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Impact of risk factors on cardiovascular mortality: Results of 30 years follow-up

English title Impact of risk factors on cardiovascular mortality: Results of 30 years follow-up
Applicant Gutzwiller Felix
Number 125710
Funding scheme Project funding (special)
Research institution Institut für Epidemiologie, Biostatistik und Prävention Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Cardiovascular Diseases
Start/End 01.06.2009 - 30.09.2012
Approved amount 331'000.00
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Keywords (15)

Swiss National Cohort; Cardiovascular disease; Mortality; Social inequality; Risk factors; French paradox; CVD risk score; Calibration; CHD; stroke; self-perceived health; self-reported data; surveys; large nested project; Swiss National Cohort 2.0

Lay Summary (German)

Lead
Lay summary
Herz-Kreislauf-Erkrankungen (HK) sind die häufigste Todesursache in der Schweiz. Rauchen, hoher Cholesterinspiegel und Blutdruck haben sich als Risikofaktoren für HK etabliert. Trotzdem bleibt bisher noch vieles ungeklärt. So können z.B. diese Risikofaktoren nicht ausreichend erklären, warum die Sterblichkeit von HK in der Romandie niedriger ist als in der Deutschschweiz oder warum Menschen mit schlechter Ausbildung deutlich häufiger an HK sterben als solche mit guter Ausbildung.Im Rahmen dieser Studie wird untersucht, welche Faktoren die Sterblichkeit von HK in der Schweizer Bevölkerung beeinflussen. Dabei werden nicht nur etablierte Risikofaktoren, sondern auch alternative Einflussgrössen mitberücksichtigt, wie zum Beispiel das selbst beurteilte Wohlbefinden. Es soll auch geklärt werden, wie Alkoholkonsum die Sterblichkeit beeinflusst und welche Faktoren die Sterblichkeits-Unterschiede zwischen den Sprachregionen erklären. Ein weiteres Ziel dieser Studie ist es zu prüfen, wie gut die in der Klinik üblichen Scores zur Beurteilung des individuellen HK-Risikos die HK-Sterblichkeit vorhersagen können. Zudem soll untersucht werden, wie gut Risikofaktoren, die nur mittels Befragung erfasst wurden, im Vergleich zu bekannten klinisch erhobenen Scores abschneiden.Die Grundlage für diese Studie bietet die Swiss National Cohort, die Sterbedaten mit Daten der Volkszählungen verbindet und damit Informationen zu soziodemografischen Einflussfaktoren liefert. Diese Daten werden anonym über demografische Variablen (Geschlecht, Geburtsdatum, Wohnort etc.) mit den Daten aus fünf Studien aus den 1970er, 1980er und 1990er Jahren verknüpft, die eine Vielzahl von gesundheitsrelevanten Mess- und Befragungsdaten enthalten. Damit werden Berechnungen der Überlebenszeit und der Sterberisiken unter Schweizer Gegebenheiten ebenso möglich wie eine Evaluation und Anpassung von bestehenden und neu entwickelten Risiko-Scores. Diese Studie bietet einen kosteneffizienten Teilersatz für das Fehlen von repräsentativen Kohortenstudien und erlaubt damit neue Erkenntnisse über den Zusammenhang zwischen HK-Risiken und der Sterblichkeit in der Schweiz. Sie bietet nicht nur die Chance, an die Bevölkerung angepasste Risiko-Scores zu entwickeln, sondern auch alternative, auf Selbstangaben beruhende Scores zu generieren. Dies ist wichtig für ein generelles Monitoring in der Bevölkerung. Ein solcher Ansatz dürfte auch international Beachtung finden. Die erwarteten Resultate werden zudem Public-Health-Fachleuten Informationen bereitstellen, um Präventionsstrategien effizienter planen und umsetzen zu können, aber auch Klinikern eine Grundlage bieten für die Beurteilung ihrer Patienten.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Independent at heart: persistent association of altitude with ischemic heart disease mortality after consideration of climate, topography and built environment - a longitudinal cohort study
Faeh David (2016), Independent at heart: persistent association of altitude with ischemic heart disease mortality after consideration of climate, topography and built environment - a longitudinal cohort study, in JECH, 70, 798-806.
