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Taieb AB, Roberts E, Luckevich M, Larsen S, le Roux CW, de Freitas PG, Wolfert D. Understanding the risk of developing weight-related complications associated with different body mass index categories: a systematic review. Diabetol Metab Syndr 2022; 14:186. [PMID: 36476232 PMCID: PMC9727983 DOI: 10.1186/s13098-022-00952-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obesity and overweight are major risk factors for several chronic diseases. There is limited systematic evaluation of risk equations that predict the likelihood of developing an obesity or overweight associated complication. Predicting future risk is essential for health economic modelling. Availability of future treatments rests upon a model's ability to inform clinical and decision-making bodies. This systematic literature review aimed to identify studies reporting (1) equations that calculate the risk for individuals with obesity, or overweight with a weight-related complication (OWRC), of developing additional complications, namely T2D, cardiovascular (CV) disease (CVD), acute coronary syndrome, stroke, musculoskeletal disorders, knee replacement/arthroplasty, or obstructive sleep apnea; (2) absolute or proportional risk for individuals with severe obesity, obesity or OWRC developing T2D, a CV event or mortality from knee surgery, stroke, or an acute CV event. METHODS Databases (MEDLINE and Embase) were searched for English language reports of population-based cohort analyses or large-scale studies in Australia, Canada, Europe, the UK, and the USA between January 1, 2011, and March 29, 2021. Included reports were quality assessed using an adapted version of the Newcastle Ottawa Scale. RESULTS Of the 60 included studies, the majority used European cohorts. Twenty-nine reported a risk prediction equation for developing an additional complication. The most common risk prediction equations were logistic regression models that did not differentiate between body mass index (BMI) groups (particularly above 40 kg/m2) and lacked external validation. The remaining included studies (31 studies) reported the absolute or proportional risk of mortality (29 studies), or the risk of developing T2D in a population with obesity and with prediabetes or normal glucose tolerance (NGT) (three studies), or a CV event in populations with severe obesity with NGT or T2D (three studies). Most reported proportional risk, predominantly a hazard ratio. CONCLUSION More work is needed to develop and validate these risk equations, specifically in non-European cohorts and that distinguish between BMI class II and III obesity. New data or adjustment of the current risk equations by calibration would allow for more accurate decision making at an individual and population level.
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Affiliation(s)
| | | | | | | | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, University College, Dublin, Ireland
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Knowles R, Carter J, Jebb SA, Bennett D, Lewington S, Piernas C. Associations of Skeletal Muscle Mass and Fat Mass With Incident Cardiovascular Disease and All-Cause Mortality: A Prospective Cohort Study of UK Biobank Participants. J Am Heart Assoc 2021; 10:e019337. [PMID: 33870707 PMCID: PMC8200765 DOI: 10.1161/jaha.120.019337] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Background There is debate whether body mass index is a good predictor of health outcomes because different tissues, namely skeletal muscle mass (SMM) and fat mass (FM), may be differentially associated with risk. We investigated the association of appendicular SMM (aSMM) and FM with fatal and nonfatal cardiovascular disease (CVD) and all-cause mortality. We compared their prognostic value to that of body mass index. Methods and Results We studied 356 590 UK Biobank participants aged 40 to 69 years with bioimpedance analysis data for whole-body FM and predicted limb muscle mass (to calculate aSMM). Associations between aSMM and FM with CVD and all-cause mortality were examined using multivariable Cox proportional hazards models. Over 3 749 501 person-years of follow-up, there were 27 784 CVD events and 15 844 all-cause deaths. In men, aSMM was positively associated with CVD incidence (hazard ratio [HR] per 1 SD 1.07; 95% CI, 1.06-1.09) and there was a curvilinear association in women. There were stronger positive associations between FM and CVD with HRs per SD of 1.20 (95% CI, 1.19-1.22) and 1.25 (95% CI, 1.23-1.27) in men and women respectively. Within FM tertiles, the associations between aSMM and CVD risk largely persisted. There were J-shaped associations between aSMM and FM with all-cause mortality in both sexes. Body mass index was modestly better at discriminating CVD risk. Conclusions FM showed a strong positive association with CVD risk. The relationship of aSMM with CVD risk differed between sexes, and potential mechanisms need further investigation. Body fat and SMM bioimpedance measurements were not superior to body mass index in predicting population-level CVD incidence or all-cause mortality.
