Long-term mortality after first Acute Myocardial Infarction in the light of changing therapeutic guidelines and diagnostic criteria between 1995 and 2003

Background: The introduction of new invasive therapies for acute myocardial infarction and new medication schemes for secondary prevention is thought to increase life expectancy in 28-day survivors of a first myocardial infarction. The present study examined mortality and re-infarction rate of those patients in the light of changed therapeutic guidelines. Methods: Cases of 25 to 74 year old 28-day survivors of a first definite AMI based on MONICA criteria were identified in the Coronary Event Registry in Augsburg, Southern Germany, who had their index event between the 1st of January 1995 and the 31st of December 2003. Mortality and re-infarction rates were calculated for 1 year, 3 years and total follow-up. Cox models were built to compare the rates of persons, who suffered the index event between 1995 and 1999 (Study period 1) with those who had their first AMI between 2000 and 2003 (Study period 2). Results: Crude mortality was higher in Study period 1 than in Study period 2 and higher for women than for men. Re-infarction rates remained stable for men during both study periods, but women from Study period 1 had a much higher re-infarction rate than women in Study period 2. The hazard ratios showed no significant differences for mortality and re-infarction in men. Hazard ratios of re-infarction in women were significantly reduced, but have to be treated with caution as the number of re-infarctions during Study period 2 was very small. Mortality hazard ratios in women were also not significant. Conclusions: When comparing the time periods before and after the introduction of new therapeutic guidelines, an effect on mortality or re-infarction rate cannot be established. Several reasons are probably responsible for this finding. The population of patients has changed with respect to their risk factors and new diagnostic criteria may have also contributed. Further studies are needed to illuminate these questions

Living alone is a risk factor for mortality in men but not women from the general population: a prospective cohort study

During the past decades a rising trend of living alone can be observed in the population especially in urban areas. Living alone is considered a psychosocial risk factor. We studied the relationship between living alone, cardiovascular risk factors and mortality. We analysed data from the population-based MONICA/KORA cohort study including 3596 men and 3420 women of at least one of three surveys carried out between 1984 and 1995 in the region of Augsburg, Germany. They were between 45 and 74 years old and were followed-up until 31 December 2002. During follow-up 811 men and 388 women died. Cox proportional hazards analysis was used to examine the association between living alone and mortality

HETEAC: The Aerosol Classification Model for EarthCARE

We introduce the Hybrid End-To-End Aerosol Classification (HETEAC) model for the upcoming EarthCARE mission. The model serves as the common baseline for development, evaluation, and implementation of EarthCARE algorithms. It shall ensure the consistency of different aerosol products from the multi-instrument platform as well as facilitate the conform specification of broad-band optical properties necessary for the EarthCARE radiative closure efforts. The hybrid approach ensures the theoretical description of aerosol microphysics consistent with the optical properties of various aerosol types known from observations. The end-to-end model permits the uniform representation of aerosol types in terms of microphysical, optical and radiative properties

Living alone is associated with an increased risk of type 2 diabetes mellitus in men but not women from the general population: the MONICA/KORA Augsburg cohort study

Objective: To examine sex-specific associations between living alone and incident Type 2 diabetes mellitus in a representative population sample in Germany. Methods: The study was based on 4424 men and 4380 women (aged 35-74 years) who participated in one of the three Monitoring trends and determinants on cardiovascular diseases Augsburg surveys between 1984 and 1995 and who were free of diabetes at baseline. Sex-specific hazard ratios (HRs) were estimated from Cox proportional hazard models. Results: A total of 402 cases of incident Type 2 diabetes among men and 271 among women were registered during the mean follow-up period of 10.9 years. Living alone was significantly associated with incident Type 2 diabetes in men but not in women. After adjustment for age, survey, parental history of diabetes, hypertension, dyslipidemia, smoking, physical activity, alcohol intake, and body mass index, the risk of developing diabetes for those who lived alone at baseline compared with those who did not live alone was 1.69 (95% confidence interval (CI), 1.19-2.37) in men and 0.85 (95% CI, 0.57-1.24) in women; the p value for the sex interaction was .006 in this model. Inclusion of education and depressed mood in the models in addition to other risk factors had no impact on the observed HRs in women and even increased the risk in men (women: HR, 0.83; 95% CI, 0.52-1.32; men: HR, 1.89; 95% CI, 1.33-2.70). Conclusions: Living alone is an independent predictor of Type 2 diabetes in men but not in women from the general population

Association of sports activities in leisure time and incident myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study

To examine sex-specific associations between sports activities in leisure time and incident myocardial infarction (MI) in a representative population sample in Germany. DESIGN: Cohort study. METHODS: The study was based on 3501 men and 3475 women (aged 45-74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995 and were followed up until 2002. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. RESULTS: A total of 295 cases of incident MIs among men and 91 among women were registered during a median follow-up period of 8.6 years. In both sexes, moderate and high level of sports activities in leisure time were associated with a reduced risk of incident MI after age and survey adjustment; the HRs of MIs associated with a moderate and high level of sports activities in leisure time were 0.68 (0.49-0.96), and 0.71 (0.50-0.99) for men and 0.42 (0.21-0.84), and 0.18 (0.04-0.74) for women. Further adjustment for other major coronary heart disease risk factors attenuated the HRs: in moderately and highly active men, the HRs were not significant anymore (HRs 0.78 and 0.84, respectively), but the HRs remained significantly reduced in moderately and highly active women (HR 0.49; 95% CI, 0.24-1.00 and HR 0.21; 95% CI, 0.05-0.87, respectively). CONCLUSION: Moderate or high levels of sports activities in leisure time are associated with a significantly reduced risk of MI in women, but not men from the general population