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Gue Y, Correa E, Thompson JLP, Homma S, Qian M, Lip GYH. Machine Learning Predicting Atrial Fibrillation as an Adverse Event in the Warfarin and Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Am J Med 2023; 136:1099-1108.e2. [PMID: 37611780 DOI: 10.1016/j.amjmed.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Atrial fibrillation and heart failure commonly coexist due to shared pathophysiological mechanisms. Prompt identification of patients with heart failure at risk of developing atrial fibrillation would allow clinicians the opportunity to implement appropriate monitoring strategy and timely treatment, reducing the impact of atrial fibrillation on patients' health. METHODS Four machine learning models combined with logistic regression and cluster analysis were applied post hoc to patient-level data from the Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm (WARCEF) trial to identify factors that predict development of atrial fibrillation in patients with heart failure. RESULTS Logistic regression showed that White divorced patients have a 1.75-fold higher risk of atrial fibrillation than White patients reporting other marital statuses. By contrast, similar analysis suggests that non-White patients who live alone have a 2.58-fold higher risk than those not living alone. Machine learning analysis also identified "marital status" and "live alone" as relevant predictors of atrial fibrillation. Apart from previously well-recognized factors, the machine learning algorithms and cluster analysis identified 2 distinct clusters, namely White and non-White ethnicities. This should serve as a reminder of the impact of social factors on health. CONCLUSION The use of machine learning can prove useful in identifying novel cardiac risk factors. Our analysis has shown that "social factors," such as living alone, may disproportionately increase the risk of atrial fibrillation in the under-represented non-White patient group with heart failure, highlighting the need for more studies focusing on stratification of multiracial cohorts to better uncover the heterogeneity of atrial fibrillation.
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Affiliation(s)
- Ying Gue
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom; The Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
| | - Elon Correa
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom; School of Computer Science and Mathematics, Liverpool John Moores University, United Kingdom
| | | | | | - Min Qian
- Columbia University Medical Center, New York, NY
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom; The Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Humbert X, Rabiaza A, Fedrizzi S, Alexandre J, Menotti A, Touzé E, Laurenzi M, Terradura-Vagnarelli O, Puddu PE. Marital status and long-term cardiovascular risk in general population (Gubbio, Italy). Sci Rep 2023; 13:6723. [PMID: 37185571 PMCID: PMC10130019 DOI: 10.1038/s41598-023-33943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
To investigate whether marital status is associated to long-term major fatal and non-fatal cardiovascular events in men and women from the Gubbio Population Study. The incidence of cardiovascular disease (CVD), including stroke and coronary heart disease (CHD) and CVD death together with all-cause mortality were analyzed. The analysis included 2832 persons (44% men, 54 ± 11 years old). Marital status was defined at entry as married (married or living conjugally) versus unmarried subjects (widowed, separated, divorced or single). Married and unmarried subjects did not differ concerning socio-demographic, anthropometric and biological variables at baseline. Over 191 months median follow-up, the incidence of CHD was lower among married versus unmarried women [HR: 0.63 (95% CI 0.41-0.96)] only; the same was true for CHD mortality [HR: 0.43 (95% CI 0.22-0.84)] and all-cause mortality [HR: 0.75 (95% CI 0.59-0.96)] independently of traditional risk factors (age, SBP, total and HDL cholesterol, cigarette smoke and BMI). In men, marital status was not associated to any of the investigated outcomes. In primary care, marital status should be investigated as it can be associated with long-term CHD and all-cause incidence and mortality risks among women.
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Affiliation(s)
- Xavier Humbert
- Département de medecine generale, Normandie Université, UNICAEN, 14000, Caen, France.
- INSERM U1086 ANTICIPE, Normandie Université, UNICAEN, 14000, Caen, France.
- Département de medecine generale, Pôle de formation et de recherche en sante, 2, rue des Rochambelles, 14000, Caen, France.
| | - Andry Rabiaza
- Département de medecine generale, Normandie Université, UNICAEN, 14000, Caen, France
| | - Sophie Fedrizzi
- EA 4650, Signalisation, électrophysiologie et imagerie des lesions d'ischémie reperfusion myocardique, UNICAEN, 14000, Caen, France
- Service de Pharmacologie, Normandie Université, UNICAEN, CHU Caen Normandie, 14000, Caen, France
| | - Joachim Alexandre
- INSERM U1086 ANTICIPE, Normandie Université, UNICAEN, 14000, Caen, France
- Service de Pharmacologie, Normandie Université, UNICAEN, CHU Caen Normandie, 14000, Caen, France
| | | | - Emmanuel Touzé
- Service de Neurologie, Normandie Université, UNICAEN, CHU Caen Normandie, 14000, Caen, France
- INSERM U1237 PhIND, Normandie Université, UNICAEN, 14000, Caen, France
| | - Martino Laurenzi
- Centro Studi Epidemiologici di Gubbio (CeSEG), 06024, Gubbio, Perugia, Italy
| | | | - Paolo E Puddu
- EA 4650, Signalisation, électrophysiologie et imagerie des lesions d'ischémie reperfusion myocardique, UNICAEN, 14000, Caen, France
- Association for Cardiac Research, 00198, Rome, Italy
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Stannard S, Berrington A, Alwan NA. Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70). PLoS One 2023; 18:e0282795. [PMID: 37053250 PMCID: PMC10101483 DOI: 10.1371/journal.pone.0282795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)-defined as having biological children with more than one partner, with obesity at midlife. METHOD The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators. RESULTS For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01-1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05-1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18-1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05-1.60). All other associations were attenuated when confounders were included. CONCLUSIONS Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth.
