Prospective Study on Waist Circumference and Risk of All-Cause and Cardiovascular Mortality - Pooled Analysis of Japanese Community-Based Studies
ABSTRACT Background: The aim of the present study was to clarify the association between waist circumference and all-cause and cardiovascular disease (CVD) mortality risk in relatively lean Japanese subjects. Methods and Results: A total of 3,554 men and 4,472 women who had no history of CVD were examined and their waist circumference measured at baseline. The subjects were aged ≥40 years and were obtained from 3 prospective cohort studies during 1988-1996. Hazard ratios for all-cause and CVD mortality were analyzed over a follow-up period of 14.7 years using a Cox proportional hazards model and penalized spline method, after adjustment for study cohort, age, smoking, alcohol drinking, hypertension, dyslipidemia, and diabetes. Compared with the lowest quintile, the highest quintile of waist circumference in men was associated with a linear reduction in all-cause mortality risk (multivariate-adjusted hazard ratio, 0.73; 95% confidence interval: 0.60-0.89; P for trend=0.001). CVD mortality risk was increased in men aged ≤65 years with a higher waist circumference. This relationship was U-shaped. Waist circumference was not associated with all-cause or CVD mortality risk in women. Conclusions: Waist circumference was associated inversely with increased risk of all-cause death in men, but not in women. Middle-aged men with a greater waist circumference potentially have an increased risk of CVD mortality.
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ABSTRACT: Background: This study compared older men and women with cardiovascular (CV) risk factors in terms of the effects of a 6-month exercise intervention on high-sensitivity C-reactive protein (hsCRP) levels, blood pressure (BP) and other risk factors. Methods and Results: Sixty older (age 61-79) overweight men and 71 such women with 2 or more risk factors (ie, systolic BP 130-179mmHg, non-fasting blood glucose 110-139mg/dl, and low-density lipoprotein cholesterol 120-219mg/dl) participated in a 6-month exercise intervention. The exercise program consisted of moderate-intensity bicycle exercise for ∼40min, performed on average 2.5 times per week. Systolic and diastolic BP reductions were found to be greater in women than in men (SBP, -10.6 vs. -5.5mmHg; DBP, -6.2 vs. -3.3mmHg; both P<0.05). Decreases in body mass index were larger in women than in men (P<0.05). There was no significant gender difference in the changes in blood glucose and lipid profiles and hsCRP levels. After adjustment for confounders (exercise frequency, weight loss, age, and baseline values), there were still significant gender differences in the SBP and DBP reductions. hsCRP reduction were similar in both genders even after adjusting for weight loss. Conclusions: There could be gender differences in the beneficial effects of exercise training on the potent CV risk factors of BP and body weight, but not on hsCRP.Circulation Journal 12/2012; 77(3). DOI:10.1253/circj.CJ-12-0607 · 3.69 Impact Factor
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ABSTRACT: Background: Angiopoietin-like protein 2 (Angptl2) is an adipokine that promotes inflammation and endothelial dysfunction of the vessels. The aim of this study was to investigate the relationship between serum Angptl2 level and chronic kidney disease (CKD). Methods and Results: A total of 3,169 community-dwelling subjects aged ≥40 years were divided into quintiles by Angptl2 level. CKD was defined as the presence of albuminuria (urine albumin-creatinine ratio ≥30.0mg/g) or decreased estimated glomerular filtration rate (eGFR <60ml·min(-1)·1.73m(-2)). The odds ratio (OR) for the presence of CKD was calculated using a logistic regression model. The overall prevalence of CKD was 37.5%. The age- and sex-adjusted ORs for the presence of CKD increased with higher serum Angptl2 level. This trend remained significant after adjusting for known cardiovascular risk factors (<2.01ng/ml: OR, 1.00 (reference); 2.01-2.48ng/ml: OR, 1.67, 95% confidence interval [CI]: 1.24-2.24; 2.49-2.99ng/ml: OR, 1.70, 95% CI: 1.27-2.28; 3.00-3.65ng/ml: OR, 1.78, 95% CI: 1.32-2.39; ≥3.66ng/ml: OR, 1.79, 95% CI: 1.32-2.43; P-value for trend=0.001). Multivariate-adjusted ORs for the presence of albuminuria increased significantly with elevated serum Angptl2 (P-value for trend=0.004), while there was no evidence of a significant relationship between serum Angptl2 level and decreased eGFR (P-value for trend=0.08). Conclusions: Elevated serum Angptl2 is associated with the likelihood of CKD in the general population.Circulation Journal 06/2013; 77(9). DOI:10.1253/circj.CJ-12-1548 · 3.69 Impact Factor
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ABSTRACT: Although malnutrition indicates an unfavorable prognosis in some clinical settings, the association between nutritional indexes and outcomes for patients with chronic heart failure (CHF) is unclear. All the previously established objective nutritional indexes were evaluated. The controlling nutritional status score (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were determined for 388 consecutive patients with CHF (mean age 69.6±12.3 years). The prevalence of malnutrition in this cohort was 60-69%. Patients were followed prospectively, with the endpoints being death due to a cardiovascular event or re-hospitalization. There were 130 events, including 33 deaths and 97 re-hospitalizations, during a mean follow-up period of 28.4 months. Patients experiencing cardiovascular events showed impaired nutritional status, higher CONUT scores, lower PNI scores, and lower GNRI scores, compared with those who did not experience cardiovascular events. CONUT score [hazard ratio 40.9, 95% confidence interval (CI) 10.8-154.8], PNI score (hazard ratio 6.4, 95% CI 5.4-25.1), and GNRI score (hazard ratio 11.6, 95% CI 3.7-10.0) were independently associated with cardiovascular events. Kaplan-Meier analysis showed that there was a significantly higher incidence of cardiovascular events in patients who were malnourished than in those who were not. Malnutrition was common in patients with CHF. Evaluation of nutritional status may provide additional prognostic information in patients with CHF.Journal of Cardiology 06/2013; 62(5). DOI:10.1016/j.jjcc.2013.05.007 · 2.57 Impact Factor