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9th January 2023
A large prospective study by Chinese researchers has found that both separately and combined, coffee and tea consumption is inversely associated with a reduced cardiovascular disease (CVD) and all-cause mortality, highlighting the potential importance of incorporating both into an individual’s diet, provided that these observed associations are causal.
Long-term and moderate consumption of coffee is known to be significantly and inversely associated with cardiovascular disease risk, with the greatest reduction seen with 3 to 5 cups per day. In addition, evidence from China also suggests that daily green tea consumption is associated with a lower risk of incident type 2 diabetes and a lower risk of all-cause mortality in diabetics though the associations for other types of tea is less clear. Nevertheless, emerging data suggests that higher green tea and coffee consumption is inversely associated with a lower risk of cardiovascular disease and stroke in the general population. To date, however, only one study has examined the mortality benefit from coffee and tea consumption, finding that higher consumption of both was associated with reduced all-cause mortality, although the study was restricted to patients with type 2 diabetes. Consequently, it remains unclear whether the benefits of consuming both drinks are more generalisable. In the present study, the Chinese researchers aimed to examine the separate and combined associations of consuming the two beverages, with total and cause-specific mortality (including cardiovascular disease, CVD, respiratory and digestive disease using data from a population-based longitudinal cohort of individuals registered with the UK Biobank.
Intake of coffee and tea were assessed at baseline using a self-reported questionnaire but the researchers also collected information on a range of factors including age, gender, sociodemographic, behavioural (e.g., smoking, exercise, alcohol intake and dietary intake). Intake of both drinks categorised as coffee: none, < 1–2, 3–4 and ≥ 5 cups/day and tea: none, < 1–1, 2–4 and ≥ 5 cups/day.
Coffee and tea intake and mortality outcomes
A total of 498,158 participants with a median age of 58 years (54% female) were included in the analysis. These individuals were followed up for a median of 12.1 years, during which time 34,699 deaths were identified.
In a separate analysis and after adjusting for potential confounders, drinking less than 1 – 2 cups/day of coffee, was inversely associated with a lower risk of all the health outcomes assessed. For example, a 9% lower risk for all-cause mortality (hazard ratio, HR = 0.91, 95% CI 0.88–0.93)and a 6% reduced risk for cardiovascular mortality (HR = 0.94, 95% CI 0.88–1.00). Among those drinking tea, 2 – 4 cups/day was associated with a lower risk for all-cause (HR = 0.86, 95% CI 0.83–0.88) as well as CVD mortality (HR = 0.88 95% CI 0.81–0.94).
However, in joint analyses and compared to those who did not drink either beverage, the combination of < 1 – 2 cups/day of coffee and 2 – 4 cups/day of tea, significantly lowered all-cause mortality (HR = 0.78 95% CI 0.73-0.85) and CVD mortality (HR = 0.76 95% CI 0.64-0.91). Interestingly, the lowest mortality occurred for gastrointestinal disease from drinking both < 1 – 2 cup/day of coffee and ≥ 5 cups/day of tea (HR = 0.42, 95% CI 0.34-0.53).
The authors concluded that consumption of both drinks were both separately and jointly, inversely associated with all-cause and cause-specific mortality.
Chen Y et al. Consumption of coffee and tea with all-cause and cause-specific mortality: a prospective cohort study. BMC Med 2022
2nd December 2022
An olive oil intake of around 20g/day is associated with a reduced risk of both cardiovascular and all-cause mortality according to the results of a meta-analysis of prospective studies by Greek and Chinese researchers.
Olive oil contains a number of plant polyphenols that have health benefits including anti-mutagenic, anti-inflammatory, anti-thrombotic, anti-atherogenic, and anti-allergic effects. In addition, the monounsaturated fatty acids present in olive oil and in particular, oleic acid, might have positive impacts on lipid peroxidation. In fact, a 2019 network meta-analysis examining the role of olive oil in the modification of metabolic factors such as glucose and circulating lipids, found that olive oil polyphenols increased HDL-cholesterol and that overall, the beneficial effect of olive oil were more pronounced in subjects with an established metabolic syndrome or other chronic conditions/diseases. Furthermore, while some analyses indicate that a higher olive oil intake is associated with lower risk of coronary heart disease, other studies that have examined the link between dietary fat intake (including olive oil) and cardiovascular disease (CVD) events, have found no association.
Trying to provide more definitive evidence, in the present study, researchers performed a meta-analysis of prospective cohort studies to investigate the relationship between olive oil consumption and risk of CVD and all-cause mortality. The team included studies in which the exposure of interest was olive oil consumption and where the recorded outcomes were total CVD or all-cause mortality.
