronic health conditions, less depression, less severe mobility limitations, but higher exercise self-efficacy and exercise outcomes expectations. They rated their local environment more highly for social activities and leisure facilities, having somewhere nice to go for a walk and feeling safe after dark, They left the house on more days per week, and were more likely to use active transport (cycle or walk) and to walk a dog regularly. Conclusions Few older adults attain current PA guidelines. Health promotion to extend the duration of moderate-intensity activity episodes to 10 minutes or more could yield important health gains among older adults. However future studies will need to clarify whether attaining guideline amounts of PA in spells lasting 10 minutes or more is critical for reducing chronic disease risks as well as improving cardiometabolic risk factors. [ABSTRACT FROM AUTHOR]

Published
2014
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27. Circulating Adiponectin Levels and Mortality in Elderly Men With and Without Cardiovascular Disease and Heart Failure.

Author

Goya Wannamethee, S., Whincup, Peter H., Lennon, Lucy, and Sattar, Naveed

Subjects
*MORTALITY, *CARDIOVASCULAR diseases in old age, *HEART failure, *OLDER men, *PROTEIN hormones, *HEART diseases
Abstract

This paper investigates the relations between adiponectin levels and mortality in older men with, and without cardiovascular disease (CVD) and heart failure. Data from a prospective study of 4046 British men drawn from general practices and followed up for mean of 6 years, during which 734 deaths were reported, was used in the analysis. Study concludes that high adiponectin levels are related with increased all-cause and CVD mortality in older men with heart failure and those without CVD.

Published
2007
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28. Alcohol, body weight, and weight gain in middle-aged men.

Author

Goya Wannamethee, S. and Gerald Shaper, A.

Abstract

Background: There is uncertainty as to whether regular alcohol consumption contributes directly to weight gain and the risk of obesity. Objective: We examined the relation between alcohol intake and body weight and the association between changes in alcohol intake and in body weight over 5 y of follow-up. Design: This was a prospective study of 7608 men aged 40-59 y drawn from general practices in 24 British towns, excluding persons with known diabetes. Five years after screening, 6832 men then aged 45-64 y and without diabetes completed a postal questionnaire on changes in alcohol intake and body weight. Results: Mean body mass index (BMI; in kg/m2) and the prevalence of men with a high BMI (⩾ 28; top quintile of the BMI distribution) increased significantly from the light-moderate to the very heavy alcohol intake group even after adjustment for potential confounders. Similar patterns were seen for all types and combinations of alcohol. After 5 y of follow-up, stable and new heavy drinkers (including very heavy drinkers of ⩾ 30 g/d) showed the greatest weight gain and had the highest prevalence rates of high BMI. Weight change patterns in heavy drinkers at baseline who reduced their intake were not significantly different from those in the stable none-occasional group but showed more weight loss and less weight gain than in the stable or new heavy drinkers. Conclusion: Heavy alcohol intake (⩾ 30 g/d) contributes directly to weight gain and obesity, irrespective of the type of alcohol consumed. [ABSTRACT FROM AUTHOR]

Published
2003
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31. Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis

Author

Natriuretic Peptides Studies Collaboration, Willeit, Peter, Kaptoge, Stephen, Welsh, Paul, Butterworth, Adam, Chowdhury, Rajiv, Spackman, Sarah, Pennells, Lisa, Gao, Pei, Burgess, Stephen, Freitag, Daniel, Sweeting, Michael, Wood, Angela, Cook, Nancy, Judd, Suzanne, Trompet, Stella, Nambi, Vijay, Olsen, Michael, Everett, Brendan, Kee, Frank, Ärnlöv, Johan, Salomaa, Veikko, Levy, Daniel, Kauhanen, Jussi, Laukkanen, Jari, Kavousi, Maryam, Ninomiya, Toshiharu, Casas, Juan-Pablo, Daniels, Lori, Lind, Lars, Kistorp, Caroline, Rosenberg, Jens, Mueller, Thomas, Rubattu, Speranza, Panagiotakos, Demosthenes, Franco, Oscar, De Lemos, James, Luchner, Andreas, Kizer, Jorge, Kiechl, Stefan, Salonen, Jukka, Goya Wannamethee, S, De Boer, Rudolf, Nordestgaard, Børge, Andersson, Jonas, Jørgensen, Torben, Melander, Olle, Ballantyne, Christie, DeFilippi, Christopher, Ridker, Paul, Cushman, Mary, Rosamond, Wayne, Thompson, Simon, Gudnason, Vilmundur, Sattar, Naveed, Danesh, John, and Di Angelantonio, Emanuele

