To assess whether better cardiovascular health is associated with a lower long-term risk of CVD in women with a history of adverse pregnancy outcomes (APOs). Using data from the UK Biobank prospective cohort, we included 2,263 participants with prior APOs and 107,260 participants without prior APOs. Life's Essential 8 (LE8) score was assessed at baseline. Multivariable-adjusted Cox models were used to estimate the associations between LE8 score and CVD events. Over a median 13.5 years of follow-up, 11,134 incident CVD events were documented. Among women with prior APOs, the incidence of total CVD was significantly lower in the top tertile compared to the bottom tertile, with a HR (95% CI) of 0.43 (0.29, 0.65). A similar trend was observed in women without APOs, with an HR (95% CI) of 0.55 (0.53, 0.58). With respect to the individual CVD outcomes, among women with APOs, only the associations with coronary heart disease, HR (95% CI) for T3 vs T1: 0.30 (0.17, 0.55) and atrial fibrillation, 0.47 (0.24, 0.91), achieved statistical significance. Women with high LE8 score and prior APOs had a similar long-term cardiovascular risk compared to women with high LE8 score and no prior APOs, 0.95 (0.63, 1.44). Among women with a history of APOs, better cardiovascular health as assessed using LE8 was associated with a significantly lower incidence of CVD, particularly coronary heart disease and atrial fibrillation. The excess risk associated with APOs appears to be attenuated among those with a high LE8 score.
Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting.A total of 65 381 women aged 50 to 75 years in 1996 were observed until 2006. Clinical depression was defined as having diagnosed depression or using antidepressants, and depressed mood was defined as having clinical depression or severe depressive symptoms, ie, a 5-item Mental Health Index (MHI-5) score of 52 or less. Self-reported type 2 diabetes mellitus was confirmed by means of a supplementary questionnaire validated by medical record review.During 10 years of follow-up (531 097 person-years), 2844 incident cases of type 2 diabetes mellitus were documented. Compared with referents (MHI-5 score of 86-100) who had the best depressive symptom scores, participants with increased severity of symptoms (MHI-5 scores of 76-85 or 53-75, or depressed mood) showed a monotonic elevated risk of developing type 2 diabetes (P for trend = .002 in the multivariable-adjusted model). The relative risk for individuals with depressed mood was 1.17 (95% confidence interval [CI], 1.05-1.30) after adjustment for various covariates, and participants using antidepressants were at a particularly higher relative risk (1.25; 95% CI, 1.10-1.41). In a parallel analysis, 7415 cases of incident clinical depression were documented (474 722 person-years). Compared with nondiabetic subjects, those with diabetes had a relative risk (95% CI) of developing clinical depression after controlling for all covariates of 1.29 (1.18-1.40), and it was 1.25 (1.09-1.42), 1.24 (1.09-1.41), and 1.53 (1.26-1.85) in diabetic subjects without medications, with oral hypoglycemic agents, and with insulin therapy, respectively. These associations remained significant after adjustment for diabetes-related comorbidities.Our results provide compelling evidence that the diabetes-depression association is bidirectional.
Introduction: Studies have suggested that dairy foods may be associated with lower risk of metabolic syndrome, HTN, and T2D. However, the relation of dairy products with CVD risk has been less clear, with mixed findings from various epidemiological studies. So far, few reports are from Chinese populations where the consumption levels are generally low. Methods: The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998 in Singapore. A validated 165-item semi-quantitative food-frequency questionnaire was used to assess usual diet at recruitment, and mortality information was identified via registry linkage up to December 31, 2013. Cox proportional hazard models were used to calculate HRs (95% CI) with adjustment for potential confounders. Results: The median total dairy intake was 20.1 g/d (ranged 0-1084 g/d). During 981,480 person-years of follow-up, we identified 5,484 CVD deaths. After controlling for socio-demographic, lifestyle and other dietary factors, marginally inverse association was observed, and the HRs (95% CI) for CVD mortality were 1.00, 0.95 (0.88-1.02), 0.96 (0.89-1.04), and 0.91 (0.84-0.99) for increasing quartiles of total dairy intake (P-trend=0.08). No significant association was observed for CHD deaths (n=3,033), and the HR comparing extreme quartiles was 0.93 (95% CI: 0.84-1.04; P-trend=0.27). Although the trend was not significant (P-trend=0.15) for stroke mortality (n=1544), the HRs were 1.00, 0.88 (0.77-1.02), 0.88 (0.76-1.01), and 0.84 (0.72-0.98) for increasing quartiles of total dairy intake. In men, higher total dairy intake was inversely associated with risk of CVD mortality [HR comparing extreme quartiles 0.89 (0.80-0.99); P-trend=0.02] and stroke mortality [0.72 (0.58-0.89); P-trend=0.005], but no significant association was observed in women [CVD mortality 0.99 (0.88-1.12); P-trend=0.41; and stroke mortality 0.93 (0.75-1.15); P-trend=0.97]. Conclusions: In this large cohort study of Chinese adults with generally low dairy consumption, high intake of total dairy products was associated with a modestly decreased risk of total CVD mortality, and this association was mainly observed for stroke mortality and only evident in men.
