Digital health intervention during cardiac rehabilitation: A randomized controlled trial Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. Leisure time physical activity and long-term cardiovascular and cancer outcomes: the Busselton Health Study The relationship of fibrinogen and factors VII and VIII to incident cardiovascular disease and death in the elderly: results from the cardiovascular health study. High Diet Quality Is Associated with a Lower Risk of Cardiovascular Disease and All-Cause Mortality in Older Men123 Serial measures of circulating biomarkers of dairy fat and total and cause-specific mortality in older adults: the Cardiovascular Health Study. Dietary fried fish intake increases risk of CVD: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary Health Care project (SUPRIM). Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. What level of physical activity protects against premature cardiovascular death? The Caerphilly study Prognostic value of depression, anxiety, and anger in hospitalized cardiovascular disease patients for predicting adverse cardiac outcomes. Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms. Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: a nationwide cohort study. A cardiovascular disease policy model that predicts life expectancy taking into account socioeconomic deprivation Plasma total homocysteine: instigator or indicator of cardiovascular disease? Depression and cardiovascular sequelae in postmenopausal women. The Women's Health Initiative (WHI). Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50 225 walkers from 11 population British cohorts Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort. Sarcopenic Obesity and Risk of Cardiovascular Disease and Mortality: A Population-Based Cohort Study of Older Men
Background Digital health interventions ( DHI ) have been shown to improve intermediates of cardiovascular health , but their impact on cardiovascular ( CV ) outcomes has not been fully explored . The aim of this study was to determine whether DHI administered during cardiac rehabilitation ( CR ) would reduce CV‐related emergency department ( ED ) visits and rehospitalizations in patients after percutaneous coronary intervention ( PCI ) for acute coronary syndrome ( ACS ) . Methods We r and omized patients undergoing CR following ACS and PCI to st and ard CR ( n = 40 ) or CR + DHI ( n = 40 ) for 3 months with 3 patients withdrawing from CR prior to initiation in the treatment arm and 6 in the control group . The DHI incorporated an online and smartphone‐based CR platform asking the patients to report of dietary and exercise habits throughout CR as well as educational information toward patients ' healthy lifestyles . We obtained data regarding ED visits and rehospitalizations at 180 days , as well as other metrics of secondary CV prevention at baseline and 90 days . Results Baseline demographics were similar between the groups . The DHI + CR group had improved weight loss compared to the control group ( −5.1 ± 6.5 kg vs. −0.8 ± 3.8 kg , respectively , P = .02 ) . Those in the DHI + CR group also showed a non‐significant reduction in CV‐related rehospitalizations plus ED visits compared to the control group at 180 days ( 8.1 % vs 26.6 % ; RR 0.30 , 95 % CI 0.08‐1.10 , P = .054 ) . Conclusions The current study demonstrated that complementary DHI  significantly improves weight loss , and might offer a method to reduce CV‐related ED visits plus rehospitalizations in patients after ACS undergoing CR . The study suggests a role for DHI as an adjunct to CR to improve secondary prevention of CV disease . Trial registration This trial is registered at clinical trials.gov ( NCT01883050 ) Diets rich in fruits and vegetables have been of interest because of their potential health benefits against chronic diseases such as cardiovascular disease ( CVD ) and cancer . The aim of this work was to assess the association of the dietary intake of a food group that includes fruits , berries and vegetables with all-cause , CVD-related and non-CVD-related mortality .  The subjects were Finnish men aged 42 - 60 y examined in 1984 - 1989 in the prospect i ve Kuopio Ischaemic Heart Disease Risk Factor ( KIHD ) Study .  Dietary intakes were assessed by 4-d food intake record during the baseline phase of the KIHD Study . The risk of all-cause and non-CVD-related deaths was studied in 2641 men and the risk of CVD-related death in 1950 men who had no history of CVD at baseline . During a mean follow-up time of 12.8 y , cardiovascular as well as noncardiovascular and all-cause mortality were lower among men with the highest consumption of fruits , berries and vegetables . After adjustment for the major CVD risk factors , the relative risk for men in the highest fifth of fruit , berry and vegetable intake for all-cause death , CVD-related and non-CVD-related death was 0.66 [ 95 % confidence interval ( CI ) 0.50 - 0.88 ] , 0.59 ( 0.33 - 1.06 ) , and 0.68 ( 0.46 - 1.00 ) , respectively , compared with men in the lowest fifth . These data show that a high fruit , berry and vegetable intake is associated with reduced risk of mortality in middle-aged Finnish men . Consequently , the findings of this work indicate that diets that are rich in plant-derived foods can promote longevity Abstract The study aim ed to investigate whether meeting