METHODS: Data from death records, 1998-2002, and from 2001 Census data were extracted for seven migrant groups [New Zealand; United Kingdom (UK)/Ireland; Germany; Greece; Italy; China/Singapore/Malaysia/Vietnam (East Asia); and India/Sri Lanka (South Asia)] aged 45-64 years. Poisson regression models were fitted to estimate the duration of residence effect (categorized in 5-year bands and also as having arrived 2-16, 17-31 and 32 years ago or more), adjusted for sex, 5-year age group and year of death, then additionally for occupational class and marital status (SES) on relative risks (RR) of CVD mortality.
RESULTS: Compared with the Australia-born population, CVD mortality was generally lower in each migrant group. Decreasing mortality with increasing duration of residence was observed for migrants from New Zealand (RR 0.95, 95% Confidence Interval 0.92-0.98, P<0.01, per 5-year increase), Greece (0.90, 0.86-0.94, P<0.01), Italy (0.94, 0.91-0.97, P<0.01) and South Asia (0.95, 0.91-0.99, P<0.01), mainly in older age groups. Trends remained after SES adjustment and also when broader categories of duration of residence were used. CVD mortality among migrants from the UK/Ireland appeared to converge towards those of the Australian-born.
CONCLUSIONS: These results show divergence in CVD mortality compared with the Australian rate for New Zealanders, Greeks, Italians and South Asians. Sustained cardio-protective behavioural practices in the Australian setting is a potential explanation.
DESIGN: Individual participant meta-analysis using data from 25 cohorts participating in the CHANCES consortium. Data were harmonised, analysed separately employing Cox proportional hazard regression models, and combined by meta-analysis.
RESULTS: Overall, 503,905 participants aged 60 and older were included in this study, of whom 37,952 died from cardiovascular disease. Random effects meta-analysis of the association of smoking status with cardiovascular mortality yielded a summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar.
CONCLUSIONS: Our study corroborates and expands evidence from previous studies in showing that smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and demonstrating that smoking cessation in these age groups is still beneficial in reducing the excess risk.
OBJECTIVE: The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged ≥60 y.
DESIGN: We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model.
RESULTS: During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points (complete adherence to an additional WHO guideline) was, on average, not associated with CVD mortality (HR: 0.94; 95% CI: 0.86, 1.03), CAD mortality (HR: 0.99; 95% CI: 0.85, 1.14), or stroke mortality (HR: 0.95; 95% CI: 0.88, 1.03). However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts (HR: 0.87; 95% CI: 0.79, 0.96; I(2) = 0%) and in the US cohort (HR: 0.85; 95% CI: 0.83, 0.87; I(2) = not applicable).
CONCLUSION: Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States.