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Affiliation(s)
- Rebecca Knowles
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Jennifer Carter
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordUnited Kingdom
| | - Derrick Bennett
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Sarah Lewington
- Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Carmen Piernas
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordUnited Kingdom
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Abdominal obesity and risk of CVD: a dose-response meta-analysis of thirty-one prospective studies. Br J Nutr 2021; 126:1420-1430. [PMID: 33431092 DOI: 10.1017/s0007114521000064] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This meta-analysis aimed to study the relationship between abdominal obesity and the risk of CVD by waist circumference (WC), waist:hip ratio (WHR) and waist:height ratio (WHtR). We systematically searched PubMed, Embase and Web of Science. Prospective studies that estimated cardiovascular events by WC, WHR and WHtR were included in this study. Pooled relative risks with 95 % CI were calculated using random effects models. A total of thirty-one studies were included in the meta-analysis, including 669 560 participants and 25 214 cases. Compared the highest with the lowest category of WC, WHR and WHtR, the summary risk ratios were 1·43 (95 % CI, 1·30, 1·56, P < 0·001), 1·43 (95 % CI, 1·33, 1·54, P < 0·001) and 1·57 (95 % CI, 1·37, 1·79, P < 0·001), respectively. The linear dose-response analysis revealed that the risk of CVD increased by 3·4 % for each 10 cm increase of WC, and by 3·5 and 6·0 % for each 0·1 unit increase of WHR and WHtR in women, respectively. In men, the risk of CVD increased by 4·0 % for each 10 cm increase of WC, and by 4·0 and 8·6 % for each 0·1 unit increase of WHR and WHtR, respectively. Collectively, abdominal obesity is associated with an increased risk of CVD. WC, WHR and WHtR are good indicators for the prediction of CVD.
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Jayedi A, Soltani S, Zargar MS, Khan TA, Shab-Bidar S. Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies. BMJ 2020; 370:m3324. [PMID: 32967840 PMCID: PMC7509947 DOI: 10.1136/bmj.m3324] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included. DATA SYNTHESIS A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves. RESULTS Of 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2 528 297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I2=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I2=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I2=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I2=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I2=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I2=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I2=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I2=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index. CONCLUSIONS Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.
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Affiliation(s)
- Ahmad Jayedi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, PO Box 14155/6117, Tehran, Iran
| | - Sepideh Soltani
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdieh Sadat Zargar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Tauseef Ahmad Khan
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis & Clinical Trials Unit, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, PO Box 14155/6117, Tehran, Iran
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Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, Brauer M, Kutty VR, Gupta R, Wielgosz A, AlHabib KF, Dans A, Lopez-Jaramillo P, Avezum A, Lanas F, Oguz A, Kruger IM, Diaz R, Yusoff K, Mony P, Chifamba J, Yeates K, Kelishadi R, Yusufali A, Khatib R, Rahman O, Zatonska K, Iqbal R, Wei L, Bo H, Rosengren A, Kaur M, Mohan V, Lear SA, Teo KK, Leong D, O'Donnell M, McKee M, Dagenais G. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020; 395:795-808. [PMID: 31492503 PMCID: PMC8006904 DOI: 10.1016/s0140-6736(19)32008-2] [Citation(s) in RCA: 841] [Impact Index Per Article: 210.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels. METHODS In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs. FINDINGS Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs. INTERPRETATION Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shofiqul Islam
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Antonio Dans
- Department of Cardiac Sciences, University of Philippines, Manila, Philippines
| | - Patricio Lopez-Jaramillo
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia; Escuela de Medicina, Universidad de Santander, Bucaramanga, Colombia
| | - Alvaro Avezum
