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Mark P Little - One of the best experts on this subject based on the ideXlab platform.
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lifetime mortality risk from cancer and Circulatory Disease predicted from the japanese atomic bomb survivor life span study data taking account of dose measurement error
Radiation Research, 2020Co-Authors: Mark P Little, Harry M Cullings, Richard Wakeford, David J Pawel, Munechika Misumi, Nobuyuki Hamada, Kotaro OzasaAbstract:Dosimetric measurement error is known to potentially bias the magnitude of the dose response, and can also affect the shape of dose response. In this report, generalized relative and absolute rate models are fitted to the latest Japanese atomic bomb survivor solid cancer, leukemia and Circulatory Disease mortality data (followed from 1950 through 2003), with the latest (DS02R1) dosimetry, using Bayesian techniques to adjust for errors in dose estimates and assessing other model uncertainties. Linear-quadratic models are fitted and used to assess lifetime mortality risks for contemporary UK, USA, French, Russian, Japanese and Chinese populations. For a test dose of 0.1 Gy absorbed dose weighted by neutron relative biological effectiveness, solid cancer, leukemia and Circulatory Disease mortality risks for a UK population using a generalized linear-quadratic relative rate model were estimated to be 3.88% Gy-1 [95% Bayesian credible interval (BCI): 1.17, 6.97], 0.35% Gy-1 (95% BCI: -0.03, 0.78) and 2.24% Gy-1 (95% BCI: -0.17, 13.76), respectively. Using a generalized absolute rate linear-quadratic model at 0.1 Gy, the lifetime risks for these three end points were estimated to be 3.56% Gy-1 (95% BCI: 0.54, 6.78), 0.41% Gy-1 (95% BCI: 0.01, 0.86) and 1.56% Gy-1 (95% BCI: -1.10, 7.21), respectively. There was substantial evidence of curvature for solid cancer (in particular, the group of solid cancers excluding lung, breast and stomach cancers) and leukemia, so that for solid cancer and leukemia, estimates of excess risk per unit dose were nearly doubled by increasing the dose from 0.01 to 1.0 Gy, with most of the increase occurring in the interval from 0.1 to 1.0 Gy. For Circulatory Disease, the dose-response curvature was inverse, so that risk per unit dose was nearly halved by going from 0.01 t o 1.0 Gy weighted absorbed dose, although there were substantial uncertainties. In general, there were higher radiation risks for females compared to males. This was true for solid cancer and Circulatory Disease overall, as well as for lung, breast, stomach and the group of other solid cancers, and was the case whether relative or absolute rate projection models were employed; however, for leukemia this pattern was reversed. Risk estimates varied somewhat between populations, with lower cancer risks in aggregate for China and Russia, but higher Circulatory Disease risks for Russia, particularly using the relative rate model. There was more pronounced variation for certain cancer sites and certain types of projection models, so that breast cancer risk was markedly lower in China and Japan using a relative rate model, but the opposite was the case for stomach cancer. There was less variation between countries using the absolute rate models for stomach cancer and breast cancer, but this was not the case for lung cancer and the group of other solid cancers, or for Circulatory Disease.
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radiation associated Circulatory Disease mortality in a pooled analysis of 77 275 patients from the massachusetts and canadian tuberculosis fluoroscopy cohorts
Scientific Reports, 2017Co-Authors: Van Tan Tran, Alina V. Brenner, Lydia B. Zablotska, Mark P LittleAbstract:High-dose ionising radiation is associated with Circulatory Disease. Risks associated with lower-dose (<0.5 Gy) exposures remain unclear, with little information on risk modification by age at exposure, years since exposure or dose-rate. Tuberculosis patients in Canada and Massachusetts received multiple diagnostic x-ray fluoroscopic exposures, over a wide range of ages, many at doses <0.5 Gy. We evaluated risks of Circulatory-Disease mortality associated with <0.5 Gy radiation exposure in a pooled cohort of 63,707 patients in Canada and 13,568 patients in Massachusetts. Under 0.5 Gy there are increasing trends for all Circulatory Disease (n = 10,209; excess relative risk/Gy = 0.246; 95% CI 0.036, 0.469; p = 0.021) and for ischaemic heart Disease (n = 6410; excess relative risk/Gy = 0.267; 95% CI 0.003, 0.552; p = 0.048). All Circulatory-Disease and ischaemic-heart-Disease risk reduces with increasing time since exposure (p < 0.005). Over the entire dose range, there are negative mortality dose trends for all Circulatory Disease (p = 0.014) and ischaemic heart Disease (p = 0.003), possibly due to competing causes of death over this dose interval.These results confirm and extend earlier findings and strengthen the evidence for Circulatory-Disease mortality radiation risk at doses <0.5 Gy. The limited information on well-known lifestyle/medical risk factors for Circulatory Disease implies that confounding of the dose trend cannot be entirely excluded.
