[Show abstract][Hide abstract] ABSTRACT: Objective:
Many psychosocial factors have been associated with coronary heart disease (CHD), including hostility, anger, and depression. We tested the hypothesis that these factors may have their basis in emotion regulation abilities. Our aim was to determine whether poor emotional control predicted long-term risk of CHD.
This Swedish national study includes 46,393 men who were conscripted for military service in 1969 and 1970. The men were aged 18 to 20 years at the time of conscription. Psychologists used a brief semistructured interview to retrospectively assess the conscripts' level of emotional control in childhood and adolescence. The outcome measure was a first fatal or nonfatal event of CHD. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for poor and adequate versus good emotional control.
After 38 years of follow-up (1971-2009), 2456 incident cases of CHD had occurred. Poor emotional control increased the risk of CHD (HR = 1.31, 95% CI = 1.18-1.45), adjusting for childhood socioeconomic position, anxiety, depression, and parental history of CHD. Further adjustment for life-style-related factors, for example, smoking and body mass index, attenuated the HR to 1.08 (95% CI = 0.97-1.21). In stratified analyses, the fully adjusted association between poor emotional control with CHD remained significantly elevated among men with a parental history of CHD (HR = 1.49, 95% CI = 1.11-2.01, p interaction = .037).
In the overall study population, poor emotional control had no direct effect on CHD beyond life-style-related factors. However, in men with a parental history of CHD, poor emotional control in adolescence remained significantly predictive of long-term CHD risk even when adjusting for life-style-related factors.
Psychosomatic Medicine 11/2015; DOI:10.1097/PSY.0000000000000254 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
We analyzed the association between light-to-moderate alcohol intake and the risk of heart failure (HF).
Methods and results:
We studied 60,665 individuals free of HF who provided information on alcohol consumption in a population-based cohort study conducted in 1995-97 in Norway. Sociodemographic factors, cardiovascular risk factors and common chronic disorders were assessed by questionnaires and/or by a clinical examination. The cohort was followed for a first HF event for an average of 11.2±3.0years. Mean alcohol consumption was 2.95±4.5g/day; 1588 HF cases occurred during follow-up. The quantity of alcohol consumption was inversely associated with incident HF in this low-drinking population. The risk was lowest for consumption over three but less than six drinks/week; the multivariate hazard ratio when comparing this category to non-drinkers was 0.67 (95% CI: 0.50-0.92). Among problem drinkers based on CAGE questionnaires, total consumption showed no favorable association with HF, even when overall consumption was otherwise moderate. Excluding former drinkers and controlling for common chronic diseases had minimal effect on these associations. Frequent alcohol consumption, i.e. more than five times/month, was associated with the lowest HF risk; the adjusted hazard ratio comparing this group to alcohol intake less than once/month was 0.83 (95% CI: 0.68-1.03). We found no evidence for a differential effect according to beverage type, nor that the competing risks of death from other causes modified the association.
Frequent light-to-moderate alcohol consumption without problem drinking was associated with a lower HF risk in this population characterized by a low average alcohol intake.
International journal of cardiology 10/2015; 203. DOI:10.1016/j.ijcard.2015.10.179 · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE We examined the associations of symptoms of sleep-disordered breathing (SDB), which was defined as loud snoring, stopping breathing for a while during sleep, and daytime sleepiness, and insomnia, with glucose metabolism and incident type 2 diabetes in older adults.
RESEARCH DESIGN AND METHODS Between 1989 and 1993, the Cardiovascular Health Study recruited 5,888 participants ≥65 years of age from four U.S. communities. Participants reported SDB and insomnia symptoms yearly through 1989–1994. In 1989–1990, participants underwent an oral glucose tolerance test, from which insulin secretion and insulin sensitivity were estimated. Fasting glucose levels were measured in 1989–1990 and again in 1992–1993, 1994–1995, 1996–1997, and 1998–1999, and medication use was ascertained yearly. We determined the cross-sectional associations of sleep symptoms with fasting glucose levels, 2-h glucose levels, insulin sensitivity, and insulin secretion using generalized estimated equations and linear regression models. We determined the associations of updated and averaged sleep symptoms with incident diabetes in Cox proportional hazard models. We adjusted for sociodemographics, lifestyle factors, and medical history.
