Traffic exposure and subclinical cardiovascular disease: Is the association modified by socioeconomic characteristics of individuals and neighbourhoods? Results from a multilevel study in an urban region.

OBJECTIVES: Traffic-related pollution is associated with cardiovascular disease in general, but previous studies suggested that low socioeconomic status (SES) groups might be more susceptible towards a negative impact. We examined whether the association between long-term exposure to high traffic and early signs of coronary artery disease is modified by SES. METHODS: Individual-level medical and social data from a population-based study were linked with census information on neighbourhood socioeconomic characteristics. Residential exposure to traffic was defined as proximity to major roads using a geographical information system. We studied associations between high traffic and coronary artery calcification (CAC) within strata of SES to examine effect modification. Data stem from an epidemiological study in Germany including 2264 women and 2037 men (45-75 years). RESULTS: High traffic and low SES were both associated with higher amounts of calcification (>or=75th age-specific percentile). More participants with low SES lived close to major roads while stratified analyses did not indicate higher susceptibility in low SES groups. Participants with low SES and simultaneous exposure to high traffic had highest levels of CAC. For example, the prevalence of high calcification was 23.9% in better-educated men with low traffic exposure but 37.7% in lower-educated men with high traffic exposure (women: 22.0% vs 28.1%). CONCLUSIONS: High traffic exposure was associated with coronary calcification in all social groups, but as low SES individuals had higher calcification in general and were also more often exposed to traffic, existing inequalities could be further shaped by traffic exposure

Prevalence of mild cognitive impairment and its subtypes in the Heinz Nixdorf Recall study cohort.

AIMS: We investigated the prevalence of mild cognitive impairment (MCI) and its subtypes according to the original (MCI-original) and modified (MCI-modified; neglecting cognitive complaints) Petersen criteria. METHODS: 4,145 subjects (aged 50-80 years) from a German population-based study completed a cognitive screening test and were poststratified into 2 groups with sample sizes of 1,125 for impaired and 3,020 for age-appropriate performance. Random samples of 445 impaired participants and 211 age-appropriate participants received a detailed neuropsychological evaluation. The prevalence of MCI was estimated by a bias correction estimator based on stratum weights. The association between MCI and age, gender and education was analyzed in a logistic regression model. RESULTS: The estimated MCI prevalence was 7.8% (95% CI: 5.7-9.9%) for the original, and 12.1% (95% CI: 9.8-14.4%) for the modified criteria. In the MCI-original group, amnestic MCI subtypes were slightly less common than non-amnestic MCI subtypes (3.5 vs. 4.3%). MCI-original was associated with lower education and older age. In the MCI-modified group, the amnestic subtypes were more common than the non-amnestic MCI subtypes (7.8 vs. 4.3%), and MCI was associated with age, gender and education. CONCLUSIONS: Prevalence rates of MCI are high in the general population and vary considerably according to the criteria applied

Are air pollution and traffic noise independently associated with atherosclerosis: the Heinz Nixdorf Recall Study

Living close to high traffic has been linked to subclinical atherosclerosis, however it is not clear, whether fine particulate matter (PM) air pollution or noise, two important traffic-related exposures, are responsible for the association. We investigate the independent associations of long-term exposure to fine PM and road traffic noise with thoracic aortic calcification (TAC), a reliable measure of subclinical atherosclerosis. We used baseline data (20002003) from the German Heinz Nixdorf Recall Study, a population-based cohort of 4814 randomly selected participants. We assessed residential long-term exposure to PM with a chemistry transport model, and to road traffic noise using faade levels from noise models as weighted 24 h mean noise (L-den) and night-time noise (L-night). Thoracic aortic calcification was quantified from non-contrast enhanced electron beam computed tomography. We used multiple linear regression to estimate associations of environmental exposures with ln(TAC1), adjusting for each other, individual, and neighbourhood characteristics. In 4238 participants (mean age 60 years, 49.9 male), PM2.5 (aerodynamic diameter 2.5 m) and L-night are both associated with an increasing TAC-burden of 18.1 (95 CI: 6.6; 30.9) per 2.4 g/m(3) PM2.5 and 3.9 (95 CI 0.0; 8.0) per 5dB(A) L-night, respectively, in the full model and after mutual adjustment. We did not observe effect measure modification of the PM2.5 association by L-night or vice versa. Long-term exposure to fine PM and night-time traffic noise are both independently associated with subclinical atherosclerosis and may both contribute to the association of traffic proximity with atherosclerosis

Are symptoms of depression more common in diabetes? Results from the Heinz Nixdorf Recall study.

