Ovuokerie Addoh

Predictive Validity of the American College of Cardiology/American Heart Association Pooled Cohort Equations in Predicting All-Cause and Cardiovascular Disease–Specific Mortality in a National Prospective Cohort Study of Adults in the United States

The predictive validity of the Pooled Cohort risk (PCR) equations for cardiovascular disease (CVD)-specific and all-cause mortality among a national sample of US adults has yet to be evaluated, which was this studys purpose. Data from the 1999-2010 National Health and Nutrition Examination Survey were used, with participants followed up through December 31, 2011, to ascertain mortality status via the National Death Index probabilistic algorithm. The analyzed sample included 11,171 CVD-free adults (40-79 years of age). The 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event was determined from the PCR equations. For the entire sample encompassing 849,202 person-months, we found an incidence rate of 1.00 (95% CI, 0.93-1.07) all-cause deaths per 1000 person-months and an incidence rate of 0.15 (95% CI, 0.12-0.17) CVD-specific deaths per 1000 person-months. The unweighted median follow-up duration was 72 months. For nearly all analyses (unadjusted and adjusted models with ASCVD expressed as a continuous variable as well as dichotomized at 7.5% and 20%), the ASCVD risk score was significantly associated with all-cause and CVD-specific mortality (P<.05). In the adjusted model, the increased all-cause mortality risk ranged from 47% to 77% based on an ASCVD risk of 20% or higher and 7.5% or higher, respectively. Those with an ASCVD score of 7.5% or higher had a 3-fold increased risk of CVD-specific mortality. The 10-year predicted risk of a first ASCVD event via the PCR equations was associated with all-cause and CVD-specific mortality among those free of CVD at baseline. In this American adult sample, the PCR equations provide evidence of predictive validity.

Multimorbidity, mortality, and physical activity.

Objectives Multimorbidity and physical inactivity are individually associated with increased mortality risk, but the possibility for physical activity to moderate the multimorbidity–mortality relationship has yet to be investigated. Methods Data from the 1999–2006 NHANES were employed, with 16,091 participants constituting the analytic sample. Participants were followed through 2011, including a median follow-up of 99 months. Physical activity was assessed via self-report with multimorbidity assessed from physician diagnosis. Results After adjustment, for every 1 morbidity increase, participants had a 23% increased risk of all-cause mortality (HR = 1.23; 95% CI: 1.19–1.28; p < 0.001). Multimorbidity mostly remained associated with all-cause mortality across all levels of physical activity, with the exception of those achieving four times the dose of the government guidelines. Discussion With the exception of those who engaged in high levels of self-reported physical activity, physical activity had a minimal effect on the multimorbidity–mortality relationship.

Accelerometer-Determined Physical Activity and All-Cause Mortality in a National Prospective Cohort Study of Adults Post-Acute Stroke

Purpose: No epidemiological study has examined the association of objectively measured physical activity with all-cause mortality among adults who have had a stroke, which was the purpose of this study. Design: Prospective. Setting: National Health and Nutrition Examination Survey 2003 to 2006. Participants: One hundred eighty-four patients with stroke. Measures: Physical activity assessed via accelerometry (ActiGraph 7164), with stroke assessed via self-report of physician diagnosis. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011. Analysis: Cox proportional hazard model. Results: The median follow-up period was 71.96 months, with 13 241 person-months; 53 deaths occurred during this follow-up period. After adjustments, for every 60 min/d increase in total physical activity, adults who have had a stroke had a 28% (hazard ratio = 0.72; 95% confidence interval: 0.59-0.88) reduced risk of all-cause mortality. Conclusion: Physical activity among stroke survivors is inversely associated with all-cause mortality.