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Affiliation(s)
- Sebastian Stannard
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Ann Berrington
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
| | - Nisreen A Alwan
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
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Wang J, Wang Q, Du X, Zhu X, Nie C, Han X, Tian W, Li H, Zhou H. Risk factors associated with cardiovascular mortality among gastric cancer patients: a population-based analysis. Jpn J Clin Oncol 2022; 52:1365-1374. [PMID: 35946330 DOI: 10.1093/jjco/hyac132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/27/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cancer patients were found at a high risk of death from cardiovascular disease. This study aims to assess cardiovascular mortality risk and identify the potential risk factors associated with cardiovascular mortality among gastric cancer patients. METHODS Gastric cancer patients were collected from the Surveillance Epidemiology and End Results database during 1975-2016. Standardized mortality ratios were calculated to compare cardiovascular mortality rates between gastric cancer patients and the general US population. Univariable Cox analysis and multivariable stepwise Cox analysis were adopted to identify the potential risk factors for cardiovascular disease death after gastric cancer diagnosis. RESULTS There were 10 886 cardiovascular disease deaths identified among 165 433 individuals with gastric cancer observed for 410207.20 person-years. Gastric cancer patients were at a higher cardiovascular disease mortality risk (standardized mortality ratio = 3.35, 95% confidence interval: 3.24-3.47, P < 0.05). The study showed that older age at diagnosis (>80 years vs. 0-69 years, hazard ratio = 7.05, 95% confidence interval: 6.66-7.46, P < 0.001; 70-80 years vs. 0-69 years, hazard ratio = 3.35, 95% confidence interval: 3.19-3.53, P < 0.001), male sex (vs. female, hazard ratio = 1.39, 95% confidence interval: 1.33-1.45, P < 0.001), black race (vs. white, hazard ratio = 1.31, 95% confidence interval: 1.24-1.38, P < 0.001), without a partner (divorced/separated vs. married/partnered, hazard ratio = 1.35, 95% confidence interval: 1.25-1.45, P < 0.001; single vs. married/partnered, hazard ratio = 1.20, 95% confidence interval: 1.12-1.29, P < 0.001; widowed vs. married/partnered, hazard ratio = 1.41, 95% confidence interval: 1.34-1.48, P < 0.001), living in the northern plains (vs. pacific coast, hazard ratio = 1.23, 95% confidence interval: 1.16-1.29, P < 0.001) and surgery not performed (vs. performed, hazard ratio = 1.70, 95% confidence interval: 1.61-1.79, P < 0.001) were significantly associated with increased risk of cardiovascular disease death. Compared with patients with localized stage, distant staged patients were less likely to die of cardiovascular disease (hazard ratio = 0.88, 95% confidence interval: 0.83-0.94, P < 0.001). CONCLUSIONS Gastric cancer patients were at an increased risk of cardiovascular disease death. Older age at diagnosis, male sex, black race, without a partner, living in the northern plains and surgery not performed were significantly associated with cardiovascular disease death after gastric cancer diagnosis.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Qi Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Xinyu Du
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Xiaojie Zhu
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Chuang Nie
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Xu Han
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Wenjing Tian
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - He Li
- Department of Cardiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Haibo Zhou
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
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Abstract
Purpose of Review Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD. Recent Findings Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence—and are influenced by—stressful aspects of acute coronary crises and longer-term patient adjustment and management. Summary Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.
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Affiliation(s)
- Timothy W Smith
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
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Mayer-Suess L, Geiger M, Dejakum B, Boehme C, Domig LM, Komarek S, Toell T, Kiechl S, Knoflach M. Sex-differences in psychosocial sequelae after spontaneous cervical artery dissection. Sci Rep 2022; 12:611. [PMID: 35022509 PMCID: PMC8755839 DOI: 10.1038/s41598-021-04686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Short- to mid-term functional outcome in spontaneous cervical artery dissection is favorable, but the concomitant psychosocial impact is underreported. We aimed to determine these possible sequelae, with a special focus on sex differences, in our cohort of spontaneous cervical artery dissection subjects. During a standardized prospective in-house follow-up visit we, among other values, evaluated functional outcome (modified Rankin Scale [mRS]), psychosocial measures (return to work-, divorce rate) and health-related quality of life (WHO-QoL-BREF and SF-36-questionnaires). 145 patients participated in the long-term prospective follow-up. Median follow-up time was 6.5 years and excellent functional outcome (mRS ≤ 1) was achieved in 89.0% subjects. 87.6% returned to work and 17.6% married patients had a divorce during follow-up. Even though relevant baseline-/discharge characteristics and functional outcome did not differ between the sexes, women were less likely to return to work compared to men (79.7% vs. 93.8%; P = 0.010) and divorce rate was considerably higher in women (30.2% vs. 9.2%; P = 0.022). Health related quality of life did not differ significantly between the sexes, but women consistently reported lower values. Even though functional outcome is beneficial in most patients, measures to prevent poor psychosocial outcome should be considered in the long-term care of patients with spontaneous cervical artery dissection, especially women.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Moritz Geiger
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Lena M Domig
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
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Abstract
Inflammation crucially drives atherosclerosis from disease initiation to the emergence of clinical complications. Targeting pivotal inflammatory pathways without compromising the host defense could compliment therapy with lipid-lowering agents, anti-hypertensive treatment, and lifestyle interventions to address the substantial residual cardiovascular risk that remains beyond classical risk factor control. Detailed understanding of the intricate immune mechanisms that propel plaque instability and disruption is indispensable for the development of novel therapeutic concepts. In this review, we provide an overview on the role of key immune cells in plaque inception and progression, and discuss recently identified maladaptive immune phenomena that contribute to plaque destabilization, including epigenetically programmed trained immunity in myeloid cells, pathogenic conversion of autoreactive regulatory T-cells and expansion of altered leukocytes due to clonal hematopoiesis. From a more global perspective, the article discusses how systemic crises such as acute mental stress or infection abruptly raise plaque vulnerability and summarizes recent advances in understanding the increased cardiovascular risk associated with COVID-19 disease. Stepping outside the box, we highlight the role of gut dysbiosis in atherosclerosis progression and plaque vulnerability. The emerging differential role of the immune system in plaque rupture and plaque erosion as well as the limitations of animal models in studying plaque disruption are reviewed.
