Biomedical subjects

A Gerald Shaper

Publications and source records attributed to A Gerald Shaper.

At least 19 recordsLinked to original sources

PubMed2006

Renal function and cardiovascular mortality in elderly men: the role of inflammatory, procoagulant, and endothelial biomarkers.

AIMS: To assess the extent to which inflammatory, procoagulant, and endothelial biomarkers modify the relationship between diminished renal function and cardiovascular mortality. METHODS AND RESULTS: Prospective study of 4029 men aged 60-79 years followed up for a mean period of 6 years, during which 304 cardiovascular deaths occurred. Predicted estimated glomerular filtration rate (eGFR) was used as a measure of renal function. Reduced eGFR was associated with increased prevalence of established cardiovascular risk factors [cardiovascular disease, diabetes, hypertension, left ventricular (LV) hypertrophy, and dyslipidaemia] and higher levels of inflammatory markers [interleukin 6 (IL-6), C-reactive protein], endothelial markers [von Willebrand factor (vWF) and tissue plasminogen activator], activated coagulation markers (fibrin D-dimer), and blood viscosity. Cardiovascular mortality risk increased with decreasing levels of eGFR, particularly among men with eGFR <60 mL/min per 1.73 m(2) even after adjustment for established risk factors (adjusted RR 1.49, 95% CI 1.10, 2.03; <60 vs. > or =70 mL/min per 1.73 m(2)). The association was attenuated after further adjustment for vWF, D-dimer, and IL-6 (adjusted RR 1.34, 95% CI 0.98-1.82). CONCLUSION: Mild-to-moderate renal insufficiency is associated with significantly increased cardiovascular mortality in elderly men, which is partly explained by the increased prevalence of established risk factors, markers of coagulation, endothelium, and inflammation.

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PubMed2006

Modifiable lifestyle factors and the metabolic syndrome in older men: Effects of lifestyle changes.

OBJECTIVES: To examine the influence of lifestyle factors and changes in these factors on risk of the metabolic syndrome in elderly men. DESIGN: Cross-sectional and longitudinal analyses of cohort study. SETTING: General practices in 24 British towns. PARTICIPANTS: Three thousand fifty-one men aged 60 to 79 with no diabetes mellitus or diagnosis of coronary heart disease. MEASUREMENTS: Lifestyle factors (smoking, physical activity, alcohol intake, body weight, dietary fat and carbohydrate intake) including recent changes in the previous 3 years (physical activity and body weight); metabolic syndrome. RESULTS: After adjustment for each of the other modifiable lifestyle factors, overweight/obesity and physical inactivity were associated with a significantly higher risk of the metabolic syndrome, as were cigarette smoking and a high-carbohydrate diet (>57% of energy). Alcohol intake and dietary fat intake were not related to the metabolic syndrome. Long-term ex-smokers showed similar risk to never smokers. Taking up physical activity and losing weight in the previous 3 years were associated with a reduction in risk of the metabolic syndrome. CONCLUSION: Overweight/obesity, physical inactivity, a high-carbohydrate diet, and cigarette smoking are associated with higher risk of the metabolic syndrome in elderly men. Modification of lifestyle factors, even later in life, has considerable potential for primary prevention of the metabolic syndrome.

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PubMed2005

Reasons for intentional weight loss, unintentional weight loss, and mortality in older men.

BACKGROUND: We have examined the relationship between intentional and unintentional weight loss and the reasons underlying intention to lose weight and all-cause mortality and mortality due to cardiovascular disease (CVD) and non-CVD causes in older men. METHODS: Prospective study of 4869 men aged 56 to 75 years drawn from general practices in 24 British towns, who in 1996 completed questionnaires about intentional and unintentional weight loss over the preceding 4 years and were followed up for a subsequent 7 years. RESULTS: Unintentional but not intentional weight loss was associated with a significant increase in risk of all-cause mortality compared with men who reported no weight change, even after adjustment for lifestyle characteristics and preexisting disease (adjusted relative risk [RR], 1.71; 95% confidence interval [CI], 1.33-2.19; and RR, 1.00; 95% CI, 0.91-1.10, respectively). Men who lost weight intentionally as a result of personal choice showed significant benefit in all-cause mortality (RR, 0.59; 95% CI, 0.34-1.00; P = .05), which was largely owing to a significant reduction in mortality from non-CVD causes (RR, 0.36; 95% CI, 0.15-0.87). The benefit in these men was most apparent in markedly overweight men (BMI [calculated as weight in kilograms divided by the square of height in meters] > or = 28) and in younger men (age < 65 years). Men who lost weight intentionally owing to ill health or physician's advice showed an increased risk of all-cause mortality (RR, 1.37; 95% CI, 0.96-1.94). No harm or benefit was seen for CVD mortality, irrespective of reasons for intentional weight loss. CONCLUSION: Intentional weight loss carried out for personal reasons is associated with a significant reduction in all-cause mortality in markedly overweight men, and the data suggest that the earlier the intervention, the greater the chance of benefit.