leisure time physical activity recommendations was associated with reduced incident and fatal cancer or cardiovascular disease ( CVD )  in a community-based cohort of middle- to late-aged adults with long-term follow-up . At baseline , 2,320 individuals were assessed on a large number of lifestyle and clinical parameters including their level of physical activity  per week , other risk factors ( e.g. smoking and alcohol use ) various anthropometric measures , blood tests and medical history . Individuals were linked to hospital and mortality registry data to identify future cancer and cardiovascular events ( fatal and non-fatal ) out to 15 years of follow-up . Cox regression analyses adjusted for relevant confounders identified a priori were used to estimate risk for all-cause , cancer-specific and CVD-specific mortality . In the full cohort an estimated 21 % decreased risk for all-cause mortality ( HR 0.79 ; 95 % CI 0.66–0.96 ) and 22 % decreased risk for fatal/non-fatal CVD events ( HR 0.78 ; 95 % CI 0.66–0.92 ) was associated with baseline self-reported physical activity levels of 150 min or more . After exclusion of those with chronic co-morbidities ( CVD , cancer , diabetes , chronic obstructive pulmonary disease , hypertension treatment ) at baseline , lower risk for fatal/non-fatal CVD events remained significantly associated with 150 min or more of physical activity ( HR 0.77 ; 95 % CI 0.62–0.96 ) . Results from this well established prospect i ve community-based cohort study support the role of leisure time physical activity in reducing all-cause mortality and CVD events ( fatal/nonfatal ) in the broader population studied . The data also suggest that physical activity associated reductions in risk for CVD events ( fatal/nonfatal ) were not overly impacted by prevalent key non-communicable diseases Little is known about the prospect i ve associations of fibrinogen , factor VII , or factor VIII with  cardiovascular disease ( CVD ) and mortality in the elderly . At baseline in the Cardiovascular Health Study ( 5888 white and African American men and women ; aged > /=65 years ) , we measured  fibrinogen , factor VIII , and factor VII .  We used sex-stratified stepwise Cox survival analysis to determine relative risks ( RRs ) for CVD events and all-cause mortality ( up to 5 years of follow-up ) , both unadjusted and adjusted for CVD risk factors and sub clinical CVD . After adjustment , comparing the fifth quintile to the first , fibrinogen was significantly associated in men with coronary heart disease events ( RR=2.1 ) and stroke or transient ischemic attack ( RR=1.3 ) , and also with mortality within 2.5 years of follow-up ( RR=5.8 ) and later ( RR=1.7 ) . Factor VIII was significantly associated in men with coronary heart disease events ( RR=1.5 ) and mortality ( RR=1.8 ) , and in women with stroke/transient ischemic attack ( RR=1.4 ) . For both factors , values were higher in those who died , whether causes were CVD-related or non-CVD-related , but highest in CVD death . Factor VII exhibited associations with incident angina ( RR=1.44 ) in men and with death in women ( RR , middle quintile compared with first=0.66 ) . However , in general , factor VII was not consistently associated with CVD events in this population . We conclude that , if confirmed in other studies , the measurement of fibrinogen and /or factor VIII may help identify older individuals at higher risk for CVD events and mortality Although diet quality is implicated in cardiovascular disease ( CVD ) risk , few studies have investigated the relation between diet quality and the risks of  CVD and mortality in older adults . This study examined the prospect i ve associations between dietary scores and risk of CVD and all-cause mortality in older British men . A total of 3328 men ( aged 60–79 y ) from the British Regional Heart Study , free from CVD at baseline , were followed up for 11.3 y for CVD and mortality . Baseline food-frequency question naire data were used to generate 2 dietary scores :  the Healthy Diet Indicator ( HDI ) , based on WHO dietary guidelines , and the Elderly Dietary Index ( EDI ) , based on a Mediterranean-style dietary intake , with higher scores indicating greater compliance with dietary recommendations . Cox proportional hazards regression analyses assessed associations between quartiles of HDI and EDI and risk of all-cause mortality , CVD mortality , CVD events , and coronary heart disease ( CHD ) events . During follow-up , 933 deaths , 327 CVD deaths , 582 CVD events , and 307 CHD events occurred . Men in the highest compared with the lowest EDI quartile had significantly lower risks of all-cause mortality ( HR : 0.75 ; 95 % CI : 0.60 , 0.94 ; P-trend = 0.03 ) , CVD mortality ( HR : 0.63 ; 95 % CI : 0.42 , 0.94 ; P-trend = 0.03 ) , and CHD events ( HR : 0.66 ; 95 % CI : 0.45 , 0.97 ; P-trend = 0.05 ) but not CVD events ( HR : 0.79 ; 95 % CI : 0.60 , 1.05 ; P-trend = 0.16 ) after adjustment for sociodemographic , behavioral , and cardiovascular risk factors . The HDI was not significantly associated with any of the outcomes . The EDI appears to be more useful than the HDI for assessing diet quality in relation to CVD and morality risk  in older men . Encouraging older adults to adhere to the guidelines inherent in the EDI criteria may have public health benefits Background