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Radiation-associated Circulatory Disease mortality in a pooled analysis of 77,275 patients from the Massachusetts and Canadian tuberculosis fluoroscopy cohorts
Scientific reports, 2017Co-Authors: Van Tan Tran, Alina V. Brenner, Lydia B. Zablotska, Mark P LittleAbstract:High-dose ionising radiation is associated with Circulatory Disease. Risks associated with lower-dose (
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radiation and Circulatory Disease
Mutation Research-reviews in Mutation Research, 2016Co-Authors: Mark P LittleAbstract:Exposure to therapeutic doses of ionizing radiation is associated with damage to the heart and coronary arteries. However, only recently have studies with high-quality individual dosimetry data allowed this risk to be quantified while also adjusting for concomitant chemotherapy, and medical and lifestyle risk factors. At lower levels of exposure the evidence is less clear. In this article I review radiation-associated risks of Circulatory Disease in groups treated with radiotherapy for malignant and non-malignant Disease, and in occupationally- or environmentally-exposed groups receiving rather lower levels of radiation dose, also for medical diagnostic purposes. Results of a meta-analysis suggest that excess relative risks per unit dose for various types of heart Disease do not exhibit statistically significant (p>0.2) heterogeneity between studies. Although there are no marked discrepancies between risks derived from the high-dose therapeutic and medical diagnostic studies and from the moderate/low dose occupational and environmental studies, at least for ischemic heart Disease and stroke there are indications of larger risks per unit dose for lower dose rate and fractionated exposures. Risks for stroke and other types of Circulatory Disease are significantly more variable (p<0.0001), possibly resulting from confounding and effect-modification by well known (but unobserved) risk factors. Adjustment for any of mean dose, dose fractionation or age at exposure results in the residual heterogeneity for cerebrovascular Disease becoming non-significant. The review provides strong evidence in support of a causal association between both low and high dose radiation exposure and most types of Circulatory Disease.
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No evidence for an increase in Circulatory Disease mortality in astronauts following space radiation exposures
Life sciences in space research, 2016Co-Authors: Francis A Cucinotta, Nobuyuki Hamada, Mark P LittleAbstract:Previous analysis has shown that astronauts have a significantly lower standardized mortality ratio for Circulatory Disease mortality compared to the U.S. population, which is consistent with the rigorous selection process and healthy lifestyles of astronauts, and modest space radiation exposures from past space missions. However, a recent report by Delp et al. estimated the proportional mortality ratio for ages of 55-64 y of Apollo lunar mission astronauts to claim a high risk of cardiovascular Disease due to space radiation compared to the U.S. population or to non-flight astronauts. In this Commentary we discuss important deficiencies in the methods and assumptions on radiation exposures used by Delp et al. that we judge cast serious doubt on their conclusions.
Ilona Koupil - One of the best experts on this subject based on the ideXlab platform.
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Socio-economic position over the life course and all-cause, and Circulatory Diseases mortality at age 50–87 years: results from a Swedish birth cohort
European journal of epidemiology, 2013Co-Authors: Gita D. Mishra, Flaminia Chiesa, Anna Goodman, Bianca De Stavola, Ilona KoupilAbstract:Both child and adult socio-economic position (SEP) predict adult mortality, but little is known about the variation in the impact of SEP across the life course. The Uppsala Birth Cohort Study is a representative birth cohort born 1915–1929 in Uppsala, Sweden. For the 5,138 males and 5,069 females alive in 1980, SEP was available at birth; in adulthood (age 31–45); and in later life (age 51–65). Follow-up for mortality (all-cause, and Circulatory Disease) was from 1980 to 2002. To test which life course model best described the association between SEP and mortality, we compared the fit of a series of nested Cox proportional hazards regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. For all-cause mortality in both genders, the sensitive period model best described the influence of SEP across the life course with a heightened effect in later adult life (males: Hazard Ratio (95 % CI) for advantaged SEP: 0.89 (0.81–0.97) at birth, 0.90 (0.81–0.98) in adulthood, 0.74 (0.67–0.82) in later life; females: 0.87 (0.78–0.98), 0.95 (0.86–1.06), 0.73 (0.64–0.83)). The effect of SEP on Circulatory Diseases mortality in males was cumulative (HR: 0.84 (0.80–0.87) per unit time in advantaged SEP). For Circulatory Disease mortality among females, a sensitive period model was selected due to SEP in later adult life (HR: 0.64 (0.52–0.80)). These findings suggest that reducing inequality throughout the life course might reduce all-cause and Circulatory Disease mortality.
