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- Wallert, John, et al.
(författare)
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Cognitive ability and mortality post myocardial infarction: Effect attenuation by health behaviours and mediation through socioeconomic status
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- INTRODUCTION: Cognitive ability is substantially hereditary and predicts socioeconomic status (SES), health behaviours, physical health, and longevity. The robustness and mediation of the CA – mortality association is however insufficiently understood. Our previous findings suggest that the effect of early-in-life CA on later-in-life mortality also holds for post MI male patients, and that a portion of this effect likely flows through a range of different but interlinked factors. Here, we examined the association of CA and five-year post-MI all-cause mortality with respect to attenuation by (a) long-term lifestyle risk factors, and (b) short-term cardiac rehabilitation participation post MI, and (c) mediation through education and income.METHODS: This decennial (2006-2015) observational cohort study used the CA exposure estimated at 18-20 years of age from Mandatory Conscript Registry data for 13093 first MI males (mean age at hospital admission = 52.5 years). No patient was lost to follow-up in the Cause of Death Registry for the five-year all-cause mortality post-MI outcome. The SWEDEHEART registries for acute coronary events (RIKS-HIA), and secondary prevention (SEPHIA) provided data on background and clinical variables. Statistics Sweden supplied data on educational attainment and income. After multivariable imputation of covariates, Cox regression and survival curves were used to estimate crude and adjusted associations. Ordinal and binomial logistic regression were applied for the mediation and outcome model, respectively, and combined in mediation analysis. RESULTS: During a mean follow up of 3.6 years, 311 deaths occurred. Compared to 1,439 patients with low IQ, (Stanine 1-2.75), 10,822 with medium (3-7) and 832 with high CA (7.25-9) were associated with a lower risk of mortality (HR [95% CI] = 0.55 [0.41, 0.74] and 0.45 [0.25, 0.81], respectively). With adjustment for long-term lifestyle factors, the IQ – mortality association was attenuated (0.61 [0.45, 0.82]; 0.55 [0.30, 1.00]), and with further adjustment for short-term cardiac rehabilitation participation it was further attenuated (0.64 [0.48, 0.86]; 0.61 [0.34, 1.11]). SES partially mediated the CA – mortality effect through education (proportion mediated = 12.5%) and income (19.6%), with a controlled direct effect of CA on mortality being dominant in both models.CONCLUSION: Mortality after the first, non-fatal myocardial infarction (MI) is predicted by early-in-life cognitive ability (CA). The CA – mortality association was found to be partially attenuated by (a) lifestyle risk factors, (b) cardiac rehabilitation participation, and (c) partially mediated through educational attainment and income.
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- Wallert, John, et al.
(författare)
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Cognitive ability, lifestyle risk factors, and two-year mortality in first myocardial infarction men: a Swedish national registry study
- 2016
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: General cognitive ability (CA) estimated early in life is positively associated with later physical and mental health, health literacy, and longevity.Methods: We investigated young adulthood CA as a long-term risk indicator for the lifestyle factors smoking, diabetes, hypertension, obesity, and two-year mortality in the largest sample to date of 60 years or younger Swedish first MI males. CA was estimated from mandatory conscript register data (INSARK) gathered when patients were 18-20 years old. The national quality register SWEDEHEART/RIKS-HIA provided data on cardiac functioning and lifestyle risk factors ~ 30 years later at first MI hospital admission. An additional two years later, the Cause of Death Register provided death dates for those deceased. The 5,680 complete cases including deceased (n = 110) and still alive (n = 5,570) were descriptively compared on CA, lifestyle risk factors and mortality. Logistic regression was used to model crude and adjusted associations.Results: Early first MI non-survivors had 0.28 SD lower young adulthood CA (M = 4.38, SD = 1.49) compared to survivors (M = 4.81, SD = 1.51). The whole first MI group CA was also 0.13 SD lower (M = 4.80, SD = 1.51) than the expected population norm (M = 5.00, SD = 1.56). Adjusting for covariates, one SD increase in CA was associated with decreased probability of being a current smoking (OR = 0.62 [0.59, 0.67], P < 0.001), previous smoker (0.79 [0.73, 0.84], P < 0.001), having diabetes (0.81 [0.74, 0.89], P < 0.001), obesity (0.89 [0.84, 0.95], P < 0.001) at hospital admission, and increased odds of being alive two years thereafter (1.27 [1.04, 1.53], P < 0.001). CA was not associated with hypertension at hospital admission (1.04 [0.97, 1.11], P = 0.228).Conclusion: This study confirms substantial inverse associations between CA, and lifestyle related cardiovascular risk factors, and mortality in the earliest first MI male patients. Our findings also expand the CA - morbidity association to comorbid diabetes and obesity. Since CA is highly stable from 18-65 years, can be cost-effectively estimated, and is presently not evaluated in clinical care, CA assessment might provide a better risk stratification and possibly aid further tailoring of secondary prevention.
