PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-23 (23)
 

Clipboard (0)
None

Select a Filter Below

Journals
more »
Year of Publication
more »
Document Types
1.  Alcohol consumption and cognitive decline in early old age 
Neurology  2014;82(4):332-339.
Objective:
To examine the association between alcohol consumption in midlife and subsequent cognitive decline.
Methods:
Data are from 5,054 men and 2,099 women from the Whitehall II cohort study with a mean age of 56 years (range 44–69 years) at first cognitive assessment. Alcohol consumption was assessed 3 times in the 10 years preceding the first cognitive assessment (1997–1999). Cognitive tests were repeated in 2002–2004 and 2007–2009. The cognitive test battery included 4 tests assessing memory and executive function; a global cognitive score summarized performances across these tests. Linear mixed models were used to assess the association between alcohol consumption and cognitive decline, expressed as z scores (mean = 0, SD = 1).
Results:
In men, there were no differences in cognitive decline among alcohol abstainers, quitters, and light or moderate alcohol drinkers (<20 g/d). However, alcohol consumption ≥36 g/d was associated with faster decline in all cognitive domains compared with consumption between 0.1 and 19.9 g/d: mean difference (95% confidence interval) in 10-year decline in the global cognitive score = −0.10 (−0.16, −0.04), executive function = −0.06 (−0.12, 0.00), and memory = −0.16 (−0.26, −0.05). In women, compared with those drinking 0.1 to 9.9 g/d of alcohol, 10-year abstainers showed faster decline in the global cognitive score (−0.21 [−0.37, −0.04]) and executive function (−0.17 [−0.32, −0.01]).
Conclusions:
Excessive alcohol consumption in men (≥36 g/d) was associated with faster cognitive decline compared with light to moderate alcohol consumption.
doi:10.1212/WNL.0000000000000063
PMCID: PMC3929201  PMID: 24431298
2.  Sitting Behavior and Obesity 
Background
Prospective studies report associations between indicators of time spent sitting and obesity risk. Most studies use a single indicator of sedentary behavior and are unable to clearly identify whether sedentary behavior is a cause or a consequence of obesity.
Purpose
To investigate cross-sectional and prospective associations between multiple sitting time indicators and obesity and examine the possibility of reverse causality.
Methods
Using data from the Whitehall II cohort, multiple logistic models were fitted to examine associations between prevalent obesity (BMI ≥30) at Phase 5 (1997–1999), and incident obesity between Phases 5 and 7 (2003–2004) across four levels of five sitting exposures (work sitting, TV viewing, non-TV leisure-time sitting, leisure-time sitting, and total sitting). Using obesity data from three prior phases (1985–1988, 1991–1993; and recalled weight at age 25 years), linear regression models were fitted to examine the association between prior obesity and sitting time at Phase 5. Analyses were conducted in 2012.
Results
None of the sitting exposures were associated with obesity either cross-sectionally or prospectively. Obesity at one previous measurement phase was associated with a 2.43-hour/week (95% CI=0.07, 4.78) increase in TV viewing; obesity at three previous phases was associated with a 7.42-hour/week (95% CI=2.7, 12.46) increase in TV-viewing hours/week at Phase 5.
Conclusions
Sitting time was not associated with obesity cross-sectionally or prospectively. Prior obesity was prospectively associated with time spent watching TV per week but not other types of sitting.
doi:10.1016/j.amepre.2012.10.009
PMCID: PMC3550520  PMID: 23332328
3.  Combined Effects of Depressive Symptoms and Resting Heart Rate on Mortality: The Whitehall II Prospective Cohort Study 
The Journal of clinical psychiatry  2010;72(9):1199-1206.
Objective
To examine the combined effects of depressive symptoms and resting heart rate (RHR) on mortality.
Methods
Data come from 5936 participants, aged 61 ± 6 years, from the Whitehall II study. Depressive symptoms were assessed in 2002–2004 using the center-for-epidemiologic-studies-depression-scale (score ≥ 16). RHR was measured at the same study phase via electrocardiogram. Participants were assigned to 1 of 6 risk-factor-groups based on depression status (yes/no) and RHR categories (<60, 60 – 80, >80 bpm). Mean follow-up for mortality was 5.6 years.
Results
In mutually adjusted Cox regression models, depression (hazard ratio = 1.93 p<0.001) and RHR>80 bpm (hazard ratio = 1.67, p<0.001) were independent predictors of mortality. After adjustment for potential confounding and mediating variables, participants with both depression and high RHR had a 3.0-fold higher (p<0.001) risk of death compared to depression-free participants with RHR ranging from 60 to 80 bpm. This risk is particularly marked in participants with prevalent CHD.
Conclusions
This study provides evidence that the coexistence of depressive symptoms and elevated RHR is associated with substantially increased risk of death compared to those without these two factors. This finding raises the possibility that treatments that improve both depression and RHR might improve survival.
doi:10.4088/JCP.09m05901blu
PMCID: PMC3226937  PMID: 21208592
depression; resting heart rate and mortality
4.  Combined effects of depressive symptoms and resting heart rate on mortality: the Whitehall II prospective cohort study 
The Journal of Clinical Psychiatry  2010;72(9):1199-1206.
Objective
To examine the combined effects of depressive symptoms and resting heart rate (RHR) on mortality.
Methods
Data come from 5936 participants, aged 61 ±6 years, from the Whitehall II study. Depressive symptoms were assessed in 2002–2004 using the center-for-epidemiologic-studies-depression-scale (score ≥16). RHR was measured at the same study phase via electrocardiogram. Participants were assigned to 1 of 6 risk-factor-groups based on depression status (yes/no) and RHR categories (<60, 60–80, >80 bpm). Mean follow-up for mortality was 5.6 years.
Results