Age Factors↗

PubMed2005

Trends in rates of different forms of diagnosed coronary heart disease, 1978 to 2000: prospective, population based study of British men.

OBJECTIVE: To examine trends over time in rates of different forms of diagnosed coronary heart disease among British men, during a period in which mortality due to coronary heart disease has been declining. DESIGN: Prospective cohort study covering the period 1978-80 to 1998-2000. PARTICIPANTS: 7735 men, aged 40-59 at entry, randomly selected from one general practice in each of 24 British towns. MAIN OUTCOME MEASURES: Trends in the rates of major coronary events, first diagnosed angina and first diagnosed coronary heart disease (any fatal or non-fatal documented event or diagnosis). Events were ascertained from NHS central registers and reviews of medical records from general practices. RESULTS: Over the 20 year period, 1561 major coronary events occurred; 1087 and 1816 men had new diagnoses of angina and coronary heart disease, respectively. The age adjusted annual relative changes were -3.6% (95% confidence interval -4.8% to -2.4%, P < 0.001) for all major coronary events, 2.6% (1.1% to 4.0%, P < 0.001) for first diagnosed angina and -0.8% (-1.8% to 0.3%, P = 0.18) for first diagnosed coronary heart disease. The fall in major coronary events occurred across all categories of event (fatal and non-fatal, first and recurrent). Similarly, first diagnosed angina increased for both uncomplicated angina and angina after myocardial infarction. The age adjusted annual relative change in case fatality at 28 days of first major coronary events was -1.4% (-3.1% to 0.4%, P = 0.12). CONCLUSIONS: Among British middle aged men, a substantial decline in the rate of major coronary events over the past two decades seems to have been largely offset by an increase in the incidence of diagnosed angina. Overall there was little change in the incidence of first diagnosed coronary heart disease. A continuing need exists for resources and services for coronary heart disease in general, and for new angina in particular.

Adult↗

PubMed2005

Lifestyle and cardiovascular disease in middle-aged British men: the effect of adjusting for within-person variation.

AIMS: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index (BMI) and the development of cardiovascular disease (CVD) in middle-aged British men. METHODS AND RESULTS: In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events (fatal/non-fatal myocardial infarction or stroke) and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men (18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers (> or =40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6% for each 1 kg/m(2) increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of < or =25 kg/m(2) (6% of the population), 66% of the observed major CVD events would have been prevented or postponed (63% before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality. CONCLUSION: Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.

Body Mass Index↗

PubMed2005

Associations between cigarette smoking, pipe/cigar smoking, and smoking cessation, and haemostatic and inflammatory markers for cardiovascular disease.

AIMS: To examine the associations between cigarette smoking, pipe/cigar smoking, and years since quitting smoking, and inflammatory and haemostatic markers. METHODS AND RESULTS: A study in 2920 men aged 60-79 with no history of myocardial infarction, angina, stroke, or diabetes, and who were not on warfarin, from general practices in 24 British towns. After adjustment for other major cardiovascular risk factors, compared with never smokers, current cigarette smokers showed significantly higher levels of C-reactive protein (2.53 vs. 1.35 mg/L), white cell count (7.92 vs. 6.42 x 10(9)/L), and fibrinogen (3.51 vs. 3.13 g/L). They also showed higher levels of haematocrit, blood and plasma viscosity, tissue plasminogen activator antigen, and fibrin D-dimer, and lower levels of albumin. Primary pipe/cigar smokers showed levels similar to never smokers. Ex-cigarette smokers and secondary pipe/cigar smokers showed intermediate levels although secondary pipe/cigar smokers showed higher odds of having elevated white cell count and fibrinogen than ex-cigarette smokers. Most inflammatory and haemostatic levels improved within 5 years of smoking cessation but took over 20 years to revert to levels of never smokers. CONCLUSION: These findings suggest that activation of inflammation and haemostasis may be potential mechanisms by which cigarette and pipe/cigar smoking increase cardiovascular risk.