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Affiliation(s)
- Teresa Gerhardt
- Charité – Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Arash Haghikia
- Charité – Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Philip Stapmanns
- Charité – Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany
| | - David Manuel Leistner
- Charité – Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: David Manuel Leistner
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Theorell T. Psychosocial stressors in psychosomatic cardiology: A narrative review. Heart Mind 2022. [DOI: 10.4103/hm.hm_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dupre ME, Farmer HR, Xu H, Navar AM, Nanna MG, George LK, Peterson ED. The Cumulative Impact of Chronic Stressors on Risks of Myocardial Infarction in US Older Adults. Psychosom Med 2021; 83:987-994. [PMID: 34297011 PMCID: PMC8578196 DOI: 10.1097/psy.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between cumulative exposure to chronic stressors and the incidence of myocardial infarction (MI) in US older adults. METHODS Nationally representative prospective cohort data of adults 45 years and older (n = 15,109) were used to investigate the association between the cumulative number of chronic stressors and the incidence of MI in US older adults. Proportional hazards models adjusted for confounding risk factors and differences by sex, race/ethnicity, and history of MI were assessed. RESULTS The median age of participants was 65 years, 714 (4.7%) had a prior MI, and 557 (3.7%) had an MI during follow-up. Approximately 84% of participants reported at least one chronic stressor at baseline, and more than half reported two or more stressors. Multivariable models showed that risks of MI increased incrementally from one chronic stressor (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.20-1.37) to four or more chronic stressors (HR = 2.71, 95% CI = 2.08-3.53) compared with those who reported no stressors. These risks were only partly reduced after adjustments for multiple demographic, socioeconomic, psychosocial, behavioral, and clinical risk factors. In adults who had a prior MI (p value for interaction = .038), we found that risks of a recurrent event increased substantially from one chronic stressor (HR = 1.30, 95% CI = 1.09-1.54) to four or more chronic stressors (HR = 2.85, 95% CI = 1.43-5.69). CONCLUSIONS Chronic life stressors are significant independent risk factors for cardiovascular events in US older adults. The risks associated with multiple chronic stressors were especially high in adults with a previous MI.
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Affiliation(s)
- Matthew E. Dupre
- Department of Population Health Sciences, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Sociology, Duke University, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
| | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, DE
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, Durham, NC
- Duke School of Nursing, Duke University, Durham, NC
| | - Ann Marie Navar
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, TX
| | - Michael G. Nanna
- Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Linda K. George
- Department of Sociology, Duke University, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - Eric D. Peterson
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, TX
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Nafisa A, Wattoo FH, Qayyum M, Gulfraz M. The association between chronic stress, hair cortisol, and angiographically documented coronary atherosclerosis, a case-control study. Stress 2021; 24:1008-1015. [PMID: 34633899 DOI: 10.1080/10253890.2021.1985994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular diseases remain the principal contributor to global mortality and morbidity. Chronic stress has emerged as a strong prognostic factor for cardiovascular diseases. We aimed to measure hair cortisol concentration (HCC) in patients with angiographically confirmed coronary atherosclerosis and find the association between HCC and classic cardiovascular risk factors in a case-control study. The study included 500 angiographically confirmed coronary atherosclerosis patients and 500 age and sex-matched controls having no coronary stenosis. Hair cortisol concentration was assessed from a single sample of scalp hair by ELISA. Perceived stress scale 10 was used to evaluate the stress level of the participants. Spearman rank correlation was applied to find the association between hair cortisol level and classic cardiovascular risk factors. Multivariate regression was executed to assess the independent contribution of hair cortisol concentration as a coronary atherosclerosis risk factor. Median hair cortisol concentration was significantly high in patients with angiographically documented coronary atherosclerosis compared to controls (158(17.6-1331.3) pg/mg versus 73 (13.4-889) pg/mg. Hair cortisol concentration showed a significant positive correlation with BMI r = 525 and Hb1Ac r = 665 (both, p = ≤0.0001). In multivariate logistic regression analysis after adjusting for all the confounding variables, HCC, matched odds ratio (MOR), 10.73;95%CI (1.60,42.09) p-value = 0.001 remained the most significant predictor of coronary atherosclerosis.LAY SUMMARYHair cortisol concentrations (HCC) were significantly high in patients with angiographically confirmed coronary atherosclerosis compared to controls. HCC showed a significant positive correlation with diabetes and obesity and remained a major predictor of coronary atherosclerosis in the final analysis.
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Affiliation(s)
- Asma Nafisa
- University Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture University, Rawalpindi, Pakistan
| | - Feroza Hamid Wattoo
- University Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture University, Rawalpindi, Pakistan
| | - Mazhar Qayyum
- Department of Zoology, PMAS-Arid Agriculture University, Rawalpindi, Pakistan
| | - Muhammad Gulfraz
- University Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture University, Rawalpindi, Pakistan
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Kim H, Lee W, Lee Y. Association of Long Working Hours With Marital Status Changes in South Korea: A Cohort Study. J Occup Environ Med 2021; 63:e689-e693. [PMID: 34325438 DOI: 10.1097/jom.0000000000002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigated the relationship between long working hours and the incidence of divorce or separation among Korean female and male workers. METHODS A cohort study was conducted in 125,108 Korean workers, married at baseline, who attended health examinations between 2012 and 2017 and had been followed annually or biennially until December 31, 2018. The weekly working hours and marital status changes were measured using self-administered questionnaires. This study was performed using sex stratification. RESULTS In a multivariable-adjusted model, by comparing working hours->52 hours/week with 35 to 40 hours/week-the hazard ratios (95% confidence intervals) for incidents of divorce or separation were 1.60 (1.03-2.49) and 0.86 (0.66-1.12) in females and males, respectively. CONCLUSIONS This study showed that long working hours could contribute to marital status changes in Korean female workers.
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Affiliation(s)
- Hyunil Kim
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ding D, Gale J, Bauman A, Phongsavan P, Nguyen B. Effects of divorce and widowhood on subsequent health behaviours and outcomes in a sample of middle-aged and older Australian adults. Sci Rep 2021; 11:15237. [PMID: 34341364 DOI: 10.1038/s41598-021-93210-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 06/14/2021] [Indexed: 11/08/2022] Open
Abstract
Marital disruption is a common life event with potential health implications. We examined the prospective association of divorce/widowhood with subsequent lifestyles, psychological, and overall health outcomes within short and longer terms using three waves of data from the 45 and Up Study in Australia (T1, 2006–09; T2, 2010; T3, 2012–16). Marital status and health-related outcomes were self-reported using validated questionnaires. Nine outcomes were examined including lifestyles (smoking, drinking, diet and physical activity), psychological outcomes (distress, anxiety and depression) and overall health/quality of life. Logistic regression was adjusted for sociodemographic characteristics and baseline health outcomes. Of the 33,184 participants who were married at T1 (mean age 59.5 ± 9.3 years), after 3.4 years, 2.9% became divorced and 2.4% widowed at T2. Recent divorce was positively associated with smoking, poor quality of life, high psychological distress, anxiety and depression at T2. Similar but weaker associations were observed for widowhood. However, these associations were much attenuated at T3 (5 years from T2). Marital disruption in midlife or at an older age can be detrimental to health, particularly psychological health in the short term. Public awareness of the health consequences of spousal loss should be raised. Resources, including professional support, should be allocated to help individuals navigate these difficult life transitions.
