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  • Systolic Blood Pressure and Vascular Disease in Men Aged 65 Years and Over: The HIMS (Health in Men Study).

    16 October 2018

    There is uncertainty about the relation between blood pressure and vascular disease at older age. We assessed the association of systolic blood pressure (SBP) and major vascular events in a prospective cohort study of 7564 men aged 65 to 94 years, recruited in 1996-1999 from the general population in Perth, Western Australia. SBP was measured at baseline and again at resurvey in 2001-2004. Participants were monitored for fatal and nonfatal vascular events. To limit the effect of reverse causality, analyses were restricted to men without previous vascular disease at baseline. Hazard ratios were estimated by Cox regression, with adjustment for age and education (further adjustment did not materially change the associations). During a mean follow-up of 11 years, there were 1557 major vascular events. Continuous log-linear associations were found between usual SBP and risk of major vascular events throughout the SBP range examined (145-170 mm Hg). Overall, 10 mm Hg higher usual SBP was associated with ≈20% higher risk of major vascular events (hazard ratio, 19%; 95% confidence interval, 13%-26%; mean age at event 80 years). There was evidence of positive associations with both ischemic heart disease and stroke and effect modification by age, with shallower associations at older ages. Even at 85 to 94 years, however, there was evidence of a positive association: 10 mm Hg higher usual SBP was associated with 14% (95% confidence interval, 1%-30%) higher risk of major vascular events.

  • The Role of Emerging Risk Factors in Cardiovascular Outcomes.

    16 October 2018

    PURPOSE OF REVIEW: This review discusses the recent evidence for a selection of blood-based emerging risk factors, with particular reference to their relation with coronary heart disease and stroke. RECENT FINDINGS: For lipid-related emerging risk factors, recent findings indicate that increasing high-density lipoprotein cholesterol is unlikely to reduce cardiovascular risk, whereas reducing triglyceride-rich lipoproteins and lipoprotein(a) may be beneficial. For inflammatory and hemostatic biomarkers, genetic studies suggest that IL-6 (a pro-inflammatory cytokine) and several coagulation factors are causal for cardiovascular disease, but such studies do not support a causal role for C-reactive protein and fibrinogen. Patients with chronic kidney disease are at high cardiovascular risk with some of this risk not mediated by blood pressure. Randomized evidence (trials or Mendelian) suggests homocysteine and uric acid are unlikely to be key causal mediators of chronic kidney disease-associated risk and sufficiently large trials of interventions which modify mineral bone disease biomarkers are unavailable. Despite not being causally related to cardiovascular disease, there is some evidence that cardiac biomarkers (e.g. troponin) may usefully improve cardiovascular risk scores. Many blood-based factors are strongly associated with cardiovascular risk. Evidence is accumulating, mainly from genetic studies and clinical trials, on which of these associations are causal. Non-causal risk factors may still have value, however, when added to cardiovascular risk scores. Although much of the burden of vascular disease can be explained by 'classic' risk factors (e.g. smoking and blood pressure), studies of blood-based emerging factors have contributed importantly to our understanding of pathophysiological mechanisms of vascular disease, and new targets for potential therapies have been identified.

  • Identifying Systematic Heterogeneity Patterns in Genetic Association Meta-analysis Studies

    16 October 2018

    Progress in mapping loci associated with common complex diseases or quantitative inherited traits has been expedited by large-scale meta-analyses combining information across multiple studies, assembled through collaborative networks of researchers. Participating studies will usually have been independently designed and implemented in unique settings that are potential sources of phenotype, ancestry or other variability that could introduce between-study heterogeneity into a meta-analysis. Heterogeneity tests based on individual genetic variants (e.g. Q, I²) are not suited to identifying locus-specific from more systematic multi-locus or genome-wide patterns of heterogeneity. We have developed and evaluated an aggregate heterogeneity M statistic that combines between-study heterogeneity information across multiple genetic variants, to reveal systematic patterns of heterogeneity that elude conventional single variant analysis. Application to a GWAS meta-analysis of coronary disease with 48 contributing studies uncovered substantial systematic between-study heterogeneity, which could be partly explained by age-of-disease onset, family-history of disease and ancestry. Future meta-analyses of diseases and traits with multiple known genetic associations can use this approach to identify outlier studies and thereby optimize power to detect novel genetic associations.

  • Dietary glycaemic index and glycaemic load in the European Prospective Investigation into Cancer and Nutrition.