Adult↗

PubMed2005

The metabolic syndrome and insulin resistance: relationship to haemostatic and inflammatory markers in older non-diabetic men.

AIMS: We have examined the cross-sectional relationship between insulin resistance, the metabolic syndrome and haemostatic and inflammatory markers. METHODS AND RESULTS: We carried out the study in 2722 non-diabetic men aged 60-79 years with no history of coronary heart disease or stroke and who were not on warfarin treatment, drawn from general practices in 24 British towns. Insulin resistance (HOMA) was significantly associated with increased inflammatory markers (C-reactive protein (CRP), white cell count), coagulation factors VII-IX, von Willebrand factor (VWF) and tissue plasminogen activator (t-PA) antigens (markers of endothelial dysfunction) and blood viscosity after adjustment for age, smoking, physical activity, alcohol intake and waist circumference. Relationships with fibrinogen and fibrin D-dimer were weak. The relationship between HOMA and CRP was abolished after adjustment for t-PA. The prevalence of the metabolic syndrome was similar using World Health Organization (WHO) and National Cholesterol Education Program definitions (26.7% and 27.0%) but associations between the metabolic syndrome and increased haemostatic markers, particularly for raised factor VIII and VWF were stronger using WHO criteria. CONCLUSION: Insulin resistance and the metabolic syndrome showed significant associations with markers of haemostasis and inflammation, which may be relevant to their associations with cardiovascular disease.

Aged↗

PubMed2005

From a postal questionnaire of older men, healthy lifestyle factors reduced the onset of and may have increased recovery from mobility limitation.

BACKGROUND AND OBJECTIVE: We have examined predictors of the onset of and recovery from mobility limitation and the association between lifestyle changes in later life and mobility status. STUDY DESIGN AND SETTING: From a cohort of 7,735 men recruited at ages 40-59 years (1978-1980), 5,075 men completed follow-up postal questionnaires in 1992 (Q92), then aged 52-73 years, and again in 1996 (Q96). Mobility limitation was defined as reported difficulty in any one or more of the following: getting outdoors, walking 400 yards, or climbing stairs. RESULTS: Lifestyle factors (smoking, obesity, physical inactivity, and heavy drinking) and manual worker social class were significantly and independently associated with onset of mobility limitation and with the exception of physical activity remained significant after further adjustment for chronic diseases. Smoking cessation and taking up physical activity in later life are associated with reduced onset of mobility limitation. Among men with mobility limitation at Q92 (n=645), light or moderate levels of physical activity were associated with significantly increased odds of recovery at Q96 (light activity, OR=2.43, 95% CI 1.48, 4.00; moderate activity, OR=2.57, 95% CI 1.31, 5.02). CONCLUSION: Maintaining and adopting a healthy lifestyle in later life reduces the onset of mobility limitation in old age. Maintaining physical activity may improve recovery.

Adult↗

PubMed2005

Measures of adiposity in the identification of metabolic abnormalities in elderly men.

BACKGROUND: Body mass index (BMI; in kg/m(2)) is considered a poor indicator of overall and abdominal obesity in the elderly. OBJECTIVES: Our goal was to determine which simple anthropometric measurements [BMI, waist-to-hip ratio (WHR), waist circumference (WC), percentage body fat (%BF), or fat mass (FM)] are most closely associated with metabolic risk factors and insulin resistance in elderly men. DESIGN: This was a cross-sectional study of 2924 men aged 60-79 y with no history of coronary heart disease, stroke, or diabetes who were drawn from general practices in 24 British towns. RESULTS: BMI and WC were the measures most strongly associated with the metabolic syndrome (>/=3 of the following: hypertension, low HDL cholesterol, high triacylglycerols, or high blood glucose) and insulin resistance. For a 1-SD increase in BMI, WC, WHR, %BF, and FM, the odds ratios (95% CIs) of having the metabolic syndrome after adjustment for age, socioeconomic status, smoking status, and physical activity were as follows: BMI, 1.61 (1.44, 1.79); WC, 1.65 (1.48, 1.81); WHR, 1.49 (1.34, 1.66); %BF, 1.41 (1.25, 1.59); and FM, 1.53 (1.38, 1.70). For insulin resistance, the odds ratios (95% CIs) were as follows: 2.48 (2.22, 2.77), 2.46 (2.19, 2.65), 1.75 (1.59, 1.93), 1.79 (1.60, 2.00), and 2.10 (1.88, 2.34), respectively. In normal-weight (BMI < 25) and overweight (BMI 25-29.9) men, the presence of the metabolic syndrome and insulin resistance increased with increasing WC; this did not occur in obese men. CONCLUSIONS: BMI and WC are the simple measures of adiposity most strongly associated with metabolic abnormalities in elderly men. Our findings suggest that WC can be used as a complementary measurement to identify health risks in normal-weight and overweight elderly persons.

