Publications by authors named "Uri Goldbourt"

143 Publications

Resumption of sexual activity after acute myocardial infarction and long-term survival.

Eur J Prev Cardiol 2020 Sep 22. Epub 2020 Sep 22.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.

Aims: Sexual activity is an important factor in the overall quality of life. We examined whether resumption of sexual activity frequency within the first few months after myocardial infarction (MI) is associated with long-term survival.

Methods And Results: Sexually active patients aged ≤65 years (n = 495; median age, 53 years), drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, were interviewed during the index hospitalization (1992-93) and after 3-6 months. Resumption of sexual activity was defined as abstaining/decreasing or maintaining/increasing according to self-reported frequency post- vs. pre-MI. Patients were followed for all-cause and cause-specific mortality through national registries. A propensity score for sexual activity resumption was calculated, based on which inverse probability weighted Cox models were constructed to examine associations. Patients who maintained/increased frequency [n = 263 (53%)] were more likely to be of higher socioeconomic status and to express lower levels of depression than their abstained/decreased counterparts. In the propensity score-weighted synthetic sample, the distribution of measured baseline covariates was similar across exposure categories. During a median follow-up of 22 years, 211 (43%) patients died. Maintaining/increasing sexual activity frequency was inversely associated with all-cause mortality [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.48-0.88], compared with abstaining/reducing. The inverse association was more robust for non-cardiovascular mortality (HR 0.56, 95% CI 0.36-0.85) than cardiovascular mortality (HR 0.90, 95% CI 0.53-1.51).

Conclusions: Resumption of sexual activity frequency within the first months after MI was strongly associated with improved long-term survival, highlighting the need for sexual counselling shortly after MI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurjpc/zwaa011DOI Listing
September 2020

Holocaust exposure and late-life cognitive performance in men with coronary heart disease.

J Psychiatr Res 2021 Feb 19;134:1-7. Epub 2020 Dec 19.

Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Israel.

Background: Holocaust victims experienced extreme physical and mental stress that could lead to prolonged deficits in psychological and physiological well-being. We aimed to examine whether exposure to Holocaust conditions is associated with cognitive function and decline in a sample of old male adults with coronary heart disease (CHD).

Methods: The sample included 346 individuals with CHD who participated in a clinical trial in 1990-1997 (mean age 56.7 ± 6.5 y). During 2004-2008 (mean age 71.8 ± 6.5 y) and 2011-2013 (mean age 77.1 ± 6.4 y) participants underwent computerized cognitive assessments. Exposure to Holocaust conditions was based on self-report at the second assessment. Linear regression and mixed-effect models were conducted to evaluate the associations between Holocaust survivorship and subsequent cognitive performance and rate of cognitive decline.

Results: Forty-Three participants (12%) survived concentration camps/ghettos, 69 (20%) were Holocaust survivors who escaped concentration camps/ghettos, and 234 (68%) were not Holocaust survivors. After adjustment for potential confounders, concentration camp/ghetto survivors had poorer global cognitive performance and poorer attention (β = -3.90; 95%CI: 7.11;-0.68 and β = -4.11; 95%CI: 7.83;-0.38, respectively) compared to individuals who were not exposed to Holocaust conditions. Additionally, participants who reported being at concentration camps/ghettoes had increased cognitive decline in global performance and executive function (β = -0.19; 95%CI: 0.37;-0.008 and β = -0.29; 95%CI: 0.53;-0.06, respectively) compared to participants who were not Holocaust survivors. Lastly, those who were Holocaust survivors but not in concentration camps/ghettos had greater decline in attention (β = -0.11; 95%CI: 0.21;-0.01).

Discussion: Exposure to Holocaust conditions in early-life may be linked with poorer cognitive function and greater cognitive decline decades later in old-adults with CHD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2020.12.044DOI Listing
February 2021

Overweight, Obesity, and Late-Life Sarcopenia Among Men With Cardiovascular Disease, Israel.

Prev Chronic Dis 2020 12 24;17:E164. Epub 2020 Dec 24.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: Little is known about the association between obesity and sarcopenia - age-related loss of muscle mass and function - among patients with cardiovascular disease. We investigated the association between overweight, obesity, and sarcopenia among community-dwelling men in Israel with cardiovascular disease.

Methods: A subset of 337 men (mean age at baseline 56.7 [SD, 6.5]) who previously (1990-1997) participated in the Bezafibrate Infarction Prevention trial underwent a neurovascular evaluation as part of the Bezafibrate Infarction Prevention Neurocognitive Study 15.0 (SD, 3.0) years after baseline and a sarcopenia evaluation 19.9 (SD, 1.0) years after baseline. We applied a multinomial logistic model to estimate odds ratios and 95% CIs for 3 categories of sarcopenia: no evidence of sarcopenia (ie, robust), probable sarcopenia, and sarcopenia.

Results: We found sarcopenia among 54.3% of participants with obesity (body mass index [BMI, in kg/m] ≥30.0), 37.0% of participants who were overweight (25.0 ≤ BMI ≤29.9), and 24.8% of participants with normal weight (BMI 18.5 to 24.9). In a comparison of BMI ≥25.0 and BMI <25.0, adjusting for covariates, the odds ratio of having probable sarcopenia was 3.27 (95% CI, 1.68-6.36) and having sarcopenia was 5.31 (95% CI, 2.50-11.27).

Conclusion: We found a positive association between obesity and late-life sarcopenia and suggest that obesity might be an important modifiable risk factor related to sarcopenia among men with cardiovascular disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5888/pcd17.200167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784548PMC
December 2020

Role of psychosocial factors in long-term adherence to secondary prevention measures after myocardial infarction: a longitudinal analysis.

Ann Epidemiol 2020 12 6;52:35-41. Epub 2020 Oct 6.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:

Purpose: Psychosocial factors have been linked to myocardial infarction (MI) outcomes. Whether psychosocial factors affect post-MI long-term adherence to secondary prevention recommendations remains uncertain.

Methods: Patients ≤65 years (n = 616) were assessed for optimism, perceived social support (PSS), sense of coherence (SOC), anxiety, and depression at initial hospitalization for acute MI (1992-1993). Adherence to secondary prevention measures was recorded in interviews 3-6 months, 1-2, 5, and 10-13 years after MI. Prevention score (proportion of recommendations met) was developed based on: (1) medication adherence; (2) exercise; (3) nonsmoking; (4) healthy diet; (5) maintaining recommended body weight. Associations between psychosocial factors and prevention scores were estimated using Generalized Estimating Equation models. The role of the prevention score in long-term survival was assessed using time-dependent Cox regression analysis.

Results: Average follow-up prevention scores ranged from 0.70 to 0.80 (SD, ≈0.20). After multivariable adjustment, PSS (β = 0.087, P = .002, per 1 SD increase) and SOC (β = 0.082, P = .006, per 1 SD increase) were positively associated with secondary prevention adherence. The prevention score predicted survival over 23-year follow-up (adjusted hazard ratio = 0.79; 95% CI: 0.68-0.91, per 1 SD increase).

Conclusions: Psychosocial factors following MI, particularly PSS and SOC, were associated with long-term adherence to secondary prevention measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2020.09.016DOI Listing
December 2020

Blood pressure variability at midlife is associated with all-cause, coronary heart disease and stroke long term mortality.

J Hypertens 2020 Sep;38(9):1722-1728

Internal Medicine Wing, The Chaim Sheba Medical Center, Tel-Hashomer, 52621, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Objective: Elevated blood pressure (BP) is associated with cardiovascular mortality. BP variability (BPV) is also associated with cardiovascular mortality. However, most studies evaluated hypertensive patients with a relatively short follow-up. We investigated in male workers the association between BPV and long-term all-cause and specific-cause mortality.

Methods: Among 10 059 men, aged 40-65, tenured civil servants and municipal employees in Israel, 9398 participants who were examined in 1963, 1965 and 1968 had assessment of diabetic and coronary morbidity status and SBP levels. Participants underwent clinical and biochemical evaluations and BP measured in the recumbent position on the right arm. We conducted analysis for SD-SBP across study visits. Hazard ratios were calculated for 18 years all-cause mortality, coronary heart disease (CHD) and stroke mortality associated with quintile of SD-SBP, with the lowest quintile serving as a reference.

Results: Multivariate analysis yielded a significant association between SD-SBP and all-cause, CHD and stroke mortality. Age and SBP-adjusted hazard ratios of all-cause mortality was 1.02 [95% confidence interval (CI), 0.90-1.17], 1.06 (95% CI, 0.94-1.20), 1.20 (95% CI, 1.06-1.35) and 1.36 (95% CI, 1.21-1.53) (for quintile 2-5, respectively). The results of CHD and stroke mortality similarly and strongly indicated increasing age-adjusted mortality risk with increasing SD-SBP. Further adjustment for smoking, BMI, diabetes mellitus and coronary heart disease yielded similar results.

Conclusion: In this cohort of tenured male workers, BPV taken over 5 years was clearly associated with 18-year all-cause, CHD and stroke mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HJH.0000000000002447DOI Listing
September 2020

Adherence to Mediterranean diet and subsequent cognitive decline in men with cardiovascular disease.

Nutr Neurosci 2020 Jan 22:1-9. Epub 2020 Jan 22.

Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel.

Evidence from recent years highlighted the importance of the Mediterranean diet for brain health. We investigated the association between adherence to Mediterranean diet and change in cognitive functions two decades later in patients with cardiovascular disease (CVD). Participants were men with a history of CVD, who previously participated in the Bezafibrate Infarction Prevention (BIP) trial between 1990 and 1997, had a food diary record, and underwent cognitive evaluations 14.6 ± 1.9 years (T1) and 19.9 ± 1.0 years after baseline (T2) as part of the BIP Neurocognitive study (= 200, mean age at 57.3 ± 6.3 years). Adherence to the Mediterranean diet was determined from the self-administered 4-day food diary record, with patients categorized into high, middle and poor levels of adherence if they received >5, 4-5 and <4 points, respectively. Cognitive function was assessed using the NeuroTrax computerized battery. Linear mixed models were applied. Among the 200 patients, 52 (26%) had poor adherence, 98 (49%) had middle adherence and 50 (25%) had high levels of adherence to the Mediterranean diet. Those categorized to the poor adherence level had poorer cognitive function at T1 compared to the other groups. Additionally, poor vs. high level of adherence was associated with a greater decline in overall cognitive performance [-score = -0.23 and 95% confidence interval (CI), -0.43;-0.04;  = 0.021] and in visual spatial functions (-0.46 95% CI, -0.86;-0.06;  = 0.023). This study stresses the possible role of the Mediterranean diet in men with a high vascular burden and may set the ground for future intervention to reduce their risk for cognitive decline.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/1028415X.2020.1715049DOI Listing
January 2020

C-reactive protein in midlife is associated with depressive symptoms two decades later among men with coronary heart disease.

Nord J Psychiatry 2020 Apr 26;74(3):226-233. Epub 2019 Nov 26.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

We investigated the relationship between midlife C-reactive protein (CRP) levels in men with coronary heart disease (CHD) and depressive symptoms at old age. CRP levels were measured in a subset of patients with CHD, who previously participated in a secondary prevention trial. Depressive symptoms were evaluated in survivors of the original cohort 15.0 ± 3 and 19.9 ± 1 years later (T1,  = 463 and T2,  = 314 respectively) using the Geriatric Depression Scale (GDS), 15-item version. Logistic regression was used to estimate ORs and 95%CIs for presence of potentially clinically significant depressive symptoms (GDS ≥5) at T1 and T2. Adjusting for demographic and health-related variables, the OR (95%CI) for GDS ≥5 was 1.23 (0.65-2.33);  = .53 at T1 and 2.36 (1.16-4.83);  = .018 at T2 in the top CRP tertile compared to the others. Similarly, consistently high CRP levels in the top tertile at baseline and 2 years later, were associated with OR of 2.85 (95%CI 1.29-6.30);  = .01 for GDS ≥5 at T2. Presence and persistence of low-grade inflammation in men with CHD during midlife are associated with increased risk of depressive symptoms twenty years later. Among middle aged men with CHD, low-grade inflammation may provide an important added value for prediction of depression in old age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08039488.2019.1695284DOI Listing
April 2020

Adherence to a Mediterranean diet by vegetarians and vegans as compared to omnivores.

Int J Food Sci Nutr 2020 May 26;71(3):378-387. Epub 2019 Sep 26.

The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

To assess adherence to the Mediterranean Diet (MedD) by vegetarians and vegans compared to omnivores, we recruited an internet-based convenience sample of 565, 151 and 514 Israeli (>20 years) vegans, vegetarians and omnivores. Studies assessing vegetarians' and vegans' adherence to the Mediterranean Diet (MedD) are scarce. We recruited an internet-based convenience sample of 565, 151 and 514 Israeli vegans, vegetarians and omnivores, mostly female with a normal weight. We assessed their MedD scores (MedDS) and their food groups' consumption by two food frequency questionnaires: (1) Trichopoulou's MedDS (range 0-9); (2) Literature-based MedDS (LBMedDS) (range 0-18). We found that vegans tend to consume significantly more legumes, nuts, fruits and vegetables than omnivores. The multivariable-adjusted odds for high MedDS a score ≥4) (compared to omnivores) assessed by Trichopoulou's score were: 32.35-fold higher in vegans (95% CI, 21.43-48.84) and 3.13-fold higher in vegetarians (95% CI, 2.06-4.76). Using the LBMedDS, vegans had 2.30-fold higher odds for high MedD adherence (a score ≥12) and vegetarians 1.66-fold higher odds compared to omnivores. In conclusion, we found a higher MedD adherence among vegans and vegetarians compared to omnivores.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09637486.2019.1663797DOI Listing
May 2020

Midlife resting heart rate, but not its visit-to-visit variability, is associated with late-life frailty status in men with coronary heart disease.

