Showing papers by "Johanna M. Geleijnse published in 2012"

Adult height and the risk of cause-specific death and vascular morbidity in 1 million people: individual participant meta-analysis

Abstract: Background The extent to which adult height, a biomarker of the interplay of genetic endowment and early-life experiences, is related to risk of chronic diseases in adulthood is uncertain. Methods We calculated hazard ratios (HRs) for height, assessed in increments of 6.5 cm, using individual-participant data on 174 374 deaths or major non-fatal vascular outcomes recorded among 1 085 949 people in 121 prospective studies. Results For people born between 1900 and 1960, mean adult height increased 0.5-1 cm with each successive decade of birth. After adjustment for age, sex, smoking and year of birth, HRs per 6.5 cm greater height were 0.97 (95% confidence interval: 0.96-0.99) for death from any cause, 0.94 (0.93-0.96) for death from vascular causes, 1.04 (1.03-1.06) for death from cancer and 0.92 (0.90-0.94) for death from other causes. Height was negatively associated with death from coronary disease, stroke subtypes, heart failure, stomach and oral cancers, chronic obstructive pulmonary disease, mental disorders, liver disease and external causes. In contrast, height was positively associated with death from ruptured aortic aneurysm, pulmonary embolism, melanoma and cancers of the pancreas, endocrine and nervous systems, ovary, breast, prostate, colorectum, blood and lung. HRs per 6.5 cm greater height ranged from 1.26 (1.12-1.42) for risk of melanoma death to 0.84 (0.80-0.89) for risk of death from chronic obstructive pulmonary disease. HRs were not appreciably altered after further adjustment for adiposity, blood pressure, lipids, inflammation biomarkers, diabetes mellitus, alcohol consumption or socio-economic indicators. Conclusion Adult height has directionally opposing relationships with risk of death from several different major causes of chronic diseases.

Fish oil and omega-3 fatty acids in cardiovascular disease: do they really work?

Abstract: Omega-3 fatty acids, which are found abundantly in fish oil, exert pleiotropic cardiometabolic effects with a diverse range of actions. The results of previous studies raised a lot of interest in the role of fish oil and omega-3 fatty acids in primary and secondary prevention of cardiovascular diseases. The present review will focus on the current clinical uses of omega-3 fatty acids and provide an update on their effects. Since recently published trials in patients with coronary artery diseases or post-myocardial infarction did not show an effect of omega-3 fatty acids on major cardiovascular endpoints, this review will examine the limitations of those data and suggest recommendations for the use of omega-3 fatty acids.

Dairy Consumption and Incidence of Hypertension: A Dose-Response Meta-Analysis of Prospective Cohort Studies

Abstract: Observational and clinical studies suggest that dairy intake, particularly low-fat dairy, could have a beneficial effect on blood pressure. We performed a dose-response meta-analysis of prospective cohort studies on dairy intake and risk of hypertension in the general population. A systematic literature search for eligible studies was conducted until July 2011, using literature databases and hand search. Study-specific dose-response associations were computed according to the generalized least squares for trend estimation method, and linear and piecewise regression models were created. Random-effects models were performed with summarized dose-response data. We included 9 studies with a sample size of 57 256, a total of 15 367 incident hypertension cases, and a follow-up time between 2 and 15 years. Total dairy (9 studies; range of intake, ≈100-700 g/d), low-fat dairy (6 studies; ≈100-500 g/d), and milk (7 studies; ≈100-500 g/d) were inversely and linearly associated with a lower risk of hypertension. The pooled relative risks per 200 g/d were 0.97 (95% CI, 0.95-0.99) for total dairy, 0.96 (95% CI, 0.93-0.99) for low-fat dairy, and 0.96 (95% CI, 0.94-0.98) for milk. High-fat dairy (6 studies), total fermented dairy (4 studies), yogurt (5 studies), and cheese (8 studies) were not significantly associated with hypertension incidence (pooled relative risks of ≈1). This meta-analysis of prospective cohort studies suggests that low-fat dairy and milk could contribute to the prevention of hypertension, which needs confirmation in randomized controlled trials.

