Summary Background Elevated blood pressure and glucose, serum cholesterol, and body mass index (BMI) are risk factors for cardiovascular diseases (CVDs); some of these factors also increase the risk of chronic kidney disease (CKD) and diabetes. We estimated CVD, CKD, and diabetes mortality attributable to these four cardio-metabolic risk factors for all countries and regions between 1980 and 2010. Methods We used data on risk factor exposure by country, age group, and sex from pooled analysis of population-based health surveys. Relative risks for cause-specific mortality were obtained from pooling of large prospective studies. We calculated the population attributable fractions (PAF) for each risk factor alone, and for the combination of all risk factors, accounting for multi-causality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific PAFs by the number of disease-specific deaths from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all inputs to the final estimates. Findings In 2010, high blood pressure was the leading risk factor for dying from CVDs, CKD, and diabetes in every region, causing over 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths; and cholesterol for 10%. After accounting for multi-causality, 63% (10.8 million deaths; 95% confidence interval 10.1–11.5) of deaths from these diseases were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7.1 million deaths; 6.6–7.6) in 1980. The mortality burden of high BMI and glucose nearly doubled between 1980 and 2010. At the country level, age-standardised death rates attributable to these four risk factors surpassed 925 deaths per 100,000 among men in Belarus, Mongolia, and Kazakhstan, but were below 130 deaths per 100,000 for women and below 200 for men in some high-income countries like Japan, Singapore, South Korea, France, Spain, The Netherlands, Australia, and Canada. Interpretations The salient features of the cardio-metabolic epidemic at the beginning of the twenty-first century are the large role of high blood pressure and an increasing impact of obesity and diabetes. There has been a shift in the mortality burden from high-income to low- and middle-income countries.
Our data showed that cardiovascular risk factors were strongly related to carotid atherosclerosis and that the proportion of severe carotid atherosclerosis with >50% stenosis was not low and was almost equal to that reported in developed western countries.
MD; for the JPHC Study GroupBackground and Purpose-The impact of light-to-moderate alcohol consumption on risk of stroke has not been well examined in a single study, although the effect is hypothesized to differ among stroke subtypes from meta-analyses. Methods-A total of 19 544 men aged 40 to 59 years living in communities were followed-up from 1990 to 1992 to the end of 2001 in the Japan Public Health Center-based Prospective Study on Cancer and Cardiovascular Disease (JPHC Study). Results-After 214 504 person-years of follow-up, 694 incident strokes were documented, of which 611 were confirmed by imaging studies or autopsy, including 219 intraparenchymal hemorrhages, 73 subarachnoid hemorrhages, and 319 ischemic strokes. Alcohol consumption was positively associated with age-adjusted risk of total stroke with a 68% excess risk among drinkers of Ն450 g ethanol per week compared with occasional drinkers. This excess risk was confined primarily to hemorrhagic stroke, which remained statistically significant even after controlling for hypertension and other cardiovascular risk factors (RR: 2.15; 95% CI: 1.22 to 3.79). There was a lower risk of ischemic stroke, more specifically lacunar infarction, a higher risk of hemorrhagic stroke, and no excess risk of total stroke among drinkers of 1 to 149 g ethanol per week compared with occasional drinkers; the respective multivariate RR (95% CI) was 0.59 (0.37 to 0.93), 0.43 (0.22 to 0.87), 1.73 (0.98 to 3.07), and 0.98 (0.71 to 1.36). Conclusions-We found differential effects of light-to-moderate alcohol consumption on risks of hemorrhagic and ischemic strokes among middle-aged men. Light-to-moderate alcohol consumption, ie, Յ2 drinks per day, does not raise the risk of total stroke.
Background and Purpose-We examined sex-specific relationships of smoking with risk of total stroke and stroke subtypes in Asian populations because of the limited data available. Methods-A total of 19 782 men and 21 500 women aged 40 to 59 years who were free of prior diagnosis of stroke, coronary heart disease, or cancer and reported their smoking status were followed in the Japan Public Health There was a dose-response relation between the number of cigarettes smoked and risks of ischemic stroke for men. A similar positive association was observed between smoking and risks of lacunar infarction and large-artery occlusive infarction, but not embolic infarction. Conclusions-Smoking raises risks of total stroke and subarachnoid hemorrhage for both men and women and risk of ischemic stroke, either lacunar or large-artery occlusive infarction, for men.
ubclinical hypothyroidism (SCH), defined as high serum thyroid-stimulating hormone (TSH) levels and normal levels of serum free-triiodothyronine (fT3) and serum free-thyroxine (fT4), is a common medical problem among the elderly. The prevalence of SCH has been reported to be 4-10% in the general population and up to 20% in women older than 60 years. [1][2][3] The incidence of SCH is 2.1-3.8% per year in thyroid-antibody-positive subjects and 0.3% per year in thyroid-antibody-negative subjects. 4 Serum lipid levels in SCH have been reported as either normal 5 or elevated. 6,7 In the Tromsø study, low-density lipoprotein-cholesterol (LDL-C) levels were significantly higher in subjects with SCH compared with controls 7 and, moreover, they were reduced with thyroxine treatment. In addition, associations between left ventricular function and SCH have been widely investigated, but the findings are controversial. Some studies have shown an association between SCH and poor left ventricular function and others have not. 8 Moreover, the positive association between arterial stiffness and hypothyroidism, even in the subclinical stage, has been reported. 9,10 Subclinical hyperthyroidism has been associated with a higher prevalence of atrial fibrillation (AF) and increased heart rate, 8 but not with elevated serum lipid levels. 6 Circulation Journal Vol.71, February 2007 In the present study we investigated whether subclinical thyroid dysfunction in Japanese individuals is associated with various phenotypes related to cardiovascular disease and metabolic syndromes. Methods Study PopulationThe selection criteria and design of the Suita study have been described previously. 11-13 Serum TSH, fT3, and fT4 levels were measured in 3,607 subjects who were not being treated for thyroid disease. The present study was approved by the Ethics Committee of the National Cardiovascular Center, and all subjects provided written informed consent. We categorized patients into 5 groups: normal (normal levels of serum TSH [0.436-3.78 U/ml], fT3 [2.1-4.1 pg/ml] and fT4 [1.0-1.7 ng/dl]), hyperthyroidism (low levels of TSH and high levels of fT3 and/or fT4), hypothyroidism (high levels of TSH and low levels of fT3 and/or fT4), SCH (high levels of TSH and normal levels of fT3 and fT4), and subclinical hyperthyroidism (low levels of TSH and normal levels of fT3 and fT4). 14 Body mass index (BMI) was calculated as body weight (kg) divided by height in square meters.The intima -media thickness (IMT) was measured on longitudinal scan of the common carotid artery at a point 10 mm proximal from the beginning of the dilation of the bulb. 11 Serum TSH, fT3, and fT4 LevelsFasting serum samples were collected at study entry and stored at -80°C until tests were run. Serum TSH was mea- Characterization of Subclinical Thyroid Dysfunction From Cardiovascular and Metabolic ViewpointsThe Suita Study Naoyuki Takashima, MD; Yasuharu Niwa, PhD; Toshifumi Mannami, MD* , **; Hitonobu Tomoike, MD*; Naoharu Iwai, MDBackground Subclinical hypothyroidism, defined as hi...
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