Controversy has emerged about the benefits compared with harms of dairy fat , including concerns over long-term effects . Previous observational studies have assessed self-reported estimates of consumption or a single biomarker measure at baseline , which may lead to suboptimal estimation of true risk . Objective The aim of this study was to investigate prospect i ve associations of serial measures of plasma phospholipid fatty acids pentadecanoic ( 15:0 ) , heptadecanoic ( 17:0 ) , and trans-palmitoleic ( trans-16:1n-7 ) acids with total mortality , cause-specific mortality  , and cardiovascular disease ( CVD ) risk among older adults . Design Among 2907 US adults aged ≥65 y and free of CVD at baseline , circulating fatty acid concentrations were measured serially at baseline , 6 y , and 13 y. Deaths and CVD events were assessed and adjudicated central ly . Prospect i ve associations were assessed by multivariate-adjusted Cox models incorporating time-dependent exposures and covariates . Results During 22 y of follow-up , 2428 deaths occurred , including 833 from CVD , 1595 from non-CVD causes , and 1301 incident CVD events . In multivariable models , circulating pentadecanoic , heptadecanoic , and trans-palmitoleic acids were not significantly associated with total mortality , with extreme-quintile HRs of 1.05 for pentadecanoic ( 95 % CI : 0.91 , 1.22 ) , 1.07 for heptadecanoic ( 95 % CI : 0.93 , 1.23 ) , and 1.05 for trans-palmitoleic ( 95 % CI : 0.91 , 1.20 ) acids . Circulating heptadecanoic acid was associated with lower CVD mortality ( extreme-quintile HR : 0.77 ; 95 % CI : 0.61 , 0.98 ) , especially stroke mortality , with a 42 % lower risk when comparing extreme quintiles of heptadecanoic acid concentrations ( HR : 0.58 ; 95 % CI : 0.35 , 0.97 ) . In contrast , heptadecanoic acid was associated with a higher risk of non-CVD mortality ( HR : 1.27 ; 95 % CI : 1.07 , 1.52 ) , which was not clearly related to any single subtype of non-CVD death . No significant associations of pentadecanoic , heptadecanoic , or trans-palmitoleic acids were seen for total incident CVD , coronary heart disease , or stroke . Conclusions Long-term exposure to circulating phospholipid pentadecanoic , heptadecanoic , or trans-palmitoleic acids was not significantly associated with total mortality or incident CVD among older adults . High circulating heptadecanoic acid was inversely associated with CVD and stroke mortality and potentially associated with higher risk of non-CVD death OBJECTIVE The objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality . DESIGN Prospect i ve cohort study among participants of the REasons for Geographic And Racial Differences in Stroke ( REGARDS ) study who resided in the USA . SETTING The primary outcome measures included the hazard ratios ( HR ) of incident CVD including first incident fatal or non-fatal ischaemic stroke or myocardial infa rct ion and all-cause mortality , based on cumulative average fish consumption ascertained at baseline . SUBJECTS Participants ( n 16 479 ) were enrolled between 2003 and 2007 , completed the self-administered Block98 FFQ and were free of CVD at baseline . RESULTS There were 700 cardiovascular events over a mean follow-up of 5·1 years . After adjustment for sociodemographic variables , health behaviours and other CVD risk factors , participants eating ≥2 servings fried fish/week ( v. < 1 serving/month ) were at a significantly increased risk of cardiovascular events ( HR=1·63 ; 95 % CI 1·11 , 2·40 ) . Intake of non-fried fish was not associated with risk of incident CVD . There was no association found with dietary fried or non-fried fish intake and cardiovascular or all-cause mortality . CONCLUSIONS Fried fish intake of two or more servings per week is associated with an increased risk of cardiovascular events . Given the increased intake of fried fish in the stroke belt and among African Americans , these data suggest that dietary fried fish intake may contribute to geographic and racial disparities in CVD BACKGROUND Psychosocial factors are independently associated with increased risk of cardiovascular disease ( CVD ) morbidity and mortality , but the effects of psychosocial factor intervention on CVD are uncertain . We performed a r and omized controlled clinical trial of cognitive behavioral therapy ( CBT ) to measure its effects on CVD recurrence . METHODS The study included 362 women and men 75 years or younger who were discharged from the hospital after a coronary heart disease event within the past 12 months . Patients were r and omized to receive traditional care  ( reference group , 170 patients ) or traditional care plus a CBT program ( intervention group , 192 patients ) , focused on stress management , with 20 two-hour sessions during 1 year . Median attendance at each CBT session was 85 % . Outcome variables were all-cause mortality , hospital admission for recurrent CVD , and recurrent acute myocardial infa rct ion . RESULTS During a mean 94 months of follow-up , the intervention group had a 41 % lower rate of fatal and nonfatal first recurrent CVD events ( hazard ratio [ 95 % confidence interval ] , 0.59 [ 0.42 - 0.83 ] ; P = .002 ) , 45 % fewer recurrent acute myocardial infa rct ions ( 0.55 [ 0.36 - 0.85 ] ; P = .007 ) , and a nonsignificant 28 % lower all-cause mortality ( 0.72 [ 0.40 - 1.30 ] ; P = .28 ) than