Olive oil intake and cardiovascular and all-cause mortality outcomes
A total of 13 prospective cohort studies were included and the duration of follow-up ranged from 4 to 28 years. Most of the studies collected the dietary data on olive oil intake from food-frequency questionnaires.
In an assessment of CVD risk, the pooled relative risk (RR) for the highest versus the lowest olive oil intake was 0.85 (95% CI 0.77 – 0.93, p < 0.001). In subgroup analysis, this relationship was independent of the region of study, sample size, follow-up duration, sex, or even the type of olive oil.
In terms of all-cause mortality and again comparing the highest and the lowest levels of intake, there was a significant reduction in all-cause mortality (RR: 0.83, 95% CI 0.77 –0.90, p < 0.001). As with CVD risk, there was no significant impact of any of the examined factors in subgroup analysis.
When the researchers looked at the amount of olive oil consumed, the relative risk for CVD for each 5g/day increment was 0.96 (95% CI 0.93 – 0.99, p = 0.005) and this was a similar order of magnitude for all-cause mortality. Interestingly, the reduction in CVD risk was largely attenuated with an intake above 20 g/day and there were also no preventive mortality effects when intake exceeded 20 g/day.
The authors concluded that consuming up to 20g/day of olive oil was associated with a reduced CVD and all-cause mortality risk but that there were no apparent benefits from exceeding this amount.
Xia M et al. Olive oil consumption and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies. Front Nutr 2022
10th October 2022
Both aerobic physical activity and muscle-strengthening activities on 2 or more days a week such as weight-lifting, are recommended to provide substantial health benefits. In fact, there is good evidence that increased levels of physical activity via aerobic type activities, are associated with a lower mortality risk. However, far less is known about the all-cause and cardiovascular mortality benefits of strength training activities. One analysis of prospective studies found that participation in strength training activities (compared to none) was associated with 21% lower risk of all-cause mortality and a borderline association with lower cardiovascular mortality. Moreover, the authors also noted in the paper that there was lack of evidence on the dose-response relationship between muscle-strengthening activities and cardiovascular risk.
For the present study, a team of US researchers set out to examine the relationship between weight-lifting and all-cause, cardiovascular and cancer mortality both independently and when combined with aerobic moderate to vigorous physical activity (MVPA). They used data from the Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial which began in 1993 and 13 years later, sent follow-up questionnaires to participants which asked about levels of weight-lifting as well as both moderate and vigorous physical activity. For the subsequent analysis of mortality data, the team adjusted for demographic and lifestyle factors which had been assessed in the follow-up questionnaire. In addition, researchers considered the mortality impact based on individual’s reported levels of aerobic MVPA, which was categorised as none, some, meets or exceeds.
Weight-lifting and cardiovascular mortality
A total of 99,713 individuals with a mean age at the start of the follow-up period of 71.3 years (52.6% female) were included in the analysis and followed over an average of 9.6 years. Overall, 23% of participants reported undertaking any weight-lifting activities.
Adults reporting any level of weight-lifting activity had a 9% lower risk of all-cause mortality (Hazard ratio, HR = 0.91, 95% CI 0.88 – 0.94) and for cardiovascular disease mortality (HR = 0.91, 95% CI 0.86 – 0.97) but the reduction in cancer mortality risk was non-significant. Without any adjustment for aerobic activity, lifting weights 1 – 2 times/week was independently associated with a 17% reduced risk of cardiovascular mortality (HR = 0.73, 95% CI 0.79 – 0.97). Interestingly however, increasing the weight-lifting frequency to between 3 and 7 or more times/week did not further reduce the risk of cardiovascular mortality (HR = 0.76, 95% CI 0.71 – 0.82).
When researchers examined all-cause mortality based on the different MVPA categories, those undertaking weight-lifting 1 – 2 times/week and who met MVPA requirement, had 41% lower all-cause mortality (HR = 0.59, 95% CI 0.54 – 0.64). As before, among those who ‘met’ the MVPA requirements, higher levels of weight-lifting activity, did not further reduce all-cause mortality (HR = 0.61).
The authors concluded that both weight-lifting and aerobic activity were independently associated with a reduced all-cause and cardiovascular disease mortality risk and support the notion that both activities were associated with longevity in older adults.
Gorzelitz J et al. Independent and joint associations of weightlifting and aerobic activity with all-cause, cardiovascular disease and cancer mortality in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial Br J Sports Med 2022
18th July 2022
‘Weekend warriors’ who restrict physical activity to just one or two sessions per week appear to have similar levels of all-cause and cause-specific mortality compared to those who are regularly active, i.e., spread their physical activity over several days. This was the conclusion of a large, prospective cohort study by an international group of researchers.