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Abstract
Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.
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Affiliation(s)
- Zhenmei Zhang
- Department of Sociology, Michigan State University, USA.
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Seung-Won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, USA
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Abstract
Background Identifying social determinants of myocardial infarction (MI) hospitalizations is crucial for reducing/eliminating health disparities. Therefore, our objectives were to identify sociodemographic determinants of MI hospitalization risks and to assess if the impacts of these determinants vary by geographic location in Florida. Methods and Results This is a retrospective ecologic study at the county level. We obtained data for principal and secondary MI hospitalizations for Florida residents for the 2005-2014 period and calculated age- and sex-adjusted MI hospitalization risks. We used a multivariable negative binomial model to identify sociodemographic determinants of MI hospitalization risks and a geographically weighted negative binomial model to assess if the strength of associations vary by location. There were 645 935 MI hospitalizations (median age, 72 years; 58.1%, men; 73.9%, white). Age- and sex-adjusted risks ranged from 18.49 to 69.48 cases/10 000 persons, and they were significantly higher in counties with low education levels (risk ratio [RR]=1.033, P<0.0001) and high divorce rate (RR, 0.995; P=0.018). However, they were significantly lower in counties with high proportions of rural (RR, 0.996; P<0.0001), black (RR, 1.026; P=0.032), and uninsured populations (RR, 0.983; P=0.040). Associations of MI hospitalization risks with education level and uninsured rate varied geographically (P for non-stationarity test=0.001 and 0.043, respectively), with strongest associations in southern Florida (RR for <high school education, 1.036-1.041; RR for uninsured rate, 0.971-0.976). Conclusions Black race, divorce, rural residence, low education level, and lack of health insurance were significant determinants of MI hospitalization risks, but associations with the latter 2 were stronger in southern Florida. Thus, interventions for addressing MI hospitalization risks need to prioritize these populations and allocate resources based on empirical evidence from global and local models for maximum efficiency and effectiveness.
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Affiliation(s)
- Evah Wangui Odoi
- Comparative and Experimental Medicine College of Veterinary Medicine The University of Tennessee Knoxville TN
| | - Nicholas Nagle
- Department of Geography The University of Tennessee Knoxville TN
| | - Russell Zaretzki
- Department of Business Analytics and Statistics The University of Tennessee Knoxville TN
| | - Melissa Jordan
- Public Health Research Division of Community Health Promotion Florida Department of Health Tallahassee FL
| | - Chris DuClos
- Environmental Public Health Tracking Division of Community Health Promotion Florida Department of Health Tallahassee FL
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Kim H, Kim M, Kim H, Park SM, Kim M, Yoon HJ, Shin MS, Park SM, Hong K, Shim W. Sex differences of the association between marital status and coronary artery disease in patients experiencing chest pain: The Korean Women's Chest Pain Registry. Menopause 2020; 27:788-793. [DOI: 10.1097/gme.0000000000001533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dhindsa DS, Khambhati J, Schultz WM, Tahhan AS, Quyyumi AA. Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med 2019; 30:215-220. [PMID: 31204239 DOI: 10.1016/j.tcm.2019.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/28/2019] [Accepted: 05/28/2019] [Indexed: 11/15/2022]
Abstract
The national burden of cardiovascular disease (CVD) continues to impose significant risk of morbidity, mortality and increased costs. While traditional risk factors have been well-established, the evolving role of non-traditional risk factors, including socioeconomic and psychosocial factors, is increasingly being recognized. Several studies have acknowledged an association between marital status and the presence of CVD and its associated adverse outcomes. Across multiple U.S. and international cohorts, patients who are unmarried, including those who are divorced, separated, widowed, or never married, have an increased rate of adverse cardiovascular events when compared to their married counterparts. Some studies suggest that marriage may have a more protective role for men compared to women. Furthermore, dissatisfaction in a marriage and marriage quality have significant impact on cardiovascular risk. Psychosocial and socioeconomic factors, as well as other acute stressors, may contribute to the association between marital status and CVD outcomes, but the underlying mechanisms are not completely clear. Further investigation is required to identify potential targets for intervention and to determine whether more aggressive targeting of standard anti-atherosclerotic therapies can favorably impact CVD risk in unmarried patients.
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Affiliation(s)
- Devinder Singh Dhindsa
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Jay Khambhati
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - William M Schultz
- Division of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Ayman Samman Tahhan
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States.
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Ramezankhani A, Azizi F, Hadaegh F. Associations of marital status with diabetes, hypertension, cardiovascular disease and all-cause mortality: A long term follow-up study. PLoS One 2019; 14:e0215593. [PMID: 31009512 PMCID: PMC6476533 DOI: 10.1371/journal.pone.0215593] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background To investigate the associations of marital status with major clinical outcomes including type 2 diabetes (T2D), hypertension, cardiovascular disease (CVD) and all-cause mortality. Methods The study cohort (1999–2014) included 9,737 (45% male) Iranian adults with a mean age of 47.6 years. Marital status was defined as married versus never married, divorced and widowed. The relationship between marital status and the four above mentioned outcomes were investigated using Cox regression models adjusted for the main confounders, specific to each outcome. Results After more than 12 years of follow-up, 1,889 (883 men) individuals developed hypertension, 1,038 (468 men) T2D, 1015 (597 men) CVD and 668 (409 men) all-cause mortality. Compared with married, being never married in men was associated with higher risk of hypertension [hazard ratio (HR): 1.55; 95% confidence interval (CI), 1.11–2.16] and all-cause mortality (2.17; 0.95–5.00; p-value = 0.066) after adjusting for confounders. Among women, compared with married status, widowed status was associated with a lower risk of T2D (0.74; 0.56–0.97) in the confounders adjusted model. Moreover, never married women had a lower risk of hypertension (0.58; 0.37–0.90) compared to married ones in the age adjusted model, a finding that did not achieve significance, after further adjustment for confounders. Conclusion We found that the relationship between marital status and health outcomes varied by gender. Being never married was an important risk factor for hypertension and tended to be a significant risk factor for mortality in men. However, among women, being widowed was associated with a lower risk of T2D.
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Affiliation(s)
- Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, ShahidBeheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
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Wong CW, Kwok CS, Narain A, Gulati M, Mihalidou AS, Wu P, Alasnag M, Myint PK, Mamas MA. Marital status and risk of cardiovascular diseases: a systematic review and meta-analysis. Heart 2018; 104:1937-1948. [PMID: 29921571 DOI: 10.1136/heartjnl-2018-313005] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD. METHODS A search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS Our analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), CHD death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants. CONCLUSIONS Marital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.
