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  • ASSOCIATION  (4)
  • MYOCARDIAL-INFARCTION  (4)
  • 1
    Keywords: RISK-FACTORS ; HEALTH ; smoking ; MYOCARDIAL-INFARCTION ; HYPERTENSION ; GENERAL-POPULATION ; PRIMARY-CARE ; SOUTHERN GERMANY ; METABOLIC-SYNDROME ; POMERANIA SHIP
    Abstract: Diabet. Med. 29, e88-e95 (2012) ABSTRACT: Aim In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health-care planning and detection of risk factors associated with this disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents. Methods Data of subjects aged 45-74 years from five regional population-based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self-reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007). Results Of the 11 688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1-9.1%). For the nationwide study, a prevalence of 8.2% (7.3-9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9-10.4%) than in women (7.6%; 6.9-8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3-13.7%) and lowest in the south with 5.8% (4.9-6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%). Conclusion The prevalence of known Type 2 diabetes showed a southwest-to-northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.
    Type of Publication: Journal article published
    PubMed ID: 22248078
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  • 2
    Keywords: RISK ; ASSOCIATION ; HEALTH ; INEQUALITIES ; MELLITUS ; LIFE-COURSE ; LOW-INCOME ; MULTILEVEL ANALYSIS ; MULTIPLE DEPRIVATION ; SMALL-AREA LEVEL
    Abstract: AIM: Our objective was to test the hypothesis that the prevalence of Type 2 diabetes increases with increasing regional deprivation even after controlling for individual socio-economic status. METHODS: We pooled cross-sectional data from five German population-based studies. The data set contained information on n = 11 688 study participants (men 50.1%) aged 45-74 years, of whom 1008 people had prevalent Type 2 diabetes (men 56.2%). Logistic multilevel regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence. We controlled for sex, age and lifestyle risk factors, individual socio-economic status and regional deprivation, based on a new small-area deprivation measure, the German Index of Multiple Deprivation. RESULTS: Adjusted for sex, age, body mass index (BMI), physical activity, smoking status and alcohol consumption, the prevalence of Type 2 diabetes showed a stepwise increase in risk with increasing area deprivation [OR 1.88 (95% CI 1.16-3.04) in quintile 4 and OR 2.14 (95% CI 1.29-3.55) in quintile 5 compared with the least deprived quintile 1], even after controlling for individual socio-economic status. Focusing on individual socio-economic status alone, the risk of having diabetes was significantly higher for low compared with medium or high educational level [OR 1.46 (95% CI 1.24-1.71)] and for the lowest compared with the highest income group [OR 1.53 (95% CI 1.18-1.99)]. CONCLUSION: Regional deprivation plays a significant part in the explanation of diabetes prevalence in Germany independently of individual socio-economic status. The results of the present study could help to target public health measures in deprived regions.
    Type of Publication: Journal article published
    PubMed ID: 23127142
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  • 3
    Keywords: MORTALITY ; DOSE-RESPONSE ; BLOOD-PRESSURE ; MYOCARDIAL-INFARCTION ; LIFE-STYLE ; CARDIOVASCULAR RISK-FACTORS ; GENERAL-POPULATION ; N-3 FATTY-ACIDS ; AUTONOMIC FUNCTION ; HABITUAL PHYSICAL-ACTIVITY
    Abstract: Background: Reduced heart rate variability (HRV), a non-invasive marker of autonomic dysfunction, and an unhealthy lifestyle are associated with an increased morbidity and mortality of cardiovascular diseases (CVD). The autonomic dysfunction is a potential mediator of the association of behavioural risk factors with adverse health outcomes. We studied the association of HRV with behavioural risk factors in an elderly population. Methods: This analysis was based on the cross-sectional data of 1671 participants (age range, 45-83 years) of the prospective, population-based Cardiovascular Disease, Living and Ageing in Halle (CARLA) Study. Physical activity, smoking habits, alcohol consumption and dietary patterns were assessed in standardized interviews. Time and frequency domain measures of HRV were computed from 5-min segments of highly standardized 20-min electrocardiograms. Their association with behavioural risk factors was determined by linear and non-parametric regression modelling. Results: There were only weak and inconsistent associations of higher physical activity, moderate consumption of alcohol, and non-smoking with higher time and frequency domain HRV in both sexes, and no association with dietary pattern. Results changed only marginally by excluding subjects with CVD, diabetes mellitus and use of cardioactive medication. Conclusion: We hypothesized that HRV is associated with behavioural factors and therefore might be a mediator of the effect of behavioural risk factors on CVD, but this hypothesis was not confirmed by our results. These findings support the interpretation that there may be no true causal association of behavioural factors with HRV
    Type of Publication: Journal article published
    PubMed ID: 21108803
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  • 4
    Keywords: UNITED-STATES ; MYOCARDIAL-INFARCTION ; RANDOMIZED-TRIAL ; CARDIOVASCULAR RISK-FACTORS ; HIGH PREVALENCE ; EUROPEAN COUNTRIES ; SEX-SPECIFIC DIFFERENCES ; BLOOD-PRESSURE CONTROL ; PRIMARY-CARE PATIENTS ; LIPID MANAGEMENT