Adipose Tissue↗

PubMed2005

Body fat distribution, body composition, and respiratory function in elderly men.

BACKGROUND: Most population studies have reported weak or nonsignificant associations between body mass index (BMI; in kg/m2) and lung function. OBJECTIVE: This study focused on the distinct effects of fat distribution and body composition on lung function and examined these relations in elderly men. DESIGN: The study was a cross-sectional evaluation of 2744 men aged 60-79 y who were free of cardiovascular disease and cancer and were drawn from general practices in 24 British towns. Anthropometric and body-composition [including fat mass (FM), fat-free mass (FFM), and percentage body fat (%BF) evaluated with bioelectric impedance] measurements were made, and lung function was examined by using spirometry. RESULTS: Height-standardized forced expiratory volume in 1 s (FEV1) was diminished only in lean (BMI < 22.5) and obese (BMI > or = 30) men, but forced vital capacity (FVC) tended to decrease with increasing BMI (P < 0.01). All other measures of adiposity [ie, waist circumference (WC), waist-hip ratio (WHR), FM, and %BF] were significantly and inversely related to FEV1 and FVC after adjustment for confounders, including age and cigarette smoking (all: P < 0.05). This was seen both in nonobese (BMI < 30) and obese men. FFM was positively associated with FEV1 (P = 0.03) and to a lesser extent with FVC. Higher BMI and FFM were both associated with reduced odds of a low FEV1-FVC ratio (ie, <70%). CONCLUSION: Total body fat and central adiposity are inversely associated with lung function, but increased FFM reflecting increases in muscle mass is associated with increased lung function and lower odds of low FEV1:FVC in the elderly.

Adipose Tissue↗

PubMed2005

Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes.

CONTEXT: The benefit of weight reduction for cardiovascular disease (CVD) outcomes remains uncertain. OBJECTIVE: To examine the effects of baseline body mass index on major CVD outcomes and diabetes over a 20 year follow up, and of weight change in the first five years over the subsequent 15 years. DESIGN AND SETTING: A prospective study of British men followed up for 20 years. PARTICIPANTS: Men aged 40-59 years with no diagnosis of CVD or diabetes (n = 7176) of whom 6798 provided full information on weight change five years later. OUTCOME MEASURES: Major CVD events (fatal and non-fatal myocardial infarction and stroke, angina, "other" CVD deaths) and diabetes. RESULTS: During the 20 year follow up there were 1989 major CVD events and 449 incident cases of diabetes in the 7176 men. Risk of major CVD and diabetes increased significantly with increasing overweight and obesity. During the 15 year follow up, weight gain was associated with increased risk of CVD and diabetes. Weight loss was associated with lower risk of diabetes than the stable group irrespective of initial weight. No significant cardiovascular benefit was seen for weight loss in any men, except possibly in considerably overweight (BMI 27.5-29.9 kg/m(2)) younger middle aged men (RR = 0.42; 95% CI 0.22 to 0.81). CONCLUSION: Long term risk of CVD and diabetes increased significantly with increasing overweight and obesity. Weight loss was associated with significant reduction in risk of diabetes but not CVD, except possibly in considerably overweight younger men. Duration and severity of obesity seem to limit the cardiovascular benefits of weight reduction in older men.

Adult↗

PubMed2004

Serum albumin and risk of stroke, coronary heart disease, and mortality: the role of cigarette smoking.

OBJECTIVE: Lower levels of serum albumin are associated with increased risk of all-cause and cardiovascular mortality as well as with coronary heart disease and stroke incidence. These relationships have been examined with specific focus on the role of cigarette smoking. STUDY DESIGN AND SETTING: A prospective study of 7,690 British men aged 40-59 years, with 16.8 years mean follow-up. RESULTS: Cigarette smoking was strongly and inversely associated with serum albumin concentrations that reverted to levels seen in never smokers after 5 years' cessation. Only in current and former smokers were there significant inverse relationships between serum albumin and risk of major CHD and stroke events even after adjustment for potential confounders. Only in current smokers was a significant inverse relationship seen between serum albumin and mortality from cardiovascular disease, cancer, and all causes. CONCLUSION: The inverse association between serum albumin concentration and disease outcome appears to be related to the effects of cigarette smoking on serum albumin concentration.

