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Added predictive ability of the CHA2DS2VASc risk score for stroke and death in patients with atrial fibrillation: the prospective Danish Diet, Cancer, and Health cohort study.

https://arctichealth.org/en/permalink/ahliterature124928
Source
Circ Cardiovasc Qual Outcomes. 2012 May;5(3):335-42
Publication Type
Article
Date
May-2012
Author
Torben Bjerregaard Larsen
Gregory Y H Lip
Flemming Skjøth
Karen Margrete Due
Kim Overvad
Lars Hvilsted Rasmussen
Author Affiliation
Department of Cardiology, Aalborg AF Study Group, Cardiovascular Research Centre, Aarhus University Hospital, Aalborg, Denmark. tobl@rn.dk
Source
Circ Cardiovasc Qual Outcomes. 2012 May;5(3):335-42
Date
May-2012
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Anticoagulants - administration & dosage
Atrial Fibrillation - drug therapy - epidemiology - mortality
Denmark - epidemiology
Diet - adverse effects
Female
Humans
Incidence
Life Style
Male
Middle Aged
Neoplasms - epidemiology
Predictive value of tests
Prognosis
Prospective Studies
ROC Curve
Registries
Risk assessment
Risk factors
Stroke - epidemiology - mortality - prevention & control
Time Factors
Abstract
The objective of this study was to evaluate the added predictive ability of the CHA(2)DS(2)VASc prediction rule for stroke and death in a nonanticoagulated population of patients with atrial fibrillation.
We included 1603 nonanticoagulated patients with incident atrial fibrillation from a Danish prospective cohort study of 57 053 middle-aged men and women. The Net Reclassification Improvement was calculated as a measure to estimate any overall improvement in reclassification with the CHA(2)DS(2)VASc sore as an alternative to the CHADS(2) score. After 1-year follow-up, crude incidence rates were 3.4 per 100 person-years for stroke and 13.6 for death. After a mean follow-up of 5.4 years (± 3.7 years), the crude incidence rates for stroke and death were 1.9 and 5.6, respectively. During the entire observation period, the c-statistics and negative predictive values were similar for both risk scores. The Net Reclassification Improvement analysis showed that 1 of 10 reclassified atrial fibrillation patients would have been upgraded correctly using the CHA(2)DS(2)VASc score.
Both the CHADS(2) as well as the CHA(2)DS(2)VASc risk score can exclude a large proportion of patients from having high risk of stroke or death. However, using the CHA(2)DS(2)VASc risk score, fewer patients will fulfill the criterion for low risk (and are truly low risk for thromboembolism). For every 10 extra patients transferred to the treatment group at 5 years, using the CHA(2)DS(2)VASc risk score, 1 patient would have had a stroke that might have been avoided with effective treatment.
PubMed ID
22534406 View in PubMed
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Adherence to a Healthy Nordic Diet and Risk of Stroke: A Danish Cohort Study.