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Socio-economic position over the life course and all-cause, Circulatory Diseases, and neoplasms mortality in adulthood and old age: Results from a Swedish birth cohort
Journal of Epidemiology & Community Health, 2011Co-Authors: Gita D. Mishra, Anna Goodman, Bianca De Stavola, F Chisea, Ilona KoupilAbstract:Objective To compare alternative lifecourse models in predicting the effects of child and adult socio-economic position (SEP) upon adult mortality. Design Life-long follow-up of a representative, population-based birth cohort (Uppsala Birth Cohort Study), with linkage to routinely collected data. Participants still alive in 1980 were followed up for mortality from 1980 to 2002. Setting Sweden. Participants 5138 males and 5069 females born 1915–1929 and still alive in 1980. Exposures SEP at birth; in adulthood (age 31–45); and in later life (age 51–65). Outcome measures Mortality (all-cause, Circulatory Disease, and neoplasms) at age 51–87 years. Analysis We compared four lifecourse models for the effect of SEP upon mortality: accumulation models (same effect at all time periods), critical period models (specific effect at one period), accumulation models with sensitive periods (varying effects from period to period) and social mobility models (interacting effects). We evaluated these models by comparing the goodness of fit of alternative Cox proportional hazards regression models. We used likelihood ratio tests to compare each model to the fully saturated model, and used the Akaike Information Criterion (AIC) to compare goodness of fit across non-nested models. Results For all-cause mortality, accumulation models with sensitive periods showed the best fit in both sexes, with the strongest effects seen for SEP in later life (HR for advantaged SEP in males: 0.89 at birth, 0.90 in adulthood 0.74 in later life, p=0.63 compared to saturated model; in females: HR 0.87, 0.95, 0.73 and p=0.49 respectively). For Circulatory Diseases, accumulation models with sensitive periods again showed good fit (HR in males: 0.77, 0.84, 0.80, p=0.51; in females: 0.98, 0.87, 0.64; p=0.31). In males (but not females) the accumulation model also showed good fit (HR 0.81 per additional time period of high SEP, p=0.69) and the AIC was lowest for this more parsimonious model. For neoplasms no model showed evidence of inferiority to the saturated model, suggesting inadequate power. The critical period models were generally not supported and adding interaction terms between time periods to capture social mobility did not improve model fit (judged by AIC) for any outcome. Conclusions With adequate power, statistical models can evaluate competing theoretical models for how SEP affects health across the lifecourse. In this population, accumulation models with later-life sensitive period were best supported for effects of SEP on all-cause and Circulatory Disease mortality while critical period and social mobility models were not supported.
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The contribution of parental and grandparental childhood social disadvantage to Circulatory Disease diagnosis in young Swedish men
Social science & medicine (1982), 2007Co-Authors: Bitte Modin, Denny Vågerö, Johan Hallqvist, Ilona KoupilAbstract:Men born out of wedlock in early twentieth century Sweden who never married have previously been shown to have a doubled mortality risk from ischaemic heart Disease compared to the corresponding group of men born to married parents. This study further explores the question of childhood social disadvantage and its long-term consequences for cardiovascular health by examining the two subsequent generations. The question posed is whether the sons and grandsons of men and women born out of wedlock in early twentieth century Sweden have an increased risk of Circulatory Disease compared with the corresponding descendants of those born inside marriage. We examined this by use of military conscription data. The material used is the Uppsala Birth Cohort Multigenerational database consisting of individuals born at Uppsala University Hospital between 1915 and 1929 (UG1), their children (UG2) and grandchildren (UG3). Conscription data were available for UG2s born between 1950 and 1982 (n=5,231) and UG3s born between 1953 and 1985 (n=10,074) corresponding to 72.1% and 73.6%, respectively, of all males born in each time-period. Logistic regression showed that significant excess risk of Circulatory Disease diagnoses was present only among descendants of men born outside marriage, with sons and grandsons demonstrating odds ratios of 1.64 and 1.83, respectively, when BMI and height at the time of conscription, father's social class in mid-life and father's or grandfather's history of Circulatory Disease had been adjusted for. Separate analyses showed that the effect of the maternal and paternal grandfather was of approximately the same magnitude. Further analyses revealed an interaction between the father's social class and the grandfather's legitimacy status at birth on UG3-men's likelihood of having a Circulatory Disease, with elevated odds only among those whose fathers were either manual workers or self-employed. The results of this study suggest that social disadvantage in one generation can be linked to health disadvantage in the subsequent two generations.