RESULTS Observed apnea, snoring, and daytime sleepiness were associated with higher fasting glucose levels, higher 2-h glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of the development of type 2 diabetes was positively associated with observed apnea (hazard ratio [HR] 1.84 [95% CI 1.19–2.86]), snoring (HR 1.27 [95% CI 0.95–1.71]), and daytime sleepiness (HR 1.54 [95% CI 1.13–2.12]). In contrast, we did not find consistent associations between insomnia symptoms and glucose metabolism or incident type 2 diabetes.
CONCLUSIONS Easily collected symptoms of SDB are strongly associated with insulin resistance and the incidence of type 2 diabetes in older adults. Monitoring glucose metabolism in such patients may prove useful in identifying candidates for lifestyle or pharmacological therapy. Further studies are needed to determine whether insomnia symptoms affect the risk of diabetes in younger adults.
Diabetes Care 09/2015; Online ahead of print. DOI:10.2337/dc15-0137 · 8.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimsCompelling evidence suggests that light-to-moderate alcohol consumption is associated with a reduced risk of acute myocardial infarction (AMI), but several issues from previous studies remain to be addressed. The aim of this study was to investigate some of these key issues related to the association between alcohol consumption and AMI risk, including the strength and shape of the association in a low-drinking setting, the roles of quantity, frequency and beverage type, the importance of confounding by medical and psychiatric conditions, and the lack of prospective data on previous drinking.MethodsA population-based prospective cohort study of 58 827 community-dwelling individuals followed for 11.6 years was conducted. We assessed the quantity and frequency of consumption of beer, wine and spirits at baseline in 1995–1997 and the frequency of alcohol intake approximately 10 years earlier.ResultsA total of 2966 study participants had an AMI during the follow-up period. Light-to-moderate alcohol consumption was inversely and linearly associated with AMI risk. After adjusting for major cardiovascular disease risk factors, the hazard ratio for a one-drink increment in daily consumption was 0.72 (95% confidence interval 0.62–0.86). Accounting for former drinking or comorbidities had almost no effect on the association. Frequency of alcohol consumption was more strongly associated with lower AMI risk than overall quantity consumed.Conclusions
Light-to-moderate alcohol consumption was linearly associated with a decreased risk of AMI in a population in which abstaining from alcohol is not socially stigmatized. Our results suggest that frequent alcohol consumption is most cardioprotective and that this association is not driven by misclassification of former drinkers.
Journal of Internal Medicine 09/2015; DOI:10.1111/joim.12428 · 6.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown.
A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969-1970 at age 18-20, who were diagnosed with CHD 1991-2007, were followed to the end of 2008. Primary outcome: recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors.
The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively).
Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Journal of Epidemiology & Community Health 12/2014; 69(4). DOI:10.1136/jech-2014-204958 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Study objectives:
To assess the association between insomnia symptoms and risk of fatal unintentional injuries.
Population-based prospective cohort study with a mean follow-up of 14 y, linking health survey data with information on insomnia symptoms to the National Cause of Death Registry.
Nord-Trøndelag County, Norway.
A total of 54,399 men and women 20-89 y of age who participated in the Nord-Trøndelag Health Study between 1995 and 1997.
Measurements and results:
There were 277 unintentional fatal injuries, including 57 fatal motor vehicle injuries during follow-up. There was a dose-dependent association between the number of insomnia symptoms and risk of unintentional fatal injuries (P for trend 0.001) and fatal motor vehicle injuries (P for trend 0.023), respectively. The proportion of unintentional fatal injuries cases that could have been prevented in the absence of difficulties initiating sleep, difficulties maintaining sleep, and having a feeling of nonrestorative sleep were 8%, 9%, and 8%, respectively. The corresponding estimates for motor vehicle injuries were 34%, 11%, and 10%.
Insomnia is a major contributor to both unintentional fatal injuries in general as well as fatal motor vehicle injuries. Increasing public health awareness about insomnia and identifying persons with insomnia may be important in preventing unintentional fatal injuries.
