After the age of 80, carrying a few extra pounds may not subtract years from your lifespan, a new study from Japan shows.
Among a group of 80-year-olds followed for four years, the researchers found that underweight individuals were more likely to die from cancer, heart disease or pneumonia than normal-weight or overweight people. "Overweight status was associated with longevity and underweight with short life," Dr. Yutaka Takata and colleagues from Kyushu Dental College in Kitakyushu City conclude.
While being overweight has been tied to a greater risk of heart disease, studies have also found that being underweight with heart disease may carry an increased risk of morbidity and mortality, Takata and his team note.
To better understand the controversial relationship between body mass index (BMI) and mortality from heart disease, as well as all-cause mortality, the researchers looked at men and women who were 80-years-old.
Fifty-two were underweight, with an average BMI of 17.2; another 468 were normal-weight, with BMIs averaging 21.8; and 155 were overweight, with an average BMI of 27.3. Just five people in the study were obese (with a BMI of 30 or greater), so they were included in the overweight group. People with BMIs between 18.5 and 25 are considered normal weight, while individuals with BMIs of 25 or greater are classified as overweight.
Mortality rates from heart disease, pneumonia and cancer for normal-weight and overweight individuals weren't significantly different, the researchers found. But underweight men and women were nearly four times as likely to die from any cause compared with as overweight individuals, and nearly 18 times more likely to die from cancer. Heart disease mortality in the underweight group was almost four times greater than among normal-weight individuals.
Other studies have found a protective effect of extra pounds among older individuals, Takata and his colleagues note; for example, among elderly US men, the lowest mortality is seen among men with BMIs of 26 and among women with BMIs of 29.6. While Takata and his colleagues attempted to control for the effects of illness, it is still possible that existing disease accounted for some of the increased mortality risk seen among the underweight individuals, they note.
"It is likely that only mild obesity (but not severe obesity) or overweight status in older people and in patients with heart disease may be associated with a lower mortality rate from any disease, as well as with lower mortality from cardiovascular disease," the researchers conclude.
SOURCE: Journal of the American Geriatrics Society, June 2007.
Showing posts with label Cardiac Mortality. Show all posts
Showing posts with label Cardiac Mortality. Show all posts
Friday, June 29, 2007
Wednesday, June 20, 2007
Mortality Rates Hold Steady for Women With Diabetes
ATLANTA, June 19 -- Mortality rates for men with diabetes -- but not for diabetic women -- have declined in tandem with the general population's drop in cardiovascular mortality.
A review of data from three large population-based cohorts showed no significant declines in either cardiovascular deaths or all-cause mortality among women with diabetes from the periods spanning 1971-1986 to 1988-2000, reported Edward W. Gregg, Ph.D., of the CDC, and colleagues,
"Our examination of U.S. adults with self-reported diabetes suggests that the well-documented reductions in mortality rates in the general U.S. adult population during the last 25 years have included men with diabetes, but their female diabetic peers have been left behind," the authors wrote online in the Annals of Internal Medicine, scheduled for print in the Aug. 7 issue.
Although the study was not designed to examine the reasons for the disparity, it may have to do with gender-based inequities in care, suggested cardiologist Nanette K. Wenger, M.D., of Emory in Atlanta, in an accompanying editorial.
"Are women with coronary heart disease and diabetes less likely to receive appropriate care?" Dr. Wenger asked. "The answer appears to be yes."
Several studies have shown that coronary heart disease is diagnosed at a later stage in women, that women receive fewer preventive measures than men, and that women less often receive guideline-based therapies during hospitalization or after discharge for an acute coronary event, she wrote.
The study by Dr. Gregg and colleagues tried to answer the question the question of whether the reported decline in all-cause mortality and cardiovascular disease mortality rates also applies to Americans with diabetes.
They compared three consecutive cohorts in the National Health and Nutrition Examination Surveys (NHANES I, II, and III), spanning the years 1971-75, 1976-1980, and 1988-1994, with mortality rates determined through 1986, 1992, and 2000, respectively.
The participants ranged in age from 35 to 74, and included adults both with and without self-reported diabetes.