https://arctichealth.org/en/permalink/ahliterature282576
Source
Stroke. 2017 Feb;48(2):259-264
Publication Type
Article
Date
Feb-2017
Author
Camilla Plambeck Hansen
Kim Overvad
Cecilie Kyrø
Anja Olsen
Anne Tjønneland
Søren Paaske Johnsen
Marianne Uhre Jakobsen
Christina Catherine Dahm
Source
Stroke. 2017 Feb;48(2):259-264
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Animals
Cohort Studies
Denmark - epidemiology
Diet, Mediterranean
Female
Fishes
Fruit
Health Promotion - methods
Healthy Diet - methods
Humans
Male
Middle Aged
Registries
Risk factors
Scandinavian and Nordic Countries - epidemiology
Stroke - diet therapy - epidemiology - prevention & control
Vegetables
Whole Grains
Abstract
Specific dietary patterns, including the Mediterranean diet, have been associated with stroke prevention. Our aim was to investigate whether adherence to a healthy Nordic diet, including fish, apples and pears, cabbages, root vegetables, rye bread, and oatmeal, was associated with risk of stroke.
Incident cases of stroke among 55?338 men and women from the Danish Diet, Cancer and Health cohort were identified from the Danish National Patient Register and verified by review of records. Cases of ischemic stroke were further subclassified based on etiology according to the TOAST classification system (Trial of Org 10172 in Acute Stroke Treatment). Information on diet was collected at baseline (1993-1997) using a semiquantitative food-frequency questionnaire. Cox proportional hazards models were used to estimate hazards ratios of total stroke and subtypes of ischemic and hemorrhagic stroke.
During a median follow-up of 13.5 years, 2283 cases of incident stroke were verified, including 1879 ischemic strokes. Adherence to a healthy Nordic diet, as reflected by a higher Healthy Nordic Food Index score, was associated with a lower risk of stroke. The hazards ratio comparing an index score of 4 to 6 (high adherence) with an index score of 0 to 1 (low adherence) was 0.86 (95% confidence interval 0.76-0.98) for total stroke. Inverse associations were observed for ischemic stroke, including large-artery atherosclerosis. No trend was observed for hemorrhagic stroke; however, a statistically insignificant trend was observed for intracerebral hemorrhage.
Our findings suggest that a healthy Nordic diet may be recommended for the prevention of stroke.
PubMed ID
28049735 View in PubMed
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Adherence to a healthy Nordic food index is associated with a lower incidence of colorectal cancer in women: the Diet, Cancer and Health cohort study.

https://arctichealth.org/en/permalink/ahliterature121827
Source
Br J Nutr. 2013 Mar 14;109(5):920-7
Publication Type
Article
Date
Mar-14-2013
Author
Cecilie Kyrø
Guri Skeie
Steffen Loft
Kim Overvad
Jane Christensen
Anne Tjønneland
Anja Olsen
Author Affiliation
Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
Source
Br J Nutr. 2013 Mar 14;109(5):920-7
Date
Mar-14-2013
Language
English
Publication Type
Article
Keywords
Animals
Avena sativa
Brassica
Bread
Cohort Studies
Colonic Neoplasms - epidemiology - prevention & control
Diet
Female
Fishes
Fruit
Health promotion
Humans
Male
Malus
Middle Aged
Norway
Pyrus
Rectal Neoplasms - epidemiology - prevention & control
Secale cereale
Vegetables
Abstract
Colorectal cancer (CRC) is a multi-factorial disease in which diet is believed to play a role. Little is known about the health effects of specific regional diets. The Nordic diet is high in fat and sugar but also includes a range of traditional products with anticipated health-promoting effects. The aim of this cohort study was to determine whether a healthy Nordic food index consisting of fish, cabbage, rye bread, oatmeal, apples, pears and root vegetables was related to CRC incidence. Data were obtained from a prospective cohort study of 57,053 Danish men and women aged 50-64 years, of whom 1025 developed CRC (13 years' follow-up). Incidence rate ratios (IRR) with 95 % CI were calculated from Cox proportional hazard models. Women who strongly adhered to a healthy Nordic food index had a 35 % lower incidence of CRC than women with poor adherence (adjusted IRR, 0·65; 95 % CI 0·46, 0·94); a similar tendency was found for men. Women had a 9 % lower incidence of CRC per point adherence to the healthy Nordic food index, but no significant effect was found for men. A regional diet based on healthy Nordic food items was therefore associated with a lower incidence of CRC in women. The protective effect was of the same magnitude as previously found for the Mediterranean diet, suggesting that healthy regional diets should be promoted in order to ensure health; this will also preserve cultural heredity and the environment.
Notes
Erratum In: Br J Nutr. 2014 Feb;111(4):758-9
PubMed ID
22874538 View in PubMed
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Adherence to a Healthy Nordic Food Index Is Associated with a Lower Risk of Type-2 Diabetes--The Danish Diet, Cancer and Health Cohort Study.