    16 October 2018

    OBJECTIVES: To describe dietary glycaemic index (GI) and glycaemic load (GL) values in the population participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study according to food groups, nutrients and lifestyle characteristics. METHODS: Single 24-h dietary recalls (24-HDRs) from 33 566 subjects were used to calculate dietary GI and GL, and an ad hoc database was created as the main reference source. Mean GI and GL intakes were adjusted for age, total energy intake, height and weight, and were weighted by season and day of recall. RESULTS: GI was the lowest in Spain and Germany, and highest in the Netherlands, United Kingdom and Denmark for both genders. In men, GL was the lowest in Spain and Germany and highest in Italy, whereas in women, it was the lowest in Spain and Greece and highest in the UK health-conscious cohort. Bread was the largest contributor to GL in all centres (15-45%), but it also showed the largest inter-individual variation. GL, but not GI, tended to be lower in the highest body mass index category in both genders. GI was positively correlated with starch and intakes of bread and potatoes, whereas it was correlated negatively with intakes of sugar, fruit and dairy products. GL was positively correlated with all carbohydrate components and intakes of cereals, whereas it was negatively correlated with fat and alcohol and with intakes of wine, with large variations across countries. CONCLUSIONS: GI means varied modestly across countries and genders, whereas GL means varied more, but it may possibly act as a surrogate of carbohydrate intake.

  • Dietary determinants of obesity.

    16 October 2018

    Obesity has become a serious public health problem worldwide, and dietary composition can play a role in its prevention and treatment. However, available literature on the impacts of different dietary factors on weight change is inconsistent, or even conflicting. In this review, we briefly summarized the mechanisms and influences of several major dietary determinants of weight change, with a focus on their potential in the prevention of weight gain or regain. We discussed the intake of fat, protein, total carbohydrates, fruits and vegetables, fibre, free sugars, fructose and sugar sweetened beverages, dietary energy density, portion size, eating outside home, glycaemic index and glycaemic load. Popular weight loss diets, including the Atkins diet, Weight Watchers, Ornish diet and Zone diet, are also briefly discussed for their safety and efficacy in the maintenance of weight loss.

  • The Association Between Diet and Obesity in Specific European Cohorts: DiOGenes and EPIC-PANACEA.

    16 October 2018

    This review summarizes evidence from two projects embedded within the European Prospective Investigation into Cancer and Nutrition (EPIC) on the association between dietary factors and obesity risk, in particular change in weight and waist circumference. A total of 12 publications from DiOGenes and six from EPIC-PANACEA were reviewed. The results show that dietary fiber, especially cereal fiber, was inversely associated with weight or waist change, as well as fruit/vegetable intake and the Mediterranean dietary pattern. Energy density and meat consumption were positively associated with the anthropometric changes, as was glycemic index with waist change. Clear associations with macronutrient composition were not observed. In additional studies, interactions with genetic polymorphism were investigated and shown to be present for protein intake and GI, although effect estimates were small. These interactions require replication. These results show that in European populations dietary factors are independently associated with weight/waist change. The findings provide further clues for the prevention of obesity.

  • Methodological challenges in the application of the glycemic index in epidemiological studies using data from the European Prospective Investigation into Cancer and Nutrition.

    16 October 2018

    Associations between the glycemic index (GI) or glycemic load (GL) and diseases are heterogeneous in epidemiological studies. Differences in assigning GI values to food items may contribute to this inconsistency. Our objective was to address methodological issues related to the use of current GI and GL values in epidemiological studies. We performed ecological comparison and correlation studies by calculating dietary GI and GL from country-specific dietary questionnaires (DQ) from 422,837 participants from 9 countries participating in the European Prospective Investigation into Cancer and Nutrition study and single standardized 24-h dietary recalls (24-HDR) obtained from a representative sample (n = 33,404) using mainly Foster Powell's international table as a reference source. Further, 2 inter-rater and 1 inter-method comparison were conducted, comparing DQ GI values assigned by independent groups with values linked by us. The ecological correlation between DQ and 24-HDR was good for GL (overall r = 0.76; P < 0.005) and moderate for GI (r = 0.57; P < 0.05). Mean GI/GL differences between DQ and 24-HDR were significant for most centers. GL but not GI from DQ was highly correlated with total carbohydrate (r = 0.98 and 0.15, respectively; P < 0.0001) and this was higher for starch (r = 0.72; P < 0.0001) than for sugars (r = 0.36; P < 0.0001). The inter-rater and inter-method variations were considerable for GI (weighted kappa coefficients of 0.49 and 0.65 for inter-rater and 0.25 for inter-method variation, respectively) but only mild for GL (weighted kappa coefficients > 0.80). A more consistent methodology to attribute GI values to foods and validated DQ is needed to derive meaningful GI/GL estimates for nutritional epidemiology.

  • Adapting the design of a new sustainable hospital building against a warming climate

    16 October 2018

    A set of future weather data derived from UK Climate Projections 2009 is used to assess the risk of overheating in the design of a sustainable hospital in the UK under, current, and future climate. Modelling results of indoor operative/ail' temperature are compared with three distinct overheating metrics including the Department of Health's Technical Memorandum 03-01, CIBSE Guide A and BS EN 15251 Adaptive Thermal Comfort Standard. To tackle future overheating of the building spaces, eighteen individual passive design measures (covering low-energy ventilation, shading and cooling) are tested in IES ApacheSim and the most effective measures are combined as adaptation packages for further testing. This work has developed a replicable methodological approach for adapting new buildings against a future warming climate. Copyright © 2011 by IPAC'11/EPS-AG.