[Show abstract][Hide abstract] ABSTRACT: AimsSymptoms of anxiety and depression often co-exist with cardiovascular disease, yet little is known about the prospective risk for heart failure (HF) in people with symptoms of depression and anxiety. We aimed to study these prospective associations using self-reported symptoms of anxiety, depression, and mixed symptoms of anxiety and depression (MSAD) in a large population sample.Methods and resultsIn the second wave of the Nord-Trøndelag Health Study (HUNT 2, 1995–1997), Norway, baseline data on symptoms of anxiety and depression, socio-demographic variables, health status including cardiovascular risk factors, and common chronic somatic diseases were registered for 62 567 adults, men and women, free of known HF. The cohort was followed for incident HF from baseline throughout 2008. A total of 1499 cases of HF occurred during a mean follow-up of 11.3 years (SD = 2.9), identified either in hospital registers or by the National Cause of Death Registry. There was no excess risk for future HF associated with symptoms of anxiety or MSAD at baseline. For depression, the multi-adjusted hazard ratios for HF were 1.07 (0.87–1.30) for moderate symptoms and 1.41 (1.07–1.87) for severe symptoms (P for trend 0.026). Established cardiovascular risk factors, acute myocardial infarction (AMI) prior to baseline, and adjustment for incident AMI as a time-dependent covariate during follow-up had little influence on the estimates.Conclusion
Symptoms of depression, but not symptoms of anxiety or MSAD, were associated with increased risk for HF in a dose–response manner. The increased risk could not be fully explained by cardiovascular or socio-economic risk factors, or by co-morbid AMI.
European Journal of Heart Failure 08/2014; 16(8). DOI:10.1002/ejhf.133 · 6.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
Women with a history of preeclampsia are at increased lifetime risk for cardiovascular disease. Their offspring may carry similar risks. The aim was to study cardiovascular and metabolic risk factors 11 years after the delivery among women who were diagnosed with mild, moderate, or severe preeclampsia, and their offspring, compared with women without preeclampsia and their offspring.
In a follow-up 11 years after a nested case-control study at birth, we studied 611 mother-offspring dyads, including 228 dyads with preeclampsia in the index pregnancy and 383 dyads without preeclampsia. Cardiovascular and metabolic risk profiles were assessed by serum lipids (total cholesterol, high-density lipoprotein [HDL] cholesterol, non-HDL cholesterol), insulin-related factors (glucose, insulin, and homeostasis assessment model for insulin resistance) and blood pressure in mothers and children.
Among mothers with mild or moderate preeclampsia, levels of glucose, insulin, and homeostasis assessment model for insulin resistance were higher than in the nonpreeclampsia group and also higher compared with mothers with severe preeclampsia (all P < .05). HDL cholesterol was lower in mothers with mild or moderate preeclampsia (all P < .05), but other lipids did not substantially differ between the groups. Body mass index and blood pressure (systolic and diastolic) were also higher in the mild and moderate preeclampsia group compared with mothers without preeclampsia (all P < .05). Among the offspring, we found no clear differences in any blood analytes between the groups.
Women with a previous diagnosis of mild or moderate, but not severe, preeclampsia may have an adverse metabolic and cardiovascular risk profile 11 years after the delivery.
American Journal of Obstetrics and Gynecology 06/2014; 211(6). DOI:10.1016/j.ajog.2014.06.026 · 4.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cardiorespiratory fitness (CRF) is a strong predictor of future health, but measurements of CRF are time-consuming and involve costly test procedures. We assessed whether a simple, non-exercise based test of CRF predicted long-term all-cause and cardiovascular (CVD) mortality.
In this prospective cohort study we used a previously published non-exercise test to estimate CRF in healthy men (n=18,348) and women (n=18,764) from the first HUNT Study (1984-86) in Norway. We used Cox-regression to obtain hazard ratios (HR) for mortality during a mean follow-up of 24 years. Assessment of model validity was performed by standard procedures of discrimination and calibration.
CRF was inversely associated with all-cause and CVD mortality in men and women below 60 years of age at baseline after adjustment for confounders. For each metabolic equivalent (MET, ~3.5 mL[BULLET OPERATOR]kg[BULLET OPERATOR]min) higher CRF, HR for CVD mortality was 21% lower in both men (95% CI, 17-26%) and women (95% CI, 12-29%). HR for all-cause mortality was 15% (95% CI, 12-17%) lower in men and 8% (95% CI, 3-13%) lower in women for each MET higher CRF. The ability of the model to discriminate mortality risk among participants below 60 was better for CRF (AUC: 0.70-0.77) compared to each variable that constituted the model (AUC: 0.55-0.63) and an aggregated sum of z-scores for each variable (AUC: 0.61-0.65). Comparison of observed and predicted risk indicated good model calibration.
This method of assessing CRF is feasible and practically useful in primary care for identification of apparently healthy individuals at increased risk of premature cardiovascular disease and all-cause mortality.