https://arctichealth.org/en/permalink/ahliterature273886
Source
Nutrients. 2015 Oct;7(10):8633-44
Publication Type
Article
Date
Oct-2015
Author
Sandra Amalie Lacoppidan
Cecilie Kyrø
Steffen Loft
Anne Helnæs
Jane Christensen
Camilla Plambeck Hansen
Christina Catherine Dahm
Kim Overvad
Anne Tjønneland
Anja Olsen
Source
Nutrients. 2015 Oct;7(10):8633-44
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Denmark
Diabetes Mellitus, Type 2 - prevention & control
Diet - ethnology - standards
Female
Food Habits
Humans
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Risk factors
Sex Factors
Abstract
Type-2 diabetes (T2D) prevalence is rapidly increasing worldwide. Lifestyle factors, in particular obesity, diet, and physical activity play a significant role in the etiology of the disease. Of dietary patterns, particularly the Mediterranean diet has been studied, and generally a protective association has been identified. However, other regional diets are less explored.
The aim of the present study was to investigate the association between adherence to a healthy Nordic food index and the risk of T2D. The index consists of six food items: fish, cabbage, rye bread, oatmeal, apples and pears, and root vegetables.
Data was obtained from a prospective cohort study of 57,053 Danish men and women aged 50-64 years, at baseline, of whom 7366 developed T2D (median follow-up: 15.3 years). The Cox proportional hazards model was used to assess the association between the healthy Nordic food index and risk of T2D, adjusted for potential confounders.
Greater adherence to the healthy Nordic food index was significantly associated with lower risk of T2D after adjusting for potential confounders. An index score of 5-6 points (high adherence) was associated with a statistically significantly 25% lower T2D risk in women (HR: 0.75, 95%CI: 0.61-0.92) and 38% in men (HR: 0.62; 95%CI: 0.53-0.71) compared to those with an index score of 0 points (poor adherence).
Adherence to a healthy Nordic food index was found to be inversely associated with risk of T2D, suggesting that regional diets other than the Mediterranean may also be recommended for prevention of T2D.
Notes
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PubMed ID
26506373 View in PubMed
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Adherence to national food-based dietary guidelines and incidence of stroke: A cohort study of Danish men and women.

https://arctichealth.org/en/permalink/ahliterature299135
Source
PLoS One. 2018; 13(10):e0206242
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
2018
Author
Sine Hammer Hansen
Kim Overvad
Camilla Plambeck Hansen
Christina Catherine Dahm
Author Affiliation
Department of Public Health, Aarhus University, Aarhus, Denmark.
Source
PLoS One. 2018; 13(10):e0206242
Date
2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Cohort Studies
Denmark - epidemiology
Diet Surveys - methods - statistics & numerical data
Female
Food
Guideline Adherence
Humans
Incidence
Male
Middle Aged
Nutrition Policy
Proportional Hazards Models
Risk factors
Stroke - epidemiology - prevention & control
Abstract
National dietary guidelines are intended to promote primary prevention of lifestyle-related diseases, but little is known about their effectiveness in prevention of stroke.
We used the Danish cohort Diet, Cancer and Health (n = 57 053) to investigate whether adherence to the Danish food-based dietary guidelines was associated with risk of stroke. Adherence was assessed by the Danish Dietary Guidelines Index, score 0 [no adherence] to 6 [complete adherence]. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals for stroke and subtypes of stroke in men and women separately.
Incident stroke was determined in 1357 men and 900 women during follow-up (median 12.5 years and 13.0 years, respectively). A higher Danish Dietary Guidelines Index score was inversely associated with total stroke in men but not in women. In men, a high Index score (=4) was also inversely associated with total ischemic stroke (hazard ratio 0.75, 95% confidence interval 0.65-0.86), large-artery atherosclerosis (hazard ratio 0.63, 95% confidence interval 0.44-0.92) and small artery occlusion (hazard ratio 0.68, 95% confidence interval 0.54-0.84) compared to a low Index score (
PubMed ID
30356304 View in PubMed
Less detail