Genome-wide association studies have identified common variants in CDKAL1, CDKN2A/B, IGF2BP2, SLC30A8, HHEX/IDE, EXT2, and LOC387761 loci that significantly increase the risk of type 2 diabetes. We aimed to replicate these observations in a population-based cohort of Chinese Hans and examine the associations of these variants with type 2 diabetes and diabetes-related phenotypes.We genotyped 17 single nucleotide polymorhisms (SNPs) in 3,210 unrelated Chinese Hans, including 424 participants with type 2 diabetes, 878 with impaired fasting glucose (IFG), and 1,908 with normal fasting glucose.We confirmed the associations between type 2 diabetes and variants near CDKAL1 (odds ratio 1.49 [95% CI 1.27-1.75]; P = 8.91 x 10(-7)) and CDKN2A/B (1.31 [1.12-1.54]; P = 1.0 x 10(-3)). We observed significant association of SNPs in IGF2BP2 (1.17 [1.03-1.32]; P = 0.014) and SLC30A8 (1.12 [1.01-1.25]; P = 0.033) with combined IFG/type 2 diabetes. The SNPs in CDKAL1, IGF2BP2, and SLC30A8 were also associated with impaired beta-cell function estimated by homeostasis model assessment of beta-cell function. When combined, each additional risk allele from CDKAL1-rs9465871, CDKN2A/B-rs10811661, IGF2BP2-rs4402960, and SLC30A8-rs13266634 increased the risk for type 2 diabetes by 1.24-fold (P = 2.85 x 10(-7)) or for combined IFG/type 2 diabetes by 1.21-fold (P = 6.31 x 10(-11)). None of the SNPs in EXT2 or LOC387761 exhibited significant association with type 2 diabetes or IFG. Significant association was observed between the HHEX/IDE SNPs and type 2 diabetes in individuals from Shanghai only (P < 0.013) but not in those from Beijing (P > 0.33).Our results indicate that in Chinese Hans, common variants in CDKAL1, CDKN2A/B, IGF2BP2, and SLC30A8 loci independently or additively contribute to type 2 diabetes risk, likely mediated through beta-cell dysfunction.
To evaluate the association of changes in red meat consumption with total and cause specific mortality in women and men.Two prospective cohort studies with repeated measures of diet and lifestyle factors.Nurses' Health Study and the Health Professionals Follow-up Study, United States.53 553 women and 27 916 men without cardiovascular disease or cancer at baseline.Death confirmed by state vital statistics records, the national death index, or reported by families and the postal system.14 019 deaths occurred during 1.2 million person years of follow-up. Increases in red meat consumption over eight years were associated with a higher mortality risk in the subsequent eight years among women and men (both P for trend<0.05, P for heterogeneity=0.97). An increase in total red meat consumption of at least half a serving per day was associated with a 10% higher mortality risk (pooled hazard ratio 1.10, 95% confidence interval 1.04 to 1.17). For processed and unprocessed red meat consumption, an increase of at least half a serving per day was associated with a 13% higher mortality risk (1.13, 1.04 to 1.23) and a 9% higher mortality risk (1.09, 1.02 to 1.17), respectively. A decrease in consumption of processed or unprocessed red meat of at least half a serving per day was not associated with mortality risk. The association between increased red meat consumption and mortality risk was consistent across subgroups defined by age, physical activity, dietary quality, smoking status, or alcohol consumption.Increases in red meat consumption, especially processed meat, were associated with higher overall mortality rates.
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