Adult↗

PubMed2004

Overweight and obesity and the burden of disease and disability in elderly men.

OBJECTIVE: To examine the prevalence of disease burden and disability associated with overweight and obesity in men aged 60-79 y and to assess whether the current WHO weight guidelines are appropriate in the elderly. DESIGN: Cross-sectional survey 20 y after enrollment. SETTING: General practices in 24 British towns. PARTICIPANTS: In total, 4232 men aged 60-79 y (77% of survivors) with measured weight and height. MAIN OUTCOME MEASURES: Cardiovascular (CV) risk factors, prevalence of diabetes, cardiovascular disease, cancer, disability and regular medication. RESULTS: In total, 17% of the men were obese (body mass index (BMI) >/=30 kg/m(2)) and a further 52% were overweight (BMI 25-29.9 kg/m(2)). Prevalence of hypertension, low HDL-cholesterol, high triglycerides and insulin resistance and the prevalence of most disease outcomes increased with increasing degrees of overweight/obesity. Men in the normal weight range (18.5-24.9 kg/m(2)) had the lowest prevalence of ill health. Compared with normal weight men, obese men showed a two-fold risk of major CVD (odds ratio (OR)=1.96, 95% CI 1.44-2.67) and locomotor disability (OR=2.26, 95% CI 1.66, 3.09) and were nearly three times as likely to have diabetes, CV interventions or to be on CV medication. Over 60% of the prevalence of high insulin resistance was attributable to overweight and obesity as was over a third of diabetes and hypertension, a quarter of locomotor disability and a fifth of major CVD. CONCLUSION: In elderly men, overweight and obesity are associated with a significantly increased burden of disease, in particular CV-related disorders and disability. The current guidelines for overweight and obesity appear to be appropriate in elderly men.

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PubMed2003

Alcohol, body weight, and weight gain in middle-aged men.

BACKGROUND: There is uncertainty as to whether regular alcohol consumption contributes directly to weight gain and the risk of obesity. OBJECTIVE: We examined the relation between alcohol intake and body weight and the association between changes in alcohol intake and in body weight over 5 y of follow-up. DESIGN: This was a prospective study of 7608 men aged 40-59 y drawn from general practices in 24 British towns, excluding persons with known diabetes. Five years after screening, 6832 men then aged 45-64 y and without diabetes completed a postal questionnaire on changes in alcohol intake and body weight. RESULTS: Mean body mass index (BMI; in kg/m(2)) and the prevalence of men with a high BMI (>or= 28; top quintile of the BMI distribution) increased significantly from the light-moderate to the very heavy alcohol intake group even after adjustment for potential confounders. Similar patterns were seen for all types and combinations of alcohol. After 5 y of follow-up, stable and new heavy drinkers (including very heavy drinkers of >or= 30 g/d) showed the greatest weight gain and had the highest prevalence rates of high BMI. Weight change patterns in heavy drinkers at baseline who reduced their intake were not significantly different from those in the stable none-occasional group but showed more weight loss and less weight gain than in the stable or new heavy drinkers. CONCLUSION: Heavy alcohol intake (>or= 30 g/d) contributes directly to weight gain and obesity, irrespective of the type of alcohol consumed.

Adult↗

PubMed2002

Physical activity and cardiovascular disease.

This review, based on prospective epidemiological studies, indicates the existence of a dose-response relationship between physical activity and coronary heart disease (CHD), which is linear at least up to a certain level of activity. Leisure time physical activity is associated with about a 30-50% reduction in risk of CHD. The benefit of leisure-time physical activity is seen in both men and women, in middle-aged and older subjects and in men with established CHD. Several mechanisms, which could contribute to the protective effect of physical activity on CHD have been identified. Prospective studies suggest that physical activity is also associated with reduced risk of stroke. Overall, the evidence points to the benefit of continued regular moderate physical activity which does not need to be vigorous or sporting, and includes activities such as walking or gardening, readily attainable by large sections of the population. Current evidence supports the recommended guidelines of 30 minutes of moderate physical activity on most days of the week in both primary and secondary prevention of CHD.

Aged↗

PubMed2002

Migration within Great Britain and cardiovascular disease: early life and adult environmental factors.

