Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study. Childhood cumulative risk and later allostatic load: mediating role of substance use. Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis☆ Impact of Baseline Health-Related Quality of Life Scores on Survival of Incident Patients on Peritoneal Dialysis: A Cohort Study Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction. Application of recursive partitioning techniques to the GISSI-2 database. Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico. Allostatic load biomarkers and asthma in adolescents. Health-Related Quality of Life and Mortality in a General and Elderly Population of Patients With Type 2 Diabetes (ZODIAC-18) Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Personality traits as risk factors for stroke and coronary heart disease mortality: pooled analysis of three cohort studies Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. Relationship Between Multimorbidity and Health-Related Quality of Life of Patients in Primary Care [Heart rate variability analysis and neurobehavioral function in community-dwelling older people aged 75 or older]. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees Objective measures of activity level and mortality in older men. Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality—16 y follow-up of middle-aged and elderly men and women Physical demands at work, physical fitness, and 30-year ischaemic heart disease and all-cause mortality in the Copenhagen Male Study.
Background Discrimination promotes multisystem physiological dysregulation termed allostatic load , which predicts morbidity and mortality . It remains unclear whether weight-related discrimination influences allostatic load . Purpose The aim of this study was to prospect ively examine 10-year associations between weight discrimination , allostatic load , and its components among adults 25–75 years in the Midlife Development in the US Biomarker Sub study . Methods Participants with information on weight discrimination were analyzed ( n=986 ) . At both timepoints , participants self-reported the frequency of perceived weight discrimination across nine scenarios as “ never/rarely ” ( scored as 0 ) , “ sometimes ” ( 1 ) , or “ often ” ( 2 ) . The two scores were averaged and then dichotomized as “ experienced ” versus “ not experienced ” discrimination . High allostatic load was defined as having ≥3 out of 7 dysregulated systems ( cardiovascular , sympathetic/parasympathetic nervous systems , hypothalamic pituitary axis , inflammatory , lipid/metabolic , and glucose metabolism ) , which collectively included 24 biomarkers . Relative risks ( RR ) were estimated from multivariate models adjusted for sociodemographic and health characteristics , other forms of discrimination , and BMI . Results Over 41 % of the sample had obesity , and 6 % reported weight discrimination at follow-up . In multivariable-adjusted analyses , individuals who experienced ( versus did not experience ) weight discrimination had twice the risk of high allostatic load ( RR , 2.07 ; 95 % CI , 1.21 ; 3.55 for baseline discrimination ; 2.16 , 95 % CI , 1.39 ; 3.36 for long-term discrimination ) . Weight discrimination was associated with lipid/metabolic dysregulation ( 1.56 ; 95 % CI 1.02 , 2.40 ) , glucose metabolism ( 1.99 ; 95 % CI 1.34 , 2.95 ) , and inflammation ( 1.76 ; 95 % CI 1.22 , 2.54 ) , but no other systems . Conclusions Perceived weight discrimination doubles the 10-year risk of high allostatic load . Eliminating weight stigma may reduce physiological dysregulation , improving obesity-related morbidity and mortality Puerto Ricans living in the United States mainl and present multiple disparities in prevalence of chronic diseases , relative to other racial and ethnic groups . Allostatic load ( AL ) , or the cumulative wear and tear of physiological responses to stressors such as major life events , social and environmental burden , has been proposed as a possible mechanism for the inequalities observed in minority groups , but has not been studied in Puerto Ricans . The aim of this study was to determine the association of AL to six chronic diseases ( abdominal obesity , hypertension , diabetes , and self-reported cardiovascular disease ( CVD ) , arthritis and cancer ) in Puerto Ricans , and to contrast AL to metabolic syndrome ( MetS ) . Participants of the Boston Puerto Rican Health Study ( n=1116 , ages 45 - 75 years ) underwent a  home-based interview  , where question naires were completed and biological sample s collected . A summary definition of AL was constructed using clinical ly-defined cutoffs and medication use for 10 physiological parameters in different