- Department of Medicine, Universidade de Santo Amaro, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Fernando Lanas
- Department of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Iolanthe M Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica (ECLA), Rosario, Santa Fe, Argentina
| | - Khalid Yusoff
- Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia; UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Prem Mony
- St John's Research Institute, St John's Medical College, Bangalore, India
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afzalhussein Yusufali
- Department of Medicine, Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine; Advocate Health Care, Chicago, IL, USA
| | | | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Li Wei
- National Centre for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hu Bo
- National Centre for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, India; Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Darryl Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Martin O'Donnell
- Department of Medicine, National University of Ireland Galway, London, UK
| | - Martin McKee
- Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Gilles Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
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The Guizhi Gancao Decoction Attenuates Myocardial Ischemia-Reperfusion Injury by Suppressing Inflammation and Cardiomyocyte Apoptosis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:1947465. [PMID: 30800167 PMCID: PMC6360628 DOI: 10.1155/2019/1947465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/25/2022]
Abstract
Guizhi Gancao Decoction (GGD) is a well-known traditional Chinese herbal medicine for the treatment of various cardiovascular diseases, such as myocardial ischemia-reperfusion (I/R) injury and arrhythmia. However, the mechanism by which GGD contributes to the amelioration of cardiac injury remains unclear. The aim of this study was to investigate the potential protective role of GGD against myocardial I/R injury and its possible mechanism. Consistent with the effect of the positive drug (Trimetazidine, TMZ), we subsequently validated that GGD could ameliorate myocardial I/R injury as evidenced by histopathological examination and triphenyltetrazolium chloride (TTC) staining. Moreover, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay demonstrated that GGD suppressed myocardial apoptosis, which may be related to the upregulation of Bcl-2, PPARα, and PPARγ and downregulation of Bax, caspase-3, and caspase-9. Pretreatment with GGD attenuated the levels of proinflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin- (IL-) 6, and IL-1β in serum by inhibiting Toll-like receptor 4 (TLR4)/NF-κB signaling pathway. These results indicated that GGD exhibits cardioprotective effects on myocardial I/R injury through inhibition of the TLR4/NF-κB signaling pathway, which led to reduced inflammatory response and the subsequent cardiomyocyte apoptosis.
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Han J, Wang D, Ye L, Li P, Hao W, Chen X, Ma J, Wang B, Shang J, Li D, Zheng Q. Rosmarinic Acid Protects against Inflammation and Cardiomyocyte Apoptosis during Myocardial Ischemia/Reperfusion Injury by Activating Peroxisome Proliferator-Activated Receptor Gamma. Front Pharmacol 2017; 8:456. [PMID: 28744220 PMCID: PMC5504166 DOI: 10.3389/fphar.2017.00456] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/26/2017] [Indexed: 12/21/2022] Open
Abstract
The cardiac ischemia-reperfusion (I/R) injury greatly influences the therapeutic effect and remains an urgent challenge in clinical therapy. Polypharmacology opens a new therapeutic opportunity to design drugs with a specific target for improving the efficacy. In this study, we first forecasted that Rosmarinic acid (RosA) could be used for the treatment of cardiovascular disease using text mining, chemometric and chemogenomic methods. Consistent with the effect of the positive drug (pioglitazone, PIO), we subsequently validated that RosA pretreatment could restore the decreased cardiac hemodynamic parameters (LVDP, ± dp/dtmin, ± dp/dtmax and CF), decreased the infarct size and the cardiomyocyte apoptosis in a rat model of cardiac I/R injury. Furthermore, RosA pre-treatment inhibited the levels of inflammatory cytokines (IL-6, TNF-α and CRP), up-regulated PPARγ expression and down-regulated NF-κB expression in myocardial tissue isolated from the rat model of I/R-induced myocardial injury. In addition, the effects of RosA were reversed by co-treatment with PPAR-γ inhibitor GW9662 and T0070907, respectively. These data suggest that RosA attenuates cardiac injury through activating PPARγ and down-regulating NF-κB-mediated signaling pathway, which inhibiting inflammation and cardiomyocyte apoptosis in a rat model of cardiac I/R injury.