Subjects
Male, Cardiovascular Diseases, Natriuretic Peptide, Brain, Humans, Female, Prospective Studies, Middle Aged, Risk Assessment, Biomarkers, Peptide Fragments, 3. Good health, Aged
Abstract

BACKGROUND: Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment. METHODS: In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie

32. Association between alcohol and cardiovascular disease

Author

Holmes, Michael V., Dale, Caroline E., Luisa Zuccolo, Silverwood, Richard J., Yiran Guo, Zheng Ye, David Prieto-Merino, Abbas Dehghan, Stella Trompet, Andrew Wong, Alana Cavadino, Dagmar Drogan, Sandosh Padmanabhan, Shanshan Li, Ajay Yesupriya, Maarten Leusink, Johan Sundstrom, Hubacek, Jaroslav A., Hynek Pikhart, Swerdlow, Daniel I., Panayiotou, Andrie G., Borinskaya, Svetlana A., Chris Finan, Sonia Shah, Kuchenbaecker, Karoline B., Tina Shah, Jorgen Engmann, Lasse Folkersen, Per Eriksson, Fulvio Ricceri, Olle Melander, Carlotta Sacerdote, Gamble, Dale M., Sruti Rayaprolu, Ross, Owen A., Stela McLachlan, Olga Vikhireva, Ivonne Sluijs, Scott, Robert A., Vera Adamkova, Leon Flicker, Bockxmeer, Frank M., Christine Power, Pedro Marques-Vidal, Tom Meade, Marmot, Michael G., Ferro, Jose M., Sofia Paulos-Pinheiro, Humphries, Steve E., Talmud, Philippa J., Irene Mateo Leach, Niek Verweij, Allan Linneberg, Tea Skaaby, Doevendans, Pieter A., Cramer, Maarten J., Pim van der Harst, Klungel, Olaf H., Dowling, Nicole F., Dominiczak, Anna F., Meena Kumari, Nicolaides, Andrew N., Cornelia Weikert, Heiner Boeing, Shah Ebrahim, Tom Gaunt, Price, Jackie F., Lars Lannfelt, Anne Peasey, Ruzena Kubinova, Andrzej Pajak, Sofia Malyutina, Voevoda, Mikhail I., Abdonas Tamosiunas, Maitland-Van Zee, Anke H., Norman, Paul E., Hankey, Graeme J., Bergmann, Manuela M., Albert Hofman, Franco, Oscar H., Jackie Cooper, Jutta Palmen, Wilko Spiering, Jong, Pim A., Diana Kuh, Rebecca Hardy, Uitterlinden, Andre G., Arfan Ikram, M., Ian Ford, Elina Hyppönen, Almeida, Osvaldo P., Wareham, Nicholas J., Kay-Tee Khaw, Anders Hamsten, Husemoen, Lise Lotte N., Anne Tjønneland, Tolstrup, Janne S., Eric Rimm, Beulens, Joline W. J., Monique Verschuren, W. M., Charlotte Onland-Moret, N., Hofker, Marten H., Goya Wannamethee, S., Whincup, Peter H., Richard Morris, Vicente, Astrid M., Hugh Watkins, Martin Farrall, Wouter Jukema, J., James Meschia, Adrienne Cupples, L., Sharp, Stephen J., Myriam Fornage, Charles Kooperberg, Lacroix, Andrea Z., Dai, James Y., Lanktree, Matthew B., Siscovick, David S., Eric Jorgenson, Bonnie Spring, Josef Coresh, Li, Yun R., Buxbaum, Sarah G., Schreiner, Pamela J., Curtis Ellison, R., Tsai, Michael Y., Patel, Sanjay R., Susan Redline, Johnson, Andrew D., Hoogeveen, Ron C., Hakon Hakonarson, Rotter, Jerome I., Eric Boerwinkle, Bakker, Paul I. W., Mika Kivimaki, Asselbergs, Folkert W., Naveed Sattar, Debbie Lawlor, John Whittaker, George Davey Smith, Kenneth Mukamal, Psaty, Bruce M., Wilson, James G., Lange, Leslie A., Ajna Hamidovic, Hingorani, Aroon D., Nordestgaard, Børge G., Martin Bobak, Leon, David A., Claudia Langenberg, Palmer, Tom M., Reiner, Alex P., Keating, Brendan J., Frank Dudbridge, Casas, Juan P., and InterAct Consortium

34. Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies

Author

Pennells, Lisa, Kaptoge, Stephen, Wood, Angela, Sweeting, Mike, Zhao, Xiaohui, White, Ian, Burgess, Stephen, Willeit, Peter, Bolton, Thomas, Moons, Karel G M, van der Schouw, Yvonne T, Selmer, Randi, Khaw, Kay-Tee, Gudnason, Vilmundur, Assmann, Gerd, Amouyel, Philippe, Salomaa, Veikko, Kivimaki, Mika, Nordestgaard, Børge G, Blaha, Michael J, Kuller, Lewis H, Brenner, Hermann, Gillum, Richard F, Meisinger, Christa, Ford, Ian, Knuiman, Matthew W, Rosengren, Annika, Lawlor, Debbie A, Völzke, Henry, Cooper, Cyrus, Marín Ibañez, Alejandro, Casiglia, Edoardo, Kauhanen, Jussi, Cooper, Jackie A, Rodriguez, Beatriz, Sundström, Johan, Barrett-Connor, Elizabeth, Dankner, Rachel, Nietert, Paul J, Davidson, Karina W, Wallace, Robert B, Blazer, Dan G, Björkelund, Cecilia, Donfrancesco, Chiara, Krumholz, Harlan M, Nissinen, Aulikki, Davis, Barry R, Coady, Sean, Whincup, Peter H, Jørgensen, Torben, Ducimetiere, Pierre, Trevisan, Maurizio, Engström, Gunnar, Crespo, Carlos J, Meade, Tom W, Visser, Marjolein, Kromhout, Daan, Kiechl, Stefan, Daimon, Makoto, Price, Jackie F, Gómez de la Cámara, Agustin, Wouter Jukema, J, Lamarche, Benoît, Onat, Altan, Simons, Leon A, Kavousi, Maryam, Ben-Shlomo, Yoav, Gallacher, John, Dekker, Jacqueline M, Arima, Hisatomi, Shara, Nawar, Tipping, Robert W, Roussel, Ronan, Brunner, Eric J, Koenig, Wolfgang, Sakurai, Masaru, Pavlovic, Jelena, Gansevoort, Ron T, Nagel, Dorothea, Goldbourt, Uri, Barr, Elizabeth L M, Palmieri, Luigi, Njølstad, Inger, Sato, Shinichi, Monique Verschuren, W M, Varghese, Cherian V, Graham, Ian, Onuma, Oyere, Greenland, Philip, Woodward, Mark, Ezzati, Majid, Psaty, Bruce M, Sattar, Naveed, Jackson, Rod, Ridker, Paul M, Cook, Nancy R, D'Agostino, Ralph B, Thompson, Simon G, Danesh, John, Di Angelantonio, Emanuele, Simpson, Lara M, Pressel, Sara L, Couper, David J, Nambi, Vijay, Matsushita, Kunihiro, Folsom, Aaron R, Shaw, Jonathan E, Magliano, Dianna J, Zimmet, Paul Z, Wannamethee, S Goya, Willeit, Johann, Santer, Peter, Egger, Georg, Casas, Juan Pablo, Amuzu, Antointtte, Tikhonoff, Valérie, Sutherland, Susan E, Cushman, Mary, Søgaard, Anne Johanne, Håheim, Lise Lund, Ariansen, Inger, Tybjærg-Hansen, Anne, Jensen, Gorm B, Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, de la Cámara, Agustin Gómez, Rubio Herrera, Miguel Angel, Friedlander, Yechiel, McCallum, John, McLachlan, Stela, Guralnik, Jack, Phillips, Caroline L, Wareham, Nick, Schöttker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Tolonen, Hanna, Vartiainen, Erkki, Jousilahti, Pekka, Harald, Kennet, D’Agostino, Ralph B, Massaro, Joseph M, Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jørgen, Møller, Lars, Bladbjerg, Else Marie, Chetrit, A, Wilhelmsen, Lars, Lissner, Lauren, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Nijpels, Giel, Stehouwer, Coen D A, Kazumasa, Yamagishi, Iso, Hiroyasu, Kurl, Sudhir, Tuomainen, Tomi-Pekka, Salonen, Jukka T, Deeg, Dorly J H, Nilsson, Peter M, Hedblad, Bo, Melander, Olle, De Boer, Ian H, DeFilippis, Andrew Paul, Verschuren, W