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Affiliation(s)
- Chun Wai Wong
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Aditya Narain
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Martha Gulati
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Anastasia S Mihalidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards and Macquarie University, Sydney, New South Wales, Australia
| | - Pensee Wu
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Keele, UK.,Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Mirvat Alasnag
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
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Kawaguchi H, Koike S, Sakurai R, Ohe K. Association between number of institutions with coronary computed tomography angiography and regional mortality ratio of acute myocardial infarction: a nationwide ecological study using a spatial Bayesian model. Int J Health Geogr 2018; 17:13. [PMID: 29784002 DOI: 10.1186/s12942-018-0133-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/15/2018] [Indexed: 02/08/2023] Open
Abstract
Background Coronary computed tomography angiography (CTA) has demonstrated high diagnostic accuracy for detection of coronary artery stenosis, and healthcare providers can detect coronary artery disease in earlier stages before it develops into more serious clinical conditions such as acute myocardial infarction (AMI). We hypothesized that the mortality ratio of AMI in regions with a higher density of coronary CTA is lower than that in regions with a lower density of coronary CTA. Methods This ecological and cross-sectional study using secondary data targeted all secondary medical service areas (SMSAs) in Japan (n = 349). We obtained the numbers of cardiologists, institutions with coronary CTA, and institutions with a cardiac catheterization laboratory (CCL) as medical resources, socioeconomic factors, lifestyle factors, exercise habit factors, and AMI mortality data from a Japanese national database. We evaluated the association between the number of these medical resources and the standardized mortality ratio (SMR) of AMI in each SMSA using a hierarchical Bayesian model accounting for spatial autocorrelation (i.e., a conditional autoregressive model). We assumed a Poisson distribution for the observed number of AMI-related deaths and set the expected number of AMI-related deaths as the offset variable. Results The number of institutions with coronary CTA was negatively and significantly associated with the SMR of AMI (relative risk [RR] 0.900; 95% credible interval [CI] 0.848–0.953), while the SMR in each SMSA was not significantly associated with the number of either cardiologists (RR 0.997; 95% CI 0.988–1.004) or institutions with a CCL (RR 1.026; 95% CI 0.963–1.096). Conclusions We observed a significant association between the number of institutions with coronary CTA and the SMR of AMI. Effective allocation of coronary CTA in each region is recommended, and it would be important to clarify the standing position of coronary CTA in regional networking for AMI treatment in the future. Electronic supplementary material The online version of this article (10.1186/s12942-018-0133-0) contains supplementary material, which is available to authorized users.
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Ghosh‐Swaby OR, Tan M, Bagai A, Yan AT, Goodman SG, Mehta SR, Fisher HN, Cohen EA, Huynh T, Cantor WJ, Le May MR, Déry J, Welsh RC, Udell JA. Marital status and outcomes after myocardial infarction: Observations from the Canadian Observational Antiplatelet Study (COAPT). Clin Cardiol 2018; 41:285-292. [PMID: 29574993 PMCID: PMC6490065 DOI: 10.1002/clc.22901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/10/2022] Open
Abstract
While divorced or living alone, patients with stable cardiovascular disease are at increased risk for adverse cardiovascular events. The importance of marital status following a myocardial infarction (MI) is less clear. We hypothesized that marital status may affect cardiovascular outcomes following MI. We analyzed outcomes among patients with MI who underwent percutaneous coronary intervention from the Canadian Observational Antiplatelet Study (COAPT). Marital status was categorized into 3 groups: married/common-law patients living together; never married; and divorced, separated, or widowed patients. Patients were followed for 15 months and our primary outcome was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite of mortality, repeat acute MI, stroke, or urgent coronary revascularization. Multivariable logistic regression models were performed, with married/common-law patients living together considered the reference group. Among 2100 patients included in analyses, 1519 (72.3%) were married/common-law patients living together, 358 (17.1%) were separated/divorced/widowed, and 223 (10.6%) patients were never married. Dual antiplatelet therapy use after 15 months was similar across groups (75.4%, 77.8%, and 73.6%, respectively). The risk of MACE after 15 months was similar among married patients living together (12.7%; referent) compared with patients who were never married (13.9%; adjusted odds ratio: 1.09, 95% confidence interval: 0.58-2.07, P = 0.79) and patients separated/divorced/widowed (14.3%; adjusted odds ratio: 0.71, 95% confidence interval: 0.40-1.25, P = 0.23). Similarly, the risk of individual endpoints, including mortality, was similar across the 3 groups. Among patients stabilized following an MI, we found no association between marital status and 15-month outcomes.