the reference group after adjustment for other outcome -affecting variables . In the CBT group there was a strong dose-response effect between intervention group attendance and outcome . During the first 2 years of follow-up , there were no significant group differences in traditional risk factors . CONCLUSIONS A CBT intervention program decreases the risk of recurrent CVD and recurrent acute myocardial infa rct ion . This may have implication s for secondary preventive programs in patients with coronary heart disease . Trial Registration clinical trials.gov Identifier : NCT00888485 OBJECTIVE The association between hyperuricemia and cardiovascular events has been documented in high-risk groups , but is still undetermined in general population s , especially Chinese . This study assessed the temporal association between serum uric acid level , hyperuricemia , and cardiovascular mortality . METHODS A prospect i ve cohort study of 41,879 men and 48,514 women ages > or = 35 years was conducted using data from the MJ Health Screening Centers in Taiwan .  Mortality from all causes , total cardiovascular disease ( CVD ) , ischemic stroke , congestive heart failure , hypertensive disease , and coronary heart disease were compared according to increasing serum uric acid levels . RESULTS A total of 1,151 ( 21.2 % ) events of 5,427 total deaths were ascribed to CVD ( mean followup 8.2 years ) . Hazard ratios ( HRs ) for hyperuricemia ( serum uric acid level > 7 mg/dl ) were estimated with Cox regression model after adjusting for age , sex , body mass index , cholesterol , triglycerides , diabetes , hypertension , heavy cigarette smoking , and frequent alcohol consumption . In all patients , HRs were 1.16 ( P < 0.001 ) for all-cause mortality , 1.39 ( P < 0.001 ) for total CVD , and 1.35 ( P = 0.02 ) for ischemic stroke . In subgroup analysis , the HRs for cardiovascular risk remained significant in patients with hypertension ( 1.44 , P < 0.001 ) and in patients with diabetes ( 1.64 , P < 0.001 ) . In addition , in a low metabolic risk subgroup , the HRs for all-cause mortality and total cardiovascular morbidity were 1.24 ( P = 0.02 ) and 1.48 ( P = 0.16 ) , respectively . CONCLUSION Hyperuricemia was an independent risk factor of mortality from all causes , total CVD , and ischemic stroke in the Taiwanese general population , in high-risk groups , and potentially in low-risk groups IMPORTANCE Sauna bathing is a health habit associated with better hemodynamic function ; however , the association of sauna bathing with cardiovascular and all-cause mortality is not known . OBJECTIVE To investigate the association of frequency and duration of sauna bathing with the risk of sudden cardiac death ( SCD ) , fatal coronary heart disease ( CHD ) , fatal cardiovascular disease ( CVD ) , and all-cause mortality . DESIGN , SETTING , AND PARTICIPANTS We performed a prospect i ve cohort study ( Finnish Kuopio Ischemic Heart Disease Risk Factor Study ) of a population -based sample of 2315 middle-aged ( age range , 42 - 60 years ) men from Eastern Finl and . Baseline examinations were conducted from March 1 , 1984 , through December 31 , 1989 . EXPOSURES Frequency and duration of sauna bathing assessed at baseline . RESULTS During a median follow-up of 20.7 years ( interquartile range , 18.1 - 22.6 years ) , 190 SCDs , 281 fatal CHDs , 407 fatal CVDs , and 929 all-cause mortality events occurred . A total of 601 , 1513 , and 201 participants reported having a sauna bathing session 1 time per week , 2 to 3 times per week , and 4 to 7 times per week , respectively . The numbers ( percentages ) of SCDs were 61 ( 10.1 % ) , 119 ( 7.8 % ) , and 10 ( 5.0 % ) in the 3 groups of the frequency of sauna bathing . The respective numbers were 89 ( 14.9 % ) , 175 ( 11.5 % ) , and 17 ( 8.5 % ) for fatal CHDs ; 134 ( 22.3 % ) , 249 ( 16.4 % ) , and 24 ( 12.0 % ) for fatal CVDs ; and 295 ( 49.1 % ) , 572 ( 37.8 % ) , and 62 ( 30.8 % ) for all-cause mortality events . After adjustment for CVD risk factors , compared with men with 1 sauna bathing session per week , the hazard ratio of SCD was 0.78 ( 95 % CI , 0.57 - 1.07 ) for 2 to 3 sauna bathing sessions per week and 0.37 ( 95 % CI , 0.18 - 0.75 ) for 4 to 7 sauna bathing sessions per week ( P for trend = .005 ) . Similar associations were found with CHD , CVD , and all-cause mortality ( P for trend ≤.005 ) . Compared with men having a sauna bathing session of less than 11 minutes , the adjusted hazard ratio for SCD was 0.93 ( 95 % CI , 0.67 - 1.28 ) for sauna bathing sessions of 11 to 19 minutes and 0.48 ( 95 % CI , 0.31 - 0.75 ) for sessions lasting more than 19 minutes ( P for trend = .002 ) ; significant inverse associations were also observed for fatal CHDs and fatal CVDs ( P for trend ≤.03 ) but not for all-cause mortality events . CONCLUSIONS AND RELEVANCE Increased frequency of sauna bathing is associated with a reduced risk of SCD , CHD , CVD , and all-cause mortality . Further studies are warranted to establish the potential mechanism that links sauna bathing and cardiovascular health CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with the metabolic syndrome and , consequently , with a potentially increased risk of cardiovascular disease ( CVD ) and related mortality later in life . Studies regarding CVD and mortality in PCOS women well into the