Effects of n-3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction.

Abstract: Aims Recent secondary prevention trials have failed to demonstrate a beneficial effect of n -3 fatty acids on cardiovascular outcomes, which may be due to the growing use of statins since the mid-1990s. The aim of the present study was to assess whether statins modify the effects of n -3 fatty acids on major adverse cardiovascular events in patients with a history of myocardial infarction (MI). Methods and results Patients who participated in the Alpha Omega Trial were divided into consistent statin users ( n = 3740) and consistent statin non-users ( n = 413). In these two groups of patients, the effects of an additional daily amount of 400 mg eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA), 2 g α-linolenic acid (ALA), or both on major cardiovascular events were evaluated. Multivariable Cox's proportional hazard models were used to calculate adjusted hazard rate ratios (HRadj). Among the statin users 495 (13%) and among the statin non-users 62 (15%) developed a major cardiovascular event. In statin users, an additional amount of n -3 fatty acids did not reduce cardiovascular events [HRadj 1.02; 95% confidence interval (CI): 0.80, 1.31; P = 0.88]. In statin non-users, however, only 9% of those who received EPA–DHA plus ALA experienced an event compared with 18% in the placebo group (HRadj 0.46; 95% CI: 0.21, 1.01; P = 0.051). Conclusion In patients with a history of MI who are not treated with statins, low-dose supplementation with n -3 fatty acids may reduce major cardiovascular events. This study suggests that statin treatment modifies the effects of n -3 fatty acids on the incidence of major cardiovascular events. ClinicalTrials.gov number: [NCT00127452][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00127452&atom=%2Fehj%2F33%2F13%2F1582.atom

Vitamin K Intake and Plasma Desphospho-Uncarboxylated Matrix Gla-Protein Levels in Kidney Transplant Recipients

Abstract: Vitamin K is essential for activation of c-carboxyglutamate (Gla)-proteins including the vascular calcification inhibitor matrix Gla-protein (MGP). Insufficient vitamin K intake leads to production of uncarboxylated, mostly inactive proteins and contributes to an increased cardiovascular risk. In kidney transplant recipients, cardiovascular risk is high but vitamin K intake and status have not been defined. We investigated dietary vitamin K intake, vascular vitamin K status and its determinants in kidney transplant recipients. We estimated vitamin K intake in a cohort of kidney transplant recipients (n=60) with stable renal function (creatinine clearance 61 [42–77] (median [interquartile range]) ml/min), who were 75 [35– 188] months after transplantation, using three-day food records and food frequency questionnaires. Vascular vitamin K status was assessed by measuring plasma desphospho-uncarboxylated MGP (dp-ucMGP). Total vitamin K intake was below the recommended level in 50% of patients. Lower vitamin K intake was associated with less consumption of green vegetables (33 vs 40 g/d, p=0.06) and increased dp-ucMGP levels (621 vs 852 pmol/L, p,0.05). Accordingly, dp-ucMGP levels were elevated (.500 pmol/L) in 80% of patients. Multivariate regression identified creatinine clearance, coumarin use, body mass index, high sensitivity-CRP and sodium excretion as independent determinants of dp-ucMGP levels. In a considerable part of the kidney transplant population, vitamin K intake is too low for maximal carboxylation of vascular MGP. The high dp-ucMGP levels may result in an increased risk for arterial calcification. Whether increasing vitamin K intake may have health benefits for kidney transplant recipients should be addressed by future studies.

Sodium intake and blood pressure in renal transplant recipients.

