A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget\'s alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.

Compared with sleep disorders, no consensus has been reached on whether a subjective complaint of having trouble sleeping is associated with increased all-cause and heart disease mortality risk. Previous studies displayed considerable heterogeneity in population disease characteristics and duration of follow-up. Therefore, the aims of this study were to examine the relationship between sleep complaints and all-cause and heart disease mortality and whether the associations were influenced by follow-up time and population disease characteristics. In addition, we aimed to figure out the influence of the joint effects of sleep duration and sleep complaints on mortality risk.
The present study utilized data from five cycles of the National Health and Nutrition Examination Survey (NHANES) (2005~2014) linked with the most updated 2019 National Death Index (NDI). Sleep complaints were determined by answers to \"Have you ever told a doctor or other health professional that you have trouble sleeping?\" and \"Have you ever been told by a doctor or other health professional that you have a sleep disorder?\". Those who answered \'Yes\' to either of the aforementioned two questions were considered as having sleep complaints.
A total of 27,952 adult participants were included. During a median follow-up of 9.25 years (interquartile range, 6.75-11.75 years), 3,948 deaths occurred and 984 were attributable to heart disease. A multivariable-adjusted Cox model revealed that sleep complaints were significantly associated with all-cause mortality risk (HR, 1.17; 95% CI, 1.07-1.28). Subgroup analysis revealed that sleep complaints were associated with all-cause (HR, 1.17; 95% CI, 1.05-1.32) and heart disease (HR, 1.24; 95% CI, 1.01-1.53) mortality among the subgroup with cardiovascular disease (CVD) or cancer. In addition, sleep complaints were more strongly associated with short-term mortality than long-term mortality. The joint analysis of sleep duration and sleep complaints showed that sleep complaints mainly increased the mortality risk in those with short (< 6 h/day, sleep complaints HR, 1.40; 95% CI, 1.15-1.69) or recommended (6-8 h/day, sleep complaints HR, 1.15; 95% CI, 1.01-1.31) sleep duration group.
In conclusion, sleep complaints were associated with increased mortality risk, indicating a potential public benefit of monitoring and managing sleep complaints in addition to sleep disorders. Of note, persons with a history of CVD or cancer may represent a potentially high-risk group that should be targeted with a more aggressive intervention of sleep problems to prevent premature all-cause and heart disease death.

UNASSIGNED: Few studies have explored the association between water intake and mortality risk, and the findings were inconsistent.
UNASSIGNED: This study aimed to explore the water intake-mortality association, utilizing the data from the National Health and Nutrition Examination Survey (NHANES) and the 2015 public-linked mortality files released by the National Center for Health Statistics.
UNASSIGNED: We used the diet- and mortality-linked data of a total of 35,463 adults (17,234 men) aged ≥20 years in the NHANESs 1999-2014 to perform a prospective study. The multivariate-adjusted Cox proportional hazards model was used to explore the associations of the amount of water intake (expressed by total water, plain water, beverage, and food water) and water intake proportion (expressed by the percentage of each kind of water) with mortality risks due to all causes, malignant neoplasms/cancer, and heart disease. The restricted cubic spline plots were adopted to clarify the dose-response relationships among them.
UNASSIGNED: With a median of 88 months (interquartile range: 49-136 months) follow-up, a total of 4,915 all-cause deaths occurred, including 1,073 and 861 deaths from malignant neoplasms/cancer and heart disease, respectively. The amount of water intake in either type was negatively associated with all-cause mortality risk. Additionally, the negative linear dose-response relationships of water intake and all-cause mortality risk were found for all types of water except for food water, which followed a non-linear pattern. Similarly, compared to the lowest quartile (beverage water intake: <676 g/day; food water intake: <532 g/day), beverage and food water intakes in the range of 1,033-1,524 and 1,612-3,802 g/day were associated with decreased malignant neoplasms/cancer mortality risk. A U-shaped dose-response relationship was found for beverage water intake and malignant neoplasms/cancer mortality risk and a negative linear dose-response relationship was found for food water intake and malignant neoplasms/cancer mortality risk. Coffee and/or tea consumption was/were negatively associated with mortality risks due to all causes and malignant neoplasms/cancer. No significant associations of water intake proportion and mortality risks were found.
UNASSIGNED: Our findings demonstrated that higher water intake is associated with lower mortality risks among the United States population.