M Monique, Watt, Graham, Tverdal, Aage, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Bakker, Stephan J L, van der Harst, Pim, Hillege, Hans L, Dallongeville, Jean, Schulte, Helmut, Trompet, Stella, Smit, Roelof A J, Stott, David J, Després, Jean-Pierre, Cantin, Bernard, Dagenais, Gilles R, Laughlin, Gail, Wingard, Deborah, Aspelund, Thor, Eiriksdottir, Gudny, Gudmundsson, Elias Freyr, Ikram, Arfan, van Rooij, Frank J A, Franco, Oscar H, Rueda-Ochoa, Oscar L, Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Howard, Barbara V, Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Günay, Yüksel, Hüsniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Ingelsson, Martin, Giedraitis, Vilmantas, Gaziano, J Michael, Shipley, Martin, Arndt, Volker, Cook, Nancy, Ibañez, Alejandro Marín, Geleijnse, Johanna M, Epidemiology, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland, Pennells, Lisa [0000-0002-8594-3061], Kaptoge, Stephen [0000-0002-1155-4872], Wood, Angela [0000-0002-7937-304X], Sweeting, Michael [0000-0003-0980-8965], Zhao, Xiaohui [0000-0001-9922-2815], Burgess, Stephen [0000-0001-5365-8760], Danesh, John [0000-0003-1158-6791], Di Angelantonio, Emanuele [0000-0001-8776-6719], Apollo - University of Cambridge Repository, Nutrition and Health, APH - Aging & Later Life, APH - Societal Participation & Health, APH - Health Behaviors & Chronic Diseases, Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Lifestyle Medicine (LM), Life Course Epidemiology (LCE), AGEM - Endocrinology, metabolism and nutrition, Internal medicine, Epidemiology and Data Science, İÜC, Lisa, Pennell, Stephen, Kaptoge, Angela, Wood, Mike, Sweeting, Xiaohui, Zhao, Ian, White, Stephen, Burge, Peter, Willeit, Thomas, Bolton, Karel G M, Moon, Yvonne T, van der Schouw, Randi, Selmer, Kay-Tee, Khaw, Vilmundur, Gudnason, Gerd, Assmann, Philippe, Amouyel, Veikko, Salomaa, Mika, Kivimaki, Børge G, Nordestgaard, Michael J, Blaha, Lewis H, Kuller, Hermann, Brenner, Richard F, Gillum, Christa, Meisinger, Ian, Ford, Matthew W, Knuiman, Annika, Rosengren, Debbie A, Lawlor, Henry, Völzke, Cyrus, Cooper, Alejandro, Marín Ibañez, Edoardo, Casiglia, Jussi, Kauhanen, Jackie A, Cooper, Beatriz, Rodriguez, Johan, Sundström, Elizabeth, Barrett-Connor, Rachel, Dankner, Paul J, Nietert, Karina W, Davidson, Robert B, Wallace, Dan G, Blazer, Cecilia, Björkelund, Chiara, Donfrancesco, Harlan M, Krumholz, Aulikki, Nissinen, Barry R, Davi, Sean, Coady, Peter H, Whincup, Torben, Jørgensen, Pierre, Ducimetiere, Maurizio, Trevisan, Gunnar, Engström, Carlos J, Crespo, Tom W, Meade, Marjolein, Visser, Daan, Kromhout, Stefan, Kiechl, Makoto, Daimon, Jackie F, Price, Agustin, Gómez de la Cámara, J, Wouter Jukema, Benoît, Lamarche, Altan, Onat, Leon A, Simon, Maryam, Kavousi, Yoav, Ben-Shlomo, John, Gallacher, Jacqueline M, Dekker, Hisatomi, Arima, Nawar, Shara, Robert W, Tipping, Ronan, Roussel, Eric J, Brunner, Wolfgang, Koenig, Masaru, Sakurai, Jelena, Pavlovic, Ron T, Gansevoort, Dorothea, Nagel, Uri, Goldbourt, Elizabeth L M, Barr, Luigi, Palmieri, Inger, Njølstad, Shinichi, Sato, W M, Monique