Medicine and science in sports and exercise 02/2014; 46(6). DOI:10.1249/MSS.0000000000000219 · 3.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We sought to investigate whether obesity in the absence of metabolic abnormalities might be a relatively benign condition in relation to acute myocardial infarction (AMI) and heart failure (HF).Background The results of previous studies are conflicting for AMI and largely unknown for HF, and the role of the duration of obesity has not been investigated.
In a population-based prospective cohort study, a total of 61,299 men and women free from cardiovascular disease were classified according to body-mass index (BMI) and metabolic status at baseline. BMI was also measured 10 and 30 years before baseline for 27,196 participants.
During 12 years of follow-up, 2,547 participants had a first AMI, and 1,201 a first HF. Compared to being normal weight (BMI>25) and metabolically healthy, the multivariable-adjusted hazard ratio (HR) for AMI was 1.1 (95% CI 0.9-1.4) among obese (BMI≥30) and metabolically healthy participants, and 2.0 (1.7-2.3) among obese and metabolically unhealthy. We found similar results for severe (BMI ≥35), long lasting (<30 years), and abdominal obesity stratified for metabolic status. For HF, the HRs associated with obesity were 1.7 (1.3-2.3) and 1.7 (1.4-2.2), for metabolically healthy and unhealthy participants, respectively. Severe and long lasting obesity were particularly harmful in relation to HF, regardless of metabolic status.
In relation to AMI, obesity without metabolic abnormalities did not confer substantial excess risk, not even for severe or long-lasting obesity. For HF, even metabolically healthy obesity was associated with increased risk, particularly for long lasting or severe obesity.
Journal of the American College of Cardiology 12/2013; 63(11). DOI:10.1016/j.jacc.2013.11.035 · 16.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The nature of the association of depression and anxiety with risk for acute myocardial infarction (AMI) remains unclear. We aimed to study the prospective association of single and recurrent self-reported symptoms of anxiety and depression with a risk of AMI in a large Norwegian population based cohort.
In the second wave of the Nord-Trøndelag Health Study (HUNT2, 1995-97) baseline data on anxiety and depression symptoms, sociodemographic variables, health status including cardiovascular risk factors and common chronic disorders were registered for 57 953 adult men and women free of cardiovascular disease. The cohort was followed up during a mean (SD) 11.4 (2.9) years for a first AMI from baseline through 2008. A total of 2111 incident AMIs occurred, either identified at hospitals or by the National Cause of Death Registry. The multi-adjusted hazard ratios were 1.31 (95% CI 1.03-1.66) for symptoms of depression and 1.25 (CI 0.99-1.57) for anxiety. Two episodes of mixed symptoms of anxiety and depression (MSAD), reported 10 years apart, increased the risk for AMI by 52% (11-108%). After exclusion of the first 5 years of follow-up, the association of depression symptoms with AMI risk was attenuated. Relative risk for AMI with anxiety symptoms and MSAD weakened when participants with chronic disorders were excluded.
Self-reported symptoms of depression and anxiety, especially if recurrent, were moderately associated with the risk of incident AMI. We had some indications that these associations might partly reflect reverse causation or confounding from common chronic diseases.
European Heart Journal 09/2013; DOI:10.1093/eurheartj/eht387 · 15.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Adult weight gain is associated with increased risk of postmenopausal breast cancer. Most previous studies are limited by using recalled or self-reported data, and it is not known if age-specific weight changes are important for breast cancer risk.
In a Norwegian cohort of 28 153 women (and 900 incident breast cancers) with longitudinal anthropometric measurements over up to 30 years, we studied both overall and age-related weight changes in adulthood and risk of postmenopausal breast cancer.
Overall, weight gain in adulthood was associated with increased breast cancer risk (hazard ratio (HR) per kg per year 1.31, 95% confidence interval (CI) 1.11–1.54). Weight gain before (HR per kg per year 1.38, 95% CI 1.09–1.75) or around menopause (1.69, 95% CI 1.32–2.16) was associated with increased risk, but there was no clear risk increase associated with later weight gain (HR per kg per year 0.92, 95% CI 0.73–1.18).
Weight gain in adulthood was associated with increased risk of breast cancer. Our results suggest that weight gain before and around menopausal age may be particularly important for breast cancer risk among postmenopausal women.
British Journal of Cancer 07/2013; 109(5). DOI:10.1038/bjc.2013.403 · 4.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Endogenous estrogens prevent lipid peroxidation, which is pivotal in atherogenesis. Dyslipidemia may therefore be more dangerous for men than for women as a risk factor for acute myocardial infarction (AMI). A differential effect by sex has not been empirically established.
In a prospective population-based cohort study of 23,525 women and 20,725 men younger than 60 years of age at baseline, we followed participants for 12 years for a first AMI. By calculating the proportion of AMI among men with dyslipidemia attributable to the synergism between male sex and dyslipidemia, we assessed the degree to which dyslipidemia is more detrimental for men than for women.
Dyslipidemia and male sex enhanced the effect of one another in relation to AMI risk. The proportion of AMI cases among men with dyslipidemia attributable to this synergism alone was 0.46 (95% confidence interval = 0.35 to 0.57) for high total serum cholesterol, 0.23 (0.05 to 0.41) for low high-density lipoprotein (HDL) cholesterol, and 0.52 (0.42 to 0.62) for high non-HDL cholesterol. In contrast, obesity and hypertension were equally detrimental for men and women in relation to AMI risk, with a corresponding attributable proportion of 0.02 (-0.21 to 0.25) and -0.01 (-0.27 to 0.24), respectively.
Current clinical guidelines of dyslipidemia management do not distinguish between men and women in relation to primary prevention of AMI. Our results suggest that in middle age, dyslipidemia is much more detrimental for men than for women, and that preventing dyslipidemia has a greater potential to reduce the occurrence of AMI among men.
[Show abstract][Hide abstract] ABSTRACT: Previous studies have reported strong associations between birth order, maternal age, and suicide, but these results might have been confounded by socioeconomic and other factors. To control for such factors, we compared suicide risk between siblings and studied how maternal age at child birth and birth order influenced risk in a cohort study of 1,690,306 Norwegians born in 1967-1996 who were followed up until 2008. Using stratified Cox regression, we compared suicide risk within families with 2 or more children in which one died from suicide. Altogether, 3,005 suicides occurred over a mean follow-up period of 15 years; 2,458 of these suicides occurred among 6,741 siblings within families of 2 or more siblings. Among siblings, a higher position in the birth order was positively associated with risk; each increase in birth order was associated with a 46% (adjusted hazard ratio = 1.46, 95% confidence interval: 1.29, 1.66) higher risk of suicide. For each 10-year increase in maternal age at child birth, the offspring's suicide risk was reduced by 57% (adjusted hazard ratio = 0.43, 95% confidence interval: 0.30, 0.62). Our study suggests that confounding due to familial factors is not likely to explain the associations of birth order and maternal age at child birth with suicide risk.
American journal of epidemiology 03/2013; 177(7). DOI:10.1093/aje/kwt014 · 5.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims Insomnia is highly prevalent among heart failure patients, but only a few small studies have investigated insomnia symptoms and risk of heart failure. We aimed to assess the prospective association between self-reported insomnia symptoms and the risk of incident heart failure in a large Norwegian cohort.
Methods and results Baseline data on insomnia symptoms, including difficulty initiating sleep, difficulty maintaining sleep and having non-restorative sleep, socio-demographic variables, and health status, including established cardiovascular risk factors, were collected from 54 279 men and women 20–89 years of age who participated in the Nord-Trøndelag Health study (HUNT) between 1995 and 1997 and were free from known heart failure at baseline. The cohort was followed for incident heart failure from baseline through 2008. We used Cox proportional hazard models to assess the association of baseline insomnia symptoms with the risk of heart failure. A total of 1412 cases of heart failure occurred during a mean follow-up of 11.3 years (SD = 2.9 years), either identified at hospitals or by the National Cause of Death Registry. There was a dose-dependent association between the number of insomnia symptoms and risk of heart failure. The multi-adjusted hazard ratios were 0.96 (0.57–1.61), 1.35 (0.72–2.50), and 4.53 (1.99–10.31) for people with one, two, and three insomnia symptoms, compared with people with none of the symptoms (P for trend 0.021).
Conclusions Insomnia is associated with an increased risk of incident heart failure. If our results are confirmed by others and causation is proved, evaluation of insomnia symptoms might have consequences for cardiovascular prevention.