Abstract: Background. Hypertension is common among renal transplant recipients (RTR) and a risk factor for graft failure and mortality. Sodium intake is a well-established determinant of blood pressure (BP) in the general population. However, data in RTR are limited. International guidelines recommend a maximum daily sodium intake of 70 mmol. We investigated sodium intake in RTR as compared to healthy controls and its association with BP. Methods. We included 660 RTR (age 53 ± 13 years, 58 male) and 201 healthy controls (age 54 ± 11 years, 46 male). Sodium intake was assessed from 24-h urine collections. The morning after completion of urine collection, BP was measured according to a strict protocol. Results. Urinary sodium excretion was 156 ± 62 mmol/24 h in RTR and 195 ± 75 in controls (difference: P 70 mmol/24 h. Systolic BP (SBP) and diastolic BP (DBP) were 136 ± 18 and 82 ± 11 mmHg, respectively. Sodium intake was positively associated with SBP (β 0.042 mmHg/mmol/24 h, P 0.002) and DBP (β 0.023 mmHg/mmol/24 h, P 0.007), independent of potential confounders. Conclusion. sAlthough RTR had a lower sodium intake than healthy controls, their intake still exceeded current guidelines. Reduction of sodium intake to recommended amounts could reduce SBP by 45 mmHg. Better control of sodium intake may help to prevent graft failure and mortality due to hypertension among RTR. © The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Variety in fruit and vegetable consumption and 10-year incidence of CHD and stroke.

Abstract: Objective: Consuming a variety of fruit and vegetables provides many different micronutrients and bioactive compounds. Whether this contributes to the beneficial association between fruit and vegetables and incident CHD and stroke is unknown. Design: Prospective population-based cohort study. Setting: The Netherlands. Subjects: Men and women (n 20 069) aged 20-65 years. Participants completed a validated 178-item FFQ, including nine fruit and thirteen vegetable items. Variety in fruit and vegetables was defined as the sum of different items consumed at least once per 2 weeks over the previous year. Hazard ratios (HR) for variety in relation to incident CHD and stroke were calculated using multivariable Cox proportional hazards models additionally adjusted for quantity of fruit and vegetables. Results: Variety and quantity in fruit and vegetables were highly correlated (r=0.81). Variety was not associated with total energy intake (r=-0.01) and positively associated with nutrient intakes, particularly vitamin C (r=0.70). During 10 years of follow-up, 245 cases of CHD and 233 cases of stroke occurred. Variety in vegetables (HR per 2 items = 1.05; 95% CI 0.94, 1.17) and in fruit (HR per 2 items = 1.00; 95% CI 0.87, 1.15) were not related to incident CHD. Variety in vegetables (HR per 2 items = 0.93; 95% CI 0.83, 1.04) and in fruit (HR per 2 items = 1.03; 95% CI 0.89, 1.18) were also not related to incident stroke. Conclusions: More variety in fruit and vegetable consumption was associated with higher intakes of fruit and vegetables and micronutrients. Independently of quantity, variety in fruit and vegetables was related neither to incident CHD nor to incident stroke.

Telomere Length and Mental Well-Being in Elderly Men from the Netherlands and Greece

Abstract: Telomeres, repetitive DNA sequences that promote chromosomal stability, have been related to different measures of mental well-being and self-rated health, but mainly in women during adulthood. We aimed to investigate whether accelerated telomere shortening is associated with poor mental well-being and poor self-rated health in community-dwelling elderly men. Leukocyte telomere length was measured using quantitative PCR in two different samples of 203 elderly men (mean age 78 years) from the Netherlands in 1993, and 123 elderly men (mean age 84 years) from Greece in 2000. We also obtained follow-up data in 2000 from 144 Dutch subjects, of whom 75 had paired telomere length data in 1993 and 2000. Mental well-being was conceptualized as dispositional optimism, depressive symptoms, cognitive functioning, and loneliness. Linear regression analyses were used to study the association between telomere length, measures of mental well being, and self-rated health, while adjusting for potential confounders. In cross-sectional analyses, leukocyte telomere length was not associated with measures of mental well-being and self-rated health, neither in the Netherlands nor in Greece. Also, the rate of leukocyte telomere shortening (mean decrease: 0.28 kbp over 7 years) in the 75 Dutch participants with longitudinal data was not associated with changes in different measures of mental well-being and self-rated health. Thus, our results provide no support for a relationship between leukocyte telomere length and mental well-being in elderly community-dwelling men.