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Affiliation(s)
- Olivia R. Ghosh‐Swaby
- Cardiovascular Division, Department of Medicine and Women's College Research InstituteWomen's College HospitalTorontoOntario
- Faculty of Medical Science, Schulich School of Medicine and DentistryWestern UniversityLondonOntario
| | - Mary Tan
- Canadian Heart Research CentreTorontoOntario
| | - Akshay Bagai
- Terrence Donnelly Heart CenterSt. Michael's Hospital, University of TorontoTorontoOntario
| | - Andrew T. Yan
- Terrence Donnelly Heart CenterSt. Michael's Hospital, University of TorontoTorontoOntario
| | - Shaun G. Goodman
- Canadian Heart Research CentreTorontoOntario
- Terrence Donnelly Heart CenterSt. Michael's Hospital, University of TorontoTorontoOntario
| | - Shamir R. Mehta
- Population Health Research Institute, Hamilton General HospitalMcMaster UniversityHamiltonOntario
| | - Harold N. Fisher
- Department of Clinical Research, Eli Lilly Canada Inc.TorontoOntario
| | - Eric A. Cohen
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntario
| | - Thao Huynh
- Department of Medicine, McGill University Health CentreMcGill UniversityMontréalQuébec
| | - Warren J. Cantor
- Division of Cardiology, Department of MedicineSouthlake Regional Health Centre and University of TorontoTorontoOntario
| | - Michel R. Le May
- Division of Cardiology, Department of MedicineUniversity of Ottawa Heart InstituteOttawaOntario
| | - Jean‐Pierre Déry
- Division of Cardiology, Québec Heart and Lung InstituteLaval HospitalQuébec CityQuébec
| | - Robert C. Welsh
- Department of Medicine, Mazankowski Alberta Heart InstituteUniversity of Alberta Hospital, Canadian VIGOUR CentreEdmontonAlberta
| | - Jacob A. Udell
- Cardiovascular Division, Department of Medicine and Women's College Research InstituteWomen's College HospitalTorontoOntario
- Peter Munk Cardiac CentreUniversity Health NetworkTorontoOntario
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Liu Q, Wang X, Wang Y, Wang C, Zhao X, Liu L, Li Z, Meng X, Guo L, Wang Y. Association between marriage and outcomes in patients with acute ischemic stroke. J Neurol 2018; 265:942-8. [PMID: 29464375 DOI: 10.1007/s00415-018-8793-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 01/03/2023]
Abstract
Backgrounds The previous studies on the association between marital status and stroke outcomes were rare. Furthermore, the existing studies mostly focused on the protective effect of marriage on survival. We conducted the study to evaluate the association between marital status and adverse stroke outcomes in patients with AIS based on China national stroke registry. Methods This was a multicenter, prospective cohort study of patients with AIS. Patients were classified into two groups based on marital status at admission: married and unmarried. The primary outcomes included all-cause mortality, stroke recurrence, combined endpoint, and stroke disability. Stroke disability was defined as modified Rankin Scale of 2–6. Results Of 12,118 patients, 1220 were unmarried and 10,898 married. Unmarried patients had higher proportion of 1-year post-stroke events than married patients did. As compared with being unmarried, the adjusted odds ratios with 95% confidence interval of being married for outcomes were as follows: 0.70 (0.58–0.84) for all-cause mortality, 0.78 (0.66–0.91) for stroke recurrence, 0.77 (0.66–0.90) for combined endpoint, and 0.75 (0.65–0.88) for stroke disability. Interactions between marital status and education were significant for all outcomes except for stroke disability. Conclusions Marital status was associated with all adverse stroke outcomes in patients with acute ischemic stroke, especially in those with middle-school education. Electronic supplementary material The online version of this article (10.1007/s00415-018-8793-z) contains supplementary material, which is available to authorized users.
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Schultz WM, Hayek SS, Samman Tahhan A, Ko YA, Sandesara P, Awad M, Mohammed KH, Patel K, Yuan M, Zheng S, Topel ML, Hartsfield J, Bhimani R, Varghese T, Kim JH, Shaw L, Wilson P, Vaccarino V, Quyyumi AA. Marital Status and Outcomes in Patients With Cardiovascular Disease. J Am Heart Assoc 2017; 6:JAHA.117.005890. [PMID: 29263033 PMCID: PMC5778993 DOI: 10.1161/jaha.117.005890] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Being unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never-married status affects outcomes in patients with cardiovascular disease has not been well characterized. METHODS AND RESULTS A prospective cohort (inception period 2003-2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7-6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular-related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06-1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18-1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27-1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10-1.81), widowed (HR: 1.71; 95% CI, 1.32-2.20), or never married (HR: 1.40; 95% CI, 0.97-2.03). The findings persisted after adjustment for medications and other socioeconomic factors. CONCLUSIONS Marital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study.
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Affiliation(s)
- William M Schultz
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ayman Samman Tahhan
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University, Atlanta, GA
| | - Pratik Sandesara
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Mosaab Awad
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Kareem H Mohammed
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Keyur Patel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Michael Yuan
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
| | - Shuai Zheng
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Matthew L Topel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Joy Hartsfield
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ravila Bhimani
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Tina Varghese
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jonathan H Kim
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Leslee Shaw
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Peter Wilson
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA.,American Institutes for Research, Washington, DC
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
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Dupre ME, Nelson A, Lynch SM, Granger BB, Xu H, Churchill E, Willis JM, Curtis LH, Peterson ED. Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease. Am J Med Sci 2017; 354:565-572. [PMID: 29208253 DOI: 10.1016/j.amjms.2017.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/13/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent studies have drawn attention to nonclinical factors to better understand disparities in the development, treatment and prognosis of patients with cardiovascular disease. However, there has been limited research describing the nonclinical characteristics of patients hospitalized for cardiovascular care. METHODS Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered before discharge were used to ascertain detailed information on patients' demographic (age, sex, race, marital status and living arrangement), socioeconomic (education, employment and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress and depressive symptoms) and behavioral (smoking, drinking and medication adherence) attributes. RESULTS Study participants were of a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic and behavioral characteristics. We also found that the patients' levels of psychosocial risks and resources were significantly associated with many of these nonclinical characteristics. Patients who were older, women, nonwhite and unmarried had generally lower levels of health literacy, self-efficacy and social support, and higher levels of stress and depressive symptoms than their counterparts. CONCLUSIONS Patients hospitalized with cardiovascular disease have diverse nonclinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Sociology, Duke University, Durham, North Carolina.
| | - Alicia Nelson
- Department of Community and Family Medicine, Duke University, Durham, North Carolina
| | - Scott M Lynch
- Department of Sociology, Duke University, Durham, North Carolina
| | - Bradi B Granger
- Duke School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Hanzhang Xu
- Duke School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Erik Churchill
- Duke Office of Clinical Research, Duke University Medical Center, Durham, North Carolina
| | - Janese M Willis
- Department of Community and Family Medicine, Duke University, Durham, North Carolina
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
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Daoulah A, Al-Murayeh M, Al-kaabi S, Lotfi A, Elkhateeb OE, Al-Faifi SM, Alqahtani S, Stewart J, Heavey J, Hurley WT, Alama MN, Faden M, Al-Shehri M, Youssef A, Alsheikh-Ali AA. Divorce and Severity of Coronary Artery Disease: A Multicenter Study. Cardiol Res Pract 2017; 2017:4751249. [PMID: 28811952 PMCID: PMC5546130 DOI: 10.1155/2017/4751249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/05/2017] [Indexed: 11/17/2022] Open
Abstract
The association between marital status and coronary artery disease (CAD) is supported by numerous epidemiological studies. While divorce may have an adverse effect on cardiac outcomes, the relationship between divorce and severe CAD is unclear. We conducted a multicenter, observational study of consecutive patients undergoing coronary angiography during the period between April 1, 2013, and March 30, 2014. Of 1,068 patients, 124 (12%) were divorced. Divorce was more frequent among women (27%) compared to men (6%). Most divorced patients had been divorced only once (49%), but a subset had been divorced 2 (38%) or ≥3 (12%) times. After adjusting for baseline differences, there was no significant association between divorce and severe CAD in men. In women, there was a significant adjusted association between divorce and severe MVD (OR 2.31 [1.16, 4.59]) or LMD (OR 5.91 [2.19, 15.99]). The modification of the association between divorce and severe CAD by gender was statistically significant for severe LMD (Pinteraction 0.0008) and marginally significant for CAD (Pinteraction 0.05). Among women, there was a significant adjusted association between number of divorces and severe CAD (OR 2.4 [95% CI 1.2, 4.5]), MVD (OR 2.0 [95% CI 1.4, 3.0]), and LMD (OR 3.4 [95% CI 1.9, 5.9]). In conclusion, divorce, particularly multiple divorces, is associated with severe CAD, MVD, and LMD in women but not in men.