Alcohol intake and prognosis of atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature113075
Source
Heart. 2013 Aug;99(15):1093-9
Publication Type
Article
Date
Aug-2013
Author
Thure Filskov Overvad
Lars Hvilsted Rasmussen
Flemming Skjøth
Kim Overvad
Ida Ehlers Albertsen
Deirdre A Lane
Gregory Y H Lip
Torben Bjerregaard Larsen
Author Affiliation
Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark.
Source
Heart. 2013 Aug;99(15):1093-9
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Alcohol Drinking - adverse effects - epidemiology
Anticoagulants - therapeutic use
Atrial Fibrillation - complications - drug therapy - epidemiology
Cohort Studies
Comorbidity
Denmark - epidemiology
Female
Humans
Male
Medical Records, Problem-Oriented - statistics & numerical data
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Risk assessment
Risk factors
Sex Factors
Thromboembolism - epidemiology - etiology - prevention & control
Abstract
To assess alcohol intake as a risk factor for adverse events among patients with incident atrial fibrillation (AF).
Prospective cohort study.
Population based cohort study and nationwide Danish registries.
The Danish Diet, Cancer and Health study included 57 053 participants (27 178 men and 29 875 women) aged between 50 and 64 years. The study population for this study included the 3107 participants (1999 men, 1108 women) who developed incident AF after inclusion.
A composite of thromboembolism or death.
During a median follow-up of 4.9 years 608 deaths and 211 thromboembolic events occurred. Of those who developed AF, 690 (35%) men and 233 (21%) women had a high intake of alcohol (>20 drinks/week for men and >13 drinks/week for women). After adjustment for use of oral anticoagulation and components of the CHA2DS2-VASc score, men with an intake of >27 drinks/week had a higher risk for thromboembolism or death (hazard ratio (HR) 1.33, 95% CI 1.08 to 1.63) than men with an intake of 20 drinks/week also had a higher risk (HR 1.23, 95% CI 0.78 to 1.96) than women in the low intake category. The higher risk among men was primarily driven by mortality (HR 1.51, 95% CI 1.20 to 1.89), whereas the risk found among women was driven by thromboembolism (HR 1.71, 95% CI 0.81 to 3.60).
High alcohol intake predicts thromboembolism or death, even after adjustment for established clinical risk factors, and may help identify high risk AF patients who could be targeted for stroke and cardiovascular prevention strategies.
PubMed ID
23766449 View in PubMed
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Anthropometry, body fat, and venous thromboembolism: a Danish follow-up study.

https://arctichealth.org/en/permalink/ahliterature147736
Source
Circulation. 2009 Nov 10;120(19):1850-7
Publication Type
Article
Date
Nov-10-2009
Author
Marianne Tang Severinsen
Søren Risom Kristensen
Søren Paaske Johnsen
Claus Dethlefsen
Anne Tjønneland
Kim Overvad
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark. m.severinsen@rn.dk
Source
Circulation. 2009 Nov 10;120(19):1850-7
Date
Nov-10-2009
Language
English
Publication Type
Article
Keywords
Adipose Tissue - pathology
Anthropometry
Body mass index
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Predictive value of tests
Proportional Hazards Models
Prospective Studies
Registries
Risk factors
Sex Distribution
Venous Thromboembolism - epidemiology - pathology - prevention & control
Waist Circumference
Waist-Hip Ratio
Abstract
Obesity, measured as body mass index, is associated with venous thromboembolism (VTE). Body mass index is a marker of excess weight and correlates well with body fat content in adults; however, it fails to consider the distribution of body fat. We assessed the association between anthropometric variables and VTE.
From 1993 to 1997, 27 178 men and 29 876 women 50 to 64 years of age were recruited into a Danish prospective study (Diet, Cancer, and Health). During 10 years of follow-up, the outcome of VTE events was identified in the Danish National Patient Registry and verified by review of medical records. Body weight, body mass index, waist circumference, hip circumference, and total body fat were measured at baseline. We used Cox proportional hazard models to assess the association between anthropometry and VTE. Age was used as a time axis, with further adjustment for smoking, physical activity, height, hypertension, diabetes mellitus, cholesterol, and, among women, use of hormone replacement therapy. We verified 641 incident VTE events and found monotonic dose-response relationships between VTE and all anthropometric measurements in both sexes. In mutually adjusted analyses of waist and hip circumference, we found that hip circumference was positively associated with VTE in women but not in men, whereas waist circumference was positively associated with VTE in men but not in women.
All measurements of obesity are predictors of the risk for VTE. Positive associations were found between VTE and body weight, body mass index, waist circumference, hip circumference, and total body fat mass.
PubMed ID
19858417 View in PubMed
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Aspirin and other non-steroidal anti-inflammatory drugs and risk of colorectal cancer: a Danish cohort study.

