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P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey.

ABSTRACT: BACKGROUND:P wave indices are an intermediate phenotype modulated by atrial conduction and electrophysiology. Their clinical correlates and association with all-cause mortality have received limited scrutiny. OBJECTIVE:To determine the relationship between P wave indices and cardiovascular and all-cause mortality in the National Health and Nutrition Examination Survey (NHANES), a highly representative United States sample. METHODS:NHANES III (1988-1994) quantified PR interval and P wave duration and amplitude. Mortality data through 2006 were obtained from National Death Index (NDI) records. RESULTS:Of 8,561 subjects with electrocardiograms (ECGs), 7,486 (mean age 60.0 ± 13.3 years., 51.9% women, 50.1% ethnic minorities) had ECGs in sinus rhythm, linked mortality data, and complete assessments. Over a median 8.6-year follow-up (range 0.1-12.2 years), there were 679 cardiovascular deaths and 1,559 all-cause mortality deaths. Older age, male sex, and higher body mass index were significantly associated with greater PR interval and P wave duration and with lower P wave amplitude. African Americans had higher mean values of all three P wave indices. In a multivariable model adjusting for cardiovascular risk factors, P wave duration was the only P wave index significantly associated with cardiovascular mortality (hazard ratio [HR] 1.13, per 1 standard deviation [SD], 95% confidence interval [CI] 1.04-1.23; P = .004) and all-cause mortality (HR 1.06 per 1 SD; 95% CI 1.00-1.13; P = .050). CONCLUSIONS:In a highly representative U.S. sample, P wave duration was significantly associated with increased cardiovascular and all-cause mortality. P wave duration may reflect subclinical disease and merits elucidation as a marker of risk for adverse outcomes.

SUBMITTER: Magnani JW

PROVIDER: S-EPMC3046401 | biostudies-literature | 2011 Jan

REPOSITORIES: biostudies-literature

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P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey.

Magnani Jared W JW Gorodeski Eiran Z EZ Johnson Victor M VM Sullivan Lisa M LM Hamburg Naomi M NM Benjamin Emelia J EJ Ellinor Patrick T PT

Heart rhythm 20100922 1

<h4>Background</h4>P wave indices are an intermediate phenotype modulated by atrial conduction and electrophysiology. Their clinical correlates and association with all-cause mortality have received limited scrutiny.<h4>Objective</h4>To determine the relationship between P wave indices and cardiovascular and all-cause mortality in the National Health and Nutrition Examination Survey (NHANES), a highly representative United States sample.<h4>Methods</h4>NHANES III (1988-1994) quantified PR interv ...[more]

PMID: 20868770

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Project description:BackgroundThe U.S. Food and Drug Administration has the authority to regulate tobacco product constituents, including menthol, if the scientific evidence indicates harm. Few studies, however, have evaluated the health effects of menthol cigarette use.ObjectiveTo investigate associations of cigarette smoking and menthol cigarette use with all-cause, cancer and cardiovascular risk in U.S. adults.MethodsWe studied 10,289 adults ? 20 years of age who participated in the National Health and Nutrition Examination Survey from 1999-2004 and were followed through December 2006. We also identified studies comparing risk of all-cause mortality, cardiovascular disease and cancer for menthol and nonmenthol cigarette smokers and estimates were pooled using random-effects models.ResultsFifty-five percent of participants were never smokers compared to 23%, 17% and 5% of former, current nonmenthol and current menthol cigarette smokers, respectively. The adjusted hazard ratios (95% CI) for former, current nonmenthol and current menthol cigarette smokers compared to never smokers were 1.24 (0.96, 1.62), 2.40 (1.56, 3.71) and 2.07 (1.20, 3.58), respectively, for all-cause mortality; 0.92 (0.62, 1.37), 2.10 (1.02, 4.31) and 3.48 (1.52, 7.99) for cardiovascular mortality; and 1.91 (1.21, 3.00), 3.82 (2.19, 6.68) and 2.03 (1.00, 4.13) for cancer mortality. Using data from 3 studies of all-cause mortality, 5 of cardiovascular disease and 13 of cancer, the pooled relative risks (95% CI) comparing menthol cigarette smokers to nonmenthol cigarette smokers was 0.94 (0.85, 1.05) for all-cause mortality, 1.28 (0.91, 1.80) for cardiovascular disease and 0.84 (0.76, 0.92) for any cancer.ConclusionsIn a representative sample of U.S. adults, menthol cigarette smoking was associated with increased all-cause, cardiovascular and cancer mortality with no differences compared to nonmenthol cigarettes. In the systematic review, menthol cigarette use was associated with inverse risk of cancer compared to nonmenthol cigarette use with some evidence of an increased risk for cardiovascular disease.