The authors found that the age-adjusted all-cause mortality rate among men with diabetes declined from 42.6 per 1,000 annually in 1971-86, to 24.4 per 1,000 in 1988-2000 (P=0.03), for a rate ratio of 0.61 (95% CI 0.43 to 0.86). The slope of the decline was similar to that seen in non-diabetic men, which went from 19.0 per 1,000 in 1971-86, to 11.6 per 1,000 from 1988-2000 (rate ratio 0.68. 95% CI 0.57 to 0.81).
Similarly, cardiovascular disease mortality trends in diabetic men paralleled those of all-cause mortality, declining from 26.4 annual deaths per 1,000 in 1971-86, to 12.8 annual deaths per 1,000 in 1988-2000 (P=0.06).
When they looked at women with diabetes, however, they found that there was no decline in either all-cause mortality of cardiovascular disease mortality from 1971-1986 to 1988-2000.
The all-cause mortality rate for non-diabetic women went from 10.1 per 1,000 in NHANES I (1971-1986) to 7.7 in NHANES III (1988-2000). Similarly, the cardiovascular mortality rate among non-diabetic women went from 4.7 in the NHANES I cohort to 2.3 in the NHANESS III cohort.
Among diabetic women, all cause mortality rose from 18.4 per 1,000 from 1971-1986 to 25.9 from 1988-2000, and cardiovascular disease-related deaths went remained essentially unchanged, at 10.5 per 1,000 in NHANES I. to 9.4 per 1,000 in NHANES III.
In addition, the difference in the all-cause mortality rate between diabetic and non-diabetic women increased by more than two-fold, from a difference of 8.3 annual deaths per 1,000 in NHANES I, to 18.2 per 1,000 in NHANES III.
The authors wrote that the decrease in death rates of diabetic men may be attributable to better control of cardiovascular disease risk factors and to improvements in interventions.
"These national data reveal three key findings," Dr. Gregg and colleagues wrote. "1) Reductions in mortality occurred among diabetic men but not among diabetic women; 2) disparities in mortality rates between women with and without diabetes have worsened; and 3) the female-over-male advantage in mortality rates among the diabetic population has been eliminated."
They called for further research into gender inequities in care of patients with diabetes, and for improved public health efforts to lower mortality rates among diabetes patients in general, and women with diabetes in particular.
"We lack an evidence-based comprehensive strategy for improving cardiovascular outcomes in diabetic women," Dr. Wenger wrote in her editorial. "Until we do, a prudent clinical approach involves two steps. First, recognize that diabetic women are at excess risk of developing coronary heart disease. Second, take an aggressive, guideline-based approach to coronary heart disease risk factor management."
Dr. Gregg and colleagues noted that their study was limited by the fact that diabetes was assessed by self-report, and that the study had insufficient statistical power to examine the factors explaining mortality trends.
The study was supported by the CDC. The authors had no conflicts of interest to report.Additional source: Annals of Internal MedicineSource reference: Gregg EW et al. "Mortality Trends in Men and Women with Diabetes, 1971-2000." Ann Intern Med. 2007; 147, 3. Additional source: Annals of Internal MedicineSource reference: Wenger NK. "Heightened Cardiovascular Risk in Diabetic Women: Can the Tide be Turned?" Ann Intern Med. 2007; 147.
A review of data from three large population-based cohorts showed no significant declines in either cardiovascular deaths or all-cause mortality among women with diabetes from the periods spanning 1971-1986 to 1988-2000, reported Edward W. Gregg, Ph.D., of the CDC, and colleagues,
"Our examination of U.S. adults with self-reported diabetes suggests that the well-documented reductions in mortality rates in the general U.S. adult population during the last 25 years have included men with diabetes, but their female diabetic peers have been left behind," the authors wrote online in the Annals of Internal Medicine, scheduled for print in the Aug. 7 issue.
Although the study was not designed to examine the reasons for the disparity, it may have to do with gender-based inequities in care, suggested cardiologist Nanette K. Wenger, M.D., of Emory in Atlanta, in an accompanying editorial.
