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Yinon L.,New York University | Chen Y.,New York University | Parvez F.,Columbia University | Bangalore S.,New York University | And 6 more authors.
Preventive Medicine | Year: 2013

Objective: Limited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes. However, most of these were in populations with pre-existing cardiovascular diseases (CVD) and studies in general population are lacking. Methods: The study included 11,153 participants in a population-based, prospective cohort study in Araihazar, Bangladesh. Resting blood pressure was measured at baseline and every two years thereafter. Participants were followed up for an average of 6.5. years (2002-2009). Results: Male gender, older age, baseline systolic blood pressure (SBP), and absence of betel leaf use were independently positively associated with greater SBP variability over time. There was a significant association between SBP variability and the risk of death from overall CVD, especially from major CVD events. The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models. In addition, the hazard ratio (HR) of stroke mortality was greater for individuals with both high baseline and high SBP variability. Similar patterns of HRs were observed for all-cause and CVD mortalities. Conclusion: In this rural Bangladeshi population, variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP. © 2013 Elsevier Inc. Source


Wu F.,New York University | Chen Y.,New York University | Parvez F.,Columbia University | Segers S.,New York University | And 7 more authors.
PLoS ONE | Year: 2013

Background: Limited data are available on smoking-related mortality in low-income countries, where both chronic disease burden and prevalence of smoking are increasing. Methods: Using data on 20, 033 individuals in the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh, we prospectively evaluated the association between tobacco smoking and all-cause, cancer, and cardiovascular disease mortality during ~7.6 years of follow-up. Cox proportional hazards models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for deaths from all-cause, cancer, CVD, ischemic heart disease (IHD), and stroke, in relation to status, duration, and intensity of cigarette/bidi and hookah smoking. Results: Among men, cigarette/bidi smoking was positively associated with all-cause (HR 1.40, 95% CI 1.06 1.86) and cancer mortality (HR 2.91, 1.24 6.80), and there was a dose-response relationship between increasing intensity of cigarette/bidi consumption and increasing mortality. An elevated risk of death from ischemic heart disease (HR 1.87, 1.08 3.24) was associated with current cigarette/bidi smoking. Among women, the corresponding HRs were 1.65 (95% CI 1.16 2.36) for all-cause mortality and 2.69 (95% CI 1.20 6.01) for ischemic heart disease mortality. Similar associations were observed for hookah smoking. There was a trend towards reduced risk for the mortality outcomes with older age at onset of cigarette/bidi smoking and increasing years since quitting cigarette/bibi smoking among men. We estimated that cigarette/bidi smoking accounted for about 25.0% of deaths in men and 7.6% in women. Conclusions: Tobacco smoking was responsible for substantial proportion of premature deaths in the Bangladeshi population, especially among men. Stringent measures of tobacco control and cessation are needed to reduce tobacco-related deaths in Bangladesh. © 2013 Wu et al. Source


Melkonian S.,University of Chicago | Argos M.,University of Chicago | Chen Y.,New York University | Parvez F.,Columbia University | And 4 more authors.
Journal of Nutrition | Year: 2012

Risk of skin lesions due to chronic arsenic exposure can be further affected by nutrient intake. We prospectively evaluated the association of nutrient intake and gender with incident skin lesions using data from the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh. Discrete time hazard models were used to estimate these effects in stratified analyses based on skin lesion severity. Overall, we observed significant associations between low intakes of various nutrients (retinol, calcium, fiber, folate, iron, riboflavin, thiamin, and vitamins A, C, and E) and skin lesion incidence, particularly for keratotic skin lesions. Associations for vitamins C and E showed significant linear trends. Gender-specific analyses revealed an inverse association between the lowest quartile of nutrient intake and keratotic skin lesion incidence for retinol equivalents, calcium, folate, iron, and fiber among women. Interactions by gender were observed for retinol equivalents (P-interaction = 0.03), calcium (P-interaction = 0.04), vitamin A (P-interaction = 0.03), and riboflavin (P-interaction = 0.04) with the incidence of keratotic skin lesions. Understanding differential susceptibility to skin lesion incidence based on nutrient intake will help researchers develop targeted interventions to prevent health consequences of arsenic poisoning in Bangladesh and beyond. © 2012 American Society for Nutrition. Source