postmenopausal age are lacking . OBJECTIVE Our objective was to examine whether postmenopausal PCOS women differ from controls regarding cardiovascular risk factors , myocardial infa rct ion ( MI ) , stroke and mortality . DESIGN AND SETTING We conducted , at a university hospital , a prospect i ve study of 35 PCOS women ( 61 - 79 yr ) and 120 age-matched controls . The study was performed 21 yr after the initial study . PARTICIPANTS Twenty-five PCOS women ( Rotterdam criteria ) and 68 controls participated in all examinations . Data on morbidity were based on 32 of 34 PCOS women and on 95 of 119 controls . INTERVENTIONS INTERVENTIONS included reexamination , interviews , and data from the National Board of Health and Welfare and from the Hospital Discharge Registry . MAIN OUTCOME MEASURES Blood pressure , glucose , insulin , triglycerides , total cholesterol , high- and low-density lipoprotein , apolipoprotein A1 and B , fibrinogen , and plasminogen activator inhibitor antigen were studied . Incidences of MI , stroke , hypertension , diabetes , cancer , cause of death , and age at death were recorded . RESULTS PCOS women had a higher prevalence of hypertension ( P = 0.008 ) and higher triglyceride levels ( P = 0.012 ) than controls . MI , stroke , diabetes , cancer , and mortality prevalence was similar in the two cohorts with similar body mass index . CONCLUSIONS The well-described cardiovascular/metabolic risk profile in pre- and perimenopausal PCOS women does not entail an evident increase in cardiovascular events during the postmenopausal period Objective : To examine the optimal intensity of leisure time physical activity ( LTPA ) to decrease the risk of all cause , cardiovascular disease ( CVD ) , and coronary heart disease ( CHD ) mortality in a population sample of middle aged British men . Design : Prospect i ve study of middle aged men with an 11 year follow up . Setting : A whole population sample of men from Caerphilly , South Wales , UK . Subjects : 1975 men aged 49–64 years without historical or clinical evidence of CHD at baseline examination . Main outcome measures : All cause , CVD , and CHD mortality . Results : Total ( cumulative ) LTPA had a grade d , significant relation with all cause , CVD , and CHD mortality but no trend with cancer deaths . When different intensities of activity were considered , light and moderate intensity LTPA had inconsistent and non-significant relations with all cause , CVD , or CHD mortality whether adjusted only for age or for other cardiovascular risk factors . In contrast a significant dose – response relation was found for heavy intensity LTPA for all cause , CVD , and CHD mortality fully adjusted for other risk factors . Conclusions : These data suggest that , in a population of men without evidence of CHD at baseline , only leisure exercise classified as heavy or vigorous was independently associated with reduced risk of premature death from CVD Although attention has recently been focused on the role of psychosocial factors in patients with cardiovascular disease ( CVD ) , the factors that have the greatest influence on prognosis have not yet been eluci date d. The aim of this study was to evaluate the effects of depression , anxiety , and anger on the prognosis of patients with CVD . Four hundred fourteen consecutive patients hospitalized with CVD were prospect ively enrolled .  Depression was evaluated using the Patient Health Question naire , anxiety using the Generalized Anxiety Disorder Question naire , and anger using the Spielberger Trait Anger Scale .  Cox proportional-hazards regression was used to examine the individual effects of depression , anxiety , and anger on a combined primary end point of cardiac death or cardiac hospitalization and on a combined secondary end point of all-cause death or hospitalization during follow-up ( median 14.2 months ) . Multivariate analysis showed that depression was a significant risk factor for cardiovascular hospitalization or death after adjusting for cardiac risk factors and other psychosocial factors ( hazard ratio 2.62 , p = 0.02 ) , whereas anxiety was not significantly associated with cardiovascular hospitalization or death after adjustment ( hazard ratio 2.35 , p = 0.10 ) . Anger was associated with a low rate of cardiovascular hospitalization or death ( hazard ratio 0.34 , p < 0.01 ) . In conclusion , depression in hospitalized patients with CVD is a stronger independent risk factor for adverse cardiac events than either anxiety or anger . Anger may help prevent adverse outcomes . Routine screening for depression should therefore be performed in patients with CVD , and the potential effects of anger in clinical practice should be reconsidered OBJECTIVES This study sought to estimate the extent to which behavioral and pathophysiological risk factors account for the association between  psychological distress  and incident cardiovascular events . BACKGROUND The intermediate processes through which psychological distress increases the risk of cardiovascular disease ( CVD ) are incompletely understood . An underst and ing of these processes is important for treating psychological distress in an attempt to reduce CVD risk . METHODS In a prospect i ve study of 6,576 healthy men and women ( ages 50.9 + /- 13.1 years ) , we measured psychological distress ( using the 12-item version