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BACKGROUND: The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. METHODS: The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering...
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Carboidratos , Cardiopatias , Gorduras , Ingestão de Alimentos , MortalidadeRESUMO
OBJECTIVES: To determine whether sex-based differences exist in clinical effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) in patients with stable coronary artery disease. BACKGROUND: A prior pre-specified unadjusted analysis from COURAGE showed that women randomized to PCI had a lower rate of death or myocardial infarction during a median 4.6-year follow-up with a trend for interaction with respect to sex. METHODS: We analyzed outcomes in 338 women (15%) and 1949 men (85%) randomized to PCI plus OMT versus OMT alone after adjustment for relevant baseline characteristics. RESULTS: There was no difference in treatment effect by sex for the primary end point (death or myocardial infarction; HR, 0.89; 95% CI, 0.77-1.03 for women and HR, 1.02, 95% CI 0.96-1.10 for men; P for interaction = .07). Although the event rate was low, a trend for interaction by sex was nonetheless noted for hospitalization for heart failure, with only women, but not men, assigned to PCI experiencing significantly fewer events as compared to their counterparts receiving OMT alone (HR, 0.59; 95% CI, 0.40-0.84, P < .001 for women and HR, 0.86; 95% CI, 0.74-1.01, P = .47 for men; P for interaction = .02). Both sexes randomized to PCI experienced significantly reduced need for subsequent revascularization (HR, 0.72; 95% CI, 0.62-0.83, P < .001 for women; HR, 0.84; 95% CI, 0.79-0.89, P < .001 for men; P for interaction = .02) with evidence of a sex-based differential treatment effect. CONCLUSION: In this adjusted analysis of the COURAGE trial, there were no significant differences in treatment effect on major outcomes between men and women. However, women assigned to PCI demonstrated a greater benefit as compared to men, with a reduction in heart failure hospitalization and need for future revascularization. These exploratory observations require further prospective study.
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Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea , Medição de Risco , Idoso , Canadá/epidemiologia , Causas de Morte/tendências , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Relação Dose-Resposta a Droga , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
Background The measurement of handgrip strength (HGS) has prognostic value with respect to all-cause mortality, cardiovascular mortality and cardiovascular disease, and is an important part of the evaluation of frailty. Published reference ranges for HGS aremostly derived from Caucasian populations in high-income countries. There is a paucity of information on normative HGS valuesin non-Caucasian populations from low- or middle-income countries. The objective of this study was to develop reference HGS rangesfor healthy adults from a broad range of ethnicities and socioeconomically diverse geographic regions. Methods HGS was measured using a Jamar dynamometer in 125,462 healthy adults aged 35-70 years from 21 countries inthe Prospective Urban Rural Epidemiology (PURE) study. Results HGS values differed among individuals from different geographic regions. HGS values were highest among thosefrom Europe/North America, lowest among those from South Asia, South East Asia and Africa, and intermediate among thosefrom China, South America, and the Middle East. Reference ranges stratified by geographic region, age, and sex are presented. These ranges varied from a median (25th75th percentile) 50 kg (4356 kg) in men 60 years from South East Asia. Reference ranges by ethnicity and body-mass index are also reported...
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Epidemiologia , Estudos de Casos e Controles , Força Muscular , População Rural , População UrbanaRESUMO
BackgroundDiet quality is strongly related to cardiovascular disease (CVD) incidence, but little is known about itsimpact on CVD events in older people at high risk of CVD and receiving effective drugs for secondary prevention. Thisstudy assessed the association between diet quality and CVD events in a large population of subjects from 40 countrieswith CVD or diabetes mellitus with end-organ damage receiving proven medications.Methods and ResultsOverall, 31 546 women and men 66.5 6.2 years of age enrolled in 2 randomized trials, theOngoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET) and theTelmisartan Randomized Assessment Study in ACEI Intolerant Subjects With Cardiovascular Disease (TRANSCEND),were studied. We used 2 dietary indexes: the modified Alternative Healthy Eating Index and the Diet Risk Score. The association between diet quality and the primary composite outcome of CV death, myocardial infarction, stroke, or congestive heart failure was assessed with Cox proportional hazard regression with adjustment for age, sex, trial enrollment allocation, region, and other known confounders. During the 56-month follow-up, there were 5190 events. Patients in the healthier quintiles of modified Alternative Healthy Eating Index scores had asignificantly lower risk of CVD (hazard ratio, 0.78; 95% confidence interval, 0.71 0.87, top versus lowest quintileof modified Alternative Healthy Eating Index). The reductions in risk for CV death, myocardial infarction, andstroke were 35%, 14%, and 19%, respectively. The protective association was consistent regardless of whetherpatients were receiving proven drugs.ConclusionsA higher-quality diet was associated with a lower risk of recurrent CVD events among people 55 yearsof age with CVD or diabetes mellitus. Highlighting the importance of healthy eating by health professionals wouldsubstantially reduce CVD recurrence and save lives globally.