Project description:Background Although accumulating evidence has demonstrated that consumption time of energy and macronutrients plays an important role in maintaining health, the association between consumption time of different foods and cardiovascular disease, cancer, and all-cause mortalities is still largely unknown. Methods and Results A noninstitutionalized household population of the US 21 503 participants from National Health and Nutrition Examination Survey was included. Meal patterns and snack patterns throughout a whole day were measured using 24-hour dietary recall. Principal component analysis was performed to establish dietary patterns. Cox proportional hazards models were used to evaluate the association between dietary patterns across meals and cardiovascular disease (CVD), cancer, and all-cause mortalities. During the 149 875 person-years of follow-up, 2192 deaths including 676 deaths because of CVD and 476 because of cancer were documented. After adjusting for potential confounders, participants consuming fruit-lunch had lower mortality risks of all-cause (hazard ratio [HR], 0.82; 95% CI, 0.72-0.92) and CVD (HR, 0.66; 95% CI, 0.49-0.87); whereas participants who consumed Western-lunch were more likely to die because of CVD (HR, 1.44; 95% CI, 1.10-1.89). Participants who consumed vegetable-dinner had lower mortality risks of all-cause, CVD, and cancer (HRall-cause, 0.69; 95% CI, 0.60-0.78; HRCVD, 0.77; 95% CI, 0.61-0.95; HRcancer, 0.63; 95% CI, 0.48-0.83). For the snack patterns, participants who consumed fruit-snack after breakfast had lower mortality risks of all-cause and cancer (HRall-cause, 0.78; 95% CI, 0.66-0.93; HRcancer, 0.55; 95% CI, 0.39-0.78), and participants who consumed dairy-snack after dinner had lower risks of all-cause and CVD mortalities (HRall-cause, 0.82; 95% CI, 0.72-0.94; HRCVD, 0.67; 95% CI, 0.52-0.87). Participants who consumed a starchy-snack after main meals had greater mortality risks of all-cause (HRafter-breakfast, 1.50; 95% CI, 1.24-1.82; HRafter-lunch, 1.52; 95% CI, 1.27-1.81; HRafter-dinner, 1.50; 95% CI, 1.25-1.80) and CVD (HRafter-breakfast, 1.55; 95% CI, 1.08-2.24; HRafter-lunch, 1.44; 95% CI, 1.03-2.02; HRafter-dinner, 1.57; 95% CI, 1.10-2.23). Conclusions Fruit-snack after breakfast, fruit-lunch, vegetable-dinner, and dairy-snack after dinner was associated with lower mortality risks of CVD, cancer, and all-cause; whereas Western-lunch and starchy-snack after main meals had greater CVD and all-cause mortalities.

Project description:ObjectiveThis study aimed to elucidate the relationship between retinopathy status or severity and the all-cause and specific-cause mortality risk based on the updated National Health and Nutrition Examination Survey (NHANES) database and 2019 Public Access Link mortality file.MethodsIn this prospective cohort study, a total of 6,797 participants aged over 40 years based on NHANES 2005-2008 were analyzed. The severity of retinopathy was classified into 4 grades-no retinopathy, mild non-proliferative retinopathy (NPR), moderate to severe NPR, and proliferative retinopathy (PR). Multiple covariate-adjusted Cox proportional hazards regression models and Fine and Gray competing risk regression models were used to assess the all-cause and cause-specific mortality risks, respectively. The propensity score matching (PSM) approach was also applied additionally to adequately balance between-group covariates to validate our findings.ResultsA final total of 4,808 participants representing 18,282,772 United States (US) non-hospitalized participants were included for analysis, 50.27% were male (n = 2,417), 55.32% were non-hispanic white (n = 2,660), and mean [SE] age, 56.10 [0.40] years. After a median follow-up of 12.24 years (interquartile range, 11.16-13.49 years), 1,164 participants died of all-cause mortality, of which 941 (80.84%) died without retinopathy and 223 (19.16%) died with retinopathy at baseline. The presence of retinopathy was associated with increased all-cause mortality, cardiovascular disease (CVD), and diabetes mellitus (DM)-specific mortality, and the results remain consistent after PSM. Severity analysis showed that only mild NPR was associated with an increased all-cause mortality risk (hazard ratio (HR) = 2.01; 95% confidence interval (CI), 1.00-4.03), while increased CVD and DM-specific mortality risk were associated with all grades of retinopathy and were exponentially greater with increasing retinopathy severity, and the trend test was also significant (P for trend 0.004 and 0.04, respectively).DiscussionOur findings suggest that the diagnosis of retinopathy is an independent risk factor for all-cause mortality in people over 40 years old. Retinopathy grading is significantly associated with the survival risk of patients with CVD or DM, it can be a valuable predictor in the stratified management and risk warning of CVD or DM patients, as well as in the monitoring of systemic vasculopathy status.

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P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey.

Publications

P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey.

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