Verschuren, Cherian V, Varghese, Ian, Graham, Oyere, Onuma, Philip, Greenland, Mark, Woodward, Majid, Ezzati, Bruce M, Psaty, Sattar, W Tipping, Naveerobert, M Simpson, Lara, L Pressel, Sara, J Couper, David, Nambi, Vijay, Matsushita, Kunihiro, R Folsom, Aaron, E Shaw, Jonathan, J Magliano, Dianna, Z Zimmet, Paul, W Knuiman, Matthew, H Whincup, Peter, Goya Wannamethee, S, Willeit, Johann, Santer, Peter, Egger, Georg, Pablo Casas, Juan, Amuzu, Antoinette, Ben-Shlomo, Yoav, Gallacher, John, Tikhonoff, Valérie, Casiglia, Edoardo, E Sutherland, Susan, J Nietert, Paul, Cushman, Mary, M Psaty, Bruce, Johanne Søgaard, Anne, Lund Håheim, Lise, Ariansen, Inger, Tybjærg-Hansen, Anne, B Jensen, Gorm, Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Palmieri, Luigi, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, Gómez de la Cámara, Agustin, Angel Rubio Herrera, Miguel, Friedlander, Yechiel, Mccallum, John, Mclachlan, Stela, Guralnik, Jack, L Phillips, Caroline, Khaw, Kay-Tee, Wareham, Nick, Schöttker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Nissinen, Aulikki, Tolonen, Hanna, Donfrancesco, Chiara, Vartiainen, Erkki, Jousilahti, Pekka, Harald, Kennet, B D’Agostino, Ralph, M Massaro, Joseph, Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jørgen, Møller, Lar, Marie Bladbjerg, Else, Chetrit, A, Rosengren, Annika, Wilhelmsen, Lar, Björkelund, Cecilia, Lissner, Lauren, Nagel, Dorothea, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Rodriguez, Beatriz, Nijpels, Giel, A Stehouwer, Coen D, Sato, Shinichi, Kazumasa, Yamagishi, Iso, Hiroyasu, Goldbourt, Uri, Salomaa, Veikko, Kurl, Sudhir, Tuomainen, Tomi-Pekka, T Salonen, Jukka, Visser, Marjolein, H Deeg, Dorly J, W Meade, Tom, M Nilsson, Peter, Hedblad, Bo, Melander, Olle, H De Boer, Ian, Paul DeFilippis, Andrew, M Monique Verschuren, W, Sattar, Naveed, Watt, Graham, Meisinger, Christa, Koenig, Wolfgang, H Kuller, Lewi, Tverdal, Aage, F Gillum, Richard, A Cooper, Jackie, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Ducimetiere, Pierre, L Bakker, Stephan J, van der Harst, Pim, L Hillege, Han, J Crespo, Carlo, Amouyel, Philippe, Dallongeville, Jean, Assmann, Gerd, Schulte, Helmut, Trompet, Stella, J Smit, Roelof A, J Stott, David, T van der Schouw, Yvonne, Després, Jean-Pierre, Cantin, Bernard, R Dagenais, Gille, Laughlin, Gail, Wingard, Deborah, Trevisan, Maurizio, Aspelund, Thor, Eiriksdottir, Gudny, Freyr Gudmundsson, Elia, Ikram, Arfan, A van Rooij, Frank J, H Franco, Oscar, L Rueda-Ochoa, Oscar, Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Völzke, Henry, V Howard, Barbara, Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Günay, Yüksel, Hüsniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Njølstad, Inger, Ingelsson, Martin, Giedraitis, Vilmanta, M Ridker, Paul, Michael Gaziano, J, Kivimaki, Mika, Shipley, Martin, J Brunner, Eric, Arndt, Volker, Brenner, Hermann, Cook, Nancy, Ford, Ian, Marín Ibañez, Alejandro, M Geleijnsed, Johanna, Rod, Jackson, Paul M, Ridker, Nancy R, Cook, Ralph B, D'Agostino, Simon G, Thompson, John, Danesh, and Emanuele, Di Angelantonio

