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This article explores the significance of analyzing historical mortality data to gain insights into current health disparities. It highlights the shift in causes of death from infectious diseases to non-communicable diseases over the past century and a half. The article emphasizes the need to contextualize recent events, such as the COVID-19 pandemic, within long-term historical trends. It also recognizes the persistence of socio-demographic inequalities in health and the importance of comprehensive population-based studies to address these disparities. The text discusses international initiatives, like the EU COST Action "The Great Leap," which aim to understand the drivers of health inequalities through historical analysis. However, the authors note that additional long-term population-based studies are necessary to tackle the public health challenges of the 21st century. The authors express gratitude to their collaborators and acknowledge financial support from the Swiss National Science Foundation. [Extracted from the article]

Purpose. Randomised controlled trials have shown that renal denervation lowers office and ambulatory blood pressure. The aim of the present study was to evaluate whether patients undergoing renal denervation procedure in a real-life setting have a reduction in antihypertensive drug prescription over the subsequent years. Material and methods. Using the healthcare utilisation database of the Lombardy Region (Italy), the 136 patients who, during the period 2011–2016, were prescribed four or more antihypertensive drugs and underwent renal denervation were included in the study cohort. The number and type of antihypertensive drugs were assessed over the year before and during the three-year period after renal denervation. Results. The median age of the patients was 67 years and 68% of them were men. Based on a multisource comorbidity score, about 40% of patients showed a poor or very poor clinical status. Before renal denervation, the majority of the patients were prescribed four or five antihypertensive drugs. The number of drugs decreased after the denervation and reached 55% after three years. Over the same period, patients prescribed six drugs decreased from 18% to 2%. All antihypertensive drugs were less prescribed throughout the post denervation period. Compared to the year before the denervation, after three years prescription of diuretics was reduced by 15%, calcium channel blockers by 21%, ACE-inhibitors by 32%, angiotensin receptor blockers by 22%, beta-blockers by 20%, and alfa-blockers by 30%. Use of antihypertensive drugs exhibited a reduction also in an age, sex, and clinically matched control group with no renal denervation to an extent, however, much lower than in denervated patients (p-value = 0.013). Conclusion. In the real-life setting, patients who underwent renal denervation had a clearcut reduction in antihypertensive drug prescription over the following years. Patients exhibited a reduction in the prescription of antihypertensive drugs during the three years that followed the denervation procedure The decrease in the number of antihypertensive drugs was marked, started after a relatively short time (six months), and involved all drugs prescribed before the denervation The number of hospitalisations for a cardiovascular event was similar before and after renal denervation Albeit blood pressure values were not recorded in our database, all these findings taken together suggest the renal denervation procedure has a favourable influence on blood pressure control and is not associated with an increase in the risk of major cardiovascular complications [ABSTRACT FROM AUTHOR]

Abstract Aims Heart failure (HF) and atrial fibrillation (AF) frequently coexist and are both associated with increased levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). It is known that AF impairs the diagnostic accuracy of NT‐proBNP for HF. The aim of the present study was to compare the diagnostic and predictive accuracy of NT‐proBNP for HF and AF in stable outpatients with cardiovascular risk factors. Methods and results Data were obtained from the DIAST‐CHF trial, a prospective cohort study that recruited individuals with cardiovascular risk factors and followed them up for 12 years. Data were validated in three independent population‐based cohorts using the same inclusion/exclusion criteria: LIFE‐Adult (n = 2869), SHIP (n = 2013), and SHIP‐TREND (n = 2408). Serum levels of NT‐proBNP were taken once at baseline. The DIAST‐CHF study enrolled 1727 study participants (47.7% female, mean age 66.9 ± 8.1 years). At baseline, patients without AF or HF (n = 1375) had a median NT‐proBNP of 94 pg/mL (interquartile range 51;181). In patients with AF (n = 93), NT‐proBNP amounted to 667 (215;1130) pg/mL. It was significantly higher than in the first group (P 50% [n = 38; 603 (175;1070) pg/mL] and those without HF (P = 1.0). Receiver‐operating characteristic curves of NT‐proBNP showed a similar area under the curve (AUC) for the detection of AF at baseline (0.84, 95% CI [0.79–0.88]) and for HF with EF 50% was significantly lower (0.61 [0.56–0.65]) than for AF (P = 0.001). During follow‐up, AF was newly diagnosed in 157 (9.1%) and HF in 141 (9.6%) study participants. NT‐proBNP was a better predictor of incident AF during the first 2 years (AUC: 0.79 [0.75–0.83]) than of newly diagnosed HF (0.59 [0.55–0.63]; P 50% is very limited.