OBJECTIVE: Heart disease is a significant concern among breast cancer survivors, in part due to cardiotoxic treatments including chemotherapy and radiotherapy. Long-term trends in heart disease mortality have not been well characterized. We examined heart disease mortality trends among US breast cancer survivors by treatment type.
METHODS: We included first primary invasive breast cancer survivors diagnosed between 1975 and 2016 (aged 18-84; survived 12 + months; received initial chemotherapy, radiotherapy, or surgery) in the SEER-9 Database. Standardized mortality ratios (SMRs) and 10-year cumulative heart disease mortality estimates accounting for competing events were calculated by calendar year of diagnosis and initial treatment regimen. Ptrends were assessed using Poisson regression. All statistical tests were 2-sided.
RESULTS: Of 516,916 breast cancer survivors, 40,812 died of heart disease through 2017. Heart disease SMRs declined overall from 1975-1979 to 2010-2016 (SMR 1.01 [95%CI: 0.98, 1.03] to 0.74 [0.69, 0.79], ptrend < 0.001). This decline was also observed for survivors treated with radiotherapy alone and chemotherapy plus radiotherapy. A sharper decline in heart disease SMRs was observed from 1975 to 1989 for left-sided radiotherapy, compared to right-sided. In contrast, there was a non-significant increasing trend in SMRs for chemotherapy alone, and significant by regional stage (ptrend = 0.036). Largest declines in 10-year cumulative mortality were observed from 1975-1984 to 2005-2016 among surgery only: 7.02% (95%CI: 6.80%, 7.23%) to 4.68% (95%CI: 4.39%, 4.99%) and radiotherapy alone: 6.35% (95%CI: 5.95%, 6.77%) to 2.94% (95%CI: 2.73%, 3.16%).
CONCLUSIONS: We observed declining heart disease mortality trends by most treatment types yet increasing for regional stage patients treated with chemotherapy alone, highlighting a need for additional studies with detailed treatment data and cardiovascular management throughout cancer survivorship.

Purpose: Living alone, an indicator of social isolation, has been increasing in the United States; 28% of households in 2019 were one-person households, compared with 13% in 1960. The working-age population is particularly vulnerable to adverse social conditions such as low social support. Although previous research has shown that social isolation and loneliness lead to poorer health and decreased longevity, few studies have focused on the working-age population and heart disease mortality in the United States using longitudinal data. Methods: This study examines social isolation as a risk factor for all-cause and heart disease mortality among U.S. adults aged 18-64 years using the pooled 1998-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (n=388,973). Cox proportional hazards regression was used to model survival time as a function of social isolation, measured by \"living alone,\" and sociodemographic, behavioral, and health characteristics. Results: In Cox regression models with 17 years of mortality follow-up, the age-adjusted all-cause mortality risk was 45% higher (hazard ratio [HR]=1.45; 95% confidence interval [CI]=1.40-1.50) and the heart disease mortality risk was 83% higher (HR=1.83; 95% CI=1.67-2.00) among adults aged 18-64 years living alone at the baseline, compared with adults living with others. In the full model, the relative risk associated with social isolation was 16% higher (HR=1.16; 95% CI=1.11-1.20) for all-cause mortality and 33% higher (HR=1.33; 95% CI=1.21-1.47) for heart disease mortality after controlling for sociodemographic, behavioral-risk, and health status characteristics. Conclusion: In this national study, adults experiencing social isolation had statistically significantly higher relative risks of all-cause and heart disease mortality in the United States than adults living with others.

Heart disease is the leading cause of mortality in adult women. Beyond the traditional risk factors of obesity, diabetes, and hypercholesterolemia, women with the pregnancy complications of preeclampsia, gestational diabetes, prematurity, and low birth weight for gestational age (fetal growth restriction) are at higher risk for later development of cardiovascular disease. Education of women and providers about the association of pregnancy complications and cardiovascular disease should begin in the postpartum period. Postpartum cardiovascular risk screening and lifestyle modifications should be considered standard of care and are essential to improving cardiac health as a preventive strategy.