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Affiliation(s)
- Jichun Han
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China.,State Key Laboratory of Natural Medicines, China Pharmaceutical UniversityNanjing, China
| | - Dong Wang
- Department of Cardiac Surgery, Shandong Provincial Qianfoshan Hospital, Shandong UniversityJinan, China
| | - Lei Ye
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China
| | - Peng Li
- College of Arts and Sciences, Shanxi Agricultural UniversityTaigu, China
| | - Wenjin Hao
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China
| | - Xiaoyu Chen
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China
| | - Jun Ma
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China
| | - Bo Wang
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China
| | - Jing Shang
- State Key Laboratory of Natural Medicines, China Pharmaceutical UniversityNanjing, China
| | - Defang Li
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China
| | - Qiusheng Zheng
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical UniversityYantai, China.,Key Laboratory of Xinjiang Endemic Phytomedicine Resources, Ministry of Education, School of Pharmacy, Shihezi UniversityShihezi, China
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8
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Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 353:i2156. [PMID: 27146380 PMCID: PMC4856854 DOI: 10.1136/bmj.i2156] [Citation(s) in RCA: 480] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. DATA SOURCES PubMed and Embase databases searched up to 23 September 2015. STUDY SELECTION Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. DATA SYNTHESIS Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. RESULTS 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I(2)=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I(2)=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I(2)=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I(2)=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years' follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. CONCLUSION Overweight and obesity is associated with increased risk of all cause mortality and the nadir of the curve was observed at BMI 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 with longer durations of follow-up. The increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. Lack of exclusion of ever smokers, people with prevalent and preclinical disease, and early follow-up could bias the results towards a more U shaped association.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Abhijit Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Manya Prasad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Serena Tonstad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pål Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Syddall HE, Westbury LD, Simmonds SJ, Robinson S, Cooper C, Sayer AA. Understanding poor health behaviours as predictors of different types of hospital admission in older people: findings from the Hertfordshire Cohort Study. J Epidemiol Community Health 2015; 70:292-8. [PMID: 26481495 DOI: 10.1136/jech-2015-206425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/02/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Rates of hospital admission are increasing, particularly among older people. Poor health behaviours cluster but their combined impact on risk of hospital admission among older people in the UK is unknown. METHODS 2997 community-dwelling men and women (aged 59-73) participated in the Hertfordshire Cohort Study (HCS). We scored (from 0 to 4) number of poor health behaviours engaged in at baseline (1998-2004) out of: current smoking, high weekly alcohol, low customary physical activity and poor diet. We linked HCS with Hospital Episode Statistics and mortality data to 31/03/2010 and analysed associations between the score and risk of different types of hospital admission: any; elective; emergency; long stay (>7 days); 30-day readmission (any, or emergency). RESULTS 32%, 40%, 20% and 7% of men engaged in 0, 1, 2 and 3/4 poor health behaviours; corresponding percentages for women 51%, 38%, 9%, 2%. 75% of men (69% women) experienced at least one hospital admission. Among men and women, increased number of poor health behaviours was strongly associated (p<0.01) with greater risk of long stay and emergency admissions, and 30-day emergency readmissions. Hazard ratios (HRs) for emergency admission for 3/4 poor health behaviours in comparison with none were: men, 1.37 (95% CI 1.11 to 1.69); women, 1.84 (95% CI 1.22 to 2.77). Associations were unaltered by adjustment for age, body mass index and comorbidity. CONCLUSIONS Clustered poor health behaviours are associated with increased risk of hospital admission among older people in the UK. Lifecourse interventions to reduce number of poor health behaviours could have substantial beneficial impact on health and use of healthcare in later life.
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Affiliation(s)
- Holly E Syddall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Leo D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Shirley J Simmonds
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sian Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Avan Aihie Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK NIHR Collaboration for Leadership in Applied Health Research and Care: Wessex, University of Southampton,Southampton, UK Institute for Ageing and Institute of Health & Society, Newcastle University, Newcastle, UK
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10
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Abazid RM, Kattea MO, Sayed S, Saqqah H, Qintar M, Smettei OA. Visceral adipose tissue influences on coronary artery calcification at young and middle-age groups using computed tomography angiography. Avicenna J Med 2015; 5:83-8. [PMID: 26229760 PMCID: PMC4510826 DOI: 10.4103/2231-0770.160242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: The purpose of the study was to evaluate the impact of excessive visceral adipose tissue (VAT) on subclinical coronary atherosclerosis and coronary artery calcifications (CAC) in young and middle-age groups using multislice computed tomography. Methods: This study is a single center, cross-sectional study. Eligible patients (n = 159), who under the age of 61 years, with chest pain and mild to moderate probability to have coronary artery disease (CAD) were enrolled. Coronary calcium score and epicardial adipose tissue (EAT) were measured at the level of the left main coronary artery while VAT was measured at the level of the iliac crest. Results: The average age was (48 ± 8 years). The mean VAT was (38 ± 21 cm2) with no significant difference between men and women (38 ± 22 vs. 37 ± 19 P = 0.8) respectively. Student's t-test analysis showed significantly higher VAT in patients with detectable CAC than patients with no CAC (48 ± 24 vs. 33 ± 18 P = 0.00002), respectively. Univariate regression analysis showed that VAT and EAT, are strong predictor for CAC (hazard ratio [HR] 1.034, 95% confidence interval [CI: 1.016–1.052]. P <0.001 and [HR] 1.344, 95% CI: [1.129–1.601] P = 0.001), respectively. Conclusion: Excessive VAT is significantly associated with positive CAC. VAT can strongly predict subclinical CAD in individuals at young and middle-age groups.