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Blood pressure, hypertension and mortality from Circulatory Disease in men and women who survived the siege of Leningrad
European journal of epidemiology, 2007Co-Authors: Ilona Koupil, Dmitri B. Shestov, Pär Sparén, Svetlana Plavinskaja, Nina Parfenova, Denny VågeröAbstract:The population of Leningrad suffered from severe starvation, cold and psychological stress during the siege in 1941–1944. We investigated long-term effects of the siege on cardiovascular risk factors and mortality in surviving men and women. 3905 men born 1916–1935 and 1729 women born 1910–1940, resident in St Petersburg (formerly Leningrad) between 1975 and 1982, of whom a third experienced the siege as children, adolescents or young adults, were examined for cardiovascular risk factors in 1975–1977 and 1980–1982 respectively and followed till end 2005. Effects of siege exposure on blood pressure, lipids, body size, and mortality were studied in multivariate analysis stratified by gender and period of birth, adjusted for age, smoking, alcohol and social characteristics. Women who were 6–8 years-old and men who were 9–15 years-old at the peak of starvation had higher systolic blood pressure compared to unexposed subjects born during the same period of birth (fully adjusted difference 8.8, 95% CI: 0.1–17.5 mm Hg in women and 2.9, 95% CI: 0.7–5.0 mm Hg in men). Mean height of women who were exposed to siege as children appeared to be greater than that of unexposed women. Higher mortality from ischaemic heart Disease and cerebrovascular Disease was noted in men exposed at age 6–8 and 9–15, respectively. The experience of severe stress and starvation in childhood and puberty may have long-term effects on systolic blood pressure and Circulatory Disease in surviving men and women with potential gender differences in the effect of siege experienced at pre-pubertal age.
Catherine G. Corey - One of the best experts on this subject based on the ideXlab platform.
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smokeless tobacco use and Circulatory Disease risk a systematic review and meta analysis
Open heart, 2018Co-Authors: Brian L. Rostron, Joanne T. Chang, Gabriella M. Anic, Manju Tanwar, Cindy M. Chang, Catherine G. CoreyAbstract:Objective Smokeless tobacco use is a public health issue throughout the world, but reviews and analyses of Circulatory Disease risks associated with smokeless tobacco use may be outdated or incomplete. This study provides a thorough and comprehensive review and meta-analysis of Circulatory Disease risks in high-income countries, including recently published study estimates. Methods We conducted a systematic review of studies of Circulatory Disease risks associated with smokeless tobacco use in Europe and North America that were identified from electronic databases and reference lists. Study estimates were extracted by region, smokeless tobacco use status, cigarette smoking status, and Circulatory condition and combined in meta-analysis using a random-effects model. We used the Newcastle-Ottawa scale to assess study quality and risk of bias. Results We identified 17 relevant cohort studies, two pooled analyses, five case–control studies and one cross-sectional analysis. We found increased risk of heart Disease (relative risk (RR) 1.17, 95% CI 1.09 to 1.27) and stroke (RR 1.28, 95% CI 1.01 to 1.62) among US smokeless tobacco users compared with non-users. Increased Circulatory Disease risk was not observed among Swedish smokeless tobacco users. Conclusion US smokeless tobacco users were found to have increased risk of heart Disease and stroke.
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Smokeless tobacco use and Circulatory Disease risk: a systematic review and meta-analysis.
