Trajectories in physical functioning at older age in relation to childhood and adulthood SES and social mobility: a population-based cohort study

INTRODUCTION: Older age is associated with the deterioration of physical functioning (PF), and low PF is strongly related to poor quality of life among older people. We conducted a study to examine the trajectories of PF between middle and old age, considering sex differences as well as the association between socioeconomic status (SES) at different life stages and changes in PF. METHODS: We analyzed data from the Polish arm of the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study, including 1,116 men and 1,178 women aged 45–64 years at baseline. Adult and childhood SES and social mobility were assessed using a retrospectively focused questionnaire. PF was assessed using the 10-question SF-36 scale at baseline examination, face-to-face re-examination, and three postal surveys, covering up to 20 years (on average, 18 years). We employed Generalized Estimating Equations models to assess changes in PF scores over time and compare PF trajectories across different SES categories. RESULTS: After adjusting for age and other covariates, we found that, in both sexes, participants with always middle or high SES, as well as those who reported upward mobility, had higher PF scores at baseline compared to those with always low SES. A decline in PF between middle and old age was observed in all SES groups; however, the decline was slower in participants with always middle or high SES compared to those with always low SES. CONCLUSION: This cohort study revealed that lower SES and downward social mobility were cross-sectionally associated with poorer PF, while upward social mobility seemed to largely reverse the effect of low childhood SES. In addition to the cross-sectional associations observed at baseline, advantaged SES was also significantly associated with a slower decline in PF over an 18-year follow-up period

Accumulation of psychosocial risk factors and incidence of cardiovascular disease: a prospective observation of the Polish HAPIEE cohort

BACKGROUND: Psychosocial risk factors for cardiovascular disease (CVD) are known to cluster in individuals, but the effect of cumulative exposure has not been thoroughly described in terms of CVD risk. AIMS: The aim of the study was to assess the relationship between accumulation of psychosocial risk factors such as low education, material deprivation, depressive symptoms, and low perceived control and the risk of incident CVD. METHODS: This cohort study with 11‑year follow‑up included a random population sample (age, 45-69 years). Psychosocial factors were assessed using standard tools. Accumulation of psychosocial risk factors was determined by summing up the number of psychosocial factors experienced. The risk of incident CVD depending on the number of psychosocial factors was estimated (reference, no psychosocial factors). Cox proportional hazards models were fitted. RESULTS: In total, 43 572 and 51 772 person‑years were analyzed. There were 479 and 291 new CVD cases in men and women, respectively. An age‑adjusted model showed an increase in CVD risk in men exposed to 3 and 4 psychosocial risk factors by nearly 60% and 125%, respectively (P <0.05). Further adjustment waved the association in individual strata, but a significant linear trend was observed. In women, in a fully adjusted model, the second and subsequent risk factors increased the risk of CVD by nearly 70% up to over 2‑fold (P <0.001). The total population attributable risk associated with exposure to psychosocial risk factors in women was 34.1%. CONCLUSIONS: The accumulation of psychosocial risk factors was associated with increased risk of CVD. In men, the relation was substantially explained by classic risk factors. In women, about one-third of incident CVD cases could be attributed to psychosocial risk factors

Alcohol use disorder increases the risk of nonfatal and fatal cardiovascular disease: an 11-year follow-up of a Polish population-based cohort. The HAPIEE study

INTRODUCTION: Self‑reported alcohol intake is an inaccurate measure, especially in heavy drinkers. The simple 4‑item CAGE questionnaire assessing alcohol use disorder was found to be positively as‑ sociated with alcohol consumption and mortality. OBJECTIVES This study aimed to investigate the relationship between alcohol use disorder assessed with the CAGE questionnaire and the incidence of cardiovascular disease (CVD) in a population‑based Polish sample. PATIENTS AND METHODS: A cohort study with an 11‑year follow‑up was conducted. A random sample of 10 728 residents of Kraków aged 45 to 69 years completed baseline examination, including the CAGE questionnaire. Information on new cases of CVD was obtained from further questionnaires and con‑ firmed by clinical diagnosis. Data on mortality and causes of death were obtained from the local registry, the Central Statistical Office, and the participants’ families. The effect of the CAGE score on the risk of CVD was assessed using Cox proportional hazard models. RESULTS: The analysis included 7112 individuals who completed the CAGE questionnaire and were free of CVD at baseline. No alcohol use disorder was reported in 94% of the participants. There was a positive association between the CAGE score and the risk of CVD. In the fully adjusted model, compared with participants scoring 0, the hazard ratios among those scoring 3 and 4 points were 2.19 (95% CI, 1.43–3.37) and 2.79 (95% CI, 1.65–4.73), respectively. The association was somewhat stronger for fatal CVD. CONCLUSIONS: We found a strong, graded association between the CAGE score and the risk of CVD incidence, which was independent of other risk factors for CVD. The CAGE questionnaire might be con‑ sidered as an additional tool to identify individuals at high risk of CVD

Association between plasma bilirubin and mortality

Introduction and aim: It has been proposed that plasma concentration of bilirubin, an endogenous antioxidant, is protective against diseases mediated by increased oxidative stress, including cardiovascular diseases (CVD) and cancer. To examine this hypothesis, we investigated the relationship between plasma bilirubin concentrations and bilirubin UDP-glucuronosyl transferase (UGT1A1) promoter gene variations (associated with increased bilirubin concentrations) with total/CVD and cancer mortality. Materials and methods: A nested case–control study was conducted within the Polish arm of the HAPIEE cohort. At baseline in 2002–2005, participants were examined in detail. Mortality follow-up (median (IQR) between blood draw and death was 3.7 (2.1–5.1) years) was performed by linkage with regional and national death registers. Plasma biomarkers were analysed in all subjects who died from any cause (cases, n = 447) and in a random subsample of survivors (controls, n = 1423). Results: There was a strong negative association between plasma bilirubin levels and total and cancer mortality, expressed more profoundly in men. The adjusted OR of deaths from all causes and cancer, comparing the highest vs. lowest plasma bilirubin categories were 0.61 (95% CI: 0.42–0.87) and 0.39 (0.24–0.65), respectively. There was no association of bilirubin with CVD mortality. The UGT1A1*28 allele, a genetic marker of raised bilirubin, was also negatively associated with total/cancer mortality, although the associations were not statistically significant. Discussion: Both the observational and genetic associations support the negative relationship between bilirubin and total mortality; this association appears to be driven by cancer mortality, while that with CVD mortality is not evident

SCORE2 risk prediction algorithms : new models to estimate 10-year risk of cardiovascular disease in Europe

Aims The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. Methods and results We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low- risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe