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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Mainz//2011; 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi); 20110926-20110929; Mainz; DOC11gmds168 /20110920/
    Publication Date: 2011-09-20
    Keywords: neighbourhood SES ; cardiovascular risk factors ; ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
    Abstract: BACKGROUND: Phytosterols are plant-derived sterols that are taken up from food and can serve as biomarkers of cholesterol uptake. Serum levels are under tight genetic control. We used a genomic approach to study the molecular regulation of serum phytosterol levels and potential links to coronary artery disease (CAD). METHODS AND RESULTS: A genome-wide association study for serum phytosterols (campesterol, sitosterol, brassicasterol) was conducted in a population-based sample from KORA (Cooperative Research in the Region of Augsburg) (n=1495) with subsequent replication in 2 additional samples (n=1157 and n=1760). Replicated single-nucleotide polymorphisms (SNPs) were tested for association with premature CAD in a metaanalysis of 11 different samples comprising 13 764 CAD cases and 13 630 healthy controls. Genetic variants in the ATP-binding hemitransporter ABCG8 and at the blood group ABO locus were significantly associated with serum phytosterols. Effects in ABCG8 were independently related to SNPs rs4245791 and rs41360247 (combined P=1.6 x 10(-50) and 6.2 x 10(-25), respectively; n=4412). Serum campesterol was elevated 12% for each rs4245791 T-allele. The same allele was associated with 40% decreased hepatic ABCG8 mRNA expression (P=0.009). Effects at the ABO locus were related to SNP rs657152 (combined P=9.4x10(-13)). Alleles of ABCG8 and ABO associated with elevated phytosterol levels displayed significant associations with increased CAD risk (rs4245791 odds ratio, 1.10; 95% CI, 1.06 to 1.14; P=2.2 x 10(-6); rs657152 odds ratio, 1.13; 95% CI, 1.07 to 1.19; P=9.4 x 10(-6)), whereas alleles at ABCG8 associated with reduced phytosterol levels were associated with reduced CAD risk (rs41360247 odds ratio, 0.84; 95% CI, 0.78 to 0.91; P=1.3 x 10(-5)). CONCLUSION: Common variants in ABCG8 and ABO are strongly associated with serum phytosterol levels and show concordant and previously unknown associations with CAD.
    Type of Publication: Journal article published
    PubMed ID: 20529992
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  • 3
    Keywords: DISEASE ; RISK ; WOMEN ; OBESITY ; MYOCARDIAL-INFARCTION ; PREVALENCE ; RECALL ; WAIST CIRCUMFERENCE ; GENERAL-POPULATION ; ABDOMINAL ADIPOSITY
    Abstract: INTRODUCTION: The mortality of circulatory diseases of the German population varies considerably across regions. The comparison of the regional distributions of cardiovascular risk factors can provide clues to the reasons for cardiovascular mortality differences. The aim of this study was to determine whether indirect measures of fat distribution within subgroups of comparable body mass indices (BMIs) differ by region in Germany. METHODS: We included six German population-based epidemiological studies conducted between 1997 and 2006 that included a detailed assessment of anthropometric measures including overall 15 215 people aged 45-74 years. We calculated mean values of BMI, waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). We estimated mean regional differences of WC, HC, and WHR within narrow ranges of BMI. RESULTS: BMI distributions across the study populations were very similar. However, body fat distributions as measured by WC within subgroups of similar BMIs differed considerably across regions. For example, among people with a BMI of 24.0-25.9, estimated WCs were on average 3.4 and 6.7 cm higher among men and women in Saxony-Anhalt than among men and women in Bavaria, respectively. CONCLUSION: We provide evidence that the BMI distributions across six population-based surveys in Germany are very similar and that body fat distributions among people with comparable BMIs show relevant regional differences. Our observed WC differences might contribute to regional cardiovascular disease risk differences in Germany. Our findings may trigger further similar analyses across European populations to explain large area variations of cardiovascular disease burden.
