March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Each chapter listed in the Table of Contents (see next page) is a hyperlink to that chapter. The reader clicks the chapter name to access that chapter.

Each chapter listed here is a hyperlink. Click on the chapter name to be taken to that chapter. 

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA’s My Life Check - Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents …

Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association.

Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)60269-X.pdf

Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60646-1.pdf

Global physical activity levels: surveillance progress, pitfalls, and prospects

Background Much uncertainty exists about the role of dietary glycemic index and glycemic load in the development of type 2 diabetes mellitus, especially in populations that traditionally subsist on a diet high in carbohydrates. Methods We observed a cohort of 64 227 Chinese women with no history of diabetes or other chronic disease at baseline for 4.6 years. In-person interviews were conducted to collect data on dietary habits, physical activity, and other relevant information using a validated questionnaire. Incident diabetes cases were identified via in-person follow-up. Associations between dietary carbohydrate intake, glycemic index, and glycemic load and diabetes incidence were evaluated using multivariable Cox proportional hazards models. Results We identified 1608 incident cases of type 2 diabetes mellitus in 297 755 person-years of follow-up. Dietary carbohydrate intake and consumption of rice were positively associated with risk of developing type 2 diabetes mellitus. The multivariable-adjusted estimates of relative risk comparing the highest vs the lowest quintiles of intake were 1.28 (95% confidence interval, 1.09-1.50) for carbohydrates and 1.78 (95% confidence interval, 1.48-2.15) for rice. The relative risk for increasing quintiles of intake was 1.00, 1.04, 1.02, 1.09, and 1.21 (95% confidence interval, 1.03-1.43) for dietary glycemic index and 1.00, 1.06, 0.97, 1.23, and 1.34 (95% confidence interval, 1.13-1.58) for dietary glycemic load. Conclusion High intake of foods with a high glycemic index and glycemic load, especially rice, the main carbohydrate-contributing food in this population, may increase the risk of type 2 diabetes mellitus in Chinese women.

/pdf/prospective-study-of-dietary-carbohydrates-glycemic-index-4q3yyqe74d.pdf

Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women.

http://www.baljvaxtakademin.se/home/halsa/dokument/legume_and_soy_food_intake_and_the_incidence_of_type_2_diabetes_in_shanghai_womens_health_study.pdf

Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study

This investigation described the effects of exercise, walking, and cycling for transportation, as well as the effect of overall nonexercise physical activity, on mortality in the Shanghai Women's Health Study (1997-2004). Women without heart disease, stroke, or cancer were followed for an average of 5.7 years (n = 67,143), and there were 1,091 deaths from all causes, 537 deaths from cancer, and 251 deaths from cardiovascular diseases. Information about physical activity and relevant covariates was obtained by interview. Proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals. Exercise and cycling for transportation were both inversely and independently associated with all-cause mortality (p(trend) < 0.05), but walking for transportation was less strongly associated with reduced risk (p(trend) = 0.07). Women reporting no regular exercise but who reported 10 or more metabolic equivalent (MET)-hours/day of nonexercise activity were at 25-50% reduced risk (p(trend) < 0.01) relative to less active women (0-9.9 MET-hours/day). Among women reporting the least nonexercise activity (0-9.9 MET-hours/day) but reporting regular exercise participation, exercise was associated with reduced mortality (hazard ratio = 0.78, 95% confidence interval: 0.62, 0.99). These findings add new evidence that overall physical activity levels are an important determinant of longevity, and that health benefit can be obtained through an active lifestyle, exercise, or combinations of both.

/pdf/influence-of-exercise-walking-cycling-and-overall-x7ldyshe4q.pdf

Influence of Exercise, Walking, Cycling, and Overall Nonexercise Physical Activity on Mortality in Chinese Women

Soy food intake has been shown to have beneficial effects on cardiovascular disease risk factors. Data directly linking soy food intake to clinical outcomes of cardiovascular disease, however, are sparse. We examined the relationship between soy food intake and incidence of coronary heart disease (CHD) among participants in the Shanghai Women's Health Study, a population-based prospective cohort study of approximately 75000 Chinese women aged 40-70 y at the baseline survey that was conducted from 1997 to 2000. Included in this study were 64915 women without previously diagnosed CHD, stroke, cancer and diabetes at baseline. Information on usual intake of soy foods was obtained at baseline through an in-person interview using a validated food-frequency questionnaire. Cohort members were followed biennially through in-person interviews. After a mean of 2.5 y (162277 person-years) of follow-up, 62 incident cases of CHD (43 nonfatal myocardial infarctions and 19 CHD deaths) were documented. There was a clear monotonic dose-response relationship between soy food intake and risk of total CHD (P for trend = 0.003) with an adjusted relative risk (RR) of 0.25 (95% CI, 0.10-0.63) observed for women in the highest vs. the lowest quartile of total soy protein intake. The inverse association was more pronounced for nonfatal myocardial infarction (RR = 0.14; 95% CI, 0.04-0.48 for the highest vs. the lowest quartile of intake; P for trend = 0.001). This study provides, for the first time, direct evidence that soy food consumption may reduce the risk of CHD in women.

/pdf/soy-food-consumption-is-associated-with-lower-risk-of-2iqixutcqm.pdf

Soy Food Consumption Is Associated with Lower Risk of Coronary Heart Disease in Chinese Women

Background: Soy consumption has been shown to modulate bone turnover and increase bone mineral density in postmenopausal women. To our knowledge, no published studies have directly examined the association between soy consumption and risk of fracture. Methods:We examined the relationship between usual soy food consumption and fracture incidence in 24403 postmenopausal women who had no history of fracture orcancerandwererecruitedbetweenMarch1,1997,and May 23, 2000, in the Shanghai Women’s Health Study, a cohort study of approximately 75000 Chinese women aged 40 to 70 years. Usual soy food intake was assessed at baseline and reassessed during follow-up through inpersoninterviewsusingavalidatedfoodfrequencyquestionnaire. Outcomes were ascertained by biennial inperson interview surveys. Results:During a mean follow-up of 4½years (110243 person-years), 1770 incident fractures were identified. After adjustment for age, major risk factors of osteoporosis,socioeconomicstatus,andotherdietaryfactors,the relativerisks(95%confidenceintervals)offracturewere 1.00, 0.72 (0.62-0.83), 0.69 (0.59-0.80), 0.64 (0.550.76), and 0.63 (0.53-0.76) across quintiles of soy protein intake (P.001 for trend). The inverse association was more pronounced among women in early menopause. The multivariate relative risks (95% confidence intervals) of fracture comparing the extreme quintiles of soyproteinintakewere0.52(0.38-0.70)forwomenwithin 10 years of menopause vs 0.71 (0.56-0.89) for late postmenopausal women. Similar results were also found for intake of isoflavones.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/486688/ioi50069.pdf

Honglan Li

Papers

Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women.

Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study

Influence of Exercise, Walking, Cycling, and Overall Nonexercise Physical Activity on Mortality in Chinese Women

Soy Food Consumption Is Associated with Lower Risk of Coronary Heart Disease in Chinese Women

Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women.