Open heart, 2018Co-Authors: Brian L. Rostron, Joanne T. Chang, Gabriella M. Anic, Manju Tanwar, Cindy M. Chang, Catherine G. CoreyAbstract:Smokeless tobacco use is a public health issue throughout the world, but reviews and analyses of Circulatory Disease risks associated with smokeless tobacco use may be outdated or incomplete. This study provides a thorough and comprehensive review and meta-analysis of Circulatory Disease risks in high-income countries, including recently published study estimates. We conducted a systematic review of studies of Circulatory Disease risks associated with smokeless tobacco use in Europe and North America that were identified from electronic databases and reference lists. Study estimates were extracted by region, smokeless tobacco use status, cigarette smoking status, and Circulatory condition and combined in meta-analysis using a random-effects model. We used the Newcastle-Ottawa scale to assess study quality and risk of bias. We identified 17 relevant cohort studies, two pooled analyses, five case-control studies and one cross-sectional analysis. We found increased risk of heart Disease (relative risk (RR) 1.17, 95% CI 1.09 to 1.27) and stroke (RR 1.28, 95% CI 1.01 to 1.62) among US smokeless tobacco users compared with non-users. Increased Circulatory Disease risk was not observed among Swedish smokeless tobacco users. US smokeless tobacco users were found to have increased risk of heart Disease and stroke.
Lydia B. Zablotska - One of the best experts on this subject based on the ideXlab platform.
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Occupational radiation exposure and morbidity of Circulatory Disease among diagnostic medical radiation workers in South Korea.
Occupational and environmental medicine, 2020Co-Authors: Eun Shil Cha, Lydia B. Zablotska, Ye Jin Bang, Won Jin LeeAbstract:Objectives We investigated the association between low-dose external occupational radiation exposure and Circulatory Disease morbidity among diagnostic medical radiation workers. Methods A cohort of 11 500 diagnostic medical radiation workers was linked with the National Dosimetry Registry data and the National Health Insurance Service data. Relative risks (RRs) were calculated to explore the association between occupational factors and Circulatory Disease morbidity, and excess relative risks per 100 milligray (ERR/100 mGy) were estimated to quantify the radiation dose-response relationship. Results Overall, there were 2270 cases of Circulatory Diseases during 93 696 person-years of observation (average follow-up=8.1 years). RRs for hypertension were significantly increased for individuals who started working before 2000 compared with those who started in 2005 and later. ERR/100 mGy for all Circulatory Diseases was 0.14 (95% CI −0.57 to 0.99). Radiation risks of cerebrovascular Diseases and ischaemic heart Disease were non-significantly increased with estimates of individual cumulative doses to the heart (ERR/100 mGy=3.10 (−0.75 to 11.59) and 1.22 (−0.71 to 4.73), respectively). However, ERR estimates were generally more strongly positive for female versus male workers and for younger workers versus more than 50-year-old workers. Conclusions This study provides little evidence in support of a positive association between occupational radiation exposure and the overall risk of Circulatory Disease over a short follow-up period among medical radiation workers in South Korea. However, significantly increased RR with earlier year first worked, elevated ERR in female workers and young workers should be further followed up.
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Circulatory Disease in french nuclear fuel cycle workers chronically exposed to uranium a nested case control study
Occupational and Environmental Medicine, 2018Co-Authors: Sergey Zhivin, Irina Guseva Canu, Estelle Davesne, E Blanchardon, Jeromephilippe Garsi, E Samson, Christine Niogret, Lydia B. ZablotskaAbstract:Objectives There is growing evidence of an association between low-dose external γ-radiation and Circulatory system Diseases (CSDs), yet sparse data exist about an association with chronic internal uranium exposure and the role of non-radiation risk factors. We conducted a nested case–control study of French AREVA NC Pierrelatte nuclear workers employed between 1960 and 2005 to estimate CSD risks adjusting for major CSD risk factors (smoking, blood pressure, body mass index, total cholesterol and glycaemia) and external γ-radiation dose. Methods The study included 102 cases of death from CSD and 416 controls individually matched on age, gender, birth cohort and socio-professional status. Information on CSD risk factors was collected from occupational medical records. Organ-specific absorbed doses were estimated using biomonitoring data, taking into account exposure regime and uranium physicochemical properties. External γ-radiation was measured by individual dosimeter badges. Analysis was conducted with conditional logistic regression. Results Workers were exposed to very low radiation doses (mean γ-radiation dose 2 and lung uranium dose 1 mGy). A positive but imprecise association was observed (excess OR per mGy 0.2, 95% CI 0.004 to 0.5). Results obtained after adjustment suggest that uranium exposure might be an independent CSD risk factor. Conclusions Our results suggest that a positive association might exist between internal uranium exposure and CSD mortality, not confounded by CSD risk factors. Future work should focus on numerous uncertainties associated with internal uranium dose estimation and on understanding biological pathway of CSD after protracted low-dose internal radiation exposure.