    Abstract: ABSTRACT: BACKGROUND: Hypertension and dyslipidemia are often insufficiently controlled in persons with type 2 diabetes (T2D) in Germany. In the current study we evaluated individual characteristics that are assumed to influence the adequate treatment and control of hypertension and dyslipidemia and aimed to identify the patient group with the most urgent need for improved health care. METHODS: The analysis was based on the DIAB-CORE project in which cross-sectional data from five regional population-based studies and one nationwide German study, conducted between 1997 and 2006, were pooled. We compared the frequencies of socio-economic and lifestyle factors along with comorbidities in hypertensive participants with or without the blood pressure target of 〈 140/90 mmHg. Similar studies were also performed in participants with dyslipidemia with and without the target of total cholesterol/HDL cholesterol ratio 〈 5. Furthermore, we compared participants who received antihypertensive/lipid lowering treatment with those who were untreated. Univariable and multivariable logistic regression models were used to assess the odds of potentially influential factors. RESULTS: We included 1287 participants with T2D of whom n = 1048 had hypertension and n = 636 had dyslipidemia. Uncontrolled blood pressure was associated with male sex, low body mass index (BMI), no history of myocardial infarction (MI) and study site. Uncontrolled blood lipid levels were associated with male sex, no history of MI and study site. The odds of receiving no pharmacotherapy for hypertension were significantly greater in men, younger participants, those with BMI 〈 30 kg/m2 and those without previous MI or stroke. Participants with dyslipidemia received lipid lowering medication less frequently if they were male and had not previously had an MI. The more recent studies HNR and CARLA had the greatest numbers of well controlled and treated participants. CONCLUSION: In the DIAB-CORE study, the patient group with the greatest odds of uncontrolled co-morbidities and no pharmacotherapy was more likely comprised of younger men with low BMI and no history of cardiovascular disease.
    Type of Publication: Journal article published
    PubMed ID: 23035799
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  • 5
    Keywords: COHORT ; cohort studies ; DISEASES ; RISK ; ASSOCIATION ; HEALTH ; WOMEN ; OBESITY ; smoking ; BLOOD-PRESSURE ; BEHAVIOR ; education ; CORONARY-HEART-DISEASE ; blood pressure ; WAIST CIRCUMFERENCE ; POSITION ; HIP RATIO
    Abstract: Background: The influence of socioeconomic status (SES) on cardiovascular diseases and risk factors is widely known, although the role of different SES indicators is not fully understood. The aim of this study was to investigate the role of different SES indicators for cardiovascular disease risk factors in a middle and old aged East German population. Methods: Cross-sectional data of an East German population-based cohort study (1779 men and women aged 45 to 83) were used to assess the association of childhood and adulthood SES indicators (childhood SES, education, occupational position, income) with cardiovascular risk factors. Adjusted means and odds ratios of risk factors by SES indicators with 95% confidence intervals (CI) were calculated by linear and logistic regression models, stratified by sex. The interaction effect of education and age on cardiovascular risk factors was tested by including an interaction term. Results: In age-adjusted models, education, occupational position, and income were statistically significantly associated with abdominal obesity in men, and with smoking in both sexes. Men with low education had a more than threefold risk of being a smoker (OR 3.44, CI 1.58-7.51). Low childhood SES was associated with higher systolic blood pressure and abdominal obesity in women (OR 2.27, CI 1.18-4.38 for obesity); a non-significant but (in terms of effect size) relevant association of childhood SES with smoking was observed in men. In women, age was an effect modifier for education in the risk of obesity and smoking. Conclusions: We found considerable differences in cardiovascular risk factors by education, occupational position, income, and partly by childhood social status, differing by sex. Some social inequalities levelled off in higher age. Longitudinal studies are needed to differentiate between age and birth cohort effects
    Type of Publication: Journal article published
    PubMed ID: 21569269
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  • 6
    Keywords: SURVIVAL ; FOLLOW-UP ; COHORT ; DEATH ; DISEASE ; MORTALITY ; RISK ; ASSOCIATION ; HEALTH ; exercise ; physical activity ; RELATIVE SURVIVAL ; PHYSICAL-ACTIVITY ; PARTICIPANTS ; sports ; athletes ; LIFE EXPECTANCY ; soccer
    Abstract: Leisure-time physical activity is associated with better health and a reduced risk of all-cause mortality. It is unclear if this association is also present with a high level of physical activity as it is found in professional athletes. In a population-based retrospective cohort study, we compared the survival experience of all soccer players participating for Germany in international matches between 1908 and 2006 to that of the general population. To summarize survival experience, we calculated cumulative relative survival ratios (RSRs) from a life table. We included data of 812 international players, of which 428 (=52.7%) died during follow-up. In all 13 intervals, cumulative observed survival was smaller than cumulative expected survival, resulting in cumulative RSRs being 〈1. The cumulative RSRs are statistically significantly different from 1 in all but the last interval. This impaired survival experience of the internationals translates into a loss of median residual lifetime of 1.9 years [95% confidence interval: 0.6, 3.2] years at the entry time into the cohort. This loss is mainly driven by the mortality of internationals from the earlier half of the observation period. Reasons for this might be poorer medical care in former times, internationals being killed in action during World War II, and a changing distribution of causes of death during the 20th century.