Dispositional optimism and loneliness in older men.

Abstract: Background: Dispositional optimism, defined as a generalized tendency to positive outcome expectancies, is associated with well-being and successful aging. However, it remains unclear whether optimism is also correlated to less feelings of loneliness over time. We aimed to determine whether dispositional optimism is prospectively associated with less feelings of loneliness, independently of potential confounders inherent to the aging process. Methods: We observed 416 older men aged between 70 and 89?years (mean 74.9?years, standard deviation [SD] 4.7 years) within the population-based Zutphen Elderly Study during 10?years of follow-up. Baseline dispositional optimism was assessed using a four-item questionnaire. The presence of feelings of loneliness, the main outcome of our study, was assessed using the 11-item loneliness scale of De Jong Gierveld in the years 1990, 1993, 1995, and 2000. The association between baseline dispositional optimism and loneliness over time was tested by using multilevel regression analysis and by adjusting for potential confounders (i.e. age, living arrangement, social contacts, widowhood, memberships, self-rated health, and depressive symptoms). Results: Feelings of loneliness significantly increased during 10?years of follow-up but showed temporal stability (reliability coefficient 0.78). Low baseline dispositional optimism was strongly associated with loneliness over time, also in the adjusted analysis. A 1 SD increase in baseline dispositional optimism was associated with a 0.14 SD (95% confidence interval 0.04–0.23) lower level of loneliness (F1,320?=?7.8; p?=?0.006). Conclusions: Dispositional optimism is correlated to lower feelings of loneliness over time in older men, independently of depression or changes in social network

Sources of dietary protein in relation to blood pressure in a general Dutch population.

Abstract: Background - Little is known about the relation of different dietary protein types with blood pressure (BP). We examined whether intake of total, plant, animal, dairy, meat, and grain protein was related to BP in a cross sectional cohort of 20,820 Dutch adults, aged 20–65 y and not using antihypertensive medication. Design - Mean BP levels were calculated in quintiles of energy-adjusted protein with adjustment for age, sex, BMI, education, smoking, and intake of energy, alcohol, and other nutrients including protein from other sources. In addition, mean BP difference after substitution of 3 en% carbohydrates or MUFA with protein was calculated. Results - Total protein and animal protein were not associated with BP (ptrend = 0.62 and 0.71 respectively), both at the expense of carbohydrates and MUFA. Systolic BP was 1.8 mmHg lower (ptrend36 g/d) than in the lowest (

Dairy intake, blood pressure and incident hypertension in a general British population: the 1946 birth cohort

Abstract: We aimed to examine the association between intake of different subgroups of dairy products and blood pressure and incident hypertension 10 years later, adjusting for confounding factors. We studied 1,750 British men and women from the 1946 British birth cohort from 1989 to 1999 (age 43 and 53 years, respectively). Diet was assessed by 5-day food diaries using photographs in the estimation of portion size. Systolic (sbp) and diastolic (dbp) blood pressure and prevalent hypertension were assessed at age 43 and 53 years. Linear regression and logistic regression were used to examine 10-year blood pressure levels and incident hypertension by baseline dairy intake. There was a weak non-significant trend of a protective effect of total dairy intake on blood pressure and incident hypertension, but no evidence for a dose–response relationship (OR for incident hypertension: 0.88 (95% CI 0.68;1.14) 2nd vs. 1st tertile and 0.93 (95% CI 0.72;1.18) 3rd vs. 1st tertile). Higher intake of low-fat and fermented dairy was linked to a higher sbp but in a nonlinear manner. Adjustment for other dietary factors, health behaviours and BMI attenuated these associations. Total dairy intake and specific dairy subgroups were not associated with blood pressure and incident hypertension among a representative sample of British adults after adjustment for confounding factors.