body systems . Logistic regression models were run to determine associations between AL score and disease status , controlling for age , sex , smoking , alcohol use , physical activity , total fat intake and energy intake . Parallel models were also run with MetS score replacing AL . We found that increasing categories of AL score were significantly associated with abdominal obesity , hypertension , diabetes and self-reported cardiovascular disease ( CVD ) and arthritis , but not with self-reported cancer . The strength of associations of AL with all conditions , except diabetes and cancer , was similar to or larger than those of MetS score . In conclusion , Puerto Rican older adults experienced physiological dysregulation that was associated with increased odds of chronic conditions . AL was more strongly associated with most conditions , compared to MetS , suggesting that this cumulative measure may be a better predictor of disease . These results have prospect i ve research implication s for Puerto Ricans and other ethnic groups OBJECTIVE The present study investigated the long-term impact of exposure to  poverty-related stressors during childhood on allostatic load , an index of physiological dysregulation , and the potential mediating role of substance use . METHOD Participants ( n = 162 ) were rural children from New York State , followed for 8 years ( between the ages 9 and 17 ) .  Poverty- related stress was computed using the cumulative risk approach , assessing stressors across 9 domains , including environmental , psychosocial , and demographic factors . Allostatic load captured a range of physiological responses , including cardiovascular , hypothalamic pituitary adrenal axis , sympathetic adrenal medullary system , and metabolic activity . Smoking and alcohol/drug use were tested as mediators of the hypothesized childhood risk-adolescent allostatic load relationship . RESULTS Cumulative risk exposure at age 9 predicted increases in allostatic load 8 years later . Smoking , but not alcohol and drug use , was a significant mediator of the prospect i ve , longitudinal relationship between childhood cumulative risk and adolescent allostatic load . CONCLUSIONS The present paper contributes to the underst and ing of the role of early life stress in health across the life span and of the mechanisms by which adverse childhood environments impact health as children emerge into early adulthood . This knowledge will have implication s for early intervention efforts Objective Recent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders , which may indicate that the focus of research in individuals at high risk ( HR ) for psychosis needs updating . In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers . Method Between February 2010 and September 2012 60 help-seeking HR individuals , aged 16–35 , were recruited from CAMEO Early Intervention in Psychosis Service , Cambridgeshire , UK . Forty-five age- and gender-matched healthy volunteers were r and omly recruited from the same geographical area . Sociodemographic , psychiatric morbidity , functioning and quality of life measures were compared between both groups . Results HR individuals suffered a wide range of DSM-IV psychiatric disorders , mainly within the affective and anxiety diagnostic spectra . In comparison to healthy volunteers , young people at HR reported more suicidal ideation/intention , depressive and anxiety symptoms and presented with remarkably poor functioning and quality of life . Conclusion The presence of co-morbid moderate or severe depressive and anxiety symptoms was common in our sample of young people at enhanced risk for psychosis . A HR mental state may be associated not only with an increased risk for psychosis , but also other psychiatric disorders . Our findings may have implication s for the future implementation of therapeutic interventions that this population could benefit from Introduction : In an attempt to decrease mortality in patients with end-stage renal disease , an increase in the lifetime of these patients without much focus on  health-related quality of life ( HRQOL )  was pursued for a long period of time . However , lately , an improvement in the quality of this extended lifetime has focused on both the physical as well as the social and emotional aspects , as these parameters may be associated with clinical outcomes in end-stage renal disease patients . Aim : To evaluate the impact of self-determined  HRQOL  at admission on survival of incident peritoneal dialysis ( PD ) patients . Patients and Methods : A total of 1,624 incident Brazilian PD patients participating in a multicenter prospect i ve cohort study ( BRAZPD ) were evaluated .  