Physical activity guidelines for Americans (and which are broadly similar across the world) recommend that adults should do at least 150 to 300 minutes a week of moderate-intensity, or 75 to 150 minutes a week of vigorous-intensity aerobic physical activity. In addition, the guidelines advocate muscle strengthening activities of moderate or greater intensity on two days or more each week. Furthermore, the evidence to date suggests that when adults engage in the recommended levels of physical activity, there is a greatly reduced risk of all-cause and cause specific mortality. Only a single study has examined the mortality benefits achieved by weekend warriors and suggested that it may be sufficient to reduce all-cause mortality risks, in comparison to those who are insufficiently active. However, it is less clear whether concentrating the recommended amounts of physical exercise into one or two sessions (e.g., weekend warriors) provides the same mortality benefits as observed by those who are physically active throughout the week.
In the present analysis, researchers examined the all-cause and cause-specific mortality between weekend warriors and those who were regularly active using data from the US National Health Interview Survey from 1997 to 2013 and linked this information to a national death index. They classified individuals as physically active (150 minutes of activity/week) or inactive (< 150 minutes/week). Among those deemed physically active, individuals were sub-divided into weekend warriors (1 – 2 sessions/week) or regularly active (> 3 sessions/week). The main outcomes of interest were all-cause, cardiovascular and cancer-related mortality. In regression models, adjustments were made for several factors including age, gender, ethnicity and various lifestyle factors such as smoking status, alcohol intake and co-morbidities.
Weekend warriors and all-cause mortality
A total of 350978 individuals with a mean age of 41.1 years (50.8% women) were followed-up for a median of 10.4 years. More than half (52.5%) were deemed physically inactive, 3% weekend warriors and the remaining 44.5% regularly active. During the period of follow-up there were 21 898 deaths including 4130 from cardiovascular disease and 6034 from cancer.
When compared to those deemed physically inactive, the adjusted hazard ratio (HR) for all-cause mortality was 0.92 (95% CI, 0.83 – 1.02) for weekend warriors and 0.85 (95% CI 0.83 – 0.88) for regularly active participants. The HR for cardiovascular disease mortality were also similar for weekend warriors (HR = 0.87) and and those who were regularly active (HR = 0.77), as were the cancer-related HRs. But when researchers compared mortality between weekend warriors and those who were regularly active, the all-cause, cardiovascular and cancer-related mortality hazard ratios, were also very similar, even after adjustment for the amount and intensity of physical activity undertaken.
The authors concluded that there were no significant differences for any cause mortality among those who were physically active, irrespective of whether the sessions were undertaken throughout the week or concentrated into one or two sessions.
dos Santos M et al. Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality: A Nationwide Cohort Study JAMA Intern Med 2022
28th March 2022
Both recurrent cardiovascular events (CVs) and death have been found to occur mainly within the first 6 months after the primary event according to a real-world analysis of registry data by researchers from the Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Cardiovascular disease (CVD) is the leading cause of deaths and disability worldwide and the World Health Organization estimates that CVD is response for 17.9 million lives lost each year. Despite falls in the mortality rates of CVD across Europe, more than 4 million people continue to die each year from the disease, with more than 1.4 million dying prematurely, before the age of 75 years. Moreover, recurrent cardiovascular events are not uncommon and one study among patients with acute coronary syndrome (ACS) found that 9% of patients experienced a recurrent cardiovascular event in the post-ACS setting during a median follow-up of 1 year.
But which factors are associated with an increased risk of recurrent CVs and death among secondary prevention patients, and when are these most likely to occur, was the subject of the present, registry-based study by the Finnish team. They undertook a retrospective analysis, using hospital data, of adult patients who experienced their first atherosclerotic cardiovascular disease (ACVD) event between 2012 and 2016. The team defined an ACVD event as a myocardial infraction (MI), unstable angina (UA), ischaemic stroke (IS) or a transient ischaemic attack (TIA). In addition, a recurrent event as a new diagnosis of the same condition as the index event, a minimum of 7 days from the first episode and all mortality data were retrieved from the hospital database.
Characteristics of cardiovascular events
In total, 48,405 adults with a median age of 71.5 years (53.8% male) were followed for a mean of 2.2 years. Among the whole cohort, 40.1% had an IS, 29.4% and MI and 19.5% a TIA as their index event. Co-morbidities included hypertension (12.9%) and diabetes (16.7%).
Among the current CVs, death was the most common subsequent event (61.5%) and a recurrent event occurred in 38.5% of patients. It was also clear that the category of subsequent events mirrored the initial episode (i.e., a second MI after the first). The cardiovascular events rate also increased after each recurrence. For instance, the combined recurrent/deaths events rate increased from 13.4 per 100 patient-years for the first event, to 36.8 for the third recurrent event.