https://arctichealth.org/en/permalink/ahliterature153341
Source
Cancer Causes Control. 2009 Jul;20(5):731-40
Publication Type
Article
Date
Jul-2009
Author
Søren Friis
Aslak H Poulsen
Henrik Toft Sørensen
Anne Tjønneland
Kim Overvad
Ulla Vogel
Joseph K McLaughlin
William J Blot
Jørgen H Olsen
Author Affiliation
Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark. friis@cancer.dk
Source
Cancer Causes Control. 2009 Jul;20(5):731-40
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Aspirin - therapeutic use
Cohort Studies
Colorectal Neoplasms - epidemiology - prevention & control
Denmark
Female
Humans
Male
Middle Aged
Abstract
The optimal duration and dose of aspirin and non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) in the potential prevention of colorectal cancer (CRC) have not been established. We examined this issue in the Danish Diet, Cancer, and Health Study.
Self-reported NSAID use at entry (January 1995-May 1997) was updated through June 2006, using a nationwide prescription database. CRC incidence was ascertained from nationwide registers. Cox proportional hazards regression was used to compute confounder-adjusted incidence rate ratios (RRs) and 95% confidence intervals (CIs).
From 51,053 cohort subjects, we identified 615 CRC cases during 1995-2006. Daily aspirin use at entry was associated with a decreased risk of CRC (RR, 0.73; 95% CI, 0.49-1.10). A similar risk reduction was seen among subjects with 10 or more prescriptions for aspirin or non-aspirin NSAIDs and five or more years of follow-up. Most aspirin prescriptions were for 75-150 mg aspirin tablets. Among non-aspirin NSAID users, only those with body mass index (BMI) above 25 showed risk reductions [RR, 0.69 (0.47-1.03) for 10 or more prescriptions].
Long-term consistent use of aspirin or non-aspirin NSAIDs appears necessary to achieve a protective effect against CRC. Further studies of the effective dose of aspirin and the potential interaction between NSAID use and BMI are warranted.
PubMed ID
19122977 View in PubMed
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Association of adherence to lifestyle recommendations and risk of colorectal cancer: a prospective Danish cohort study.