Subjects
Male, Cardiac & Cardiovascular Systems, Nutrition and Disease, Prevention and Epidemiology, PREDICTION, Áhættuþættir, 030204 cardiovascular system & hematology, GUIDELINES, 0302 clinical medicine, Risk Factors, Voeding en Ziekte, FRAMINGHAM, Discrimination, Medicine, Cardiac and Cardiovascular Systems, Blóðrásarsjúkdómar, Prospective Studies, Prospective cohort study, Non-U.S. Gov't, 1102 Cardiorespiratory Medicine and Haematology, CALIBRATION, Kardiologi, Framingham Risk Score, Emerging Risk Factors Collaboration, SCORES, Research Support, Non-U.S. Gov't, Incidence (epidemiology), Middle Aged, Cardiovascular disease, Justice and Strong Institutions, Risk prediction, ddc, 3. Good health, Cardiovascular Diseases, Meta-analysis, Cohort, Calibration, Female, Risk assessment, Cardiology and Cardiovascular Medicine, Algorithm, Life Sciences & Biomedicine, Algorithms, SDG 16 - Peace, Risk algorithms, DISEASE PREVENTION, Research Support, Risk Assessment, VALIDATION, 03 medical and health sciences, Clinical Research, Journal Article, Humans, ddc:610, Risk factor, VLAG, Aged, Science & Technology, business.industry, SDG 16 - Peace, Justice and Strong Institutions, 030229 sport sciences, R1, STATIN USE, Cardiovascular System & Hematology, Cardiovascular System & Cardiology, business, PRIMARY PREVENTION, TASK-FORCE
Abstract