Aging Male 2019 Sep 14:1-7. Epub 2019 Sep 14.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel.

Autonomic imbalance is linked with multiple health conditions, yet its associations with frailty were rarely studied. We assessed the relationship of resting heart rate (RHR) and visit-to-visit heart rate variability (HRV) with future frailty among elderly men with coronary heart disease (CHD). Three-hundred-six community-dwelling men with CHD who participated in the Bezafibrate Infarction Prevention (BIP) trial (1990-1998; mean age 56.6 ± 6.5 years) underwent assessment of physical frailty in 2011-2013 (mean age 77.0 ± 6.4 years). Mean RHR and visit-to-visit HRV were calculated from electrocardiogram as indicators of autonomic imbalance. Nominal logistic and linear regression models were used to assess the relationships of RHR and HRV with frailty status and its components (i.e. gait speed, grip strength, weight loss, exhaustion and activity), respectively. Adjustments were made for various demographic, clinical and metabolic covariates. Of the 306 men, 81 (26%) were frail and 117 (38%) were prefrail. After controlling for potential confounders, RHR, but not visit-to-visit HRV, was associated with higher odds of being prefrail [OR = 1.44 (95%CI 1.15, 1.79)] and frail [OR = 1.35 (95%CI 1.03, 1.77)]. Each 5-bpm increase in RHR was associated with weaker grip (β= -1.12 ± 0.32 kg; -value < .001) and slower gait speed (β = 0.19 ± 0.08s/m; -value = .022). Midlife RHR may be associated with late-life frailty in men with CHD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13685538.2019.1664456DOI Listing
September 2019

Angina pectoris severity and late-life frailty among men with cardiovascular disease.

Aging Male 2019 Aug 26:1-8. Epub 2019 Aug 26.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Tel-Aviv , Israel.

We investigated the association between severity of angina pectoris (AP) and subsequent late-life frailty among men with cardiovascular disease (CVD). A subset of 351 men (mean age at baseline 56.7 ± 6.5 years) who previously participated in the Bezafibrate Infarction Prevention, BIP trial (1990-1997) underwent a neurovascular evaluation as part of the BIP Neurocognitive study 15.0 ± 3.0 years after baseline (T1) and a frailty evaluation according to Fried 19.9 ± 1.0 years after baseline (T2). Severity of AP was assessed at baseline of the BIP trial using the Canadian Cardiovascular Society angina classification. We assessed the odds of being in the advanced rank of frailty status (robust, pre-frail, and frail) using ordered logistic regression. Among 351 participants, 134 (38.2%) were classified as pre-frail and 100 (28.5%) as frail. Frailty was found among 42% participants in the AP class ≥2 and among 26% participants in the AP class <2. Adjusting for demographic, health-related and cognitive variables, odds ratio (OR), and 95% confidence interval (95% CI) for advanced rank of frailty was 2.68 (95% CI: 1.29-5.59) comparing AP class ≥2 to AP class <2. Among men with CVD, severity of AP should be taken into risk consideration due to its strong association with late-life frailty, particularly among inactive participants and participants with cerebral microvascular damage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13685538.2019.1657082DOI Listing
August 2019

Uric acid variability at midlife as an independent predictor of coronary heart disease and all-cause mortality.

PLoS One 2019 5;14(8):e0220532. Epub 2019 Aug 5.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Background: Serum uric acid (SUA) has long been associated with cardiovascular disease. Variability of serum uric acid (SUA) has seldom been examined in association with long-term morbidity and mortality. Therefore, we aimed to investigate the association between SUA variability and long-term all-cause and specific-cause mortality.

Methods: Among 10,059 men, aged 40-65, tenured civil servants and municipal employees in Israel, 8822 participants who were examined in 1963, 1965 and 1968 had assessment of diabetic and coronary morbidity status and SUA levels. We conducted analysis examining whether the standard deviations (SD) of Z-scores of SUA across study visits predicted coronary heart disease (CHD) and mortality. Hazard ratios (HR) associated with the SD of SUA-Z were calculated for stroke, CHD mortality and all-cause mortality associated with quartiles of the above variability.

Results: Multivariate analysis of 18-year CHD mortality yielded a significant association with the 1963-1968 SD of SUA-Z with age adjusted HR of CHD mortality of 0.97 (95% CI, 0.8-1.19), 1.05 (95% CI, 0.87-1.28) and 1.37 (95% CI, 1.15-1.65) for quartiles 2 to 4 respectively). The results of all-cause mortality similarly and strongly indicated increasing age-adjusted mortality risk with increasing SD of SUA-Z: HR = 1.08 (95% CI, 0.97-1.21), 1.15 (1.03-1.28) and 1.37 (1.23-1.51). No association was observed between the SD of SUA-Z and stroke mortality.

Conclusion: In this cohort of tenured male workers, with diverse occupations, higher variability of SUA measurement taken over 5 years was clearly predictive of 18-year CHD and all-cause mortality, above and beyond the SUA levels proper.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220532PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681967PMC
March 2020

Frequency of Sexual Activity and Long-term Survival after Acute Myocardial Infarction.

Am J Med 2020 01 8;133(1):100-107. Epub 2019 Jul 8.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel; Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel. Electronic address:

Background: Previous studies have shown an inverse relationship between sexual activity and mortality in the general population. We evaluated the association between sexual activity and long-term survival among patients with acute myocardial infarction.

Methods: Patients aged ≤65 years (n=1120; mean age, 53) discharged from 8 hospitals in central Israel after first myocardial infarction from 1992-1993 were followed for mortality through 2015. Frequency of sexual activity was self-reported during the index hospitalization (baseline; referring to the year preceding the infarct) and after 5 and 10-13 years, along with sociodemographic and clinical data. Cox proportional hazards models were constructed to estimate the association with all-cause mortality in time-dependent sexual activity categories.