Association between muscle strengthening physical activities and mortality among American adults with mobility limitations

Compared to aerobic-based physical activity, less research has evaluated the effects of muscle-strengthening physical activity (MSPA) on mortality. Additionally, limited research has evaluated this among adults with mobility limitations, which was this studys purpose. Data from the 2003-2006 NHANES, with follow-up through 2011, were used (analyzed in 2016). MSPA was assessed via self-report, with all-cause, CVD-specific, and cancer-specific mortality assessed as the outcome variables. Analyses were limited to adults with mobility limitations (N=1411), assessed via a validated questionnaire. After adjustments, those meeting MSPA guidelines (vs. not) had a 38% reduced hazard of all-cause death (HR=0.62; 95% CI: 0.41-0.95). Results were similar for CVD-specific mortality (HR=0.46; 95% CI: 0.23-0.97) and cancer-specific mortality (HR=0.27; 95% CI: 0.06-1.20). Meeting MSPA guidelines is associated with reduced all-cause and cause-specific mortality among adults with mobility limitations. This is an encouraging observation as adults with mobility limitations may be unable to engage in sufficient amounts of aerobic-based physical activity. Thus, promotion of MSPA among this population may be of critical importance.

Physical Activity and Residual-specific Mortality among Adults in the United States

INTRODUCTION The purpose of this study was to examine the association between physical activity and residual-specific mortality (deaths not from the major nine causes of death) among a national sample of adults in the United States, which has yet to be investigated. METHODS Data from the 1999-2006 National Health and Nutrition Examination Survey were employed, with 16,329 participants constituting the analytical sample. Participants were followed through 2011, including a median follow-up of 101 months. Moderate to vigorous physical activity (MVPA) was assessed via self-report and accelerometry. RESULTS After adjusting for age, gender, race-ethnicity, blood pressure, and other covariates, participants who self-reported meeting physical activity guidelines (≥2000 MET·min·month) had a 33% reduced risk for residual-specific mortality (HR = 0.67; 95% confidence interval, 0.53-0.85; P = 0.001). With regard to accelerometry-assessed MVPA, for every 30 min·d increase in MVPA, participants had a 53% reduced hazard of residual-specific mortality (HR = 0.47; 95% confidence interval, 0.26-0.84; P = 0.01; N = 7739). CONCLUSION The major finding of this study was that physical activity was inversely associated with residual-specific mortality risk.

The Effects of Free‐Living Physical Activity on Mortality After Coronary Artery Disease Diagnosis

Previous research demonstrates greater survival among coronary artery disease (CAD) patients who engage in cardiac rehabilitation. No national prospective studies, however, have examined the effects of objectively measured free‐living physical activity on mortality among CAD patients, which is important because only 25% of eligible cardiac patients participate in cardiac rehabilitation. Therefore, the purpose of this study was to examine the association between objectively measured free‐living physical activity on all‐cause mortality among a national sample of CAD patients.

Physical activity, body mass index and waist circumference change, and normal-range glycated hemoglobin on incident diabetes: Jackson Heart Study

ABSTRACT Objectives: The purpose of this study was to 1) evaluate whether physical activity has a protective effect on incident diabetes among African Americans across combinations of body mass index (BMI) and waist circumference (WC), 2) evaluate the effect of changes on BMI and WC on incident diabetes, and 3) evaluate the effect of ‘normal range’ glycated hemoglobin (A1C) on incident diabetes. Methods: Data from the prospective Jackson Heart Study were evaluated, with baseline data assessed between 2001 and 2004 and follow-up data occurring between 2009 and 2013. Physical activity was assessed via a validated questionnaire, with measured BMI, WC and A1C assessed via standard procedures. Results: The sample included 2,450 adults who did not have evidence of diabetes at the baseline assessment, with 286 incident diabetes cases occurring at the follow-up assessment. Physical activity did not have a protective effect against incident diabetes across different BMI and WC combinations. Notably, BMI change from baseline to follow-up was associated with incident diabetes (HR = 1.08; 95% CI: 1.03–1.13). Further, higher levels of A1C within the ‘normal-range’ was associated with incident diabetes (HR = 7.51, 95% CI = 2.66–21.25). Conclusion: Increases in BMI over time and higher A1C within the normal range were associated with incident diabetes. Serial monitoring of BMI, as well as A1C, even among those with a ‘normal’ A1C, may be warranted by clinicians. Future work evaluating this novel three-way model (physical activity, BMI and WC) should consider utilizing an objective measure of physical activity.