    Type of Publication: Journal article published
    PubMed ID: 20571406
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  • 4
  • 5
    Keywords: POPULATION ; HEALTH ; RISK FACTOR ; BLOOD-PRESSURE ; DISORDERS ; hyperthyroidism ; HYPOTHYROIDISM ; ARTERIAL STIFFNESS ; SUBCLINICAL THYROID-DYSFUNCTION ; ENDOTHELIUM-DEPENDENT VASODILATATION
    Abstract: Background: Recent data from a population-based study in children and adolescents suggest that serum thyrotropin (TSH) levels are associated with arterial blood pressure and hypertension. These results are in agreement with some but not all population-based studies in adults. Discrepancies in results might be explained by drug intake, different iodine supplies, and sizes of populations investigated. In addition, it is not clear whether an association between TSH and hypertension exists longitudinally or only cross-sectionally. Thus, our aim was to investigate cross-sectional and longitudinal associations between thyroid function and arterial blood pressure in a large consortium of cohort studies in adults. Methods: Data from five population-based studies were pooled resulting in 17,023 individuals being available for cross-sectional and 10,048 individuals for longitudinal analyses. Associations of baseline TSH with baseline blood pressure or hypertension were analyzed by multivariable median or logistic regression models. Multivariable median or Poisson regression models were used to investigate associations of baseline TSH with five-year change in arterial blood pressure or incident hypertension. Results: There was a cross-sectional positive association of TSH with arterial blood pressure (p〈0.001) and hypertension (odds ratio [OR]=1.76 [confidence interval (CI) 1.24-2.50], p=0.002). Likewise, hypothyroidism was associated with systolic (beta=1.1 [CI 0.1-2.1], p=0.040) and diastolic blood pressure (beta=1.4 [CI 0.7-2.0], p〈0.001). TSH, however, was not consistently associated with a five-year change in blood pressure or incident hypertension. Conclusions: High serum TSH levels were associated with current hypertension and blood pressure but not with a five-year change in blood pressure and incident hypertension. This argues for only a short-term effect of thyroid hormone levels on arterial blood pressure or a spurious association that needs further evaluation in population-based studies.
    Type of Publication: Journal article published
    PubMed ID: 23427935
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  • 6
    Keywords: RISK-FACTORS ; CARDIOVASCULAR-DISEASE ; INSULIN SENSITIVITY ; GENERAL-POPULATION ; OBESE WOMEN ; THYROID-STIMULATING HORMONE ; REFERENCE RANGE ; SUBCLINICAL HYPOTHYROIDISM ; EUTHYROID SUBJECTS ; TSH LEVEL
    Abstract: Background: Population-based studies investigating the sex-specific association between thyrotropin (TSH) levels and serum lipid concentrations are scarce. We examined the association between TSH and total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides in men and women from the general population. Furthermore, the association with TSH outside and within the reference range and lipid levels was studied. Methods: Individual data of 13,571 men and women without lipid medication of four population-based studies conducted in Western European adults were pooled for cross-sectional analyses. The association between TSH levels and lipid concentrations were analyzed by calculating sex-specific multivariable median regression models. Results: In the pooled population, serum TSH levels were significantly positively associated with triglyceride values in men and with total cholesterol, LDL cholesterol, and triglyceride values in women. In the pooled male population, low serum TSH levels (〈3.0 mIU/L) were significantly associated with lower total cholesterol, while high serum TSH levels (〉= 3.0 mIU/L) were associated with higher triglyceride values. In the pooled female population, low serum TSH levels were significantly associated with lower total cholesterol, LDL cholesterol, and HDL cholesterol. High TSH levels were associated with higher total cholesterol and LDL cholesterol in the pooled female population. In both sexes, serum TSH levels within the reference range (0.3-3.0 mIU/L) were significantly positively associated with triglyceride concentrations. Conclusions: Increasing levels of TSH were associated with a less favorable lipid profile in both men and women from the general population. In both sexes, TSH levels within the reference range were significantly positively associated with triglyceride concentrations.