AIM: To examine the relative contributions of early life and adult life factors to risk of cardiovascular disease (CVD) in middle-aged men using migration within Great Britain (GB). METHODS: Prospective study of 7,735 men (40-59 years) drawn from one group practice in each of 24 British towns. Zones of birth and/or examination: South of England and rest of GB (Midlands and Wales, North of England, and Scotland). RESULTS: There were 1,392 coronary heart disease (CHD) events and 1154 cardiovascular deaths during 21.8 years mean follow-up. Regardless of birth zone, men examined in the South showed lower risk of CHD events and CVD mortality than those examined in the rest of GB. Migrants from South to rest of GB showed a small increase in cardiovascular risk. Men born and examined in the rest of GB showed the highest adjusted risk of CHD events (RR = 1.15, 95% CI: 0.96-1.38) and CVD mortality (RR = 1.28, 95% CI: 1.04-1.57). Men born in the rest of GB who moved to the South showed adjusted risks of CHD events and CVD mortality similar to those born and examined in the South. Zone of examination was more strongly associated with CHD events and CVD mortality than zone of birth (RR = 1.23 versus 0.95 for CHD; RR = 1.26 versus 1.04 for CVD mortality). Smokers, irrespective of zone of birth or examination, showed higher risk than non-smokers. CONCLUSION: Factors in adult life appear to be dominant in determining cardiovascular risk in middle and older age although this does not exclude early life effects on cardiovascular risk.

Adult↗

PubMedDate not supplied

Weight change, weight fluctuation, and mortality.

OBJECTIVE: To examine the relation between weight change and weight fluctuation (cycling) and mortality in middle-aged men. METHODS: A prospective study of 5608 men aged 40 to 59 years at screening, drawn from one general practice in each of 24 British towns. Changes in weight observed during a 12- to 14-year period were related to mortality during the subsequent 8 years. RESULTS: There were 943 deaths from all causes: 458 cardiovascular disease (CVD) and 485 non-CVD deaths. Those with stable weight or weight gain had the lowest total, CVD, and non-CVD mortality. Sustained weight loss or weight fluctuation (loss-gain or gain-loss) showed a significantly higher mortality risk than stable weight even after adjustment for lifestyle variables (relative risk [95% confidence interval], 1.60 [1.32-1.95], 1.50 [1.17-1.91], and 1.63 [1.24-2.14], respectively). Adjustment or exclusion of men with preexisting disease markedly attenuated the increased risk of CVD and total mortality associated with sustained weight loss and weight gain-weight loss. In long-term nonsmokers, any weight loss since screening was associated with an increased risk of mortality, but this was markedly attenuated by adjustment for preexisting disease. Recent ex-smokers showed the most marked increase in mortality associated with sustained weight loss. CONCLUSIONS: The increased mortality in middle-aged men with sustained weight loss and weight fluctuation (cycling) is determined to a major extent by disadvantageous lifestyle factors and preexisting disease. The evidence suggests that weight loss and weight fluctuation (cycling) in these men does not directly increase the risk of death.

Adult↗

PubMedDate not supplied

Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus.

BACKGROUND: We sought to compare metabolic syndrome (MetS) with the Framingham Risk Score (FRS) as predictors of coronary heart disease (CHD), stroke, and type 2 diabetes mellitus (DM2) in middle-aged men. METHODS: A prospective study of 5128 men aged 40 to 59 years with no history of cardiovascular disease (CVD) (CHD or stroke) or DM2 drawn from general practices in 24 British towns and observed for 20 years. Metabolic syndrome was defined as the presence of 3 or more metabolic abnormalities based on modified National Cholesterol Education Program criteria. RESULTS: Men with MetS at baseline (26%) showed significantly higher relative risk (RR) than men without MetS of developing CHD (RR, 1.64; 95% confidence interval [CI], 1.41-1.90), stroke (RR, 1.61 95% CI, 1.26-2.06), and DM2 (RR, 3.57; 95% CI, 2.83-4.50). The probability of developing CVD or DM2 over 20 years increased from 11.9% in those with no abnormalities to 31.2% in those with 3 abnormalities to 40.8% in those with 4 or 5 abnormalities. The FRS was a better predictor of CHD and stroke than MetS but was less predictive of DM2. Areas under the receiver-operating characteristic curves for FRS vs the number of metabolic abnormalities were 0.68 vs 0.59 for CHD, 0.60 vs 0.70 for DM2, and 0.66 vs 0.55 for stroke (P< .001 for all). CONCLUSIONS: Presence of MetS is a significant predictor of CVD and DM2 but is a stronger predictor of DM2 than of CHD. Although MetS does not predict CHD as well as the FRS, it serves well as a simple clinical tool for identifying high-risk subjects predisposed to CVD or DM2.

Adult↗