AIMS: To estimate the association between depressive symptoms and Type 2 diabetes, as well as previously undetected diabetes, in a large population-based sample in Germany and to determine associated variables. METHODS: We used baseline data on 4595 participants (age 45-75 years, 50.2% women) from the German Heinz Nixdorf Recall study, a population-based, prospective cohort study which started in 2000. Diabetes mellitus was assessed by self report (physician diagnosis or medication), undiagnosed diabetes based on blood glucose levels. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale short form (cut-off >or= 15 points). We fitted multiple logistic regression models. RESULTS: The prevalence of diagnosed and previously undetected diabetes was 9.3% (95% confidence interval 8.2-11.6) and 7.6% (6.6-8.8) in men and 6.0% (5.1-7.1) and 3.2% (2.5-4.0) in women, respectively. Compared with non-diabetic women, the prevalence of depressive symptoms was not significantly different in diabetic women (age-adjusted odds ratio, 95% confidence interval 1.48; 0.98-2.24) and women with undiagnosed diabetes (0.67; 0.33-1.36). In men, the prevalence of depressive symptoms tended to be lower in diabetic than in non-diabetic subjects (0.62; 0.35-1.09), but the depressive symptoms were significantly less frequent in men with undiagnosed diabetes (0.30; 0.13-0.70). The pattern remained after further adjustment. Significant associations with depressive symptoms were found for co-morbidities and living without a partner in both women and in men, and for body mass index and activity level in women only. CONCLUSIONS: After adjustment for relevant covariates, the association between depressive symptoms and Type 2 diabetes was heterogenous in our population-based study. In subjects with undiagnosed diabetes, however, depressive symptoms were less frequent in men. Co-morbidities and psychosocial conditions are strongly associated with depressive symptoms

Coronary artery calcification and its relationship to validated genetic variants for diabetes mellitus assessed in the Heinz Nixdorf recall cohort.

OBJECTIVE: To examine the association between genomewide association study-based diabetes mellitus-related single-nucleotide polymorphisms (SNPs) and coronary artery calcification (CAC), a valid risk factor for coronary heart disease, in a large, unselected, population-based cohort. METHODS AND RESULTS: We genotyped 11 validated genomewide association study-based diabetes SNPs in 4459 participants of the Heinz Nixdorf Recall Study. We applied generalized linear regression models to explore the impact of the diabetes SNPs on CAC and to jointly model the effect of the SNPs and CAC on diabetes status. We observed a significant association between cyclin-dependent kinase inhibitor 2A/2B (CDKN2A/2B) variant rs564398 and quantitative CAC (P=1.81 x 10(-5) and adjusted P=4.02 x 10(-4); odds ratio for the presence of CAC, 1.12 [95% CI, 1.02 to 1.25]). Moreover, we observed no strong impact of CAC on diabetes risk in the presence of the other genetic variants. CONCLUSIONS: We show that a genetic variant near CDKN2A/2B that has been reported to be strongly associated with diabetes is strongly associated with CAC. In contrast, variants near insulin-like growth factor-binding protein 2 (IGFBP2), CDK5 regulatory subunit associated protein 1-like 1 (CDKAL1), solute carreir family 30 (zinc transporter), member 8 (SLC30A8), hematopoietically-expressed homeobox (HHEX), and transcription factor 7-like2 (TCF7L2) were clearly associated with diabetes; no evidence for an association to CAC was observable. This differential association pattern underlines the potential of endophenotypes, such as CAC, to extend the scope of disease outcome associations