Publisher's version (útgefin grein), Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms. Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need., The work of the co-ordinating centre was funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/ 002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, UK National Institute for Health Research Cambridge Biomedical Research Centre, European Research Council (268834), and European Commission Framework Programme 7 (HEALTH-F2-2012-279233). The Emerging Risk Factor Collaboration’s website https://www.phpc.cam.ac.uk/ceu/erfc/list-of-studies/ has compiled a list provided by investigators of some of the funders of the component studies in this analysis. I.W. was supported by the Medical Research Council Unit Programme MC_UU_12023/21. M.K. is supported by the Netherlands Organization for Scientific Research (NWO) Veni grant (Veni, 91616079). J.P. is supported by Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission.

Published
2019

35. Self-reported sleep duration and napping, cardiac risk factors and markers of subclinical vascular disease: cross-sectional study in older men.

Author

Zonoozi S, Ramsay SE, Papacosta O, Lennon L, Ellins EA, Halcox JPJ, Whincup PH, and Goya Wannamethee S

Subjects
Aged, Aged, 80 and over, Asymptomatic Diseases, Atherosclerosis complications, Atherosclerosis diagnostic imaging, Biomarkers blood, Carotid Intima-Media Thickness, Cross-Sectional Studies, Disorders of Excessive Somnolence complications, Disorders of Excessive Somnolence physiopathology, Forced Expiratory Volume, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Male, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Pulse Wave Analysis, Risk Factors, Self Report, Time Factors, Troponin blood, Vascular Stiffness, von Willebrand Factor metabolism, Atherosclerosis physiopathology, Blood Glucose metabolism, Disorders of Excessive Somnolence blood, Glycated Hemoglobin metabolism, Insulin blood, Sleep physiology
Abstract

Studyobjectives: Daytime sleep has been associated with increased risk of cardiovascular disease and heart failure (HF), but the mechanisms remain unclear. We have investigated the association between daytime and night-time sleep patterns and cardiovascular risk markers in older adults including cardiac markers and subclinical markers of atherosclerosis (arterial stiffness and carotid intima-media thickness (CIMT))., Methods: Cross-sectional study of 1722 surviving men aged 71-92 examined in 2010-2012 across 24 British towns from a prospective study initiated in 1978-1980. Participants completed a questionnaire and were invited for a physical examination. Men with a history of heart attack or HF (n=251) were excluded from the analysis., Results: Self-reported daytime sleep duration was associated with higher fasting glucose and insulin levels (p=0.02 and p=0.01, respectively) even after adjustment for age, body mass index, physical activity and social class. Compared with those with no daytime sleep, men with daytime sleep >1 hour, defined as excessive daytime sleepiness (EDS), had a higher risk of raised N-terminal pro-brain natriuretic peptide of ≥400 pg/mL, the diagnostic threshold for HF (OR (95% CI)=1.88 (1.15 to 3.1)), higher mean troponin, reduced lung function (forced expiratory volume in 1 s) and elevated von Willebrand factor, a marker of endothelial dysfunction. However, EDS was unrelated to CIMT and arterial stiffness. By contrast, night-time sleep was only associated with HbA1c (short or long sleep) and arterial stiffness (short sleep)., Conclusions: Daytime sleep duration of >1 hour may be an early indicator of HF., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Published
2017
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36. Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis.

Author

Natriuretic Peptides Studies Collaboration, Willeit P, Kaptoge S, Welsh P, Butterworth AS, Chowdhury R, Spackman SA, Pennells L, Gao P, Burgess S, Freitag DF, Sweeting M, Wood AM, Cook NR, Judd S, Trompet S, Nambi V, Olsen MH, Everett BM, Kee F, Ärnlöv J, Salomaa V, Levy D, Kauhanen J, Laukkanen JA, Kavousi M, Ninomiya T, Casas JP, Daniels LB, Lind L, Kistorp CN, Rosenberg J, Mueller T, Rubattu S, Panagiotakos DB, Franco OH, de Lemos JA, Luchner A, Kizer JR, Kiechl S, Salonen JT, Goya Wannamethee S, de Boer RA, Nordestgaard BG, Andersson J, Jørgensen T, Melander O, Ballantyne ChM, DeFilippi Ch, Ridker PM, Cushman M, Rosamond WD, Thompson SG, Gudnason V, Sattar N, Danesh J, and Di Angelantonio E

Subjects
Aged, Biomarkers blood, Cardiovascular Diseases blood, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Assessment, Cardiovascular Diseases diagnosis, Natriuretic Peptide, Brain blood, Peptide Fragments blood
Abstract

Background: Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment., Methods: In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie, <5%, 5% to <7·5%, and ≥7·5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure., Findings: We recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95 617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1·76 (95% CI 1·56-1·98) for the combination of coronary heart disease and stroke and 2·00 (1·77-2·26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0·012 (0·010-0·014) and a net reclassification improvement of 0·027 (0·019-0·036) for the combination of coronary heart disease and stroke and a C-index increase of 0·019 (0·016-0·022) and a net reclassification improvement of 0·028 (0·019-0·038) for the combination of coronary heart disease, stroke, and heart failure., Interpretation: In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention., Funding: British Heart Foundation, Austrian Science Fund, UK Medical Research Council, National Institute for Health Research, European Research Council, and European Commission Framework Programme 7., (Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)

Published
2016
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