    Type of Publication: Journal article published
    PubMed ID: 24102572
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  • 7
    Keywords: MORTALITY ; antibodies ; FUNCTION TESTS ; EXCRETION ; HORMONE CONCENTRATIONS ; REFERENCE INTERVALS ; UNITED-STATES POPULATION ; THYROTROPIN ; EXTREME LONGEVITY ; IODINE INTAKE
    Abstract: BACKGROUND: Age and gender may be involved in the regulation of TSH and thyroid hormones. Reliable investigations concerned with the matter of whether or not these factors are of importance for diagnostic evaluation of the thyroid function are scarce. We used serum values of the CARLA study to calculate reference intervals for TSH, FT3, and FT4 and examine these parameters for their association with age or gender. METHODS: The CARLA study included 967 men and 812 women aged 45 to 83 years. We defined a reference group of 1002 subjects that were free of thyroid disease for data analysis by laboratory analysis and questionnaire, calculated age-dependent moving percentiles (2.5th/97.5th) for TSH, FT4, and FT3 and tested this data set for the confounding factors age and gender. Thereafter, the results were compared to data from the Leipzig Blood Donor study established in 2005. RESULTS: TSH (significant in trend (p = 0.064)) and FT3 (p = 0.001) were inversely associated with age. The correlation of FT3 with age was furthermore influenced by gender (p 〈 0.001). Neither gender nor age influenced values of FT4. CONCLUSIONS: The decreased TSH and FT3 levels with increasing age suggest a diagnostically relevant modification in the feed back regulation of thyroid function of the elderly. FT3 data should thus be interpreted gender-dependent and even age-dependent for males. These findings should be considered for the diagnostic examination of older patients with suspected disorders of thyroid function.
    Type of Publication: Journal article published
    PubMed ID: 25291952
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  • 8
    Keywords: OBESITY ; CARDIOVASCULAR-DISEASE ; ARTERIAL-HYPERTENSION ; MASS ; RECOMMENDATIONS ; HYPERTENSIVE PATIENTS ; CHAMBER QUANTIFICATION ; ELECTROCARDIOGRAPHIC CRITERIA ; LOSARTAN INTERVENTION ; ECG
    Abstract: BACKGROUND: Arterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy (LVH) is an independent risk factor in arterial hypertension. Electrocardiographic indices like the Sokolow-Lyon index (SLI) are recommended as diagnostic screening methods for LVH. We assessed the diagnostic performance of the SLI in a cohort of a large general population. METHODS: We used electrocardiographic and echocardiographic data from the prospective, population-based cohort study CARdio-vascular Disease, Living and Ageing in Halle (CARLA). Linear and logistic regression models were used to assess the association of SLI with LVH. To assess the impact of the body-mass-index (BMI), we performed interaction analyses. RESULTS: AUC of SLI to predict LVH was 55.3 %, sensitivity of the SLI was 5 %, specificity 97 %. We found a significant association of SLI after covariate-adjustment with echocardiographically detected LVH (increase of left-ventricular mass index, LVMI 7.0 g/m(2) per 1 mV increase of SLI, p 〈 0.0001). However, this association was mainly caused by an association of SLI with the left-ventricular internal diameter (LVIDd, increase of 0.06 cm/m(2) per 1 mV increase of SLI, p 〈 0.0001). In obese (BMI 〉 30 kg/m(2)) we found the strongest association with an increase of 9.2 g/m(2) per 1 mV. CONCLUSIONS: Although statistically significant, relations of SLI and echocardiographic parameters of LVH were weak and mainly driven by the increase in LVIDd, implicating a more eccentric type of LVH in the collective. The relations were strongest when obese subjects were taken into account. Our data do not favour the SLI as a diagnostic screening test to identify patients at risk for LVH, especially in non-obese subjects without eccentric LVH.