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Affiliation(s)
- Amin Daoulah
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Mushabab Al-Murayeh
- Cardiovascular Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | - Salem Al-kaabi
- Cardiology Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Osama E. Elkhateeb
- Cardiac Center, King Abdullah Medical City, Holy Capital, Makkah, Saudi Arabia
| | - Salem M. Al-Faifi
- Section of Pulmonology, Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Saleh Alqahtani
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, 1830 East Monument Street, Suite 428, Baltimore, MD 21287, USA
| | - James Stewart
- Anesthesiology Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Jon Heavey
- Emergency Medicine Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William T. Hurley
- Emergency Medicine Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mohamed N. Alama
- Cardiology Unit, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Mazen Faden
- Anesthesiology Department, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Mohamed Al-Shehri
- Cardiovascular Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | | | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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Cox LAT. Socioeconomic and air pollution correlates of adult asthma, heart attack, and stroke risks in the United States, 2010-2013. Environ Res 2017; 155:92-107. [PMID: 28208075 DOI: 10.1016/j.envres.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/04/2016] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Abstract
Asthma in the United States has become an important public health issue, with many physicians, regulators, and scientists elsewhere expressing concern that criterion air pollutants have contributed to a rising tide of asthma cases and symptoms. This paper studies recent associations (from 2008 to 2012) between self-reported asthma experiences and potential predictors, including age, sex, income, education, smoking, and county-level average annual ambient concentrations of ozone (O3) and fine particulate matter (PM2.5) levels recorded by the U.S. Environmental Protection Agency, for adults 50 years old or older for whom survey data are available from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). We also examine associations between these variables and self-reported heart attack and stroke experience; all three health outcomes are positively associated with each other. Young divorced women with low incomes are at greatest risk of asthma, especially if they are ever-smokers. Income is an important confounder of other relations. For example, in logistic regression modeling, PM2.5 is positively associated (p<0.06) with both stroke risk and heart attack risk when these are regressed only against PM2.5, sex, age, and ever-smoking status, but not when they are regressed against these variables and income. In this data set, PM2.5 is significantly negatively associated with asthma risk in regression models, with a 10μg/m3 decrease in PM2.5 corresponding to about a 6% increase in the probability of asthma, possibly because of confounding by smoking, which is negatively associated with PM2.5 and positively associated with asthma risk. A variety of non-parametric methods are used to quantify these associations and to explore potential causal interpretations.
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Affiliation(s)
- Louis Anthony Tony Cox
- Cox Associates and University of Colorado, 503 N. Franklin Street, Denver, CO 80218, USA.
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Sbarra DA, Coan JA. Divorce and health: good data in need of better theory. Curr Opin Psychol 2017; 13:91-5. [DOI: 10.1016/j.copsyc.2016.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/06/2016] [Accepted: 05/20/2016] [Indexed: 11/30/2022]
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Daoulah A, Lotfi A, Al-Murayeh M, Al-kaabi S, Al-Faifi SM, Elkhateeb OE, Alama MN, Hersi AS, Dixon CM, Ahmed W, Al-Shehri M, Youssef A, Elimam AM, Abougalambou AS, Murad W, Alsheikh-Ali AA. Polygamy and Risk of Coronary Artery Disease in Men Undergoing Angiography: An Observational Study. Int J Vasc Med 2017; 2017:1925176. [PMID: 28250991 PMCID: PMC5303868 DOI: 10.1155/2017/1925176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 01/05/2017] [Indexed: 12/29/2022] Open
Abstract
Epidemiologic evidence suggests a link between psychosocial risk factors such as marital status and coronary artery disease (CAD). Polygamy (multiple concurrent wives) is a distinct marital status practiced in many countries in Asia and the Middle East, but its association with CAD is not well defined. We conducted a multicenter, observational study of consecutive patients undergoing coronary angiography during the period from April 1, 2013, to March 30, 2014. Of 1,068 enrolled patients, 687 were married men. Polygamy was reported in 32% of married men (1 wife: 68%, 2 wives: 19%, 3 wives: 10%, and 4 wives: 3%). When stratified by number of wives, significant baseline differences were observed in age, type of community (rural versus urban), prior coronary artery bypass grafting (CABG), and household income. After adjusting for baseline differences, there was a significant association between polygamy and CAD (adjusted OR 4.6 [95% CI 2.5, 8.3]), multivessel disease (MVD) (adjusted OR 2.6 [95% CI 1.8, 3.7]), and left main disease (LMD) (adjusted OR 3.5 [95% CI 2.1, 5.9]). Findings were consistent when the number of wives was analyzed as a continuous variable. In conclusion, among married men undergoing coronary angiography for clinical indications, polygamy is associated with the presence of significant CAD, MVD, and LMD.