Results: At baseline, a > once per week frequency of sexual activity was reported by 42% of the patients, whereas no sexual activity was reported by 6%. After 10-13 years, the rates were 21% and 27%, respectively. Lower sexual activity was associated with older age, female sex, lack of a steady partner and more comorbidities. During follow-up, 524 deaths (47%) occurred. An inverse relationship was observed between sexual activity frequency and death, with hazard ratios (95% confidence intervals) of 0.30 (0.23-0.38) for > once per week, 0.36 (0.28-0.46) for once per week, and 0.53 (0.42-0.66) for < once per week, compared with none. After adjusting for relevant confounding factors, the estimates were attenuated to 0.68 (0.50-0.91), 0.63 (0.48-0.83), and 0.72 (0.57-0.93), respectively (P for trend = .004).

Conclusions: Using repeated assessments of sexual activity after myocardial infarction, an inverse association was demonstrated with mortality, which was only partly accounted for by measured potential confounders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2019.06.019DOI Listing
January 2020

Diet quality in relation to healthy ageing: the Israeli Longitudinal Study on Aging (ILSA)-a study protocol.

BMJ Open 2019 04 20;9(4):e024673. Epub 2019 Apr 20.

Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: Population ageing is accelerating rapidly in Israel as well as worldwide, necessitating adaptation of the healthcare system and consideration of new approaches that serve the specific needs of older adults. In addition to cognitive function, frailty is one of the most challenging expressions of physical and mental ageing, a multidimensional syndrome of increased vulnerability. Several studies have shown that low intake of certain micronutrients and protein is associated with higher risk of frailty and cognitive impairment. However, whether global diet quality is involved in the aetiology of the latter outcomes is unclear.

Methods And Analysis: We are conducting, among older adult subjects who took part in 'Mabat Zahav' (Israeli National Health and Nutrition Survey of Older Adults) in 2005-2006 (T0, n=1852), an extensive follow-up interview (T1) that includes comprehensive geriatric assessment and evaluation of general health and quality of life. Diet quality is evaluated using the Healthy Eating Index (HEI) 2010, based on 24-hour diet recall measured at T0 and T1. Frailty is assessed using two different approaches: the phenotype framework and the accumulation of deficits model. Cognitive function is assessed by Mini-Mental State Examination (MMSE) and cognitive decline is assessed by the difference between repeated MMSE measurements. Different analytic methods will be applied to evaluate the role of diet quality in development of frailty and cognitive decline with inverse probability weighting used to minimise attrition bias. About 600 subjects are expected to be interviewed between May 2017 and December 2019.

Ethics And Dissemination: Ethical approval was obtained from the Helsinki Committee of Sheba Medical Center, Tel Hashomer, Israel and the Ethical Committee of Tel-Aviv University. All participants sign an informed consent form. The findings of the study will be published in peer-reviewed journals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2018-024673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500277PMC
April 2019

Plasma Lipids, Apolipoproteins, and Subsequent Cognitive Decline in Men with Coronary Heart Disease.

J Alzheimers Dis 2019 ;67(3):827-837

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Background: Lipid levels are associated with an increased risk of cardiovascular disease.

Objective: We investigated the association between plasma lipids, apolipoproteins levels, apolipoprotein B/low-density lipoprotein cholesterol (Apo-B/LDL-C), and Apo-B/Apo-A ratios and rate of cognitive decline two decades later in men with coronary heart disease (CHD).

Methods: A subset of 337 men (mean age at baseline 56.6±6.4 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990-1997) underwent cognitive evaluations 15±3 years (T1) and 19.9±1 years after baseline (T2) as part of the BIP Neurocognitive study. Lipid and apolipoprotein fractions were measured at baseline. Cognitive function for memory, executive function, visual spatial, attention domains, and composite score were assessed using the NeuroTrax Computerized Battery at T1 and T2 evaluations. Linear mixed models were used to assess change in cognitive function between the two cognitive evaluations.

Results: Controlling for confounders, the decline in composite cognitive score (β= -0.161±0.06; p = 0.013) as well as in memory (β= -0.269±0.10; p = 0.009) and visual spatial function (β= -0.304±0.12; p = 0.010) was greater among patients in the upper (≥105 mg/dL) Apo-B tertile as compared to counterparts with < 105 mg/dL. The decline in the composite cognitive score (β= -0.124±0.06; p = 0.043) was also greater among patients in the estimated LDL-C≥160 mg/dL group compared to counterparts with LDL-C<160 mg/dL. Upper tertile of Apo-B/LDL-C ratio (≥0.75) compared to the lower tertiles was significantly associated with change in memory score (β= -0.210±0.10; p = 0.041).

Conclusion: Our findings suggest that the plasma concentrations of Apo-B, LDL-C, and Apo-B/LDL-C ratio are potential predictors of accelerated late-life cognitive decline among men with CHD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/JAD-180849DOI Listing
May 2020

Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.

Authors:
Lisa Pennells Stephen Kaptoge Angela Wood Mike Sweeting Xiaohui Zhao Ian White Stephen Burgess Peter Willeit Thomas Bolton Karel G M Moons Yvonne T van der Schouw Randi Selmer Kay-Tee Khaw Vilmundur Gudnason Gerd Assmann Philippe Amouyel Veikko Salomaa Mika Kivimaki Børge G Nordestgaard Michael J Blaha Lewis H Kuller Hermann Brenner Richard F Gillum Christa Meisinger Ian Ford Matthew W Knuiman Annika Rosengren Debbie A Lawlor Henry Völzke Cyrus Cooper Alejandro Marín Ibañez Edoardo Casiglia Jussi Kauhanen Jackie A Cooper Beatriz Rodriguez Johan Sundström Elizabeth Barrett-Connor Rachel Dankner Paul J Nietert Karina W Davidson Robert B Wallace Dan G Blazer Cecilia Björkelund Chiara Donfrancesco Harlan M Krumholz Aulikki Nissinen Barry R Davis Sean Coady Peter H Whincup Torben Jørgensen Pierre Ducimetiere Maurizio Trevisan Gunnar Engström Carlos J Crespo Tom W Meade Marjolein Visser Daan Kromhout Stefan Kiechl Makoto Daimon Jackie F Price Agustin Gómez de la Cámara J Wouter Jukema Benoît Lamarche Altan Onat Leon A Simons Maryam Kavousi Yoav Ben-Shlomo John Gallacher Jacqueline M Dekker Hisatomi Arima Nawar Shara Robert W Tipping Ronan Roussel Eric J Brunner Wolfgang Koenig Masaru Sakurai Jelena Pavlovic Ron T Gansevoort Dorothea Nagel Uri Goldbourt Elizabeth L M Barr Luigi Palmieri Inger Njølstad Shinichi Sato W M Monique Verschuren Cherian V Varghese Ian Graham Oyere Onuma Philip Greenland Mark Woodward Majid Ezzati Bruce M Psaty Naveed Sattar Rod Jackson Paul M Ridker Nancy R Cook Ralph B D'Agostino Simon G Thompson John Danesh Emanuele Di Angelantonio

Eur Heart J 2019 02;40(7):621-631

Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

Methods And Results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms.

Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurheartj/ehy653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374687PMC
February 2019

Physical frailty and cognitive function among men with cardiovascular disease.

Arch Gerontol Geriatr 2018 Sep - Oct;78:1-6. Epub 2018 May 29.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address:

Aims: To assess the relationship between physical frailty and cognitive function among elderly men with a history of cardiovascular disease (CVD).

Methods: Three-hundred-twenty-four community-dwelling men with chronic CVD (mean age 77.2 ± 6.4 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990-1998) underwent assessment of frailty and cognitive function between 2011 and 2013. Physical frailty was assessed using the Fried phenotypic model, and cognitive performance overall and in memory, executive function, visuospatial and attention domains was evaluated using a validated set of computerized cognitive tests. Linear regression models were used to assess the cross-sectional relationship of frailty status and its components (gait speed, grip strength, weight loss, exhaustion and activity) with cognitive function overall and in specific domains, adjusting for age, education, smoking status, physical activity, history of myocardial infarction, hypertension, diabetes and dyslipidemia, systolic blood pressure, BMI and depression.

Results: Of the 324 men, 91 (28%) were frail and 121 (37%) were pre-frail. After controlling for potential confounders, severity of frailty was strongly associated with global cognitive function (β = -8.0, 95%CI = -11.9,-4.1 and β = -3.3, 95%CI = -6.0,-0.5 comparing frail and pre-frail to non-frail, respectively), with the most profound associations observed in executive function and attention. Gait speed was associated with overall cognitive performance and with all cognitive domains assessed in this study, and activity with none.

Conclusion: Cognitive function is poor among frail and pre-frail men with CVD, particularly in non-memory domains. Future research is warranted to address mechanisms and to assess the efficacy of interventions to improve physical and cognitive health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.archger.2018.05.013DOI Listing
May 2019

Impaired Cerebral Hemodynamics and Frailty in Patients with Cardiovascular Disease.

J Gerontol A Biol Sci Med Sci 2018 11;73(12):1714-1721

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Background: Recent studies suggest that impaired cerebrovascular reactivity (CVR), a marker of cerebral microvascular damage, is associated with a higher risk of stroke, cognitive decline, and mortality. We tested whether abnormal cerebrovascular status is associated with late-life frailty among men with pre-existing cardiovascular disease.

Methods: A subset of 327 men (mean age at baseline 56.7 ± 6.5 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990-1997) and then in the BIP Neurocognitive Study underwent a neurovascular evaluation 14.6 ± 1.9 years after baseline (T1) and were evaluated for frailty 19.9 ± 1.0 years after baseline (T2). CVR was measured at T1 using the breath-holding index and carotid large-vessel disease using ultrasound. Frailty status was measured at T2 according to the physical phenotype developed by Fried. Patients were categorized into CVR tertiles with cutoff points at ≤0.57, 0.58-0.94, and ≥0.95 and also as normal or impaired (<0.69) CVR. We assessed the change in the odds of being in the advanced rank of frailty status (normal, prefrail, and frail) using ordered logistic regression.

Results: After adjustment, the estimated OR (95% confidence intervals) for increasing frailty in the lower tertile was 1.94 (1.09-3.46) and in the middle tertile 1.24 (0.70-2.19), compared with the higher CVR tertile. The estimated OR for increasing frailty for patients with impaired vs. normal CVR was 1.76 (1.11-2.80).

Conclusions: These findings provide support that cerebral microvascular dysfunction among patients with pre-existing cardiovascular disease is related to prefrailty and frailty and suggest an added value of assessing the cerebral vascular functional status for identifying patients at-risk of developing frailty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/gerona/glx253DOI Listing
November 2018

Cardiovascular Health and Cognitive Decline 2 Decades Later in Men with Preexisting Coronary Artery Disease.

Am J Cardiol 2018 02 23;121(4):410-415. Epub 2017 Nov 23.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel. Electronic address:

Cardiovascular health (CVH) factors are associated with lower risk of cardiovascular disease, stroke, and mortality. We investigated the association between a modified CVH metrics score and change in cognitive functions 2 decades later in patients with pre-existing coronary artery disease. A subset of 200 men (mean age at baseline 57.3 ± 6.3 years) who previously participated in a secondary prevention trial (1990 to 1997) underwent cognitive evaluation 14.6 ± 1.9 years after baseline (mean age 72.3 ± 6.2 years, T1 evaluation), and were re-evaluated for cognitive performance 19.9 ± 1.0 years after baseline (mean age 77.2 ± 6.4 years, T2 evaluation). A CVH metrics score at baseline was calculated, including 3 health parameters and 4 health behaviors. We have scored each of these CVH metrics into best (2 points), intermediate (1 point), and poor (0 points) levels. Cognitive function was assessed using the NeuroTrax Computerized Battery. A linear mixed model was used to assess change in cognitive functions between T1 and T2 cognitive evaluations. Among the 200 patients, 68 (34.0 %) had ≤7 (bottom group), 85 (42.5%) had 8 to 9 (middle group), and 47 (23.5%) had ≥10 (top group) CVH metrics points. After adjustments, the top group of CVH score versus others was associated with slower decline in the overall cognitive performance composite z-score (0.23 ± 0.09, p = 0.009) and on tests of executive and visual spatial functions (0.23 ± 0.11, p = 0.047, and 0.49 ± 0.17, p = 0.004, respectively). In conclusion, an inverse association was observed between the score of best CVH metrics and cognitive decline. Lifestyle factors are important predictors of late-life decline in cognitive function among high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2017.11.003DOI Listing
February 2018

Use of Repeated Blood Pressure and Cholesterol Measurements to Improve Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis.