Cross-sectional association of exercise, strengthening activities, and cardiorespiratory fitness on generalized anxiety, panic and depressive symptoms

ABSTRACT Objective: Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20–39 years) adults, with considerations by sex. Methods: Data from the 1999–2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2.1). PA and MSA were assessed via validated self-report questionnaires and CRF was determined via a submaximal treadmill-based test. An index variable was created summing the number (range = 0–3) of these parameters for each participant. For example, those meeting PA guidelines, MSA guidelines and having moderate-to-high CRF were classified as having an index score of 3. Results: MSA was not independently associated with generalized anxiety, panic and depressive symptoms, but those with higher levels of PA and CRF had a reduced odds of these symptoms (ranging from 40 to 46% reduced odds). Compared to those with an index score of 0, those with an index score of 1, 2, and 3, respectively, had a 39%, 54% and 71% reduced odds of having generalized anxiety, panic and depressive symptoms. Results were consistent across both sexes. Conclusion: PA and CRF, but not MSA, were independently associated with generalized anxiety, panic and depressive symptoms. There was evidence of an additive association between PA, CRF, and MSA on these symptoms.

Individual and Combined Associations of Cognitive and Mobility Limitations on Mortality Risk in Older Adults

Objective: To evaluate the potential independent and combined associations of cognitive and mobility limitations on risk of all‐cause mortality in a representative sample of the US older adult population who, at baseline, were free of cardiovascular and cerebrovascular disease. Patients and Methods: Data from the 1999 to 2002 National Health and Nutrition Examination Survey were used to identify 1852 adults (age, 60–85 years) with and without mobility and/or cognitive limitations. Hazard ratios (HRs) for mortality risk were calculated for 4 mutually exclusive groups: no limitation (group 1 as reference), mobility limitation only (group 2), cognitive limitation only (group 3), both cognitive and mobility limitations (group 4). Results: Compared with group 1, the adjusted HRs (95% CI) for groups 2, 3, and 4 were 1.72 (1.24–2.38), 2.00 (1.37–2.91), and 2.18 (1.57–3.02), respectively. The mortality risk when comparing group 4 (HR, 2.18) with group 3 (HR, 2.00), however, was not statistically significant (P=.65). Similarly, the mortality risk when comparing group 4 (HR, 2.18) with group 2 (HR, 1.72) was not statistically significant (P=.16). Conclusion: Although the highest mortality risk occurred in those with both limitations (group 4), this point estimate was not statistically significantly different when compared with those with cognitive or mobility limitations alone.

Physical Activity–Related Obesity Risk Classification Model and All-Cause Mortality

BACKGROUND This study evaluated a physical activity-related obesity model on mortality. METHODS Data from the 1999-2006 NHANES were used (N = 16,077), with follow-up through 2011. Physical activity (PA) was subjectively assessed, with body mass index (BMI) and waist circumference (WC) objectively measured. From these, 12 mutually exclusive groups (G) were evaluated, including: G1: Normal BMI, Normal WC and Active; G2: Normal BMI, Normal WC and Inactive; G3: Normal BMI, High WC and Active; G4: Normal BMI, High WC and Inactive; G5: Overweight BMI, Normal WC and Active; G6: Overweight BMI, Normal WC and Inactive; G7: Overweight BMI, High WC and Active; G8: Overweight BMI, High WC and Inactive; G9: Obese BMI, Normal WC and Active; G10: Obese BMI, Normal WC and Inactive; G11: Obese BMI, High WC and Active; and G12: Obese BMI, High WC and Inactive. RESULTS Compared with G2, the following had a reduced mortality risk: G1, G3, G5, G6, G7, G8, G9, and G11. Compared with G12, the following had a reduced mortality risk: G1, G3, G5, G7, G9, and G11. In each respective group for BMI and WC, the active group had a reduced mortality risk. CONCLUSIONS Across all BMI and WC combinations, PA improved mortality risk identification.