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Affiliation(s)
- Rami M Abazid
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia ; Department of Cardiac Imaging, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - M Obadah Kattea
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia ; Department of Cardiac Imaging, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - Sawsan Sayed
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - Hanaa Saqqah
- Department of Cardiac CT Technicians, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
| | - Mohammed Qintar
- Department of Internal Medicine, Cleveland Clinic Foundation Cleveland, OH, USA
| | - Osama A Smettei
- Department of Cardiology, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia ; Department of Cardiac Imaging, Prince Sultan Cardiac Center-Al Qassim, Buraydah, Saudi Arabia
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11
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Abstract
Heart disease is the leading cause of death in women. Unique risk factors have been recognized, including pre-eclampsia, eclampsia and autoimmune diseases. Diabetes and hypertension (HTN) also play a unique role in women. Women with diabetes have a higher risk for coronary heart disease and microvascular disease compared with males. Additionally, older women have a high prevalence of uncontrolled HTN and women tend to have more treatment resistant HTN, increasing risk for cardiovascular events and mortality. The outcomes of cardiovascular disease have shown an increase in the number of heart attacks in younger women, though there is decreasing mortality. Treatment with coronary artery bypass graft surgery and percutaneous intervention has also shown to have poorer outcomes in women.
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Affiliation(s)
- Jacqueline Kurth
- Department of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Shaista Malik
- Division of Cardiology, Department of Medicine, University of California Irvine, 333 City Boulevard West, Suite 400, Orange, CA 92868-3298, USA
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12
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Vold ML, Aasebø U, Wilsgaard T, Melbye H. Low oxygen saturation and mortality in an adult cohort: the Tromsø study. BMC Pulm Med 2015; 15:9. [PMID: 25885261 PMCID: PMC4342789 DOI: 10.1186/s12890-015-0003-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/20/2015] [Indexed: 11/18/2022] Open
Abstract
Background Oxygen saturation has been shown in risk score models to predict mortality in emergency medicine. The aim of this study was to determine whether low oxygen saturation measured by a single-point measurement by pulse oximetry (SpO2) is associated with increased mortality in the general adult population. Methods Pulse oximetry was performed in 5,152 participants in a cross-sectional survey in Tromsø, Norway, in 2001–2002 (“Tromsø 5”). Ten-year follow-up data for all-cause mortality and cause of death were obtained from the National Population and the Cause of Death Registries, respectively. Cause of death was grouped into four categories: cardiovascular disease, cancer except lung cancer, pulmonary disease, and others. SpO2 categories were assessed as predictors for all-cause mortality and death using Cox proportional-hazards regression models after correcting for age, sex, smoking history, body mass index (BMI), C-reactive protein level, self-reported diseases, respiratory symptoms, and spirometry results. Results The mean age was 65.8 years, and 56% were women. During the follow-up, 1,046 (20.3%) participants died. The age- and sex-adjusted hazard ratios (HRs) (95% confidence intervals) for all-cause mortality were 1.99 (1.33–2.96) for SpO2 ≤ 92% and 1.36 (1.15–1.60) for SpO2 93–95%, compared with SpO2 ≥ 96%. In the multivariable Cox proportional-hazards regression models that included self-reported diseases, respiratory symptoms, smoking history, BMI, and CRP levels as the explanatory variables, SpO2 remained a significant predictor of all-cause mortality. However, after including forced expiratory volume in 1 s percent predicted (FEV1% predicted), this association was no longer significant. Mortality caused by pulmonary diseases was significantly associated with SpO2 even when FEV1% predicted was included in the model. Conclusions Low oxygen saturation was independently associated with increased all-cause mortality and mortality caused by pulmonary diseases. When FEV1% predicted was included in the analysis, the strength of the association weakened but was still statistically significant for mortality caused by pulmonary diseases.