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- Wallert, John, et al.
(författare)
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Cognitive ability, lifestyle risk factors, and two-year survival in first myocardial infarction men : A Swedish National Registry study
- 2017
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 231, s. 13-17
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Tidskriftsartikel (refereegranskat)abstract
- Background: General cognitive ability (CA) is positively associated with later physical and mental health, health literacy, and longevity. We investigated whether CA estimated approximately 30 years earlier in young adulthood predicted lifestyle-related risk factors and two-year survival in first myocardial infarction (MI) male patients.Methods: Young adulthood CA estimated through psychometric testing at age 18–20 years was obtained from the mandatory military conscript registry (INSARK) and linked to national quality registry SWEDEHEART/RIKS-HIA data on smoking, diabetes, hypertension, obesity (BMI > 30 kg/m2) in 60 years or younger Swedish males with first MI. Patients were followed up in the Cause of Death registry. The 5659 complete cases (deceased = 106, still alive = 5553) were descriptively compared. Crude and adjusted associations were modelled with logistic regression.Results: After multivariable adjustment, one SD increase in CA was associated with a decreased odds ratio of being a current smoker (0.63 [0.59, 0.67], P < 0.001), previous smoker (0.79 [0.73, 0.84], P < 0.001), having diabetes (0.82 [0.74, 0.90], P < 0.001), being obese (0.90 [0.84, 0.95], P < 0.001) at hospital admission, and an increased odds ratio of two-year survival (1.26 [1.02, 1.54], P < 0.001). CA was not associated with hypertension at hospital admission (1.03 [0.97, 1.10], P = 0.283).Conclusions: This study found substantial inverse associations between young adulthood CA, and middle-age lifestyle risk factors smoking, diabetes, and obesity, and two-year survival in first MI male patients. CA assessment might benefit risk stratification and possibly aid further tailoring of secondary preventive strategy.
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- Wallert, John, 1982-
(författare)
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Forecasting myocardial infarction and subsequent behavioural outcomes
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is compiled from four studies dealing with the prediction of myocardial infarction (MI) and some associated risk behaviours post MI.Study 1 extends the field of possible psychosocial stress-triggering of MI to Sweden, and to the phenomenon of temporal crests and troughs in national MI rates. These findings are in the present thesis integrated into a more comprehensive theoretical framework than provided by previous studies. By controlling for different confounders, analysis in subgroups, and more, the probable effect of psychosocial stress on the triggering of MI producing slight oscillations in daily MI rates at different temporal cycles was supported.Study 2 extends the existing literature of cognitive epidemiology to secondary preventive cardiology. Males with higher cognitive ability (CA), as assessed at mandatory military conscription in young adulthood, were found to be more adherent to their statin medication post MI, approximately 30 years later. The association is likely causal, given the fundamental importance of CA as a predictor for our individual ability to understand, plan, and execute everyday behaviour, including such health promoting behaviour as adhering to statin medication after MI.Study 3 continues the thesis thread of predicting clinically relevant health-promoting behaviour. It generated important hypotheses of what predicts adherence to internet-based cognitive behaviour therapy (ICBT) for symptoms of anxiety and/or depression after MI. In particular, the linguistic variables which were derived from what the patients actually wrote online to their ICBT therapist, predicted adherence. Using a flexible random forest model with a moderately sized sample, the aim was to handle a range of predictors and possible higher order effects in the relative strength estimation of these predictors.Study 4 presents the derivation and external validation of a new risk model, STOPSMOKE. Developed as a linear support vector machine with robust resampling, STOPSMOKE proved accurate in the unseen validation cohort for predicting one-year smoking abstinence at the start of cardiac rehabilitation (CR) post MI. STOPSMOKE predictions may inform the targeting of more elaborate interventions to high risk patients. Today, such intervention is not systematic as standard counselling does not account for the individual probability of future smoking abstinence failure. STOPSMOKE thus provides a novel real-world probabilistic basis for the risk of future smoking abstinence failure after MI. This basis may then be used by clinicians, patients, and organisations to tailor smoking intervention as best suited the particular individual or high-risk group. Implemented as part of a spectrum of models in a semi-automatic system, cost-effective tailored risk assessment could allow for augmented CR for future patients.
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