Am J Epidemiol 2017 Oct;186(8):899-907

The added value of incorporating information from repeated blood pressure and cholesterol measurements to predict cardiovascular disease (CVD) risk has not been rigorously assessed. We used data on 191,445 adults from the Emerging Risk Factors Collaboration (38 cohorts from 17 countries with data encompassing 1962-2014) with more than 1 million measurements of systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol. Over a median 12 years of follow-up, 21,170 CVD events occurred. Risk prediction models using cumulative mean values of repeated measurements and summary measures from longitudinal modeling of the repeated measurements were compared with models using measurements from a single time point. Risk discrimination (C-index) and net reclassification were calculated, and changes in C-indices were meta-analyzed across studies. Compared with the single-time-point model, the cumulative means and longitudinal models increased the C-index by 0.0040 (95% confidence interval (CI): 0.0023, 0.0057) and 0.0023 (95% CI: 0.0005, 0.0042), respectively. Reclassification was also improved in both models; compared with the single-time-point model, overall net reclassification improvements were 0.0369 (95% CI: 0.0303, 0.0436) for the cumulative-means model and 0.0177 (95% CI: 0.0110, 0.0243) for the longitudinal model. In conclusion, incorporating repeated measurements of blood pressure and cholesterol into CVD risk prediction models slightly improves risk prediction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/aje/kwx149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860526PMC
October 2017

Smoking Status and Incidence of Cancer After Myocardial Infarction: A Follow-Up Study of over 20 Years.

Am J Med 2017 09 8;130(9):1084-1091. Epub 2017 Apr 8.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. Electronic address:

Objectives: We evaluated long-term incidence of cancer after myocardial infarction among current, former, and never smokers, and assessed whether reducing cigarette consumption is associated with decreased cancer risk.

Methods: Consecutive patients aged ≤65 years discharged from 8 hospitals in central Israel after first myocardial infarction in 1992-1993 were followed for cancer and death. Extensive data including smoking habits were obtained at the index hospitalization and 4 time points during follow-up. Survival methods were applied to assess the hazard ratios (HRs) for cancer associated with smoking categories.

Results: Included in the study were 1486 cancer-free participants (mean age, 54 years; 81% men), among whom 787 were current smokers at baseline (average daily cigarette consumption = 29). Smokers were younger than nonsmokers and more likely to be male and of lower socioeconomic status. Over a median follow-up of 21.4 years, 273 (18.4%) patients developed cancer. Baseline smoking was associated with a ∼40% excess adjusted risk of cancer; ∼25% after accounting for death as a competing event. Considering changes in smoking during follow-up, the excess risk was confined to persistent smokers (adjusted HR 1.75; 95% confidence interval [CI], 1.22-2.50), whereas post- (HR 1.14; 95% CI, 0.80-1.62) and pre-myocardial infarction quitters (HR 1.02; 95% CI, 0.71-1.47) were comparable with never smokers. Among persistent smokers, each reduction of 10 cigarettes relative to pre-myocardial infarction consumption was associated with a ∼10% reduced adjusted risk.

Conclusion: Among young survivors of first myocardial infarction followed-up longitudinally, smoking cessation is associated with lower risk of cancer. Reducing consumption among smokers may also be beneficial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2017.02.052DOI Listing
September 2017

Insulin Resistance and Future Cognitive Performance and Cognitive Decline in Elderly Patients with Cardiovascular Disease.

J Alzheimers Dis 2017 ;57(2):633-643

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Background: The role of insulin resistance (IR) in the pathogenesis of cognitive performance is not yet clear.

Objective: To examine the associations between IR and cognitive performance and change in cognitive functions two decades later in individuals with cardiovascular disease with and without diabetes.

Methods: A subset of 489 surviving patients (mean age at baseline 57.7±6.5 y) with coronary heart disease who previously participated in the secondary prevention Bezafibrate Infarction Prevention (BIP trial; 1990-1997), were included in the current neurocognitive study. Biochemical parameters including IR (using the homeostasis model of assessment; HOMA-IR) were measured at baseline. During 2004-2008, computerized cognitive assessment and atherosclerosis parameters were measured (T1; n = 558; mean age 72.6±6.4 years). A second cognitive assessment was performed during 2011-2013 (T2; n = 351; mean age 77.2±6.4 years). Cognitive function, overall and in specific domains, was assessed. We used linear regression models and linear mixed models to evaluate the differences in cognitive performance and decline, respectively.

Results: Controlling for potential confounders, IR (top HOMA-IR quartile versus others) was associated with subsequent poorer cognitive performance overall (β= -4.45±Standard Error (SE) 1.54; p = 0.004) and on tests of memory and executive function among non-diabetic patients (β= -7.16±2.38; p = 0.003 and β= -3.33±1.84; p = 0.073, respectively). Moreover, among non-diabetic patients, IR was related to a greater decline overall (β= -0.17±0.06; p = 0.008), and in memory (β= -0.22±0.10; p = 0.024) and executive function (β= -0.19±0.08; p = 0.012). The observed associations did not differ after excluding subjects with prevalent stroke or dementia.

Conclusion: IR is related to subsequent poorer cognitive performance and greater cognitive decline among patients with cardiovascular disease with and without diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/JAD-161016DOI Listing
February 2018

Triceps and Subscapular Skinfold in Men Aged 40-65 and Dementia Prevalence 36 Years Later.

J Alzheimers Dis 2017 ;57(3):873-883

Division of Epidemiology, and Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Background: The relationship of obesity with risk for dementia is complex and may change with age.

Objective: To analyze the relationship between measures of obesity at age 40-65 and dementia prevalence in survivors 36 years later.

Methods: Obesity-related measures of triceps and subscapular skinfold thickness were assessed in 1963 in n = 9,760 men aged 40-65 participating in the Israel Ischemic Heart Disease study. Cognitive evaluation and assessment of dementia prevalence were performed in n = 1,643 participants of the original cohort who survived until 1999/2000 (age ≥76 years) and had anthropometric measures in 1963.

Results: Age-adjusted prevalence of dementia in survivors in 1999/2000 by baseline triceps skinfold quintile was 20.5%, 21.2%, 17.6%, 15.6%, and 14.5%, respectively, from lowest to highest (p = 0.006 in trend test). Using logistic regression, a 6-mm increment of triceps skinfold was associated with an age and BMI-adjusted odds ratio of 0.81 (95% CI, 0.70-0.94) for dementia prevalence among survivors. Age-adjusted risk for dementia by subscapular skinfold quintile demonstrated 20.5%, 17.1%, 15.7%, 19.4%, and 18.1%, respectively, in groups of subjects by subscapular skinfold quintile from lowest to highest (p = 0.6 in trend test).

Conclusions: Lower triceps skinfold at age 40-65, reflecting diminished peripheral fat, was associated with higher dementia prevalence in late life, potentially suggesting a protective role of peripheral fat to brain health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/JAD-160786DOI Listing
August 2017

C-reactive protein is related to future cognitive impairment and decline in elderly individuals with cardiovascular disease.

Arch Gerontol Geriatr 2017 Mar - Apr;69:31-37. Epub 2016 Nov 9.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.

Aims: To explore the association of C-reactive protein (CRP) plasma levels with subsequent cognitive performance and decline among elderly individuals with pre-existing cardiovascular disease (CVD), and to assess the role of cerebrovascular indices in this relationship.