In terms of the time to the recurrent event, after 6 months, 14% of patients had suffered any recurrent event or had died. This stabilised over time, so that after 5 years, 41.5% of patients had either suffered an event or died.
When considering the risk factors most significantly associated with risk of subsequent cardiovascular events, this increased with each increased year of age (hazard ratio, HR = 1.02 (95% CI 1.02 – 1.02, p < 0.001). Other significant factors included the presence of diabetes (HR = 1.21, 95% CI 1.11 – 1.32, p < 0.001) and hypertension (HR = 1.18). The risk of death was also significantly associated with male gender (HR = 1.18) but the only co-morbidity was diabetes (HR = 1.63, 95% CI 1.53 – 1.73, p < 0.001). Moreover, male gender and diabetes were also significantly associated with the risk of recurrency to death.
The authors concluded that given their findings, an acute CV event should be promptly followed by secondary prevention measures.
Toppila I et al. Cardiovascular event rate and death in high‐risk secondary prevention patient cohort in Finland: A registry study Clin Cardiol 2022
14th February 2022
The use of anti-hypertensive drugs when combined with healthy lifestyle measures appears to be the best strategy to reduce all-cause and cause-specific mortality. This is according to a study by Chinese researchers from the Department of Epidemiology and Biostatistics, School of Public Health, Huazhong University of Science and Technology, Hubei, China.
Hypertension significantly increases the risks of heart, brain, kidney and other diseases and according to the World Health Organisation, an estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most of whom are living in low- and middle-income countries. Furthermore, a 2019 analysis calculated that a high systolic blood pressure accounted for approximately 10·8 million deaths which was 19.2% of all recorded deaths in 2019. Hypertension is managed with a range of different classes of medicines, yet non-adherence to anti-hypertensive treatment affects 10%–80% of hypertensive patients and is one of the key drivers of suboptimal BP control. With respect to lifestyle modification, there is strong evidence supporting the benefits of regular physical activity and exercise for the prevention and management of hypertension. However, whether the combination of anti-hypertensive medication and healthy lifestyle measures yields additional benefits and if adoption of healthy lifestyle measures after a diagnosis of hypertension provides a mortality benefit remains uncertain.
For the present study, the Chinese team examined the relationship between anti-hypertensive use and lifestyle measures and the effect of this on all-cause and cause-specific mortality among hypertensive patients. They used data from the Dongfeng-Tongji cohort, which prospectively followed hypertensive patients for a median of 7.3 years. The team assessed specific lifestyle factors including body mass index, smoking status, diet, physical activity and sleep duration and computed an overall lifestyle score based on these five attributes, with higher scores (ranging from 0 to 10) indicating a healthier lifestyle. In addition, participants were categorised into the following subgroups: favourable lifestyle (scores 8 – 10), intermediate (5- 7) and unfavourable (0 – 4). The use of anti-hypertensive medication was dichotomised into yes or no.
Anti-hypertensive use and subsequent mortality
A total of 14,392 participants with a mean age of 65.6 years (50.6% male) using anti-hypertensive medicines were included in the analysis. Over a median of 7.3 years, there were 2015 deaths including 761 due to cardiovascular disease and 525 from cancer. Taking individuals not using anti-hypertensives and following an unfavourable lifestyle as the reference group, individuals using anti-hypertensives and with a favourable lifestyle had the lowest risk of all-cause mortality (hazard ratio, HR = 0.32, 95% CI 0.25 – 0.42). This was also true for cardiovascular mortality (HR = 0.33) and death due to cancer (HR = 0.30).
Interestingly, when using the same reference group, individuals who were not using anti-hypertensives but adopted a favourable lifestyle, also had a lower risk of all-cause mortality (HR = 0.34), cardiovascular (HR = 0.40) and cancer mortality (HR = 0.33). In fact, there was a linear association with lifestyle score and mortality, such that regardless or anti-hypertensive medication use, each 1-point increase in lifestyle score was associated with a 17% lower risk of all-cause mortality, with similar reductions for cardiovascular and cancer deaths.
There was also a reduced mortality risk through the adoption of lifestyle measures after a diagnosis of hypertension. For example, compared to those with a consistently low lifestyle score between baseline and the first follow-up, those who instigated a change in lifestyle score from low to high also had a significantly reduced risk for all-cause (HR = 0.52), cardiovascular (HR = 0.53) mortality although the reduced risk of cancer mortality was non-significant.
The authors concluded that the combined effect of anti-hypertensive medication and adoption of a healthy lifestyle resulted in a significantly reduced risk of all and specific cause mortality.
Lu Q et al. Association of Lifestyle Factors and Antihypertensive Medication Use With Risk of All-Cause and Cause-Specific Mortality Among Adults With Hypertension in China JAMA Netw Open 2022