Gender-specific associations of marine n-3 fatty acids and fish consumption with 10-year incidence of stroke.

Abstract: Background There is some evidence that the association of fish and marine fatty acids with stroke risk differs between men and women. We investigated the gender-specific associations of habitual intake of the marine fatty acids eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) and fish on incident stroke in a population-based study in the Netherlands. Methods We prospectively followed 20,069 men and women, aged 20–65 years, without cardiovascular diseases at baseline. Habitual diet was assessed with a validated 178-item food frequency questionnaire. Incidence of stroke was assessed through linkage with mortality and morbidity registers. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (95%CI). Results During 8–13 years of follow-up, 221 strokes occurred. In women, an inverse dose-response relation (P-trend = 0.02) was observed between EPA-DHA intake and incident stroke, with an HR of 0.49 (95% CI: 0.27–0.91) in the top quartile of EPA-DHA (median 225 mg/d) as compared to the bottom quartile (median 36 mg/d). In men, the HR (95%CI) for the top quartile of EPA-DHA intake was 0.87 (0.51–1.48) (P-trend = 0.36). Similar results were observed for fish consumption and stroke incidence. Conclusion A higher EPA-DHA and fish intake is related to a lower stroke risk in women, while for men an inverse association could not be demonstrated

Urinary magnesium excretion and risk of cardiovascular disease in the general population

Abstract: Magnesium has been favorable associated with many cardiovascular (CVD) risk factors. Previous studies on dietary magnesium and risk of CVD have yielded inconsistent results, possibly due to the use of dietary questionnaires or blood levels to assess magnesium exposure. Whether urinary excretion of magnesium, as reflection of actual dietary uptake, is associated with CVD risk remains unclear. We prospectively followed 7747 adults free of diagnosed cardiovascular diseases or cancer at baseline (1997-1998) from the community-based, observational PREVEND (Prevention of Renal and Vascular End-Stage Disease) Study. Urinary magnesium excretion was estimated from two 24-h urine collections and was measured by a xylidyl blue method on a Modular analyzer (Roche). During a median follow-up of 10.5 year, 638 CVD events occurred. After adjustment for age, BMI, sex, smoking status, alcohol consumption and educational attainment, urinary magnesium excretion showed a nonlinear relationship with CVD risk. The hazard ratios (HR) for CVD were significantly lower (P >In conclusion, low urinary magnesium excretion was associated with a higher risk of CVD, even after controlling for possible intermediates in the causal pathway such as blood pressure, diabetes and markers of inflammation and atherosclerosis. These results highlight the need to evaluate whether increasing the uptake of dietary magnesium could be effective for primary prevention of CVD.

The Effect of Conjugated Linoleic Acid, a Natural Trans Fat From Milk and Meat, on Human Blood Pressure: Results From a Randomized Crossover Feeding Study

Abstract: Cis-9, trans-11 conjugated linoleic acid (CLA) is a natural trans fatty acid that is largely restricted to ruminant fats and consumed in foods and supplements. Its role in blood pressure (BP) regulation is still unclear. We examined the effect of cis-9, trans-11 CLA on BP compared with oleic acid. A total of 61 healthy volunteers were sequentially fed each of 3 diets for 3 weeks, in random order, for a total of 9 weeks. The diets were identical except for 7% of energy (18.9 g in a diet of 10 MJ day(-1)) that was provided either by oleic acid, by industrial trans fatty acids or by cis-9, trans-11 CLA. We measured BP on two separate days at the end of each intervention period. At baseline, mean BP was 113.8±14.4 mm Hg systolic and 66.3±9.6 mm Hg diastolic. The effect of the CLA diet compared with the oleic acid diet was 0.11 mm Hg (95% confidence interval: -1.27, 1.49) systolic and -0.45 mm Hg (-1.63, 0.73) diastolic. After the industrial trans fatty acid diet, the effect was 1.13 mm Hg (-0.25, 2.51) systolic and -0.44 mm Hg (-1.62, 0.73) diastolic compared with the oleic acid diet. Our study suggests that short-term high intakes of cis-9,trans-11 CLA do not affect BP in healthy volunteers.