of the General Health Question naire > or=4 ) and behavioral ( smoking , alcohol , physical activity ) and pathophysiological ( C-reactive protein , fibrinogen , total and high-density lipoprotein cholesterol , obesity , hypertension ) risk factors at baseline . The main outcome was CVD events ( hospitalization for nonfatal myocardial infa rct ion , coronary artery bypass , angioplasty , stroke , heart failure , and CVD-related mortality ) . RESULTS Cigarette smoking , physical activity , alcohol intake , C-reactive protein , and hypertension were independently associated with psychological distress . There were 223 incident CVD events ( 63 fatal ) over an average follow-up of 7.2 years . The risk of CVD increased in relation to presence of psychological distress in age- and sex-adjusted models ( hazard ratio : 1.54 , 95 % confidence interval : 1.09 to 2.18 , p = 0.013 ) . In models that were adjusted for potential mediators , behavioral factors explained the largest proportion of variance ( approximately 65 % ) , whereas pathophysiological factors accounted for a modest amount ( C-reactive protein approximately 5.5 % , hypertension , approximately 13 % ) . CONCLUSIONS The association between psychological distress and CVD risk is largely explained by behavioral processes . Therefore , treatment of psychological distress that aims to reduce CVD risk should primarily focus on health behavior change Objectives In many current guidelines , blood pressure (BP)-lowering drug treatment for primary prevention of cardiovascular disease ( CVD ) is based on absolute risk . However , in clinical practice , therapeutic decisions are often based on BP levels alone . We sought to investigate which approach was superior by conducting a post hoc analysis of the Australian National Blood Pressure ( ANBP ) cohort , a seminal study establishing the efficacy of BP lowering in ‘ mild hypertensive ’ persons . Design A post hoc subgroup analysis of the ANBP trial results by baseline absolute risk tertile . Setting and participants 3244 participants aged 35–69 years in a community-based r and omised placebo controlled trial of blood pressure-lowering medication . Interventions Chlorothiazide500 mg versus placebo . Primary outcome measures All-cause mortality and non-fatal events ( non-fatal CVD , congestive cardiac failure , renal failure , hypertensive retinopathy or encephalopathy ) . Results Treatment effects were assessed by HR , absolute risk reduction and number needed to treat . Participants had an average 5-year CVD risk in the intermediate range ( 10.5±6.5 ) with moderately elevated BP ( mean 159/103 mmHg ) and were middle aged ( 52±8 years ) . In a subgroup analysis , the relative effects ( HR ) and absolute effects ( absolute risk reduction and number needed to treat ) did not statistically differ across the three risk groups except for the absolute benefit in all-cause mortality ( p for heterogeneity=0.04 ) . With respect to absolute benefit , drug treatment significantly reduced the number of events in the high-risk group regarding any event with a number needed to treat of 18 ( 10 to 64 ) , death from any cause with 45 ( 25 to 196 ) and major CVD events with 23 ( 12 to 193 ) . Conclusion Our analysis confirms that the benefit of treatment was substantial only in the high-risk tertile , reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation OBJECTIVE To determine whether a  cardiovascular disease ( CVD ) health screening program is associated with CVD-related health conditions , incidence of cardiovascular events , mortality , healthcare utilization , and costs . METHODS Cohort study of a 3 % r and om sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted . A total 443,337 study participants were followed-up from January 1 , 2005 through December 31 , 2010 . RESULTS In primary analysis , the hazard ratios for CVD mortality , all-cause mortality , incident composite CVD events , myocardial infa rct ion , cerebral infa rct ion , and cerebral hemorrhage comparing participants who attended a screening exam during 2003 - 2004 compared to those who did not were 0.58 ( 95 % CI : 0.53 - 0.63 ) , 0.62 ( 95 % CI : 0.60 - 0.64 ) , 0.82 ( 95 % CI : 0.78 - 0.85 ) , 0.84 ( 95 % CI : 0.75 - 0.93 ) , 0.84 ( 95 % CI : 0.79 - 0.89 ) , and 0.73 ( 95 % CI : 0.67 - 0.80 ) , respectively . Screening attenders had higher rates of newly diagnosed hypertension , diabetes mellitus , and dyslipidemia , lower inpatient days of stay and cost , and lower outpatient cost compared to non-attenders . CONCLUSIONS Participation in CVD health screening was associated with lower rates of CVD , all-cause mortality , and CVD events , higher detection of CVD-related health conditions , and lower healthcare utilization and costs Objectives A policy model is a model that can evaluate the effectiveness and cost-effectiveness of interventions and inform policy decisions . In this study , we introduce a cardiovascular disease ( CVD ) policy model which can be used to model remaining life expectancy including a measure of socioeconomic deprivation as an independent risk factor for CVD . Design A state transition model was developed using the Scottish Heart Health Extended Cohort ( SHHEC ) linked to Scottish morbidity and death records . Individuals start in a CVD-free state and can transit to three CVD event states plus