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Vitamin d deficiency and metabolic syndrome:The joint effect on cardiovascular and all-cause mortality in the United States adults

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World journal of Cardiology 2022年第7期14卷 411-426页

作者： Longjian Liu Saishi Cui Stella L Volpe Nathalie S May Deeptha Sukumar Rose Ann DiMaria-Ghalili howard j eisen Department of Epidemiology and Biostatistics Dornsife School of Public HealthDrexel UniversityPhiladelphiaPA 19104United States Department of Human Nutrition Foodsand ExerciseVirginia Polytechnic Institute and State UniversityBlacksburgVA 24061United States Department of Medicine College of MedicineDrexel UniversityPhiladelphiaPA 19102United States Department of Nutrition Sciences College of Nursing and Health ProfessionsDrexel UniversityPhiladelphiaPA 19102United States Department of Graduate Nursing College of Nursing and Health ProfessionsDrexel UniversityPhiladelphiaPA 19102United States Division of Cardiology Heart and Vascular InstitutePennsylvania State UniversityHersheyPA 17033United States

BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrationsjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated wit

关键词： joint effect Serum 25 hydroxyvitamin D concentration Metabolic syndrome Cardiovascular and all-cause mortality Cox model and machine learning

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Impact of diabetes mellitus and cardiometabolic syndrome on the risk of Alzheimer’s disease among postmenopausal women

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World journal of Diabetes 2021年第1期12卷 69-83页

作者： Longjian Liu Edward j Gracely Xiaoyan Yin howard j eisen Department of Epidemiology and Biostatistics Dornsife School of Public HealthDrexel UniversityPhiladelphiaPA 19104United States Department of Family Community and Preventive MedicineDrexel University College of MedicinePhiladelphiaPA 19129United States Institute for Diabetes Obesity and MetabolismPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA 19104United States Heart and Vascular Institute Pennsylvania State UniversityHersheyPA 17033United States

BACKGROUND In spite of an increase in the incidence and prevalence of diabetes mellitus(DM)and Alzheimer’s disease(AD)in the aging population worldwide,limited attention has been paid to their potential association.AIM To investigate the association of DM and cardiometabolic syndrome(CMS,a precursor to DM)with risk of incident AD among postmenopausal women.METHODS Postmenopausal women aged 50-79(n=63117)who participated in the U.S.Women’s Health Initiative Observational Study(WHIOS),recruited in 1993-1998,without baseline AD and followed up through March 1,2019,were analyzed.AD was classified by participant-reported history of doctor-diagnosis of incident AD in the WHIOS.DM was defined by participant-report or treated because of diabetes or serum glucose concentrations≥126 mg/dL.CMS was defined as having≥3 of five CMS components:large waist circumference,high blood pressure,elevated triglycerides,elevated glucose,and low high-density lipoprotein cholesterol.The associations of DM and CMS with AD were analyzed using Cox’s proportional hazards regression analysis.RESULTS During a median follow-up of 20 years(range:3.36 to 23.36 years),of 63117 participants,8340 developed incident AD.Women with DM had significantly higher incidence of AD[8.5,95%confidence interval(CI):8.0-9.0 per 1000 personyears(PY)]than those without DM(7.1,95%CI:6.9-7.2 per 1000 PY).Multivariate Cox’s regression analysis indicated that women with DM or CMS had a significantly higher risk of AD than those without DM or CMS.The corresponding hazard ratios[HR(95%CI)]were 1.22(1.13-1.31,Pjects with DM,and 1.18(1.09-1.27,Pjects with CMS.The HRs diminished with age and became non-significant in the oldest age group.CONCLUSION During a median follow-up of 20 years,DM and CMS were significantly associated with the risk of AD among postmenopausal women.More specifically,women aged 50-69 with DM or CMS vs those without these conditions had significantly higher relative risks of AD than the relative risks of AD in those aged 70-79

关键词： Epidemiology Diabetes mellitus Cardiometabolic disorders Alzheimer’s disease Aging population

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Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: Evidence on health outcomes and antidiabetic treatment in United States adults

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World journal of Diabetes 2016年第18期7卷 449-461页

作者： Longjian Liu Barbara Simon jinggaofu Shi Arshpreet Kaur Mallhi howard j eisen Department of Epidemiology and Biostatistics Drexel University Dornsife School of Public Health Division of Endocrinology Drexel University College of Medicine Division of Cardiology Drexel University College of Medicine

AIMTo examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Fileson prescribed medicines for patients with DM were used to test the research questions. χ 2, Poisson and Cox’s regression models were applied in data analysis.RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P jects without DM,respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations,specifically for metformin use, sho

关键词： Epidemic of diabetes mellitus Cardiovascular disease Pharmacoepidemiologic profiles United States

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心血管疾病病死率与血清25-羟基维生素D浓度相关性研究

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成都医学院学报 2013年第2期8卷 131-134页

作者：刘隆健魏敏陈明 Shelley R Hankins Ana E.Nùez Robert A Watson Perry j Weinstock Craig j.Newschaffer howard j eisen 邹强杨书陈卫中德雷塞尔大学公共卫生学院成都医学院公共卫生系成都610083 重庆医科大学第一附属医院德雷塞尔大学医学院费城Abington Memorial医院宾夕法尼亚州费城19001 Cooper大学医院新泽西州camden08103

目的研究心衰死亡、心血管疾病死亡和过早死亡与血清25-羟基维生素D[25(OH)D]浓度的相关性。方法在第3次美国健康和营养调查中,1988～1994年为基线数据,纳入35岁以上参与者13 131名(男性6130名,女性7 001名),随访至2000年12月31日。结... 详细信息

目的研究心衰死亡、心血管疾病死亡和过早死亡与血清25-羟基维生素D[25(OH)D]浓度的相关性。方法在第3次美国健康和营养调查中,1988～1994年为基线数据,纳入35岁以上参与者13 131名(男性6130名,女性7 001名),随访至2000年12月31日。结果随访8年期间,共有3 266人死亡(24.9%),其中心衰死亡101人,心血管疾病死亡1 451人,早死1 066人。心衰死亡者中有37%血清25(OH)D水平低于20ng/mL,非心衰死亡者为26%(P<0.001)。多元Cox模型显示,血清25(OH)D水平低于20ng/mL的心衰死亡风险是超过30ng/mL的2.06倍(95%CI:1.01～4.25)(P<0.001),过早死亡风险为1.40倍(95%CI:1.17～1.68;P<0.001);血清25(OH)D浓度20～29ng/mL的过早死亡风险是超过30ng/mL的1.11倍(95%CI:0.93～1.33)。结论血清25(OH)D水平不足的成年人死于心血管病、心衰和过早死亡的风险较高。

关键词： 25-羟基维生素D 心衰心血管疾病病死率

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