Impact of different domains of physical activity on cause-specific mortality: A longitudinal study
Wanner Miriam, Tarnutzer Silvan, Martin Brian W, Braun Julia, Rohrmann Sabine, Bopp Matthias, Faeh David (2014), Impact of different domains of physical activity on cause-specific mortality: A longitudinal study, in Preventive Medicine, 62, 89-95.
Mortality risk associated with underweight: a census-linked cohort of 31,578 individuals with up to 32 years of follow-up
Roh Lucienne, Braun Julia, Chiolero Arnaud, Bopp Matthias, Rohrmann Sabine, Faeh David (2014), Mortality risk associated with underweight: a census-linked cohort of 31,578 individuals with up to 32 years of follow-up, in BMC Public Health, 14, 371.
Variation in mortality patterns among the general population, study participants and different types of nonparticipants: evidence from 25 years of follow-up
Bopp Matthias, Braun Julia, Faeh David (2014), Variation in mortality patterns among the general population, study participants and different types of nonparticipants: evidence from 25 years of follow-up, in AJE, 180(10), 1028-1035.
Blood glucose may be an alternative to cholesterol in CVD risk prediction models
Braun Julia, Bopp Matthias, Faeh David (2013), Blood glucose may be an alternative to cholesterol in CVD risk prediction models, in Cardiovascular Diabetology, 12, 24.
Country specific and up to date cardiovascular risk charts can be efficiently obtained with record linkage of routine and observational data
Faeh David, Braun Julia, Rufibach Kaspar, Puhan Milo A, Marques-Vidal Pedro, Bopp Matthias (2013), Country specific and up to date cardiovascular risk charts can be efficiently obtained with record linkage of routine and observational data, in PLoS ONE , 8(2), e56149.
Direct estimation of death attributable to smoking in Switzerland based on record linkage of routine and observational data
Maag Judith, Braun Julia, Bopp Matthias, Faeh David (2013), Direct estimation of death attributable to smoking in Switzerland based on record linkage of routine and observational data, in Nicotine&Tobacco Research, 15, 1588-1597.
Inverse association between circulating vitamin D and mortality – dependent on sex and cause of death?
Rohrmann Sabine, Braun Julia, Bopp Matthias, Faeh David (2013), Inverse association between circulating vitamin D and mortality – dependent on sex and cause of death?, in Nutrition, Metabolism and Cardiovascular Diseases , 23, 960-966.
J-shaped association between plasma glucose concentration and cardiovascular disease mortality over a follow-up of 32 years
von Gunten Elisabeth, Braun Julia, Bopp Matthias, Keller Ulrich, Faeh David (2013), J-shaped association between plasma glucose concentration and cardiovascular disease mortality over a follow-up of 32 years, in Preventive Medicine , 57, 623-628.
Ability of a biomarker-based score to predict death from circulatory disease and cancer in NHANES III.
Van Hemelrijck Mieke, Eichholzer Monika, Faeh David, Rohrmann Sabine (2012), Ability of a biomarker-based score to predict death from circulatory disease and cancer in NHANES III., in BMC public health, 12(1), 895-895.
Body mass index vs cholesterol in cardiovascular disease risk prediction models
Faeh David, Braun Julia, Bopp Matthias (2012), Body mass index vs cholesterol in cardiovascular disease risk prediction models, in Archives of Internal Medicine, 172, 1766-1768.
Health Risk or Resource? Gradual and Independent Association Between Self-Rated Health and Mortality Persists Over 30 Years
Bopp Matthias, Braun Julia, Gutzwiller Felix, Faeh David (2012), Health Risk or Resource? Gradual and Independent Association Between Self-Rated Health and Mortality Persists Over 30 Years, in PloSOne, 7(2), 0-0.
Possible consequences of the new operation criteria for bariatric surgery in Switzerland.
Faeh David, Hauser Renward (2012), Possible consequences of the new operation criteria for bariatric surgery in Switzerland., in Obesity surgery, 22(1), 192-3.