This meta-analysis aimed to compare the effects of bariatric surgery and nonsurgery on cardiovascular outcomes in patients with obesity. A systematic literature search of the Medline (via PubMed), Embase, and Cochrane Central Register of Controlled Trials databases was performed until August 18th, 2021. Population-based cohort studies comparing long-term cardiovascular outcomes for patients with obesity undergoing bariatric surgery or not were included. A meta-analysis of relative risks (RRs) was performed for all outcomes. We conducted subgroup analyses and meta-regression to explore sources of heterogeneity and the stability of the results. Twenty-one population-based cohort studies involving 2,857,016 participants were identified. The major adverse cardiovascular event (MACE) RR in the bariatric surgery group was.53 (95% confidence interval [CI] =.45–.62, P <.001) relative to the nonsurgical group. Relative to the nonsurgical group, the risk of myocardial infarction (MI) (RR =.40, 95% CI =.30–.52, P <.001), stroke (RR =.60, 95% CI =.46–.79, P <.001), cardiovascular death (RR =.43, 95% CI =.35–.54, P <.001), and all-cause death (RR =.44, 95% CI =.32–.59, P <.001) was significantly reduced for patients who underwent bariatric surgery. In subgroup analyses, as the proportion of patients with diabetes mellitus increased, lower RRs for MACE, MI, and stroke were observed in the surgery group relative to the nonsurgical group. The decreased risk of MACE was also observed in the subgroup with median follow-up duration ≥5 years.Bariatric surgery improves cardiovascular outcomes in patients with obesity, especially providing long-term benefits, and this effect is more pronounced in patients with comorbid diabetes. [ABSTRACT FROM AUTHOR]

Aims: The association between metformin use and neurodegenerative disease (ND) onset remains controversial. In this systematic review and meta‐analysis, we aimed to determine the relationship between metformin use and ND risk based on data from population‐based cohort studies. Methods: Articles were systematically searched in PubMed, EMBASE and Cochrane Library databases. Pooled relative risks (RRs) with 95% CIs were obtained using a random‐effects model. Subgroup analyses, sensitivity analyses and meta‐regression were performed to identify the sources of heterogeneity and strengthen the results. Results: Twelve population‐based cohort studies involving 194,792 participants (94,462 metformin users and 100,330 metformin non‐users) were eligible for inclusion in this meta‐analysis. The pooled RR of NDs reached 0.77 (95% CI 0.67–0.88) when comparing metformin users with non‐users. The effects were more prominent in long‐term metformin users (≥4 years) (RR 0.29, 95% CI 0.13–0.44) and studies from Asian countries (RR 0.69, 95% CI 0.64–0.74). The effect estimates were stable when stratified by subtypes of NDs, study designs, and control definitions (p for interaction >0.05). Meta‐regression did not identify the coefficients as the sources of heterogeneity (all p > 0.05). Conclusions: This systematic review and meta‐analysis found that metformin use, especially long‐term use, was associated with lower ND risk. However, because there was substantial heterogeneity among studies, high‐quality randomized controlled trials are still needed to confirm this finding. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) and atrial fibrillation (AF) frequently coexist and are both associated with increased levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). It is known that AF impairs the diagnostic accuracy of NT‐proBNP for HF. The aim of the present study was to compare the diagnostic and predictive accuracy of NT‐proBNP for HF and AF in stable outpatients with cardiovascular risk factors. Methods and results: Data were obtained from the DIAST‐CHF trial, a prospective cohort study that recruited individuals with cardiovascular risk factors and followed them up for 12 years. Data were validated in three independent population‐based cohorts using the same inclusion/exclusion criteria: LIFE‐Adult (n = 2869), SHIP (n = 2013), and SHIP‐TREND (n = 2408). Serum levels of NT‐proBNP were taken once at baseline. The DIAST‐CHF study enrolled 1727 study participants (47.7% female, mean age 66.9 ± 8.1 years). At baseline, patients without AF or HF (n = 1375) had a median NT‐proBNP of 94 pg/mL (interquartile range 51;181). In patients with AF (n = 93), NT‐proBNP amounted to 667 (215;1130) pg/mL. It was significantly higher than in the first group (P < 0.001) and compared with those with only HF [n = 201; 158 (66;363) pg/mL; P < 0.001]. The highest levels of NT‐proBNP [868 (213;1397) pg/mL] were measured in patients with concomitant HF and AF (n = 58; P < 0.001 vs. control and vs. HF, P = 1.0 vs. AF). In patients with AF, NT‐proBNP levels did not differ between those with HF and preserved ejection fraction (EF) > 50% [n = 38; 603 (175;1070) pg/mL] and those without HF (P = 1.0). Receiver‐operating characteristic curves of NT‐proBNP showed a similar area under the curve (AUC) for the detection of AF at baseline (0.84, 95% CI [0.79–0.88]) and for HF with EF < 50% (0.78 [0.72–0.85]; P = 0.18). The AUC for HF with EF > 50% was significantly lower (0.61 [0.56–0.65]) than for AF (P = 0.001). During follow‐up, AF was newly diagnosed in 157 (9.1%) and HF in 141 (9.6%) study participants. NT‐proBNP was a better predictor of incident AF during the first 2 years (AUC: 0.79 [0.75–0.83]) than of newly diagnosed HF (0.59 [0.55–0.63]; P < 0.001). Data were validated in three independent population‐based cohorts (LIFE‐Adult, n = 2869; SHIP, n = 2013; and SHIP‐TREND, n = 2408). Conclusions: In stable outpatients, NT‐proBNP is a better marker for prevalent and incident AF than for HF. In AF patients, the diagnostic value of NT‐proBNP for HF with EF > 50% is very limited. [ABSTRACT FROM AUTHOR]