HRQOL  was assessed using the SF-36 , divided into mental and physical components . Cox proportional regression analysis was used to determine the influence of HRQOL ( mental and physical components ) on mortality . Multivariate Cox proportional hazards analyses were used to adjust gradually for more potential explanatory variables : first for demographic variables , followed by additional adjustment for socioeconomic , clinical and laboratory variables . The significance level in all analyses was set at p < 0.05 . All analyses were carried out with SPSS 17.0 . Results : Incident PD patients presented with low HRQOL scores on admission to therapy . Even after correction for sociodemographic variables , comorbidities , PD modality and laboratory parameters , HRQOL ( both the mental and the physical components ) remained a predictor [ HR : 0.97 ( CI : 0.95 - 0.98 ) ; HR : 0.97 ( CI : 0.96 - 0.99 ) , respectively ] of survival . Conclusion : On admission to therapy , patients presenting with low HRQOL scores for both the mental and the physical components were associated with a higher mortality . These results suggest that early and timely intervention measures to improve the QOL of these patients are important BACKGROUND Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological , social and behavioural factors . Nevertheless , the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infa rct ion survivors has been seldom investigated . METHODS AND RESULTS In the framework of the GISSI-2 trial , the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project . Overall , 2449 patients were evaluated , 63 of whom died during the study period . All patients undertook a self-administered question naire ( Cognitive Behavioural Assessment Hospital Form ) , investigating 16 psychological dimensions relative to three areas ( state variables , vital exhaustion , trait variables ) . The impact of psychological variables on prognosis and their interaction with clinical variables were investigated by using a tree-growing technique ( RECursive Partitioning and AMalgamation-RECPAM ) applied to survival analysis . This statistical method allowed the identification of three separate classes , characterized by different prognoses : Class I ( presence of vital exhaustion ) , Class II ( concomitance of no vital exhaustion , depression and low levels of anxiety ) and Class III ( all other patients ) . After adjusting for the clinical variables , Class I was associated with an intermediate prognosis ( hazard ratio [ HR ] = 2.2 ; 95 % confidence intervals [ CI ] , 1.2 - 4.0 ) and Class II to the worst ( HR = 3.2 ; 95 % CI = 1.6 - 6.2 ) , as compared to Class III . High levels of neuroticism and extroversion were associated with a better prognosis . When clinical and psychological variables were simultaneously investigated by RECPAM , Type A behaviour was shown to be an important risk predictor among patients with better clinical conditions , i.e. those eligible for exercise test ( HR = 2.6 , 95 % CI = 1.2 - 5.5 ) . Finally , a striking difference in the impact of the most predictive clinical variables ( exercise test in eligibility , late and early ventricular failure ) was found among patients with and without vital exhaustion . CONCLUSIONS This study shows that acute myocardial infa rct ion survivors are heterogeneous with respect to 6-month mortality according to their psychological profile . More important , the impact of these variables appears comparable to that of very well known clinical risk predictors . The availability of a large study population , together with the use of innovative statistical techniques , allowed us to identify subgroups of patients for whom the joint action of clinical and psychological characteristics has been clearly documented . This suggests the need for incorporating  psychological evaluation  in the care of acute myocardial infa rct ion patients RATIONALE Allostatic load ( AL ) , a novel measure of the physiologically dysregulated response of the body to stress , represents a biomarker of chronic stress exposure . OBJECTIVES To determine whether preadolescent children with high AL are more susceptible to asthma as adolescents . METHODS This was a prospect i ve evaluation of children recruited at 7 to 10 years of age in the nested case-control arm of the Study of Asthma , Genes and Environment and followed until 11 to 14 years of age .  