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radiation associated Circulatory Disease mortality in a pooled analysis of 77 275 patients from the massachusetts and canadian tuberculosis fluoroscopy cohorts
Scientific Reports, 2017Co-Authors: Van Tan Tran, Alina V. Brenner, Lydia B. Zablotska, Mark P LittleAbstract:High-dose ionising radiation is associated with Circulatory Disease. Risks associated with lower-dose (<0.5 Gy) exposures remain unclear, with little information on risk modification by age at exposure, years since exposure or dose-rate. Tuberculosis patients in Canada and Massachusetts received multiple diagnostic x-ray fluoroscopic exposures, over a wide range of ages, many at doses <0.5 Gy. We evaluated risks of Circulatory-Disease mortality associated with <0.5 Gy radiation exposure in a pooled cohort of 63,707 patients in Canada and 13,568 patients in Massachusetts. Under 0.5 Gy there are increasing trends for all Circulatory Disease (n = 10,209; excess relative risk/Gy = 0.246; 95% CI 0.036, 0.469; p = 0.021) and for ischaemic heart Disease (n = 6410; excess relative risk/Gy = 0.267; 95% CI 0.003, 0.552; p = 0.048). All Circulatory-Disease and ischaemic-heart-Disease risk reduces with increasing time since exposure (p < 0.005). Over the entire dose range, there are negative mortality dose trends for all Circulatory Disease (p = 0.014) and ischaemic heart Disease (p = 0.003), possibly due to competing causes of death over this dose interval.These results confirm and extend earlier findings and strengthen the evidence for Circulatory-Disease mortality radiation risk at doses <0.5 Gy. The limited information on well-known lifestyle/medical risk factors for Circulatory Disease implies that confounding of the dose trend cannot be entirely excluded.
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Radiation-associated Circulatory Disease mortality in a pooled analysis of 77,275 patients from the Massachusetts and Canadian tuberculosis fluoroscopy cohorts
Scientific reports, 2017Co-Authors: Van Tan Tran, Alina V. Brenner, Lydia B. Zablotska, Mark P LittleAbstract:High-dose ionising radiation is associated with Circulatory Disease. Risks associated with lower-dose (
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Circulatory Disease mortality in the massachusetts tuberculosis fluoroscopy cohort study
European Journal of Epidemiology, 2016Co-Authors: Mark P Little, Lydia B. Zablotska, Alina V. Brenner, Steven E. LipshultzAbstract:High-dose ionizing radiation is associated with Circulatory Disease. Risks from lower-dose fractionated exposures, such as from diagnostic radiation procedures, remain unclear. In this study we aimed to ascertain the relationship between fractionated low-to-medium dose radiation exposure and Circulatory Disease mortality in a cohort of 13,568 tuberculosis patients in Massachusetts, some with fluoroscopy screenings, between 1916 and 1961 and follow-up until the end of 2002. Analysis of mortality was in relation to cumulative thyroid (cerebrovascular) or lung (all other Circulatory Disease) radiation dose via Poisson regression. Over the full dose range, there was no overall radiation-related excess risk of death from Circulatory Disease (n = 3221; excess relative risk/Gy -0.023; 95% CI -0.067, 0.028; p = 0.3574). Risk was somewhat elevated in hypertensive heart Disease (n = 89; excess relative risk/Gy 0.357; 95% CI -0.043, 1.030, p = 0.0907) and slightly decreased in ischemic heart Disease (n = 1950; excess relative risk/Gy -0.077; 95% CI -0.130, -0.012; p = 0.0211). However, under 0.5 Gy, there was a borderline significant increasing trend for all Circulatory Disease (excess relative risk/Gy 0.345; 95% CI -0.032, 0.764; p = 0.0743) and for ischemic heart Disease (excess relative risk/Gy 0.465; 95% CI, -0.032, 1.034, p = 0.0682). Pneumolobectomy increased radiation-associated risk (excess relative risk/Gy 0.252; 95% CI 0.024, 0.579). Fractionation of dose did not modify excess risk. In summary, we found no evidence of radiation-associated excess Circulatory death risk overall, but there are indications of excess Circulatory death risk at lower doses (<0.5 Gy). Although consistent with other radiation-exposed groups, the indications of higher risk at lower doses are unusual and should be confirmed against other data.