UNASSIGNED: Despite the long-term decline, heart disease has remained the leading cause of death in the United States (US) over the past eight decades, accounting for 23% of all deaths in 2017. Although psychological distress has been associated with cardiovascular disease mortality, the relationship between different psychological distress levels and heart disease mortality in the US has not been analyzed in detail. Using a national longitudinal dataset, we examined the association between levels of psychological distress and US heart disease mortality.
UNASSIGNED: We analyzed the Kessler 6-item psychological distress scale as a risk factor for heart disease mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N=513,081). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates.
UNASSIGNED: In Cox models with 18 years of mortality follow-up, the heart disease mortality risk was 121% higher (hazard ratio [HR]=2.21; 95% CI=1.99,2.45) in adults with serious psychological distress (SPD) (p<0.001), controlling for age, and 96% higher (HR=1.96; 95% CI=1.77,2.18) in adults with SPD (p<0.001), controlling for age, gender, race/ethnicity, immigrant status, education, marital status, poverty status, housing tenure, and geographic region when compared with adults without psychological distress. The relative risk of heart disease mortality associated with SPD decreased but remained significant (HR=1.14, 95% CI=1.02,1.28) after controlling for additional covariates of smoking, alcohol consumption, self-assessed health, activity limitation, and body mass index. There was a dose-response relationship, with relative risks of heart disease mortality increasing consistently at higher levels of psychological distress. Moreover, the association varied significantly by gender and race/ethnicity. The relative risk of heart disease mortality for those who experienced SPD was 2.42 for non-Hispanic Whites and 1.76 for non-Hispanic Blacks, compared with their counterparts who did not experience psychological distress.
UNASSIGNED: US adults with serious psychological distress had statistically significantly higher heart disease mortality risks than those without psychological distress. These findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing heart disease mortality.

One hypothesized explanation for the recent slowing of declines in heart disease death rates is the generational shift in the timing and accumulation of risk factors. However, directly testing this hypothesis requires historical age-group-specific risk factor data that do not exist. Using national death records, we compared spatiotemporal patterns of heart disease death rates by age group, time period, and birth cohort to provide insight into possible drivers of trends. To do this, we calculated county-level percent change for five time periods (1973-1980, 1980-1990, 1990-2000, 2000-2010, 2010-2015) for four age groups (35-44, 45-54, 55-64, 65-74), resulting in eight birth cohorts for each decade from the 1900s through the 1970s. From 1973 through 1990, few counties experienced increased heart disease death rates. In 1990-2000, 49.0% of counties for ages 35-44 were increasing, while all other age groups continued to decrease. In 2000-2010, heart disease death rates for ages 45-54 increased in 30.4% of counties. In 2010-2015, all four age groups showed widespread increasing county-level heart disease death rates. Likewise, birth cohorts from the 1900s through the 1930s experienced consistently decreasing heart disease death rates in almost all counties. Similarly, with the exception of 2010-2015, most counties experienced decreases for the 1940s birth cohort. For birth cohorts in the 1950s, 1960s, and 1970s, increases were common and geographically widespread for all age groups and calendar years. This analysis revealed variation in trends across age groups and across counties. However, trends in heart disease death rates tended to be generally decreasing and increasing for early and late birth cohorts, respectively. These findings are consistent with the hypothesis that recent increases in heart disease mortality stem from the beginnings of the obesity and diabetes epidemics. However, the common geographic patterns within the earliest and latest time periods support the importance of place-based macro-level factors.

OBJECTIVE: To demonstrate the implications of choosing analytical methods for quantifying spatiotemporal trends, we compare the assumptions, implementation, and outcomes of popular methods using county-level heart disease mortality in the United States between 1973 and 2010.
METHODS: We applied four regression-based approaches (joinpoint regression, both aspatial and spatial generalized linear mixed models, and Bayesian space-time model) and compared resulting inferences for geographic patterns of local estimates of annual percent change and associated uncertainty.
RESULTS: The average local percent change in heart disease mortality from each method was -4.5%, with the Bayesian model having the smallest range of values. The associated uncertainty in percent change differed markedly across the methods, with the Bayesian space-time model producing the narrowest range of variance (0.0-0.8). The geographic pattern of percent change was consistent across methods with smaller declines in the South Central United States and larger declines in the Northeast and Midwest. However, the geographic patterns of uncertainty differed markedly between methods.
CONCLUSIONS: The similarity of results, including geographic patterns, for magnitude of percent change across these methods validates the underlying spatial pattern of declines in heart disease mortality. However, marked differences in degree of uncertainty indicate that Bayesian modeling offers substantially more precise estimates.