Methods: CRP levels were measured in a subgroup of individuals with chronic CVD, who previously participated in a secondary prevention trial. Cognitive performance was evaluated 14.7±1.9 and 19.9±1.0years after entry to the trial. A validated set of computerized cognitive tests was used (Neurotrax Computerized Cognitive Battery) to assess performance globally and in memory, executive function, visuospatial and attention domains. Linear regression and mixed models were used to assess the relationship of CRP plasma levels with cognitive scores and decline, respectively. In addition, we tested whether cerebrovascular reactivity, carotid intima media thickness and presence of carotid plaques modify these associations.

Results: Among 536 participants (mean age at the first cognitive evaluation 72.6±6.4years; 95% males), CRP at the top tertile vs. the rest was associated with subsequent poorer performance overall (ß=-2.2±1.0; p=0.031) and on tests of executive function and attention (ß=-2.3±1.1; p=0.043 and ß=-2.0±1.4; p=0.047, respectively). Moreover, CRP levels were positively related to a greater decline in executive functions (ß=-2.4±1.1; p=0.03). These associations were independent of potential confounders and were not modified by cerebrovascular indices.

Conclusion: Our findings suggest that systemic chronic inflammation, potentially associated with underlying atherosclerosis, is related to cognitive impairment and decline two decades later, in elderly individuals with pre-existing CVD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.archger.2016.11.002DOI Listing
July 2017

Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study.

Mayo Clin Proc 2017 Jan 19;92(1):49-56. Epub 2016 Nov 19.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address:

Objective: To assess the association between dispositional optimism, defined as generalized positive expectations about the future, and long-term mortality in young survivors of myocardial infarction (MI).

Patients And Methods: A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow-up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT-derived optimism.

Results: The mean age of the participants was 52.4±8.6 years; 98 (15%) were women. The median follow-up period was 22.4 years (25th-75th percentiles, 16.1-22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5±4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person-years, respectively (P<.01). With sequential adjustment for sociodemographic, clinical, and psychosocial variables, a decreased mortality was associated with the upper tertile (adjusted hazard ratio, 0.67; 95% CI, 0.47-0.95). A nonlinear inverse relationship was observed using spline analysis, with the slope increasing sharply beyond the median LOT score.

Conclusion: Higher levels of optimism during hospitalization for MI were associated with reduced mortality over a 2-decade follow-up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mayocp.2016.09.014DOI Listing
January 2017

Cardiovascular health among two ethnic groups living in the same region: A population-based study.

Int J Cardiol 2017 Feb 9;228:23-30. Epub 2016 Nov 9.

Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Poor cardiovascular health (CVH) among ethnic/racial minorities, studied primarily in the USA, may reflect lower access to healthcare. We examined factors associated with minority CVH in a setting of universal access to healthcare.

Methods And Results: CVH behaviors and factors were evaluated in a random population sample (551 Arabs, 553 Jews) stratified by sex, ethnicity and age. More Jews (10%) than Arabs (3%) had 3 ideal health behaviors. Only one participant had all four. Although ideal diet was rare (≤1.5%) across groups, Arabs were more likely to meet intake recommendations for whole grains, but less likely to meet intake recommendations for fruits/vegetables and fish. Arabs had lower odds of attaining ideal levels for body mass index and physical activity. Smoking prevalence was 57% among Arab men and 6% among Arab women. Having four ideal health factors (cholesterol, blood pressure, glucose, smoking) was observed in 2% and 8% of Arab and Jewish men, respectively, and 13% of Arab and Jewish women. Higher prevalence of ideal total-cholesterol corresponded to lower high-density lipoprotein cholesterol among Arabs. No participant met ideal levels for all 7 metrics and only 1.8% presented with 6. Accounting for age and lower socioeconomic status, Arabs were less likely to meet a greater number of metric goals (odds ratio (95% confidence interval): 0.62 (0.42-0.92) for men, and 0.73 (0.48-1.12) for women).

Conclusions: Ideal CVH, rare altogether, was less prevalent among the Arab minority albeit universal access to healthcare. Health behaviors were the main contributors to the CVH disparity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2016.11.079DOI Listing
February 2017

Tall stature in coronary heart disease patients is associated with decreased risk of frailty in late life.

Geriatr Gerontol Int 2017 Sep 19;17(9):1270-1277. Epub 2016 Aug 19.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Aim: We investigated the possible inverse association between tall stature and subsequent late-life frailty.

Methods: A subset of surviving men with coronary heart disease (n = 1232; mean age at baseline 57.0 ± 6.0 years), who previously participated in the Bezafibrate Infarction Prevention clinical trial (1990-1997) were reassessed during 2004-2008 (T1; n = 558) and 2011-2013 (T2; n = 351) at the mean ages of 72.6 ± 6.4 years and 77.2 ± 6.4 years, respectively. Frailty status was measured at T2 according to the physical phenotype developed by Fried, and was categorized into non-frail, prefrail and frail. We estimated the odds ratios of increasing frailty by tertiles of height at baseline.

Results: Among 351 patients, 117 (33.3%) were classified as non-frail, 134 (38.2%) as prefrail and 100 (28.5%) as frail. Frailty was found among 21% of participants at the highest tertile, 33% at the middle tertile and 46% at the lowest tertile for height (P for trend = 0.002). Adjusting for age, weight, place of birth, education, blood pressure, New York Heart Association classification functional class and comorbidity score, the estimated OR for increasing frailty for participants in the highest tertile was 0.32 (95% CI 0.17-0.59) and for those at the middle tertile 0.46 (95% CI 0.27-0.79), as compared with the lowest tertile. An increment of 1 SD of height was associated with a 38% (95% CI 18-53%) decrease in frailty odds.

Conclusion: Among men with coronary heart disease, tall stature was associated with lower adjusted odds of late-life frailty. Geriatr Gerontol Int 2017; 17: 1270-1277.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ggi.12855DOI Listing
September 2017

Cancer incidence in Holocaust male survivors-An Israeli cohort study.

Int J Cancer 2016 12 25;139(11):2426-35. Epub 2016 Aug 25.

Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel.