AL was measured using eight biomarkers : fasting glucose , total cholesterol , high-density lipoprotein cholesterol , dehydroepi and rosterone sulfate , cortisol , systolic and diastolic blood pressure , and waist-to-hip ratio . AL , created from the sum of biomarkers in a high-risk quartile , was related to prevalence and incidence of asthma using logistic regression . MEASUREMENTS AND MAIN RESULTS Among 352 participants followed until 11 to 14 years of age , prevalent asthma was four times more likely in boys with high ( > 3 ) versus low ( ≤2 ) AL after adjusting for current asthma/atopy , age , ethnicity , parental history of asthma , and overweight status . Similar results were observed in the analysis of new-onset asthma in boys ( adjusted odds ratio , 4.35 ; 95 % confidence interval , 1.19 - 15.9 ) . In girls , there were no associations between AL and asthma . In the analysis of a subset of biomarkers , combinations of total cholesterol , glucose , and cortisol were associated with similar or greater risk of asthma prevalence or onset in boys . CONCLUSIONS AL and its biomarkers are associated with an increased likelihood of asthma in adolescent boys . The observed association between AL and asthma may be attributable to a combined subset of AL biomarkers OBJECTIVE Diabetes negatively impacts the health-related quality of life ( HRQOL ) of patients with type 2 diabetes . An earlier analysis showed HRQOL to be associated with mortality , which suggests that measuring HRQOL could have clinical implication s. We studied the association between  HRQOL  and total and cardiovascular mortality in patients with type 2 diabetes during long-term follow-up and specifically focused on old age and sex differences . RESEARCH DESIGN AND METHODS HRQOL was measured in a prospect ively followed cohort of 1,353 patients with type 2 diabetes using the R AND -36 . Cox proportional hazard models were used to measure the independent effect of baseline HRQOL on mortality . RESULTS During a mean follow-up of 9.6 years , 570 ( 42 % ) patients  died , 280 of whom died of cardiovascular disease ( 49 % ) . The Physical Component Score ( PCS ) and the Mental Component Score ( MCS ) were inversely associated with total mortality , with hazard ratios of 0.988 ( 95 % CI 0.983–0.993 ) and 0.990 ( 95 % CI 0.985–0.995 ) , respectively . A 10-point-higher score on the PCS and MCS decreased the risk for total mortality by 11 and 10 % , respectively . An inverse relationship with mortality was also seen for men , women , and for patients aged > 75 years . Mental health was significantly related to mortality in men but not in women . CONCLUSIONS Lower physical and mental HRQOL was associated with a higher total mortality and cardiovascular mortality in patients with type 2 diabetes ; this is also the case when study ing men and women and the elderly separately . The dimension mental health , related to depression and anxiety , was only associated with mortality in men , not in women BACKGROUND We sought to examine the relationship between health-related quality of life ( HRQL ) and a first emergency rehospitalization and mortality in patients with heart failure ( HF ) having a wide variation in ventricular ejection fraction and functional status . METHODS Prospect i ve study conducted with 394 patients admitted for HF-related emergencies at 4 Spanish hospitals . Baseline HRQL was measured with a generic question naire , the Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) , and with an HF-specific instrument , the Minnesota Living With Heart Failure ( MLWHF ) question naire . Cox proportional hazards models were used to calculate hazard ratios ( HRs ) for hospitalization and death on the basis of HRQL scores . RESULTS During a median follow-up of approximately 6 months , 138 patients ( 35.0 % ) underwent a first emergency rehospitalization and 70 ( 17.8 % ) died . After adjustment for biomedical , psychosocial , and health care variables , the frequency of hospital readmission was higher in patients with worse scores on the SF-36 physical functioning ( HR , 1.65 ; 95 % confidence interval [ CI ] , 1.11 - 2.44 ; P = .01 ) , general health ( HR , 1.73 ; 95 % CI , 1.19 - 2.52 ; P = .003 ) , and mental health ( HR , 1.65 ; 95 % CI , 1.10 - 2.47 ; P = .02 ) subscales . Results were similar for the mortality end point . For the MLWHF question naire , worse overall and worse physical and emotional summary scores were associated with higher mortality . CONCLUSIONS Worse HRQL is associated with hospital readmission and death in patients with HF . The magnitude of this association , for both physical and mental HRQL components , is comparable to that for other well-known predictors of hospital readmission and death , such as personal history of diabetes , previous hospitalizations , and treatment with angiotensin-converting enzyme inhibitors We examined whether personality traits are differently associated with  coronary heart disease and stroke