https://arctichealth.org/en/permalink/ahliterature139798
Source
BMJ. 2010;341:c5504
Publication Type
Article
Date
2010
Author
Helene Kirkegaard
Nina Føns Johnsen
Jane Christensen
Kirsten Frederiksen
Kim Overvad
Anne Tjønneland
Author Affiliation
Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark. helene.kirkegaard@webspeed.dk
Source
BMJ. 2010;341:c5504
Date
2010
Language
English
Publication Type
Article
Keywords
Alcohol Drinking - adverse effects
Colorectal Neoplasms - epidemiology - prevention & control
Denmark - epidemiology
Diet
Educational Status
Exercise
Female
Humans
Incidence
Life Style
Male
Middle Aged
Patient compliance
Prospective Studies
Risk factors
Smoking - adverse effects
Waist Circumference
Abstract
To evaluate the association between a simple lifestyle index based on the recommendations for five lifestyle factors and the incidence of colorectal cancer, and to estimate the proportion of colorectal cancer cases attributable to lack of adherence to the recommendations.
Prospective cohort study.
General population of Copenhagen and Aarhus, Denmark.
55?487 men and women aged 50-64 years at baseline (1993-7), not previously diagnosed with cancer.
Risk of colorectal cancer in relation to points achieved in the lifestyle index (based on physical activity, waist circumference, smoking, alcohol intake, and diet (dietary fibre, energy percentage from fat, red and processed meat, and fruits and vegetables)) modelled through Cox regression.
During a median follow-up of 9.9 years, 678 men and women had colorectal cancer diagnosed. After adjustment for potential confounders, each additional point achieved on the lifestyle index, corresponding to one additional recommendation that was met, was associated with a lower risk of colorectal cancer (incidence rate ratio 0.89 (95% confidence interval 0.82 to 0.96). In this population an estimated total of 13% (95% CI 4% to 22%) of the colorectal cancer cases were attributable to lack of adherence to merely one additional recommendation among all participants except the healthiest. If all participants had followed the five recommendations 23% (9% to 37%) of the colorectal cancer cases might have been prevented. Results were similar for colon and rectal cancer, but only statistically significant for colon cancer.
Adherence to the recommendations for physical activity, waist circumference, smoking, alcohol intake, and diet may reduce colorectal cancer risk considerably, and in this population 23% of the cases might be attributable to lack of adherence to the five lifestyle recommendations. The simple structure of the lifestyle index facilitates its use in public health practice.
Notes
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PubMed ID
20978063 View in PubMed
Less detail

The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality: a prospective cohort study among Danish men and women.

https://arctichealth.org/en/permalink/ahliterature263399
Source
Br J Nutr. 2015 Mar 14;113(5):849-58
Publication Type
Article
Date
Mar-14-2015
Author
Kristina E N Petersen
Nina F Johnsen
Anja Olsen
Vanna Albieri
Lise K H Olsen
Lars O Dragsted
Kim Overvad
Anne Tjønneland
Rikke Egeberg
Source
Br J Nutr. 2015 Mar 14;113(5):849-58
Date
Mar-14-2015
Language
English
Publication Type
Article
Keywords
Alcohol Abstinence
Alcohol Drinking - adverse effects
Cardiovascular Diseases - etiology - mortality - prevention & control - therapy
Cohort Studies
Combined Modality Therapy
Denmark - epidemiology
Female
Follow-Up Studies
Health promotion
Humans
Life Style
Male
Middle Aged
Mortality
Motor Activity
Neoplasms - etiology - mortality - prevention & control - therapy
Nutrition Policy
Overweight - physiopathology - prevention & control - therapy
Patient compliance
Prospective Studies
Smoking Cessation
Waist Circumference
Weight Loss
Abstract
Individual lifestyle factors have been associated with lifestyle diseases and premature mortality by an accumulating body of evidence. The impact of a combination of lifestyle factors on mortality has been investigated in several studies, but few have applied a simple index taking national guidelines into account. The objective of the present prospective cohort study was to investigate the combined impact of adherence to five lifestyle factors (smoking, alcohol intake, physical activity, waist circumference and diet) on all-cause, cancer and cardiovascular mortality based on international and national health recommendations. A Cox proportional hazards model was used to estimate hazard ratios (HR) with 95 % CI. During a median follow-up of 14 years, 3941 men and 2827 women died. Among men, adherence to one additional health recommendation was associated with an adjusted HR of 0·73 (95 % CI 0·71, 0·75) for all-cause mortality, 0·74 (95 % CI 0·71, 0·78) for cancer mortality and 0·70 (95 % CI 0·65, 0·75) for cardiovascular mortality. Among women, the corresponding HR was 0·72 (95 % CI 0·70, 0·75) for all-cause mortality, 0·76 (95 % CI 0·73, 0·80) for cancer mortality and 0·63 (95 % CI 0·57, 0·70) for cardiovascular mortality. In the present study, adherence to merely one additional health recommendation had a protective effect on mortality risk, indicating a huge potential in enhancing healthy lifestyle behaviours of the population.
PubMed ID
25690300 View in PubMed
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