Chen Y.,New York University | McClintock T.R.,New York University | Segers S.,New York University | Parvez F.,Columbia University | And 6 more authors.
International Journal of Cardiology | Year: 2013

Background: Dietary pattern analysis is emerging as a practical, effective tool for relating comprehensive dietary intake to risk of cardiovascular disease mortality. However, no studies have applied this technique to a population outside of the developed world. Methods: We conducted prospective cohort analyses in 11,116 participants enrolled in the Health Effects of Arsenic Study in Araihazar, Bangladesh, measuring deaths attributable to disease of circulatory system, heart disease, and cerebrovascular disease. Participants were enrolled in 2000 and followed up for an average of 6.6 years. Dietary information was obtained through a previously validated food-frequency questionnaire at baseline. Results: Principal component analysis based on our comprehensive, 39 item FFQ yielded 3 dietary patterns: (i) a balanced pattern, comprised of steamed rice, red meat, fish, fruit and vegetables; (ii) an animal protein diet, which was more heavily weighted towards eggs, milk, red meat, poultry, bread, and vegetables; and (iii) a gourd and root vegetable diet that heavily relied on a variety of gourds, radishes, pumpkin, sweet potato, and spinach. We observed a positive association between increasing adherence to the animal protein diet and risk of death from both disease of the circulatory system and heart disease; the hazard ratios were 1.13 (95% CI, 1.00-1.28, p = 0.05) and 1.17 (95% CI, 0.99-1.38, p = 0.07), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern, after controlling for age, sex, body mass index, smoking status, and energy intake. The positive association was more significant among ever smokers; the hazard ratios (95% CI) for deaths from disease of the circulatory system and heart disease were 1.17 (1.02-1.34) and 1.20 (1.00-1.45), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern. Conclusions: An animal protein-rich diet in rural Bangladesh may increase risk of heart disease mortality, especially among smokers. This emphasizes the need to further explore and address the impact of dietary patterns on cardiovascular disease in populations undergoing epidemiologic transition. © 2012 Elsevier Ireland Ltd. Source


Melkonian S.,University of Chicago | Argos M.,University of Chicago | Hall M.N.,Columbia University | Chen Y.,New York University | And 11 more authors.
PLoS ONE | Year: 2013

Background: We utilized data from the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh, to evaluate the association of steamed rice consumption with urinary total arsenic concentration and arsenical skin lesions in the overall study cohort (N=18,470) and in a subset with available urinary arsenic metabolite data (N=4,517). Methods: General linear models with standardized beta coefficients were used to estimate associations between steamed rice consumption and urinary total arsenic concentration and urinary arsenic metabolites. Logistic regression models were used to estimate prevalence odds ratios (ORs) and their 95% confidence intervals (CIs) for the associations between rice intake and prevalent skin lesions at baseline. Discrete time hazard models were used to estimate discrete time (HRs) ratios and their 95% CIs for the associations between rice intake and incident skin lesions. Results: Steamed rice consumption was positively associated with creatinine-adjusted urinary total arsenic (β=0.041, 95% CI: 0.032-0.051) and urinary total arsenic with statistical adjustment for creatinine in the model (β=0.043, 95% CI: 0.032-0.053). Additionally, we observed a significant trend in skin lesion prevalence (P-trend=0.007) and a moderate trend in skin lesion incidence (P-trend=0.07) associated with increased intake of steamed rice. Conclusions: This study suggests that rice intake may be a source of arsenic exposure beyond drinking water. © 2013 Melkonian et al. Source

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