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Affiliation(s)
- Monica Linea Vold
- Department of Respiratory Medicine, University Hospital of North Norway, 9038, Tromsø, Norway. .,Department of Community Medicine, University of Tromsø, Tromsø, Norway.
| | - Ulf Aasebø
- Department of Respiratory Medicine, University Hospital of North Norway, 9038, Tromsø, Norway. .,Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
| | - Tom Wilsgaard
- Department of Community Medicine, University of Tromsø, Tromsø, Norway.
| | - Hasse Melbye
- Department of Community Medicine, University of Tromsø, Tromsø, Norway.
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Yatsuya H, Li Y, Hilawe EH, Ota A, Wang C, Chiang C, Zhang Y, Uemura M, Osako A, Ozaki Y, Aoyama A. Global Trend in Overweight and Obesity and Its Association With Cardiovascular Disease Incidence. Circ J 2014; 78:2807-18. [DOI: 10.1253/circj.cj-14-0850] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine
- Department of Cardiology, Fujita Health University School of Medicine
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yuanying Li
- Department of Public Health, Fujita Health University School of Medicine
| | - Esayas Haregot Hilawe
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
- Department of Public Health, School of Medicine, Mekelle University
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine
| | - Chaochen Wang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yan Zhang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Mayu Uemura
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Ayaka Osako
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
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14
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Canoy D, Cairns BJ, Balkwill A, Wright FL, Green J, Reeves G, Beral V. Body mass index and incident coronary heart disease in women: a population-based prospective study. BMC Med 2013; 11:87. [PMID: 23547896 PMCID: PMC3661394 DOI: 10.1186/1741-7015-11-87] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 04/02/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A high body mass index (BMI) is associated with an increased risk of mortality from coronary heart disease (CHD); however, a low BMI may also be associated with an increased mortality risk. There is limited information on the relation of incident CHD risk across a wide range of BMI, particularly in women. We examined the relation between BMI and incident CHD overall and across different risk factors of the disease in the Million Women Study. METHODS 1.2 million women (mean age=56 years) participants without heart disease, stroke, or cancer (except non-melanoma skin cancer) at baseline (1996 to 2001) were followed prospectively for 9 years on average. Adjusted relative risks and 20-year cumulative incidence from age 55 to 74 years were calculated for CHD using Cox regression. RESULTS After excluding the first 4 years of follow-up, we found that 32,465 women had a first coronary event (hospitalization or death) during follow-up. The adjusted relative risk for incident CHD per 5 kg/m2 increase in BMI was 1.23 (95% confidence interval (CI) 1.22 to 1.25). The cumulative incidence of CHD from age 55 to 74 years increased progressively with BMI, from 1 in 11 (95% CI 1 in 10 to 12) for BMI of 20 kg/m2, to 1 in 6(95% CI 1 in 5 to 7) for BMI of 34 kg/m2. A 10 kg/m2 increase in BMI conferred a similar risk to a 5-year increment in chronological age. The 20 year cumulative incidence increased with BMI in smokers and non-smokers, alcohol drinkers and non-drinkers, physically active and inactive, and in the upper and lower socioeconomic classes. In contrast to incident disease, the relation between BMI and CHD mortality (n=2,431) was J-shaped. For the less than 20 kg/m2 and ≥35 kg/m2 BMI categories, the respective relative risks were 1.27 (95% CI 1.06 to 1.53) and 2.84 (95% CI 2.51 to 3.21) for CHD deaths, and 0.89 (95% CI 0.83 to 0.94) and 1.85 (95% CI 1.78 to 1.92) for incident CHD. CONCLUSIONS CHD incidence in women increases progressively with BMI, an association consistently seen in different subgroups. The shape of the relation with BMI differs for incident and fatal disease.
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Affiliation(s)
- Dexter Canoy
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Angela Balkwill
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - F Lucy Wright
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Gillian Reeves
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford, OX3 7LF, UK
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