"Are women with coronary heart disease and diabetes less likely to receive appropriate care?" Dr. Wenger asked. "The answer appears to be yes."
Several studies have shown that coronary heart disease is diagnosed at a later stage in women, that women receive fewer preventive measures than men, and that women less often receive guideline-based therapies during hospitalization or after discharge for an acute coronary event, she wrote.
The study by Dr. Gregg and colleagues tried to answer the question the question of whether the reported decline in all-cause mortality and cardiovascular disease mortality rates also applies to Americans with diabetes.
They compared three consecutive cohorts in the National Health and Nutrition Examination Surveys (NHANES I, II, and III), spanning the years 1971-75, 1976-1980, and 1988-1994, with mortality rates determined through 1986, 1992, and 2000, respectively.
The participants ranged in age from 35 to 74, and included adults both with and without self-reported diabetes.
The authors found that the age-adjusted all-cause mortality rate among men with diabetes declined from 42.6 per 1,000 annually in 1971-86, to 24.4 per 1,000 in 1988-2000 (P=0.03), for a rate ratio of 0.61 (95% CI 0.43 to 0.86). The slope of the decline was similar to that seen in non-diabetic men, which went from 19.0 per 1,000 in 1971-86, to 11.6 per 1,000 from 1988-2000 (rate ratio 0.68. 95% CI 0.57 to 0.81).
Similarly, cardiovascular disease mortality trends in diabetic men paralleled those of all-cause mortality, declining from 26.4 annual deaths per 1,000 in 1971-86, to 12.8 annual deaths per 1,000 in 1988-2000 (P=0.06).
When they looked at women with diabetes, however, they found that there was no decline in either all-cause mortality of cardiovascular disease mortality from 1971-1986 to 1988-2000.
The all-cause mortality rate for non-diabetic women went from 10.1 per 1,000 in NHANES I (1971-1986) to 7.7 in NHANES III (1988-2000). Similarly, the cardiovascular mortality rate among non-diabetic women went from 4.7 in the NHANES I cohort to 2.3 in the NHANESS III cohort.
Among diabetic women, all cause mortality rose from 18.4 per 1,000 from 1971-1986 to 25.9 from 1988-2000, and cardiovascular disease-related deaths went remained essentially unchanged, at 10.5 per 1,000 in NHANES I. to 9.4 per 1,000 in NHANES III.
In addition, the difference in the all-cause mortality rate between diabetic and non-diabetic women increased by more than two-fold, from a difference of 8.3 annual deaths per 1,000 in NHANES I, to 18.2 per 1,000 in NHANES III.
The authors wrote that the decrease in death rates of diabetic men may be attributable to better control of cardiovascular disease risk factors and to improvements in interventions.
"These national data reveal three key findings," Dr. Gregg and colleagues wrote. "1) Reductions in mortality occurred among diabetic men but not among diabetic women; 2) disparities in mortality rates between women with and without diabetes have worsened; and 3) the female-over-male advantage in mortality rates among the diabetic population has been eliminated."
They called for further research into gender inequities in care of patients with diabetes, and for improved public health efforts to lower mortality rates among diabetes patients in general, and women with diabetes in particular.
"We lack an evidence-based comprehensive strategy for improving cardiovascular outcomes in diabetic women," Dr. Wenger wrote in her editorial. "Until we do, a prudent clinical approach involves two steps. First, recognize that diabetic women are at excess risk of developing coronary heart disease. Second, take an aggressive, guideline-based approach to coronary heart disease risk factor management."
Dr. Gregg and colleagues noted that their study was limited by the fact that diabetes was assessed by self-report, and that the study had insufficient statistical power to examine the factors explaining mortality trends.
The study was supported by the CDC. The authors had no conflicts of interest to report.Additional source: Annals of Internal MedicineSource reference: Gregg EW et al. "Mortality Trends in Men and Women with Diabetes, 1971-2000." Ann Intern Med. 2007; 147, 3. Additional source: Annals of Internal MedicineSource reference: Wenger NK. "Heightened Cardiovascular Risk in Diabetic Women: Can the Tide be Turned?" Ann Intern Med. 2007; 147.