mortality . Participants were pooled from three prospect i ve cohort studies ( Health and Retirement Study , Wisconsin Longitudinal Study graduate and sibling sample s ; n = 24,543 men and women , mean age 61.4 years , mortality follow-up between 3 and 15 years ) . There were 423 coronary heart disease deaths and 88 stroke deaths  during 212,542 person-years at risk . Higher extraversion was associated with an increased risk of stroke ( hazard ratio per each st and ard deviation increase in personality trait HR = 1.41 , 95 % CI 1.10–1.80 ) but not with coronary heart disease mortality ( HR = 0.93 , 0.83–1.05 ) . High neuroticism , in turn , was more strongly related to the risk of coronary heart disease ( HR = 1.16 , 1.04–1.29 ) than stroke deaths ( HR = 0.95 , 0.78–1.17 ) . High conscientiousness was associated with lower mortality risk from both coronary heart disease ( HR = 0.74 , 0.67–0.81 ) and stroke ( HR = 0.78 , 0.63–0.97 ) . Cardiovascular risk associated with personality traits appears to vary between main cardiac and cerebral disease endpoints BACKGROUND It is unclear from prior reports whether the relationships between self-ratings of anxiety or emotional stress and parasympathetic nervous system components of heart rate variability are independent of personality and cardiorespiratory fitness . We examined those relationships in a clinical setting prior to a st and ardized exercise test . METHODS AND RESULTS Heart rate variability ( HRV ) was measured during 5 min of supine rest among 92 healthy men ( N=52 ) and women ( N=40 ) who had above-average cardiorespiratory fitness as indicated by peak oxygen uptake measured during grade -incremented treadmill exercise . HRV data sets were decomposed into low-frequency ( LF ; 0.05 - 0.15 Hz ) and high-frequency ( HF ; 0.15 - 0.5 Hz ) components using spectral analysis . Self-ratings of trait anxiety and perceived emotional stress during the past week were also assessed . CONCLUSIONS There was an inverse relationship between perceived emotional stress during the past week and the normalized HF component of HRV ( P=0.038 ) . This indicates a lower cardiac vagal component of HRV among men and women who perceived more stress . That relationship was independent of age , gender , trait anxiety , and cardiorespiratory fitness . It was also independent of heart rate ; mean arterial blood pressure ; and respiration rate , factors which can influence HRV and might be elevated among people reporting anxiety and perceived stress . We conclude that vagal modulation of heart period appears to be sensitive to the recent experience of persistent emotional stress , regardless of a person 's level of physical fitness and disposition toward experiencing anxiety Previous studies about the association of multimorbidity and the health-related quality of life ( HRQOL ) in primary -care patients are limited because of their reliance on simple counts of diseases from a limited list of diseases and their failure to assess the severity of disease . We evaluated the association while taking into account the severity of the medical conditions based on the Cumulative Illness Rating Scale ( CIRS ) score , and controlling for potential confounders ( age , sex , household income , education , self-perception of economic status , number of people living in the same dwelling , and perceived social support ) . We r and omly selected 238 patients to construct quintiles of increasing multimorbidity ( CIRS ) . Patients completed the 36-item Medical Outcomes study question naire ( SF-36 ) to evaluate their HRQOL . Applying bivariate and multivariate linear regression analyses , we used the CIRS as either a continuous or a categorical ( quintiles ) variable . Use of the CIRS revealed a stronger association of HRQOL with multimorbidity than using a simple count of chronic conditions . Physical more than mental health deteriorated with increasing multimorbidity . Perceived social support and self-perception of economic status were significantly related to all scales of the SF-36 ( p < 0.05 ) . Increased multimorbidity adversely affected HRQOL in primary -care adult patients , even when confounding variables were controlled for BACKGROUND Although heart rate variability ( HRV ) has been found to be associated with increased mortality in the elderly , the association of HRV and cognitive function and activity of daily living ( ADL ) capacity in the very elderly are not clear . METHODS A sample of very elderly people ( N = 138 ) , aged 75 years and older , living in Urausu , Hokkaido , participated in this study . Participants were classified into three groups : normal , borderline , and dementia . Time and frequency domain measures