Cardiovascular risk management of hypertension and hypercholesterolaemia in the Netherlands: from unifactorial to multifactorial approach

Abstract: About 30 years ago, the first Dutch unifactorial guidelines on hypertension and hypercholesterolaemia were developed. These guidelines have been revised several times, often after publication of landmark studies on new generations of drugs. In 1978, cut-off points for pharmacological treatment of hypertension were based on diastolic blood pressure values ≥115 mmHg, and in 2000 they were lowered to >100 mmHg. From 1997 onwards, cut-off points for systolic blood pressure values >180 mmHg were introduced, which became leading. In 1987, cut-offs for hypercholesterolaemia of ≥8 mmol/l were set and from 2006 pharmacological treatment was based on a total/HDL cholesterol ratio >8. Around 2000, treatment decisions for hypertension and/or hypercholesterolaemia were no longer based on high levels of individual risk factors, but on a multifactorial approach based on total risk of cardiovascular diseases (CVD), determined by a risk function. In the 2006 multidisciplinary guideline on cardiovascular risk management, the Framingham risk tables were replaced by European SCORE risk charts. A cut-off point of 10% CVD mortality was set in the Netherlands. In 2011, this cut-off point changed to 20% fatal plus nonfatal CVD risk. Nowadays, ‘the lower the risk factors, the lower the absolute risk’ is the leading paradigm in CVD prevention.

Sources of dietary protein and risk of hypertension in a general Dutch population

Abstract: Evidence suggests a small beneficial effect of dietary protein on blood pressure (BP), especially for plant protein. We examined the relationship between several types of dietary protein (total, plant, animal, dairy, meat and grain) and the risk of hypertension in a general population of 3588 Dutch adults, aged 26-65 years, who were free of hypertension at baseline. Measurements were done at baseline and after 5 and 10 years of follow-up. Hazard ratios (HR), with 95 % CI, for incident hypertension were obtained in tertiles of energy-adjusted protein, using time-dependent Cox regression models. Models were adjusted for age, sex, BMI, education, smoking, baseline systolic BP, dietary confounders and protein from other sources (if applicable). Mean BP was 118/76 mmHg at baseline. Protein intake was 85 (sd 22) g/d (approximately 15 % of energy) with 62 % originating from animal sources. The main sources of protein were dairy products (28 %), meat (24 %) and grain (19 %). During the follow-up, 1568 new cases of hypertension were identified (44 % of the participants). Energy-adjusted intake of total protein, plant protein and animal protein was not significantly associated with hypertension risk (all HR approximately 1·00, P>0·60). Protein from grain showed a significant inverse association with incident hypertension, with a HR of 0·85 (95 % CI 0·73, 1·00, P trend = 0·04) for the upper tertile ( ≥ 18 g/d) v. the lower tertile ( < 14 g/d), whereas dairy protein and meat protein were not associated with incident hypertension. In conclusion, higher intake of grain protein may contribute to the prevention of hypertension, which warrants confirmation in other population-based studies and randomised controlled trials.