a non-CVD death state . Individuals who have a non-fatal first event are then followed up until death . Taking a competing risk approach , the cause-specific hazards of a first event are modelled using parametric survival analysis . Survival following a first non-fatal event is also modelled parametrically . We assessed discrimination , validation and calibration of our model . Results Our model achieved a good level of discrimination in each component ( c-statistics for men (women)—non-fatal coronary heart disease ( CHD ) : 0.70 ( 0.74 ) , non-fatal cerebrovascular disease ( CBVD ) : 0.73 ( 0.76 ) , fatal CVD : 0.77 ( 0.80 ) , fatal non-CVD : 0.74 ( 0.72 ) , survival after non-fatal CHD : 0.68 ( 0.67 ) and survival after non-fatal CBVD : 0.65 ( 0.66 ) ) . In general , our model predictions were comparable with observed event rates for a Scottish r and omised statin trial population which has an overlapping follow-up period with SHHEC . After applying a calibration factor , our predictions of life expectancy closely match those published in recent national life tables . Conclusions Our model can be used to estimate the impact of primary prevention interventions on life expectancy and can assess the impact of interventions on inequalities Abstract Cardiovascular disease ( CVD ) is a major cause of morbidity and mortality in developed countries . However , traditional risk factors can not fully account for this . In the last 20 years , there has been an explosion of interest in plasma total homocysteine ( tHcy ) as a potential modifiable risk factor for CVD . Recent meta-analyses of epidemiological studies support the concept that increased tHcy concentrations are associated with CVD . This has led to the ‘ homocysteine hypothesis ’ , which states that lowering plasma tHcy using folic acid and other B-vitamins will reduce the risk of CVD . In experimental studies , homocysteine has been shown to cause oxidative stress , endothelial cell dysfunction and promote thrombogenesis . However , data from recent large r and omized controlled trials have shown that there is no clinical benefit to lowering plasma tHcy concentrations with folic acid and other B-vitamins . This lack of effect of tHcy lowering strongly suggests that homocysteine is not an instigator but merely an indicator of CVD BACKGROUND Sub clinical depression , often clinical ly unrecognized , may pose increased risk of cardiovascular disease . Few studies have prospect ively investigated cardiovascular events related to depression in older women . We describe prevalence , cardiovascular correlates , and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women . METHODS The Women 's Health Initiative Observational Study followed up 93 676 women for an average of 4.1 years .  Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale .  Risks of cardiovascular disease ( CVD ) events were estimated from Cox proportional hazards models adjusting for multiple demographic , clinical , and risk factor covariates . RESULTS Current depressive symptoms above the screening cutoff point were reported by 15.8 % of women . Depression was significantly related to CVD risk and comorbidity ( odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina ) . Among women with no history of CVD , depression was an independent predictor of CVD death ( relative risk , 1.50 ) and all-cause mortality ( relative risk , 1.32 ) after adjustment for age , race , education , income , diabetes , hypertension , smoking , high cholesterol level requiring medication , body mass index , and physical activity . Taking antidepressant medications did not alter the depression-associated risks associated . CONCLUSIONS A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality , even after controlling for established CVD risk factors . Whether early recognition and treatment of sub clinical depression will lower CVD risk remains to be determined in clinical trials Background / objectives Walking pace is associated with risk of premature mortality . However , whether this relationship is independent of total volume of physical activity and highest physical activity intensity remains unclear . We examined the associations between  walking pace  and cause-specific mortality , investigating the potential modifying effect of factors such as total physical activity volume , highest physical activity intensity , age , sex and body mass index ( BMI ) . Methods Prospect i ve pooled analysis of 11 population -based baseline surveys in Engl and and Scotl and between 1994 and 2008 that were linked with mortality records . Multivariate-adjusted Cox proportional hazards models examined associations between  walking pace  ( slow , average , brisk/fast ) and all-cause , cancer and cardiovascular disease ( CVD ) mortality . Results 50 225 walkers were entered in the core analyses . Among participants who did not experience an event in the first 2 years of follow-up ( n=49 731 ) , walking at an average or brisk/fast pace was associated with a reduced risk of all-cause ( 20 % ( 95 % CI 12 % to 28 % ) and 24 % ( 95 % CI 13 % to 33 % ) , respectively ) and CVD mortality ( 24 % ( 95 % CI 9 % to 36 % ) and 21 % ( 95 % CI 1 % to 38 % ) , respectively ) , compared with reporting walking at a slow pace . In stratified analyses , such associations were evident among those over 50 years , those not meeting the physical activity recommendations and those who did not undertake vigorous-intensity activity . There were no interactions by sex or BMI . No associations were seen between pace and cancer mortality . Conclusion Walking benefits health . Assuming causality , these analyses suggest that increasing walking pace could reduce risk for all-cause and CVD mortality .  