Previous studies, often using proxy exposure assessment and not controlling for individual risk factors, suggested higher cancer risk in Holocaust survivors. We have used individual-level data from a male cohort of Israeli civil servants recruited in 1963 to investigate cancer incidence in Holocaust survivors, controlling for potential confounders. The analysis included 4,669 Europe-born subjects; 689 exposed = E (immigrated to Israel after 1939 and reported of being in Nazi camps during World War II); 2,307 potentially exposed = PE (immigrated to Israel after 1939 and reported of not being in Nazi camps); and 1,673 non-exposed = NE (immigrated to Israel prior to 1939). Vital status and cancer incidence in the cohort were determined based on national registries. Socioeconomic level, health behaviors and cancer incidence were compared between the groups and Cox proportional hazards regression models adjusting for potential confounders assessed hazard risk ratios for cancer by exposure status. All-cause mortality was studied as a competing risk. In total, 241, 682, and 522 cancer cases were diagnosed in the E, PE, and NE, respectively. Compared with the NE, all-site cancer incidence was higher in the E (HR = 1.13, 95%CI 0.97-1.32) but not in the PE. All-cause mortality competed with all-site invasive cancer incidence in the E group (HR = 1.18, 95%CI 1.02-1.38). Colorectal and lung cancer seemed to be positively though non-significantly associated with the exposure while prostate cancer was not. Male Holocaust survivors may be at a weakly increased risk for all-site, colorectal and lung cancer. The role of age at exposure and residual confounding should be further investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijc.30378DOI Listing
December 2016

Perceived social support at different times after myocardial infarction and long-term mortality risk: a prospective cohort study.

Ann Epidemiol 2016 06 1;26(6):424-8. Epub 2016 Apr 1.

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Purpose: Previous research has explored the association between social support (SS), cardiovascular disease, and mortality. Perceived SS (PSS) refers to an individual's attitude toward received SS. This study aimed to: (1) assess the association between PSS levels and long-term mortality among first myocardial infarction (MI) survivors, (2) compare the effect of PSS measured shortly after the first MI to PSS measured 10-13 years after MI, and (3) compare the prognostic role of different PSS components: family, friends, and significant others.

Methods: Patients were drawn from the longitudinal prospective Israel Study of First Acute Myocardial Infarction (ISFAMI). PSS, sociodemographic and health variables were assessed in two subcohorts during initial hospitalization from 1992 to 1993 (T1, n = 660) and in 2002-2005 (T2, n = 969). Vital status was determined through 2011. Cox regression models assessed mortality risk associated with PSS.

Results: By the end of follow-up, 212 (32%) of the T1 and 229 (24%) of T2 subcohorts had died. Higher PSS levels were associated with lower mortality risk at both T1 and T2 (per one standard deviation [1SD] increase hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.75-0.96; HR = 0.74, 95% CI = 0.66-0.83, respectively). These associations were attenuated on adjustment for sociodemographic and clinical variables (HR = 0.93, 95% CI = 0.80-1.07; HR = 0.88, 95% CI = 0.77-1.00, respectively). PSS from friends was significantly associated with lower mortality risk at both T1 and T2 and remained significant only at T2 after adjustment (HR = 0.85, 95% CI = 0.73-0.98).

Conclusions: Higher PSS levels were significantly associated with reduced mortality risk post-MI. This should encourage clinicians to assess post-MI psychosocial status to identify high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2016.03.005DOI Listing
June 2016

Serum uric acid and subsequent cognitive performance in patients with pre-existing cardiovascular disease.

PLoS One 2015 20;10(3):e0120862. Epub 2015 Mar 20.

Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

High serum uric acid (UA) levels are associated with numerous vascular risk factors, and vascular disease, that predispose patients to cognitive impairment, yet UA is also a major natural antioxidant and higher levels have been linked to slower progression of several neurodegenerative disease. In-order to test the association between UA and subsequent cognitive performance among patients that carry a high vascular burden, UA levels were determined by calorimetric enzymatic tests in a sub-cohort of patients with chronic cardiovascular disease who previously participating in a secondary prevention trial. After an average of 9.8±1.7 years, we assessed cognitive performance (Neurotrax Computerized Cognitive Battery) as well as cerebrovascular reactivity (CVR) and common carotid intima-media thickness (IMT). Among 446 men (mean age 62.3±6.4 yrs) mean UA levels were 5.8±1.1 mg/dL. Adjusted linear regression models revealed that low UA levels (bottom quintile) were associated with poorer cognitive performance. Adjusted differences between the bottom quintile and grouped top UA quintiles were (B coefficient±SE) -4.23±1.28 for global cognitive scores (p = 0.001), -4.69±1.81 for memory scores (p = 0.010), -3.32±1.43 for executive scores (p = 0.020) and -3.43±1.97 for visual spatial scores (p = 0.082). Significant difference was also found for attention scores (p = 0.015). Additional adjustment for impaired CVR and high common carotid IMT slightly attenuated the relationship. Stronger UA effect on cognitive performance was found for older (age>65) patients with significant age interaction for global cognitive score (p = 0.016) and for executive (p = 0.018) and attention domains (p<0.001). In conclusion, we demonstrate that low UA levels in patients with preexisting cardiovascular disease are associated with poorer cognitive function a decade later. These findings lend support to the hypothesis that oxidative stress may be involved in the pathogenesis of age-associated cognitive impairment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120862PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368665PMC
February 2016

Impaired Cerebral Hemodynamics and Cognitive Performance in Patients with Atherothrombotic Disease.

J Alzheimers Dis 2015 ;46(1):137-44

The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.

Background And Objective: Patients with pre-existing atherothrombotic disease are prone to cognitive impairment. We tested whether impaired cerebrovascular reactivity (CVR), a marker of cerebral microvascular hemodynamic dysfunction, is associated with poorer cognitive scores among patients with and without carotid large-vessel disease.

Methods: A subgroup of non-demented patients with chronic coronary heart disease followed-up for 15 ± 3 years was assessed for cognitive function (Neurotrax Computerized Cognitive Battery; scaled to an IQ style scale with a mean of 100 and SD of 15) and for CVR using the breath-holding index (BHI) with transcranial Doppler and for carotid plaques using ultrasound. We assessed cognitive scores in specific domains in patients with and without impaired CVR (BHI <0.47; bottom quartile).

Results: Among 415 patients (mean age 71.7 ± 6.2 y) median BHI was 0.73 (25% 0.47, 75% 1.04). Impaired CVR was associated with diabetes and peripheral artery disease. Adjusting for potential confounders, impaired CVR was associated with lower executive function (p = 0.02) and global cognitive scores (p = 0.04). There was an interaction with carotid large-vessel disease for executive function (p <  0.001), memory (p = 0.03), and global cognitive scores (p = 0.02). In the carotid large-vessel disease group there were pronounced differences by CVR status in executive function (p <  0.001), memory (p = 0.02), attention (p <  0.001), and global cognitive scores (p = 0.001).

Conclusion: Impaired CVR, a marker of cerebral microvascular dysfunction, is associated with poorer cognitive functions and in particular executive dysfunction among non-demented patients with concomitant carotid large-vessel disease. These findings emphasize the importance of cerebral hemodynamics in cognitive performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/JAD-150052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753416PMC
June 2016