No effects of n-3 fatty acid supplementation on serum total testosterone levels in older men: the Alpha Omega Trial

Abstract: The intake of the n-3 fatty acids alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been related to testosterone levels in epidemiological analyses. The aim of this study was to assess whether the n-3 fatty acids affects testosterone levels in post-myocardial infarction (MI) patients, who are at risk of testosterone deficiency. In a double-blind, placebo-controlled trial of low-dose supplementation of n-3 fatty acids, we included 1850 male post-MI patients aged 60–80 y who participated in the Alpha Omega Trial. Patients were randomly allocated to margarines that provided 400 mg/d of EPA–DHA (n=453), 2 g/d of ALA (n=467), EPA–DHA plus ALA (n=458), or placebo (n=472). Serum testosterone levels were assessed at baseline and after 41 months using whole day blood samples obtained at the subjects' home or at the hospital. Subjects were on average age of 68.4 (SD 5.3) years old and had baseline mean serum total testosterone of 14.8 (SD 5.6) nmol/L. The four randomized groups did not differ for baseline characteristics. ALA, EPA–DHA, and EPA–DHA plus ALA supplementation did not affect serum total testosterone compared to placebo. Moreover, n-3 fatty acid supplementation did not affect the risk of incident testosterone deficiency (n=76 with total testosterone <8.0 nmol/L). We conclude that n-3 fatty acids supplementation did not affect serum total testosterone in men who had had a MI.

Linoleic acid intake, plasma cholesterol and 10-year incidence of CHD in 20,000 middle-aged men and women in the Netherlands.

Abstract: We studied the associations of a difference in linoleic acid or carbohydrate intake with plasma cholesterol levels and risk of CHD in a prospective cohort study in the Netherlands. Data on diet (FFQ) and plasma total and HDL-cholesterol were available at baseline (1993–7) of 20 069 men and women, aged 20–65 years, who were initially free of CVD. Incidence of CHD was assessed through linkage with mortality and morbidity registers. During an average of 10 years of follow-up, 280 CHD events occurred. The intake of linoleic acid ranged from 3·6 to 8·0 % of energy (en%), whereas carbohydrate intake ranged from 47·6 to 42·5 en% across quintiles of linoleic acid intake. Linoleic acid intake was inversely associated with total cholesterol and HDL-cholesterol in women but not in men. Linoleic acid intake was not associated with the ratio of total to HDL-cholesterol. No association was observed between linoleic acid intake and CHD incidence, with hazard ratios varying between 0·83 and 1·00 (all P>0·05) compared to the bottom quintile. We conclude that a 4–5 en% difference in linoleic acid or carbohydrate intake did not translate into either a different ratio of total to HDL-cholesterol or a different CHD incidence

Levels and trends in cardiovascular risk factors and drug treatment in 4837 elderly Dutch myocardial infarction patients between 2002 and 2006

Abstract: Background It is important to gain insight into opportunities for secondary prevention of cardiovascular disease. Our aim was to investigate levels and trends in cardiovascular risk factors and drug treatment in Dutch post-myocardial infarction (MI) patients between 2002 and 2006 and to make comparisons with the EUROASPIRE surveys (1999–2007).

C-reactive protein haplotypes and dispositional optimism in obese and nonobese elderly subjects

Abstract: Background Chronic low-grade inflammation, characterized by elevated plasma levels of C-reactive protein (CRP), has been inversely associated with dispositional optimism. Using a Mendelian randomization design, this study explores whether CRP haplotypes that determine CRP plasma levels are also associated with dispositional optimism.

The role of fatty acids from fish in the prevention of stroke

Abstract: Fish oil supplements may not be protective in at risk patients who are optimally managed Fish consumption once or twice a week is widely recommended for cardiovascular health. Fish is the main dietary source of the long chain omega 3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. Low doses of these fatty acids (about 250 mg/day) have been suggested to protect against death from coronary heart disease (CHD).1 Fewer data are available on the part that fish intake plays in preventing stroke. In a linked systematic review and meta-analysis of prospective studies and randomised controlled trials (doi:10.1136/bmj.e6698), Chowdhury and colleagues evaluate the role of fish and omega 3 fatty acid intake in the primary and secondary prevention of stroke.2 Several meta-analyses on fish and incident stroke have been published previously.3 4 5 A 2004 meta-analysis of eight population based prospective cohort studies found that eating fish at least once a week was significantly associated with a 13-31% reduction in the risk of stroke when compared with eating fish less than once per month. The association was most pronounced for ischaemic stroke. A recently published update of this meta-analysis, which analysed 16 prospective cohort studies, came to a similar conclusion, although the effect sizes were smaller (9-14% lower risk).5 Another meta-analysis, published in 2011, which was based on 15 prospective cohort …