Response to comment on: Routine Data Sources Challenge International Diabetes Federation Extrapolations of National Diabetes Prevalence in Switzerland. Diabetes Care. 2011;34:2387-2389
Bopp Matthias, Faeh David (2012), Response to comment on: Routine Data Sources Challenge International Diabetes Federation Extrapolations of National Diabetes Prevalence in Switzerland. Diabetes Care. 2011;34:2387-2389, in Diabetes Care, 35-37.
Obesity but not overweight is associated with increased mortality risk.
Faeh David, Braun Julia, Tarnutzer Silvan, Bopp Matthias (2011), Obesity but not overweight is associated with increased mortality risk., in European journal of epidemiology, 26(8), 647-55.
Prevalence of obesity in Switzerland 1992-2007: the impact of education, income and occupational class.
Faeh D, Braun J, Bopp M (2011), Prevalence of obesity in Switzerland 1992-2007: the impact of education, income and occupational class., in Obesity reviews : an official journal of the International Association for the Study of Obesity, 12(3), 151-66.
Public health significance of four cardiovascular risk factors assessed 25 years ago in a low prevalence country.
Faeh David, Braun Julia, Tarnutzer Silvan, Bopp Matthias (2011), Public health significance of four cardiovascular risk factors assessed 25 years ago in a low prevalence country., in European journal of cardiovascular prevention and rehabilitation : official journal of the European , 0-0.
Routine data sources challenge international diabetes Federation extrapolations of national diabetes prevalence in Switzerland.
Bopp Matthias, Zellweger Ueli, Faeh David (2011), Routine data sources challenge international diabetes Federation extrapolations of national diabetes prevalence in Switzerland., in Diabetes care, 34(11), 2387-9.
Correspondence: Response to Letters Regarding Article, "Lower Mortality from Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland" Circulation. 2010;121:e378
Faeh David, Gutzwiller Felix, Bopp Matthias (2010), Correspondence: Response to Letters Regarding Article, "Lower Mortality from Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland" Circulation. 2010;121:e378, in Circulation, 121, e378-e379.
Educational inequalities in mortality and associated risk factors: German--versus French-speaking Switzerland.
Faeh David, Bopp Matthias, Swiss National Cohort Study Group (2010), Educational inequalities in mortality and associated risk factors: German--versus French-speaking Switzerland., in BMC public health, 10, 567-567.
Establishing a follow-up of the Swiss MONICA participants (1984-1993): record linkage with census and mortality data.
Bopp Matthias, Braun Julia, Faeh David, Gutzwiller Felix, Swiss National Cohort Study Group (2010), Establishing a follow-up of the Swiss MONICA participants (1984-1993): record linkage with census and mortality data., in BMC public health, 10, 562-562.
Excess weight in the canton of Zurich, 1992-2009: harbinger of a trend reversal in Switzerland?
Faeh D, Bopp M (2010), Excess weight in the canton of Zurich, 1992-2009: harbinger of a trend reversal in Switzerland?, in Swiss medical weekly, 140, 13090-13090.
Increase in the prevalence of obesity in Switzerland 1982-2007: birth cohort analysis puts recent slowdown into perspective.
Faeh David, Bopp Matthias (2010), Increase in the prevalence of obesity in Switzerland 1982-2007: birth cohort analysis puts recent slowdown into perspective., in Obesity (Silver Spring, Md.), 18(3), 644-6.
Where have all the conscripts gone?
Bopp Matthias, Faeh David (2010), Where have all the conscripts gone?, in Swiss medical weekly, 140(23-24), 354-354.
Underestimation of obesity prevalence in Switzerland: comparison of two methods for correction of self-report.
Faeh D, Braun J, Bopp M (2009), Underestimation of obesity prevalence in Switzerland: comparison of two methods for correction of self-report., in Swiss medical weekly, 139(51-52), 752-6.