Thursday, June 07, 2007
Cardiac Mortality Drop Attributed to Therapies and Risk Factor Reductions
ATLANTA, June 6 -- Credit for the near halving of the rate of coronary disease deaths in the U.S, from 1980 to 2000, belongs equally to reductions in risk factors and to the rise of evidence-based therapies, found CDC and British researchers..
There were 341,745 fewer deaths from coronary heart disease in 2000 than in 1980, and about 47% of that decline can be attributed to primary and secondary medical therapies and interventions, they reported in the June 7 issue of the New England Journal of Medicine.
Reductions in risk factors such as smoking, high cholesterol, hypertension and inactivity get the nod for an additional 44% of the drop in coronary heart disease mortality, according to Earl S. Ford, M.D., M.P.H., of the National Center for Chronic Disease Prevention and Health Promotion, and colleagues.
But they also found that two major factors prevented the decreases in deaths from being even greater.
"Our analysis estimated that increases in the body-mass index accounted overall for about 26,000 additional deaths from coronary heart disease in 2000, and increases in the prevalence of diabetes for about 33,500 additional deaths; both figures are consistent with the results of other recent studies," they wrote. "Efforts to address these two risk factors should therefore receive particular attention in future measures to improve the public health."
The investigators used a previously validated statistical model called IMPACT to analyze the relative contributions of risk factor reduction, medical therapies, and interventions such as coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty to the decline in coronary disease-related deaths. The analyses were conducted at the University of Liverpool in England.
The difference between the expected and actual number of deaths from coronary heart disease in 2000 versus 1980 was distributed proportionally among the various treatments and risk factors included in the analyses.
They employed primarily data sources that were specific to the U.S. population, using the most up-to-date, least biased, and most representative sources whenever possible.
They found that the age-adjusted death rate for coronary heart disease among men fell from 542.9 deaths per 100,000 in 1980 to 266.8 per 100,000 in 2000. Among women, the rate fell from 263.3 per 100,000 in 1980 to 134.4 deaths per 100,000 in 2000. The total difference in observed vs. expected deaths in 2000 was 341,745.
About 47% of the decrease (159,330 fewer deaths) was attributed to treatments as follows:
Secondary preventive therapies after myocardial infarction or revascularization, 11%
Initial treatments for acute myocardial infarction or unstable angina 10%,
Treatments for heart failure, 9%
Revascularization for chronic angina, 5%,
Other therapies 12%.
An additional 44% of the drop could be attributed to the following changes in risk factors (numbers represent percentage of total reduction, and overlap):
Reductions in total cholesterol, 24%,
Decrease in systolic blood pressure, 20%,
Decline in smoking prevalence, 12%
Reduction in physical inactivity, 5%.
Progress in risk factor reductions was partially offset, however, by an 8% increase in body-mass index over the two decades, by a 10% rise in the prevalence of diabetes, the authors noted.
"Irrespective of the assumptions used, we found that the largest contributions from medical therapies consistently came from secondary prevention, followed by treatments for acute coronary syndromes, then heart failure," they wrote. "Revascularization by means of CABG or angioplasty for stable or unstable disease together accounted for approximately 7% of the overall drop in deaths from coronary heart disease, a finding that is consistent with the results of previous studies in the United States and elsewhere."
They noted that possible study limitations included the use of data from various sources, including some studies that might have been limited by ethnic, geographic, or selections biases. They also noted that most of varying quality o and the averaging of interactions across broad groups, although the analyses were limited only to reductions in deaths, and did not include quality-of-life measures.
There were 341,745 fewer deaths from coronary heart disease in 2000 than in 1980, and about 47% of that decline can be attributed to primary and secondary medical therapies and interventions, they reported in the June 7 issue of the New England Journal of Medicine.
Reductions in risk factors such as smoking, high cholesterol, hypertension and inactivity get the nod for an additional 44% of the drop in coronary heart disease mortality, according to Earl S. Ford, M.D., M.P.H., of the National Center for Chronic Disease Prevention and Health Promotion, and colleagues.