Cardiovascular risk factor management of myocardial infarction patients with and without diabetes in the Netherlands between 2002 and 2006: a cross-sectional analysis of baseline data

Abstract: Objective: We examined levels and trends in cardiovascular risk factors and drug treatment in myocardial infarction (MI) patients with and without diabetes. Design: Cross-sectional analysis of baseline Alpha Omega Trial data, a randomised controlled trial. Setting: 32 hospitals in the Netherlands. Participants: In total, we had 1014 MI patients with diabetes (74% men) and 3823 without diabetes (79% men) aged 60–80 years, analysed over the period 2002–2006. Results: Between 2002 and 2006, a significantly decreasing trend in the prevalence of obesity (−5%, ptrend=0.02) and in systolic blood pressure (BP) levels (−5 mm Hg, ptrend<0.0001) was demonstrated in nondiabetic patients, but not in diabetic patients. In 2006, obesity, mean systolic BP and serum triglyceride levels were significantly higher, whereas high-density lipoprotein cholesterol levels were lower in diabetic patients compared to those without. Prescription of antihypertensive drug (diabetic vs non-diabetic patients respectively, 95% vs 93%, p=0.08) and statin treatment were high (86% and 90%, p=0.11). Conclusions: A high proportion of MI patients with and without diabetes was similarly treated with cardiovascular drugs. In spite of high drug treatment levels, more adverse risk factors were found in patients with diabetes.

Parental longevity correlates with offspring's optimism in two cohorts of community-dwelling older subjects.

Abstract: Dispositional optimism and other positive personality traits have been associated with longevity. Using a familial approach, we investigated the relationship between parental longevity and offspring’s dispositional optimism among community-dwelling older subjects. Parental age of death was assessed using structured questionnaires in two different population-based samples: the Leiden Longevity Study (n = 1,252, 52.2% female, mean age 66 years, SD = 4) and the Alpha Omega Trial (n = 769, 22.8% female, mean age 69 years, SD = 6). Adult offspring’s dispositional optimism was assessed with the Life Orientation Test—Revised (LOT-R). The association between parental age of death and levels of optimism in the offspring was analysed using linear regression analysis within each sample and a meta-analysis for the overall effect. In both samples, the parental mean age of death was positively associated with optimism scores of the offspring. The association remained significant after adjustment for age, gender, living arrangement, body mass index, smoking status, education and self-rated health of the offspring. The pooled B coefficient (increase in LOT-R score per 10-year increase in parental mean age of death) was 0.30 (SE = 0.08, p < 0.001). In conclusion, parental longevity was positively associated with optimism in adult offspring, suggesting a partial linked heritability of longevity and optimism.

Reply: Some caution when conducting long-term follow-up study of cardiovascular mortality

Abstract: cardiovascular endpoints that we found between the 2 areas. Also, the fact that the mortalities of stroke and coronary heart disease in Japan have substantially changed during the past decades cannot explain our findings. Regrettably, our data did not allow separate analyses for hemorrhagic stroke and cerebral infarction, although we agree that it would be worthwhile examining these different types of stroke. We did examine coronary heart disease mortality, but the number of events was very small and HRs were unstable. In Tanushimaru, the HRs for coronary heart disease mortality were 1.68 (95%CI, 0.64– 4.42) in the mid category and 1.76 (95%CI, 0.60–5.20) in the upper category of systolic BP, compared to the lower category. In Ushibuka, these HRs were 0.80 (95%CI, 0.24–2.62) and 1.32 (95%CI, 0.42–4.20), respectively.