Peter N. Lee - One of the best experts on this subject based on the ideXlab platform.
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Circulatory Disease and smokeless tobacco in western populations a review of the evidence
International Journal of Epidemiology, 2007Co-Authors: Peter N. LeeAbstract:BACKGROUND Use of oral snuff or 'snus' has risen in Sweden. Sales of snuff in the US have also risen, overtaking sales of chewing tobacco. There is some evidence that nicotine contributes to Circulatory Disease (CID) from smoking. We therefore reviewed the evidence relating smokeless tobacco (ST) to CID and related risk factors. METHODS Publications that described relevant cohort, case-control and cross-sectional studies were identified from in-house files, a Medline search in December 2005 and reference lists. Relative risks (RRs) and odds ratios (ORs) for ischaemic heart Disease, stroke and all CID for ST use, stratified by smoking habit, were estimated and combined by meta-analysis to provide an overall RR estimate. For diabetes, increased blood pressure, and other risk factors, evidence was qualitatively reviewed, with results from clinical studies also considered. RESULTS ST use in non-smokers was associated with an increased risk of heart Disease (RR 1.12, 95% CI 0.99-1.27, n = 8), stroke (1.42, 1.29-1.57, n = 5) and CID (1.25, 1.14-1.37, n = 3). The increases mainly derived from two large US studies. The Swedish studies provided little evidence of an increase for heart Disease (1.06, 0.83-1.37, n = 5) or stroke (1.17, 0.80-1.70, n = 2), although the estimates by country are not notably heterogeneous, even for stroke (P = 0.29). No dose-response was evident. No increase was seen in former users of ST, or in ST users who also smoked. No clear relationship to diabetes was seen. In the US, an acute blood pressure rise following ST use was consistently reported, and isolated reports linked specific risk factors to ST. In Sweden, though one study reported that snuff acutely increased blood pressure, and two linked snuff to Raynaud-type symptoms, the overall evidence for an effect was inconclusive. Swedish studies generally showed no chronic effect of snuff on blood pressure or various risk factors. CONCLUSIONS Any CID risk from ST appears to be substantially less than from smoking, and no clear risk from Swedish snuff is seen. However, the overall evidence is limited.
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Circulatory Disease and smokeless tobacco in Western populations: a review of the evidence
International journal of epidemiology, 2007Co-Authors: Peter N. LeeAbstract:Use of oral snuff or 'snus' has risen in Sweden. Sales of snuff in the US have also risen, overtaking sales of chewing tobacco. There is some evidence that nicotine contributes to Circulatory Disease (CID) from smoking. We therefore reviewed the evidence relating smokeless tobacco (ST) to CID and related risk factors. Publications that described relevant cohort, case-control and cross-sectional studies were identified from in-house files, a Medline search in December 2005 and reference lists. Relative risks (RRs) and odds ratios (ORs) for ischaemic heart Disease, stroke and all CID for ST use, stratified by smoking habit, were estimated and combined by meta-analysis to provide an overall RR estimate. For diabetes, increased blood pressure, and other risk factors, evidence was qualitatively reviewed, with results from clinical studies also considered. ST use in non-smokers was associated with an increased risk of heart Disease (RR 1.12, 95% CI 0.99-1.27, n = 8), stroke (1.42, 1.29-1.57, n = 5) and CID (1.25, 1.14-1.37, n = 3). The increases mainly derived from two large US studies. The Swedish studies provided little evidence of an increase for heart Disease (1.06, 0.83-1.37, n = 5) or stroke (1.17, 0.80-1.70, n = 2), although the estimates by country are not notably heterogeneous, even for stroke (P = 0.29). No dose-response was evident. No increase was seen in former users of ST, or in ST users who also smoked. No clear relationship to diabetes was seen. In the US, an acute blood pressure rise following ST use was consistently reported, and isolated reports linked specific risk factors to ST. In Sweden, though one study reported that snuff acutely increased blood pressure, and two linked snuff to Raynaud-type symptoms, the overall evidence for an effect was inconclusive. Swedish studies generally showed no chronic effect of snuff on blood pressure or various risk factors. Any CID risk from ST appears to be substantially less than from smoking, and no clear risk from Swedish snuff is seen. However, the overall evidence is limited.