Collaboration

Group / person Country
Types of collaboration
Institute of Social and Preventive Medicine, Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
In the framework of the Swiss National Cohort Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Communication with the public

Communication Title Media Place Year
Media relations: print media, online media Medienmitteilung Zeitungen, Zeitschriften International Western Switzerland German-speaking Switzerland Rhaeto-Romanic Switzerland Italian-speaking Switzerland 2012
Media relations: radio, television Sag mir, wie du dich fühlst Radio SWR International 2012
Media relations: radio, television Zufriedene leben länger German-speaking Switzerland 2012

Associated projects

Number Title Start Funding scheme
143897 Predicting CVD mortality: Can self-reported parameters compensate for lacking information on classical risk factors? 01.10.2012 Project funding (special)

Abstract

Background.Besides obesity and diabetes, risk factors for cardiovascular disease (CVD) include hypertension, unfavourable lipid profile and smoking. Based on these classical risk factors, algorithms have been proposed to assess an individual’s risk for fatal and non-fatal CVD events. In the past decades, several additional biological, socio-economic, psycho-social and lifestyle CVD risk factors emerged. Such data is typically gathered with cross-sectional, representative health surveys but only rarely combined with a mortality follow-up. Also, measuring risk factors in a general population is expensive: data are thus scarce and geographically limited. Only few studies have evaluated the potential of survey data in predicting CVD mortality and disentangling the respective contributions of risk factors. This project aims at compensating the lack of population-based cohorts relating risk factors with CVD mortality in Switzerland. Switzerland deserves special attention, as the incidence of CVD is globally low, albeit with a distinct gradient by socio-economic status (SES). Also, and similarly to that found between northern and southern regions of Europe, there is a pronounced German-Latin gradient for CVD risk factors and CVD mortality. Specific aims. With this project the following specific research questions will be answered:•What is the contribution of classical and additional lifestyle, SES, psycho-social and biological risk factors to the prediction of CVD mortality? Is alcohol consumption an effect modifier?•How much of the geographical patterns (e.g. difference between French, Italian and German Switzerland) and the SES gradient in CVD mortality are explained by lifestyle factors such as smoking, alcohol consumption and obesity? •How valid are the widely used CVD risk scores in the Swiss context? •Can CVD mortality be predicted by self-reported risk factors and derived multivariate risk models and how does this prediction perform compared to that of classical risk algorithms? Methods. To obtain a longitudinal design, we will construct historical cohorts based on four population-based surveys linked with the Swiss National Cohort (SNC), i.e., a nationwide record linkage of census data and death certificates since 1990. Linkage for deaths between 1977 and 1990 will be done with this project. All surveys have been carried out between 1977 and 1993. They include nearly 40,000 participants and provide comparable information on risk factors. Summing up the follow-up time of all study participants, we will obtain 630,000 person-years and we expect to obtain 7,400 deaths, of which 3,300 due to CVD. The SNC will provide additional socio-demographic information (e.g. place of birth, household type, main language, dwelling attributes and changes in these variables) as well as survival time and cause of death. Poisson, logistic and proportional hazards (Cox and Weibull) regression will be used to examine the independent effects of risk factors on mortality. For discrimination and calibration of risk scores we will apply C statistics and modified Hosmer-Lemeshow statistics and alternative measures of fit. Significance. The quality and the wide range of information, a follow-up time of 30 years and the number of subjects in this study will enable to assess the respective contributions of CVD risk factors in the different language regions of Switzerland. The cultural diversity of this country will further allow a simulation of European patterns within common health care and data management systems. Special attention will be devoted to the role of alcohol consumption, as a low-moderate consumption can be protective and a higher consumption harmful. This project will also permit to evaluate, how indicators of self-reported health and well-being can increase the efficacy in predicting CVD mortality. Since measured data on population level is lacking, multivariate risk models derived from health surveys could allow monitoring of distinct subpopulations and trends. Modelled absolute risk estimations can be adopted to validate and recalibrate CVD risk algorithms in order to provide clinicians a customized tool that improves risk assessment in their patients and facilitates decision making. In light of the large SES gradient found in Switzerland, efforts should be taken in order to reduce the disparity in CVD mortality. We aim at providing information on CVD risk factors that mediate the difference in mortality between high and low SES strata. These findings could indicate public health authorities fields for intervention and make an important contribution to the international discussion. The presented project offers the unique opportunity to establish a life course approach in a cost-efficient and elegant manner. It further exploits the potential of the SNC which is one of the largest longitudinal datasets worldwide. The combination with risk factor data from population surveys generates substantial added value and is much more than just an additional feature. It will provide for all parts of Switzerland region-specific results in many aspects comparable with those from a large - very costly, time consuming and still less representative - cohort study.
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