Walking pace could be emphasised in public health messages , especially in situations when increase in walking volume or frequency is less feasible BACKGROUND Studies suggest that moderate drinkers have lower cardiovascular disease ( CVD ) mortality than nondrinkers and heavy drinkers , but there have been no r and omized trials on this topic . Although most observational studies control for major cardiac risk factors , CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking . METHODS Data from the 2003 Behavioral Risk Factor Surveillance System , a population -based telephone survey of U.S. adults , was used to assess the prevalence of CVD risk factors and potential confounders among  moderate drinkers and nondrinkers . Moderate drinkers were defined as men who drank an average of two drinks per day or fewer , or women who drank one drink or fewer per day . RESULTS After adjusting for age and gender , nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors , social factors , behavioral factors , access to health care , and health-related conditions . Of the 30 CVD-associated factors or groups of factors that we assessed , 27 ( 90 % ) were significantly more prevalent among nondrinkers . Among factors with multiple categories ( e.g. , body weight ) , those in higher-risk groups were progressively more likely to be nondrinkers . Removing those with poor health status or a history of CVD did not affect the results . CONCLUSIONS These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding . Given their limitations , nonr and omized studies about the health effects of moderate drinking should be interpreted with caution , particularly since excessive alcohol consumption is a leading health hazard in the United States OBJECTIVE Limited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes . However , most of these were in population s with pre-existing cardiovascular diseases ( CVD ) and studies in general population are lacking . METHODS The study included 11,153 participants in a population -based , prospect i ve cohort study in Araihazar , Bangladesh .  Resting blood pressure was measured at baseline and every two years thereafter . Participants were followed up for an average of 6.5 years ( 2002 - 2009 ) . RESULTS Male gender , older age , baseline systolic blood pressure ( SBP ) , and absence of betel leaf use were independently positively associated with greater SBP variability over time . There was a significant association between SBP variability and the risk of death from overall CVD , especially from major CVD events . The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models . In addition , the hazard ratio ( HR ) of stroke mortality was greater for individuals with both high baseline and high SBP variability . Similar patterns of HRs were observed for all-cause and CVD mortalities . CONCLUSION In this rural Bangladeshi population , variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP Objectives To examine associations between sarcopenia , obesity , and sarcopenic obesity and risk of cardiovascular disease ( CVD ) and all-cause mortality in older men . Design Prospect i ve cohort study . Setting British Regional Heart Study . Participants Men aged 60–79 years ( n = 4,252 ) . Measurements Baseline waist circumference ( WC ) and midarm muscle circumference ( MAMC ) measurements  were used to classify participants into four groups : sarcopenic , obese , sarcopenic obese , or optimal WC and MAMC . The cohort was followed for a mean of 11.3 years for CVD and all-cause mortality . Cox regression analyses assessed associations between sarcopenic obesity groups and all-cause mortality , CVD mortality , CVD events , and coronary heart disease ( CHD ) events . Results There were 1,314 deaths , 518 CVD deaths , 852 CVD events , and 458 CHD events during follow-up . All-cause mortality risk was significantly greater in sarcopenic ( HR = 1.41 , 95 % CI = 1.22–1.63 ) and obese ( HR = 1.21 , 95 % CI = 1.03–1.42 ) men than in the optimal reference group , with the highest risk in sarcopenic obese ( HR = 1.72 , 95 % CI = 1.35–2.18 ) , after adjustment for lifestyle characteristics . Risk of CVD mortality was significantly greater in sarcopenic and obese but not sarcopenic obese men . No association was seen between sarcopenic obesity groups and CHD or CVD events . Conclusion Sarcopenia and central adiposity were associated with greater cardiovascular mortality and all-cause mortality . Sarcopenic obese men had the highest risk of all-cause mortality but not CVD mortality . Efforts to promote healthy aging should focus on preventing obesity and maintaining muscle mass
Overall , these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a positive impact on risk factors for CVD
OBJECTIVE To assess the potential benefit of digital health interventions ( DHIs ) on  cardiovascular disease ( CVD ) outcomes ( CVD events , all-cause mortality , hospitalizations ) and risk factors compared with non-DHIs .