of HRV were compared with behavioral and cognitive functions . RESULTS HRV components , except for the LF/HF ratio , did not correlate with age in the very elderly . The LF component showed a statistically significant correlation with all the variables of behavioral functions . Most HRV components showed statistically significant and positive correlations with the flexibility of the back . The LF and LF/HF ratio were significantly lower in the dementia group than in the normal group . CONCLUSION Although the meaning of the LF component is still controversial , we foundadefinite relationship between the LF component and behavioral functions . A positive relationship between most HRV components and the flexibility of the back may suggest that reduced flexibility leads to deteriorated cardiopulmonary function and reduced HRV . A further prospect i ve study is needed to examine whether HRV and neurobehavioral functions are independent predictors of morbidity and mortality in very elderly people Abstract Objective : To examine the association between work stress , according to the job strain model and the effort-reward imbalance model , and the risk of death from cardiovascular disease . Design : Prospect i ve cohort study . Baseline examination in 1973 determined cases of cardiovascular disease , behavioural and biological risks , and stressful characteristics of work . Biological risks were measured at 5 year and 10 year follow up . Setting : Staff of a company in the metal industry in Finl and . Participants : 812 employees ( 545 men , 267 women ) who were free from cardiovascular diseases at baseline . Main outcome measure : Cardiovascular mortality 1973 - 2001 from the national mortality register . Results : Mean length of follow up was 25.6 years . After adjustment for age and sex , employees with high job strain , a combination of high dem and s at work and low job control , had a 2.2-fold ( 95 % confidence interval 1.2 to 4.2 ) cardiovascular mortality risk compared with their colleagues with low job strain . The corresponding risk ratio for employees with effort-reward imbalance ( low salary , lack of social approval , and few career opportunities relative to efforts required at work ) was 2.4 ( 1.3 to 4.4 ) . These ratios remained significant after additional adjustment for occupational group and biological and behavioural risks at baseline . High job strain was associated with increased serum total cholesterol at the 5 year follow up . Effort-reward imbalance predicted increased body mass index at the 10 year follow up . Conclusions : High job strain and effort-reward imbalance seem to increase the risk of cardiovascular mortality . The evidence from industrial employees suggests that attention should be paid to the prevention of work stress OBJECTIVES To examine associations between objective measures of activity level and mortality risk in older men . DESIGN Prospect i ve cohort study . SETTING Six U.S. sites . PARTICIPANTS Men aged 71 and older followed an average of 4.5 years ( N = 2,918 ) .  MEASUREMENTS Time awake spent in sedentary behavior  ( metabolic equivalent ( MET ) level ≤1.50 ) , light activity  ( MET level 1.51 - 2.99 ) , and at least moderate activity  ( MET level ≥3.00 ) measured using an activity monitor worn for 5 days or longer and expressed as quartiles . Deaths were confirmed with death certificates ; cause of death was adjudicated by review of certificates and records . RESULTS During follow-up , 409 ( 14 % ) men died . After multivariable adjustment , comparing Q4 with Q1 , more time spent in sedentary behavior ( Q4 vs Q1 , hazard ratio ( HR ) = 1.51 , 95 % confidence interval ( CI ) = 1.10 - 2.08 ) , less time spent in light activity ( Q1 vs Q4 , HR = 1.54 , 95 % CI = 1.06 - 2.24 ) , and less time spent in at least moderate activity ( Q1 vs Q4 , HR = 1.56 , 95 % CI = 1.09 - 2.25 ) were similarly associated with greater mortality risk primarily due to higher risks of cardiovascular and noncardiovascular , noncancer death . The association between time spent in sedentary behavior and mortality varied according to time spent at higher activity level . More time spent in sedentary behavior was associated with greater risk of death in men spending 1.2 ( median ) h/d or more in at least moderate activity ( Q4 vs Q1 , HR = 2.09 , 95 % CI = 1.26 - 3.49 ) but not in those spending less time ( Q4 vs Q1 , HR = 1.02 , 95 % CI = 0.62 - 1.66 ) ( P = .005 for interaction ) . CONCLUSION In older men exceeding current guidelines on physical activity , more time spent in sedentary behavior is associated with greater mortality risk OBJECTIVE : To investigate the independent associations and the possible interaction