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Affiliation(s)
- Amin Daoulah
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Mushabab Al-Murayeh
- Cardiovascular Department, Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia
| | - Salem Al-kaabi
- Cardiovascular Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Salem M. Al-Faifi
- Section of Pulmonology, Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Osama E. Elkhateeb
- Cardiac Center, King Abdullah Medical City in Holy Capital, Makkah, Saudi Arabia
| | - Mohamed N. Alama
- Cardiovascular Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ahmad S. Hersi
- Cardiovascular Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ciaran M. Dixon
- Emergency Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Waleed Ahmed
- Section of Infectious Disease, Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Mohamed Al-Shehri
- Cardiovascular Department, Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ali Youssef
- Cardiovascular Department, Suez Canal University, Ismailia, Egypt
| | | | | | - Waheed Murad
- Cardiovascular Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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Abstract
BACKGROUND Stroke is among the leading causes of disability and death in the United States, and nearly 7 million adults are currently alive after experiencing a stroke. Although the risks associated with having a stroke are well established, we know surprisingly little about how marital status influences survival in adults with this condition. This study is the first prospective investigation of how marital history is related to survival after stroke in the United States. METHODS AND RESULTS Data from a nationally representative sample of older adults who experienced a stroke (n=2351) were used to examine whether and to what extent current marital status and past marital losses were associated with risks of dying after the onset of disease. Results showed that the risks of dying following a stroke were significantly higher among the never married (hazard ratio [HR], 1.71; 95% CI, 1.31–2.24), remarried (HR, 1.23; 95% CI, 1.06–1.44), divorced (HR, 1.23; 95% CI, 1.01–1.49), and widowed (HR, 1.25; 95% CI, 1.10–1.43) relative to those who remained continuously married. We also found that having multiple marital losses was especially detrimental to survival-regardless of current marital status and accounting for multiple socioeconomic, psychosocial, behavioral, and physiological risk factors. CONCLUSIONS Marital history is significantly associated with survival after stroke. Additional studies are needed to further examine the mechanisms contributing to the associations and to better understand how this information can be used to personalize care and aggressively treat vulnerable segments of the population.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Community and Family Medicine, Duke University, Durham, NC
- Department of Sociology, Duke University, Durham, NC
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
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Katz M, Bosworth HB, Lopes RD, Dupre ME, Morita F, Pereira C, Franco FG, Prado RR, Pesaro AE, Wajngarten M. A time-series analysis of the relation between unemployment rate and hospital admission for acute myocardial infarction and stroke in Brazil over more than a decade. Int J Cardiol 2016; 224:33-6. [DOI: 10.1016/j.ijcard.2016.08.309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 11/21/2022]
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31
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Cutler SJ, Brăgaru C. Do Worries About Cognitive Functioning and Concerns About Developing Alzheimer’s Disease Affect Psychological Well-Being? J Aging Health 2017; 29:1271-87. [DOI: 10.1177/0898264316674535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: The objective of this study is to determine if cognitive worries affect psychological well-being, if these effects are long-term, and if such concerns affect well-being more so among persons with a parent having Alzheimer’s disease (AD). Method: We used structural equation models with three waves of data collected from persons ages 40 to 60 at T1. We created summative scores on five indicators of concerns about cognitive functioning and worries about dementia. Well-being measures included depression, life satisfaction, stress, and mastery. Results: We found (a) cognitive worries at Waves 1, 2, and 3 were generally associated with lower levels of psychological well-being at each of these waves; (b) there was no evidence of long-term, lagged effects, and (c) these relationships were statistically similar across groups of adult children and controls. Discussion: Because concerns about cognitive functioning and developing AD are pervasive among middle-aged and older persons, practitioners should be aware of their potentially deleterious effect on psychological well-being.
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Abstract
Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n = 2197). We found that adults who were never married (odds ratio [OR] = 1.73), currently divorced (OR = 1.70), or widowed (OR = 1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12% for every additional marital loss and decreased by 7% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.
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Affiliation(s)
- Matthew E Dupre
- Department of Sociology, Duke University, Durham, NC, USA; Department of Community and Family Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Alicia Nelson
- Department of Community and Family Medicine, Duke University, Durham, NC, USA
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Whisman MA, Robustelli BL, Sbarra DA. Marital disruption is associated with shorter salivary telomere length in a probability sample of older adults. Soc Sci Med 2016; 157:60-7. [PMID: 27062452 PMCID: PMC4883574 DOI: 10.1016/j.socscimed.2016.03.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/15/2016] [Accepted: 03/20/2016] [Indexed: 02/07/2023]
Abstract
RATIONALE Marital disruption (i.e., marital separation, divorce) is associated with a wide range of poor mental and physical health outcomes, including increased risk for all-cause mortality. One biological intermediary that may help explain the association between marital disruption and poor health is accelerated cellular aging. OBJECTIVE This study examines the association between marital disruption and salivary telomere length in a United States probability sample of adults ≥50 years of age. METHOD Participants were 3526 individuals who participated in the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction (qPCR) on DNA extracted from saliva samples. Health and lifestyle factors, traumatic and stressful life events, and neuroticism were assessed via self-report. Linear regression analyses were conducted to examine the associations between predictor variables and salivary telomere length. RESULTS Based on their marital status data in the 2006 wave, people who were separated or divorced had shorter salivary telomeres than people who were continuously married or had never been married, and the association between marital disruption and salivary telomere length was not moderated by gender or neuroticism. Furthermore, the association between marital disruption and salivary telomere length remained statistically significant after adjusting for demographic and socioeconomic variables, neuroticism, cigarette use, body mass, traumatic life events, and other stressful life events. Additionally, results revealed that currently married adults with a history of divorce evidenced shorter salivary telomeres than people who were continuously married or never married. CONCLUSION Accelerated cellular aging, as indexed by telomere shortening, may be one pathway through which marital disruption is associated with morbidity and mortality.
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Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality among women. Despite improvements in cardiovascular disease prevention efforts, there remain gaps in cardiovascular disease awareness among women, as well as age and racial disparities in ASCVD outcomes for women. Disparity also exists in the impact the traditional risk factors confer on ASCVD risk between women and men, with smoking and diabetes both resulting in stronger relative risks in women compared to men. Additionally there are risk factors that are unique to women (such as pregnancy-related factors) or that disproportionally affect women (such as auto-immune disease) where preventive efforts should be targeted. Risk assessment and management must also be sex-specific to effectively reduce cardiovascular disease and improve outcomes among women. Evidence supports the use of statin therapy for primary prevention in women at higher ASCVD risk. However, some pause should be given to prescribing aspirin therapy in women without known ASCVD, with most evidence supporting the use of aspirin for women≥65 years not at increased risk for bleeding. This review article will summarize (1) traditional and non-traditional assessments of ASCVD risk and (2) lifestyle and pharmacologic therapies for the primary prevention of ASCVD in women.
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Affiliation(s)
- Rebeccah A McKibben
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Mahmoud Al Rifai
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Lena M Mathews
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
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35
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van der Wall EE. Gender: the state of being male or female. Neth Heart J 2015. [PMID: 26199141 PMCID: PMC4547942 DOI: 10.1007/s12471-015-0738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- E E van der Wall
- Netherlands Society of Cardiology/Holland Heart House, Moreelsepark 1, 3511, Utrecht, EP, The Netherlands,
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