    Type of Publication: Journal article published
    PubMed ID: 21435018
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  • 7
    Keywords: MYOCARDIAL-INFARCTION ; HYPERTENSION ; CARDIOVASCULAR RISK-FACTORS ; HIGH PREVALENCE ; CORONARY-HEART-DISEASE ; INSULIN-RESISTANCE ; PRIMARY-CARE ; KORA SURVEY 2000 ; ATHEROSCLEROTIC DISEASE ; NONDIABETIC SUBJECTS
    Abstract: ABSTRACT: BACKGROUND: Although most deaths among patients with type 2 diabetes (T2D) are attributable to cardiovascular disease, modifiable cardiovascular risk factors appear to be inadequately treated in medical practice. The aim of this study was to describe hypertension, dyslipidemia and medical treatment of these conditions in a large population-based sample. METHODS: The present analysis was based on the DIAB-CORE project, in which data from five regional population-based studies and one nationwide German study were pooled. All studies were conducted between 1997 and 2006. We assessed the frequencies of risk factors and co-morbidities, especially hypertension and dyslipidemia, in participants with and without T2D. The odds of no or insufficient treatment and the odds of pharmacotherapy were computed using multivariable logistic regression models. Types of medication regimens were described. RESULTS: The pooled data set comprised individual data of 15, 071 participants aged 45-74 years, including 1287 (8.5%) participants with T2D. Subjects with T2D were significantly more likely to have untreated or insufficiently treated hypertension, i.e. blood pressure of 〉 = 140/90 mmHg (OR = 1.43, 95% CI 1.26-1.61) and dyslipidemia i.e. a total cholesterol/HDL-cholesterol ratio 〉 = 5 (OR = 1.80, 95% CI 1.59-2.04) than participants without T2D. Untreated or insufficiently treated blood pressure was observed in 48.9% of participants without T2D and in 63.6% of participants with T2D. In this latter group, 28.0% did not receive anti-hypertensive medication and 72.0% were insufficiently treated. In non-T2D participants, 28.8% had untreated or insufficiently treated dyslipidemia. Of all participants with T2D 42.5% had currently elevated lipids, 80.3% of these were untreated and 19.7% were insufficiently treated. CONCLUSIONS: Blood pressure and lipid management fall short especially in persons with T2D across Germany. The importance of sufficient risk factor control besides blood glucose monitoring in diabetes care needs to be emphasized in order to prevent cardiovascular sequelae and premature death.
    Type of Publication: Journal article published
    PubMed ID: 22569118
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  • 8
    Keywords: ASSOCIATION ; HEALTH ; QUESTIONNAIRE ; HEART-RATE-VARIABILITY
    Abstract: The CARLA study (Cardiovascular Disease, Living and Ageing in Halle) is a population-based cohort study of the elderly general population of the city of Halle (Saale) aged 45-83 years. The aim is to investigate established cardiovascular risk factors and a reduced heart rate variability (HRV) as indicator of autonomous dysfunction. In total, 1779 probands (812 women and 967 men) were investigated at baseline. Of those, 1436 participants were re-examined at a 4-years follow-up. The corresponding response rates were 64.1% in the baseline and 92% in the follow-up investigation. In the cross-sectional analysis a clear decrease was found in all parameters of HRV with increasing age, but no consistent associations to cardiovascular classical risk factors and diseases could be shown. Compared to other German cohorts a striking risk constellation was found consisting of high prevalence of hypertension, frequent occurrence of central overweight (measured by waist-hip ratio) and high prevalence of diabetes mellitus. These findings will be further scrutinized in the ongoing analyses of the 4-year follow-up and the 10-years follow-up which will start in 2012.
    Type of Publication: Journal article published
    PubMed ID: 22736158
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