The impact of different sleeping categories on the risk of breast cancer has remained debatable. This paper sought to systematically synthesise the available literature on this relationship from population-based cohort studies using meta-analytic procedures. Studies about sleep duration and breast cancer were identified from the Cochrane Library database, EMBASE and PubMed databases for papers published up to February 2019. Identified studies were analysed for quality using the Newcastle-Ottawa Scale. Effect sizes were visualised using funnel plots. Study heterogeneity was quantified using I2 and visualised using Baujat plots. Publication prejudice was evaluated using Eggers regression model, with visualisations using funnel plots. Eight cohort studies met the inclusion criteria. Random-effects model revealed non-statistically significant evidence of an association between short or long sleep and breast cancer Odds Ratio (OR) =0.90;(95% CI 0.79–1.02) and OR=0.95 (0.88–1.02) respectively. There was moderate to high heterogeneity I2 (95% CI)=74.40% (48.20– 87.40%) among studies examining short sleep and breast cancer, and low to moderate heterogeneity in studies for long sleep and breast cancer I2 (95% CI)=3.0% (0.00–68.60%). This study found non-substantial evidence of associations between sleeping periods and breast cancer in women. Studies employing novel sleep-measurement methodologies should be carried out to examine the underlying relationship. [ABSTRACT FROM AUTHOR]