of  body mass index ( BMI ) , leisure time physical activity ( LTPA ) and perceived physical fitness and functional capability with the risk of mortality . DESIGN : Prospect i ve 16 y follow-up study .SUBJECTS : A regionally representative cohort of 35–63 -y-old Finnish men ( n=1090 ) and women ( n=1122 ) . MEASUREMENTS : All-cause , cardiovascular disease ( CVD ) and coronary heart disease ( CHD ) mortality were derived from the national census data until the end of September 1996 while the initial levels of BMI , LTPA , physical fitness and function were determined from self-administered question naires . RESULTS : After adjustment for age , marital and employment status , perceived health status , smoking and alcohol consumption , the Cox proportional hazards model showed that BMI was not associated with the risk of death among the men or the women . Compared with the most active subjects the men and women with no weekly vigorous activity had relative risks of 1.61 ( 95 % confidence interval , CI , 0.98–2.64 ) and 4.68 ( 95 % CI , 1.41–15.57 ) , respectively , for CVD mortality , and for the men there was a relative risk of 1.66 ( 95 % CI , 0.92–2.99 ) for CHD mortality . When compared with the men who perceived their fitness as better than their age-mates , the men with the ‘ worse ’ assessment had a relative risk of 3.29 ( 95 % CI , 1.80–6.02 ) for all-cause mortality and 4.37 ( 95 % CI , 1.80–10.6 ) for CVD mortality . Men with at least some difficulty in walking a distance of 2 km had a relative risk of 1.62 ( 95 % CI , 1.05–2.50 ) for all-cause mortality when compared with those who had no functional difficulties . In addition , in the comparison with subjects with no functional difficulties , the men and women who had some difficulty climbing several flights of stairs had relative risks of 1.47 ( 95 % CI , 0.97–2.23 ) and 2.39 ( 95 % CI , 1.25–4.60 ) for all-cause mortality , respectively . For CVD mortality the relative risks were 1.85 ( 95 % CI , 1.04–3.30 ) and 3.38 ( 1.22–9.41 ) , respectively . CONCLUSIONS : Although BMI did not prove to be an independent risk factor for mortality from CVD , CHD or from all causes combined , perceived physical fitness and functional capability did . An increase in LTPA seems to have a similar beneficial effect on the mortality risk of obese and nonobese men and women , and the effect also seems to be similar for fit and unfit subjects OBJECTIVE No previous long-term prospect i ve studies have examined if workers with low cardiorespiratory fitness have an increased risk of cardiovascular mortality due to high physical work dem and s. We tested this hypothesis . METHOD We carried out a 30-year follow-up of the Copenhagen Male Study of 5249 employed men aged 40 - 59 years . We excluded from follow-up 274 men with a history of myocardial infa rct ion , prevalent symptoms of angina pectoris , or intermittent claudication . We estimated physical fitness [ maximal oxygen consumption ( VO (2)Max ) ] using the Astr and cycling test and determined physical work dem and s with two self-reported questions . RESULTS In the Copenhagen Male Study , 587 men ( 11.9 % ) died due to ischaemic heart disease ( IHD ) . Using men with low physical work dem and s as the reference group , Cox analyses -- adjusted for age , blood pressure , smoking , alcohol consumption , body mass index , diabetes , and hypertension -- showed that high physical work dem and s were associated with an increased risk of IHD mortality in the least fit [ VO (2)Max range 15 - 26 , N=892 , hazard ratio ( HR ) 2.04 , 95 % confidence interval ( 95 % CI ) 1.20 - 3.49 ] and moderately fit ( VO (2)Max range 27 - 38 , N=3037 , HR 1.75 , 95 % CI 1.24 - 2.46 ) , but not among the most fit men ( VO (2)Max range 39 - 78 , N=1014 , HR 1.08 , 95 % CI 0.52 - 2.17 ) . We found a similar , although slightly weaker , relationship with respect to all-cause mortality . CONCLUSIONS The hypothesis was supported . Men with low and medium physical fitness have an increased risk of cardiovascular and all-cause mortality if exposed to high physical work dem and s. Ours observations suggest that , among men with high physical work dem and s , being physically fit protects against adverse cardiovascular effects
Lifestyle coping behaviours therefore have a significant contribution to AL .
This study is among the first to explore multiple domains of HRB in relation to AL .
Health risk behaviours ( HRB ) across the lifespan have been associated with higher cumulative physiological burden as measured by allostatic load ( AL ) .
This study examines the contribution of HRB and their effects on multisystem biological risk associated with morbidity and early mortality .