But they also found that two major factors prevented the decreases in deaths from being even greater.
"Our analysis estimated that increases in the body-mass index accounted overall for about 26,000 additional deaths from coronary heart disease in 2000, and increases in the prevalence of diabetes for about 33,500 additional deaths; both figures are consistent with the results of other recent studies," they wrote. "Efforts to address these two risk factors should therefore receive particular attention in future measures to improve the public health."
The investigators used a previously validated statistical model called IMPACT to analyze the relative contributions of risk factor reduction, medical therapies, and interventions such as coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty to the decline in coronary disease-related deaths. The analyses were conducted at the University of Liverpool in England.
The difference between the expected and actual number of deaths from coronary heart disease in 2000 versus 1980 was distributed proportionally among the various treatments and risk factors included in the analyses.
They employed primarily data sources that were specific to the U.S. population, using the most up-to-date, least biased, and most representative sources whenever possible.
They found that the age-adjusted death rate for coronary heart disease among men fell from 542.9 deaths per 100,000 in 1980 to 266.8 per 100,000 in 2000. Among women, the rate fell from 263.3 per 100,000 in 1980 to 134.4 deaths per 100,000 in 2000. The total difference in observed vs. expected deaths in 2000 was 341,745.
About 47% of the decrease (159,330 fewer deaths) was attributed to treatments as follows:
Secondary preventive therapies after myocardial infarction or revascularization, 11%
Initial treatments for acute myocardial infarction or unstable angina 10%,
Treatments for heart failure, 9%
Revascularization for chronic angina, 5%,
Other therapies 12%.
An additional 44% of the drop could be attributed to the following changes in risk factors (numbers represent percentage of total reduction, and overlap):
Reductions in total cholesterol, 24%,
Decrease in systolic blood pressure, 20%,
Decline in smoking prevalence, 12%
Reduction in physical inactivity, 5%.
Progress in risk factor reductions was partially offset, however, by an 8% increase in body-mass index over the two decades, by a 10% rise in the prevalence of diabetes, the authors noted.
"Irrespective of the assumptions used, we found that the largest contributions from medical therapies consistently came from secondary prevention, followed by treatments for acute coronary syndromes, then heart failure," they wrote. "Revascularization by means of CABG or angioplasty for stable or unstable disease together accounted for approximately 7% of the overall drop in deaths from coronary heart disease, a finding that is consistent with the results of previous studies in the United States and elsewhere."
They noted that possible study limitations included the use of data from various sources, including some studies that might have been limited by ethnic, geographic, or selections biases. They also noted that most of varying quality o and the averaging of interactions across broad groups, although the analyses were limited only to reductions in deaths, and did not include quality-of-life measures.
Monday, March 12, 2007
Diabetes and Severe Depression Raise Risk of Cardiac Mortality
Among patients with coronary artery disease, comorbid diabetes or depression increases the risk of dying from heart disease.
The risk is even higher when both diabetes and severe depression are present, investigators report today at the annual meeting of the American Psychosomatic Society in Budapest, Hungary.
Senior investigator Dr. Lana L. Watkins said her team's interest was roused by recent findings from the National Health and Nutrition Examination Survey (NHANES), which showed that symptoms of depression increase the risk associated with diabetes.
"We wanted to know if these findings would also hold true for patients with coronary artery disease," Dr. Watkins told Reuters Health.
http://www.medscape.com/viewarticle/553389?sssdmh=dm1.253904&src=nldne
The risk is even higher when both diabetes and severe depression are present, investigators report today at the annual meeting of the American Psychosomatic Society in Budapest, Hungary.
Senior investigator Dr. Lana L. Watkins said her team's interest was roused by recent findings from the National Health and Nutrition Examination Survey (NHANES), which showed that symptoms of depression increase the risk associated with diabetes.
"We wanted to know if these findings would also hold true for patients with coronary artery disease," Dr. Watkins told Reuters Health.
http://www.medscape.com/viewarticle/553389?sssdmh=dm1.253904&src=nldne
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