European Heart Journal 03/2013; 35(21). DOI:10.1093/eurheartj/eht019 · 15.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Study objectives:
Previous studies have found an inverse association between insomnia and self-reported physical activity, but it is not clear whether insomnia is associated with cardiorespiratory fitness. Our aim was to investigate different insomnia symptoms in relation to the gold standard measure of cardiorespiratory fitness, i.e., peak oxygen uptake (VO(2peak)).
Cross-sectional population study.
Nord-Trøndelag County, Norway.
The group comprised 3,489 men and women who were free from cardiovascular or pulmonary diseases, cancer, and sarcoidosis and who did not use antihypertensive medication. They were included in the fully adjusted model when assessing all insomnia symptoms simultaneously.
Measurements and results:
For insomnia, the participants reported how often they had experienced sleep problems during the past 3 months, including difficulties falling asleep at night, repeated awakenings during the night, early awakenings without being able to go back to sleep, and daytime sleepiness. Response options were "never/almost never," "sometimes" or "several times a wk." To measure cardiorespiratory fitness, the participants were asked to walk or run on a treadmill with increasing speed and/or incline until exhaustion, and VO(2peak) was recorded. We found a modest inverse and graded association of the insomnia symptoms with VO(2peak). The association was independent of self-reported physical activity and was apparent for all insomnia symptoms except for early awakenings. We found a dose-response relation for a cumulative combination of insomnia symptoms and VO(2peak) for experiencing zero, one to two, or three to four symptoms (P for trend < 0.001).
We found a modest inverse association of insomnia with VO(2peak) independent of the conventional cardiovascular risk factors and self-reported physical activity.
[Show abstract][Hide abstract] ABSTRACT: Insomnia is associated with increased risk of coronary heart disease (CHD), but the underlying mechanisms are not understood. To our knowledge, no previous studies have examined insomnia in relation to endothelial function, an indicator of preclinical atherosclerosis. Our aim was to assess the association of insomnia with endothelial function in a large population based study of healthy individuals.
A total of 4 739 participants free from known cardiovascular or pulmonary diseases, cancer, and sarcoidosis, and who were not using antihypertensive medication were included in the study. They reported how often they had experienced difficulties falling asleep at night, repeated awakenings during the night, early awakenings without being able to go back to sleep, and daytime sleepiness. Endothelial function was measured by flow mediated dilation (FMD) derived from the brachial artery.
We found no consistent association between the insomnia symptoms and endothelial function in multiadjusted models, but individual insomnia symptoms may be related to endothelial function. Among women who reported early awakenings, endothelial function may be lower than in women without this symptom (p = 0.03).
This study provided no evidence that endothelial function, an early indicator of atherosclerosis, is an important linking factor between insomnia and CHD. Further studies are needed to explore the complex interrelation between sleep and cardiovascular pathology.
PLoS ONE 12/2012; 7(12):e50933. DOI:10.1371/journal.pone.0050933 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
The prognostic role of job insecurity in coronary heart disease is unknown. We aimed to analyze whether job insecurity predicts mortality and recurrent events after a first acute myocardial infarction (AMI).
We studied non-fatal AMI cases involved in the Stockholm Heart Epidemiology Program who were in paid employment and younger than 65 years (n=676). Shortly after their AMI, patients completed a questionnaire about job insecurity, demographic, work-related, clinical and lifestyle factors and participated in a clinical examination three months after discharge from the hospital. They were followed for 8.5 years for mortality and cardiovascular events.
After adjusting for previous morbidity, demographic and work-related factors, job insecurity was associated with an increased risk of the combined endpoint of cardiac death and non-fatal AMI, of total mortality and of heart failure; the hazard ratios (HR) and the 95% confidence intervals (CI) were 1.50 (1.02-2.22), 1.69 (1.04-2.75) and 1.62 (1.07-2.44), respectively. Similar associations, but with less statistical power were observed between job insecurity and cardiac death (HR (95% CI): 1.57 (0.80-3.09)) and stroke (HR (95% CI): 1.46 (0.71-3.02)), respectively. Adjustment for potential mediators, i.e. sleep problems, health behaviour, hypertension, blood lipids, glucose, inflammatory and coagulation factors did not alter considerably the relationship between job insecurity and the combination of cardiac mortality and non-fatal AMI.
Our results suggest that job insecurity is an adverse prognostic factor in patients with a first AMI. Future studies are needed to confirm this finding and to determine the mechanisms underlying the observed relationship.
International journal of cardiology 08/2012; 167(6). DOI:10.1016/j.ijcard.2012.07.005 · 4.04 Impact Factor