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Aims Guidelines support use of drug combinations in most hypertensive patients, and recently treatment initiation with two drugs has been also recommended. However, limited evidence is available on whether this leads to greater cardiovascular (CV) protection compared to initial monotherapy. Methods and results Using the healthcare utilization database of the Lombardy Region (Italy), the 44 534 residents of the region (age 40–80 years) who in 2010 started treatment with one antihypertensive drug (n  = 37 078) or a two-drug fixed-dose combination (FDC, n  = 7456) were followed for 1 year after treatment initiation to compare the risk of hospitalization for CV disease associated with the two treatment strategies. To limit the confounding associated with non-randomized between-group comparisons, data were also analysed by: (i) matching the two groups by the high-dimensional propensity score (HDPS) and (ii) comparing, in patients experiencing one or more CV events (n  = 2212), the CV event incidence during subperiods in which patients were prescribed mono- or FDC therapy (self-controlled case series design). Compared to initial monotherapy, patients on initial FDC therapy showed a reduced 1 year risk of hospitalization for any CV event (−21%, P  < 0.01). This was the case also when groups were compared according to the HDPS analysis (−15%, P  < 0.05). Finally, in patients experiencing CV events, the event incidence was much less when, during the 1 year follow-up, they were under FDC therapy than under monotherapy (−56%, P  < 0.01). The reduced risk of hospitalization was always significant for ischaemic heart disease and new onset atrial fibrillation, and included hospitalization for cerebrovascular disease and heart failure when monotherapy and FDC therapy were compared within patients. Conclusion In a real-life setting, a comparison of the incidence of early CV events during antihypertensive monotherapy and FDC shows that the latter strategy leads to a more effective CV protection. This scores in favour of a two-drug FDC strategy as first step in the hypertensive population. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Genome-wide association studies (GWAS) have discovered many risk variants for type 2 diabetes. However, estimates of the contributions of risk variants to type 2 diabetes predisposition are often based on highly selected case-control samples, and reliable estimates of population-level effect sizes are missing, especially in non-European populations. Methods: The individual and cumulative effects of 59 established type 2 diabetes risk loci were measured in a population-based China Kadoorie Biobank (CKB) study of 93,000 Chinese adults, including >7,100 diabetes cases. Results: Association signals were directionally consistent between CKB and the original discovery GWAS: of 56 variants passing quality control, 48 showed the same direction of effect (binomial test, p = 2.3 × 10). We observed a consistent overall trend towards lower risk variant effect sizes in CKB than in case-control samples of GWAS meta-analyses (mean 19-22% decrease in log odds, p ≤ 0.0048), likely to reflect correction of both 'winner's curse' and spectrum bias effects. The association with risk of diabetes of a genetic risk score, based on lead variants at 25 loci considered to act through beta cell function, demonstrated significant interactions with several measures of adiposity (BMI, waist circumference [WC], WHR and percentage body fat [PBF]; all p < 1 × 10), with a greater effect being observed in leaner adults. Conclusions/interpretation: Our study provides further evidence of shared genetic architecture for type 2 diabetes between Europeans and East Asians. It also indicates that even very large GWAS meta-analyses may be vulnerable to substantial inflation of effect size estimates, compared with those observed in large-scale population-based cohort studies. Access to research materials: Details of how to access China Kadoorie Biobank data and details of the data release schedule are available from . [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of incidental findings (IFs) in the population-based 'Leipzig Research Centre for Civilization Diseases (LIFE) Child Study' within 1 year. Methods: From July 2011 to June 2012, 969 children participated in the study. The IFs were analysed with respect to age, gender, type of examination and clinical action taken. Results: The IFs were detected in 63 participants (6.5%), including five children who presented with two IFs simultaneously. Eleven children received a new, hence previously unknown, clinical diagnosis. Alternatively, 18 IFs could not be confirmed or were of a transient and self-limiting condition. The frequency of IFs varied widely depending on the type of examination, but did not differ by gender. Conclusion: Although IFs were common events, there was no finding with a profound clinical impact on the subject's life. Our current IF management protocol may be useful in creating management plans for other cohort studies. [ABSTRACT FROM AUTHOR]

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose of Review: Exposure assessment efforts in population-based studies are increasingly incorporating measurements. The published literature was reviewed to identify the measurement sources and the approaches used to incorporate measurements into these efforts., Recent Findings: The variety of occupations and industries in these studies made collecting participant-specific measurements impractical. Thus, the starting point was often the compilation of large databases of measurements from inspections, published literature, and other exposure surveys. These measurements usually represented multiple occupations, industries, and worksites, and spanned multiple decades. Measurements were used both qualitatively and quantitatively, dependent on the coverage and quality of the data. Increasingly, statistical models were used to derive job-, industry-, time period-, and other determinant-specific exposure concentrations. Quantitative measurement-based approaches are increasingly replacing expert judgment, which facilitates the development of quantitative exposure-response associations. Evaluations of potential biases in these measurement sources, and their representativeness of typical exposure situations, warrant additional examination.