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Cirurgia Torácica , Dieta , Estado Nutricional , Prevenção SecundáriaRESUMO
BackgroundWe sought to determine the association between influenza vaccination and major adverse vascular events because the association remains uncertain.Methods and ResultsA total of 31 546 participants were enrolled from 40 countries. Eligibility included age 55 years and known vascular disease. The primary outcome was a composite of death resulting from cardiovascular causes, myocardial infarction, or stroke during 4 influenza seasons (20032007). Influenza vaccination was associated with a lower risk of the outcome during 3 influenza seasons (defined using World Health Organization FluNet reports): 2004to 2005 (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.500.77), 2005 to 2006 (adjusted OR, 0.69; 95% CI, 0.53 0.91), and 2006 to 2007 (adjusted OR, 0.52; 95% CI, 0.42 0.65), the same years that circulating influenza matched the vaccine antigen. In 2003 to 2004, there was an incomplete match between circulating influenza and the vaccine antigen, and there was no association between influenza vaccination and the outcome (adjusted OR, 0.96; 95% CI, 0.731.27). However, tests of potential biases in the analyses revealed associations between influenza vaccination and outcome during noninfluenza seasons except 2003 to 2004. The summary ORs in the influenza season (OR, 0.65; 95% CI, 0.580.74]) and noninfluenza season (OR, 0.66; 95% CI, 0.57 0.76) were almost identical. The reduction in risk of noncardiovascular death associated with the influenza vaccine ranged from 73% to 79%.ConclusionAlthough initial analyses suggest that influenza vaccination was associated with reduced risk of majoradverse vascular events during influenza seasons when the influenza vaccine matched the circulating virus, sensitivity analyses revealed that risk of bias remained. A randomized trial is needed to definitively address this question.
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Acidente Vascular Cerebral , Infarto do Miocárdio , Infecções , Prevenção de Doenças , VacinaçãoRESUMO
Background Although most cardiovascular disease occurs in low-income and middle-income countries, little is known about the use of effective secondary prevention medications in these communities. We aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, â blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins) in individuals with a history of coronary heart disease or stroke.MethodsIn the Prospective Urban Rural Epidemiological (PURE) study, we recruited individuals aged 3570 years from rural and urban communities in countries at various stages of economic development. We assessed rates of previous cardiovascular disease (coronary heart disease or stroke) and use of proven effective secondary preventive drugs and blood-pressure-lowering drugs with standardised questionnaires, which were completed by telephone interviews, household visits, or on patient's presentation to clinics. We report estimates of drug use at national, community, and individual levels.FindingsWe enrolled 153 996 adults from 628 urban and rural communities in countries with incomes classified as high (three countries), upper-middle (seven), lower-middle (three), or low (four) between January, 2003, and December, 2009. 5650 participants had a self-reported coronary heart disease event (median 5·0 years previously [IQR 2·010·0]) and 2292 had stroke (4·0 years previously [2·08·0]). Overall, few individuals with cardiovascular disease took antiplatelet drugs (25·3%), â blockers (17·4%), ACE inhibitors or ARBs (19·5%), or statins (14·6%). Use was highest in high-income countries (antiplatelet drugs 62·0%, â blockers 40·0%, ACE inhibitors or ARBs 49·8%, and statins 66·5%), lowest in low-income countries (8·8%, 9·7%, 5·2%, and 3·3%, respectively), and decreased in line with reduction of country economic status (ptrend<0·0001 for every drug type)...