    Type of Publication: Journal article published
    PubMed ID: 26169782
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  • 9
    Abstract: OBJECTIVES: Aim was to examine the relationship between individually perceived changes in psychosocial stressors associated with German reunification and cardiovascular effects. We hypothesised that higher levels of psychosocial stress related to German reunification were associated with an increase in cardiovascular risk factors and cardiovascular diseases (CVDs). DESIGN: Cross-sectional data from 2 cohort studies in East Germany were used: Cardiovascular Disease, Living and Ageing in Halle Study (CARLA), and Study of Health in Pomerania (SHIP). SETTING: 2 populations in East Germany. PARTICIPANTS: CARLA study: 1779 participants, aged 45-83 years at baseline (812 women), SHIP study: 4308 participants, aged 20-79 years at baseline (2193 women). PRIMARY AND SECONDARY OUTCOME MEASURES: Psychosocial stressors related to reunification were operationalised by the Reunification Stress Index (RSI; scale from 0 to 10). This index was composed of questions that were related to individually perceived changes in psychosocial stressors (occupational, financial and personal) after reunification. To examine the associations between the RSI and each stressor separately with cardiovascular risk factors and CVD, regression models were used. RESULTS: RSI was associated with CVD in women (RR=1.15, 95% CI 1.00 to 1.33). Cardiovascular risk factors were associated with RSI for both men and women, with strongest associations between RSI and diabetes in women (RR=1.10, 95% CI 1.01 to 1.20) and depressive disorders in men (RR=1.15, 95% CI 1.07 to 2.77). The change in occupational situation related to reunification was the major contributing psychosocial stressor. We observed a strong association with CVD in women who experienced occupational deterioration after reunification (RR=4.04, 95% CI 1.21 to 13.43). CONCLUSIONS: Individually perceived deterioration of psychosocial stressors (occupational, financial and personal) related to German reunification was associated with cardiovascular risk factors and CVD. The associations were stronger for women than for men. An explanation for these findings could be that women were more often affected by unemployment after reunification. Morbidity and mortality follow-up of both cohorts could enhance the results.
    Type of Publication: Journal article published
    PubMed ID: 26729378
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  • 10
    Abstract: BACKGROUND: Disagreement exists on the association between changes in blood pressure and cognitive impairment. We aimed to examine whether 4-year changes in systolic and diastolic blood pressure (SBP and DBP) are associated with cognitive status in a representative sample of older men and women. METHODS: Analysis of longitudinal data from 854 participants of a population-based German sample (aged 60-87 years) was performed with standard cognitive screening and blood pressure measurements. Effects of changes in SBP and DBP (10 mmHg and 5 mmHg respectively as unit of regression effect measure) on cognitive status were evaluated using non-parametric and linear regression modeling. RESULTS: No clear associations were seen between changes in SBP or in DBP and cognitive scores. Small effects were found after stratification for sex and hypertension awareness. Specifically, larger decreases in SBP were associated with higher cognitive scores in those men aware of their hypertension (10 mmHg decrease in SBP, beta = -0.26, 95% CI: -0.51 to -0.02) and men with controlled hypertension (10 mmHg decrease in SBP, beta = -0.44, 95% CI: -0.92 to -0.03). Additionally larger increases in DBP were associated with higher cognitive scores in men with controlled hypertension (5 mmHg increase in DBP, beta = 0.67, 95% CI: 0.19-1.15). For women aware of their hypertension, larger decreases in DBP were associated with higher cognitive scores (5 mmHg decrease in DBP, beta = -0.26; 95%CI: -0.51 to -0.01). CONCLUSIONS: Changes in blood pressure were only weakly associated with cognitive status. Specifically, decreases in SBP were associated with higher cognitive scores in men aware of their hypertension and especially those that were medically controlled.
    Type of Publication: Journal article published
    PubMed ID: 26918011
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