In mutually adjusted Cox regression models, depression (hazard ratio = 1.93 p<0.001) and RHR>80 bpm (hazard ratio = 1.67, p<0.001) were independent predictors of mortality. After adjustment for potential confounding and mediating variables, participants with both depression and high RHR had a 3.0-fold higher (p<0.001) risk of death compared to depression-free participants with RHR ranging from 60 to 80 bpm. This risk is particularly marked in participants with prevalent CHD.
Conclusions
This study provides evidence that the coexistence of depressive symptoms and elevated RHR is associated with substantially increased risk of death compared to those without these two factors. This finding raises the possibility that treatments that improve both depression and RHR might improve survival.
doi:10.4088/JCP.09m05901blu
PMCID: PMC3226937  PMID: 21208592
depression; resting heart rate and mortality
5.  Do We Need Age-Specific Alcohol Consumption Guidelines? 
doi:10.1093/alcalc/ags023
PMCID: PMC3331620  PMID: 22398024
6.  Rising adiposity curbing decline in the incidence of myocardial infarction: 20-year follow-up of British men and women in the Whitehall II cohort 
European heart journal  2011;33(4):478-485.
Aims
To estimate the contribution of risk factor trends to 20-year declines in myocardial infarction (MI) incidence in British men and women.
Methods and results
From 1985 to 2004, 6379 men and 3074 women in the Whitehall II cohort were followed for incident MI and risk factor trends. Over 20 years, the age–sex-adjusted hazard of MI fell by 74% (95% confidence interval 48–87%), corresponding to an average annual decline of 6.5% (3.2–9.7%). Thirty-four per cent (20–76%) of the decline in MI hazard could be statistically explained by declining non-HDL cholesterol levels, followed by increased HDL cholesterol (17%, 10–32%), reduced systolic blood pressure (13%, 7–24%), and reduced cigarette smoking prevalence (6%, 2–14%). Increased fruit and vegetable consumption made a non-significant contribution of 7% (−1–20%). In combination, these five risk factors explained 56% (34–112%). Rising body mass index (BMI) was counterproductive, reducing the scale of the decline by 11% (5–23%) in isolation. The MI decline and the impact of the risk factors appeared similar for men and women.
Conclusion
In men and women, over half of the decline in MI risk could be accounted for by favourable risk factor time trends. The adverse role of BMI emphasizes the importance of addressing the rising population BMI.
doi:10.1093/eurheartj/ehr142
PMCID: PMC3272419  PMID: 21653562
Myocardial infarction; Incidence; Time Trends; Population; Prevention; Risk factors
7.  Limitations to functioning and independent living after the onset of coronary heart disease: what is the role of lifestyle factors and obesity? 
Background: People with coronary disease have a higher risk of functional limitations than their same-age counterparts without disease. This study examined prospectively the extent to which functioning and independent living among individuals with coronary disease in early old age are associated with lifestyle factors before and after disease onset. Methods: Participants were 986 British civil servants (657 men and 329 women aged 35–55 years), who were free of coronary disease at study entry in 1985–88 but developed disease during 21 years follow-up (the Whitehall II study). Lifestyle factors (obesity, smoking, alcohol, diet and physical activity) were measured at baseline and follow-up in 2007–09. Post-disease limitations to functioning were measured in 2006–09 at mean age is 68 years using activities of daily living scales. Results: Low physical activity and being overweight [body mass index (BMI) ≥25] before and after disease onset were associated with having one or more limitations in activities of daily living among coronary patients [age-, sex- and socio-economic position adjusted odds ratios for pre-disease inactivity and obesity 1.53 [95% confidence interval (95% CI) 0.99–2.35] and 2.53 (95% CI 1.53–4.18), respectively]. A decrease in physical activity [odds ratio (OR): 2.42, 95% CI 1.59–3.68] and an increase of >5 U in BMI (OR: 2.05, 95% CI 1.34–3.13) were also related to limitations in activities of daily living after disease onset. These relationships were not accounted for by measured co-morbidities. No robust associations were observed for smoking, alcohol use and diet. Conclusion: Physical activity and weight control across the adult life course are associated with fewer limitations to functioning and independent living after the onset of coronary disease.
doi:10.1093/eurpub/ckr150
PMCID: PMC3505445  PMID: 22037803
8.  Rising adiposity curbing decline in the incidence of myocardial infarction: 20-year follow-up of British men and women in the Whitehall II cohort 
European Heart Journal  2011;33(4):478-485.
Aims
To estimate the contribution of risk factor trends to 20-year declines in myocardial infarction (MI) incidence in British men and women.
Methods and results
From 1985 to 2004, 6379 men and 3074 women in the Whitehall II cohort were followed for incident MI and risk factor trends. Over 20 years, the age–sex-adjusted hazard of MI fell by 74% (95% confidence interval 48–87%), corresponding to an average annual decline of 6.5% (3.2–9.7%). Thirty-four per cent (20–76%) of the decline in MI hazard could be statistically explained by declining non-HDL cholesterol levels, followed by increased HDL cholesterol (17%, 10–32%), reduced systolic blood pressure (13%, 7–24%), and reduced cigarette smoking prevalence (6%, 2–14%). Increased fruit and vegetable consumption made a non-significant contribution of 7% (−1–20%). In combination, these five risk factors explained 56% (34–112%). Rising body mass index (BMI) was counterproductive, reducing the scale of the decline by 11% (5–23%) in isolation. The MI decline and the impact of the risk factors appeared similar for men and women.
Conclusion
In men and women, over half of the decline in MI risk could be accounted for by favourable risk factor time trends. The adverse role of BMI emphasizes the importance of addressing the rising population BMI.
doi:10.1093/eurheartj/ehr142
PMCID: PMC3272419  PMID: 21653562
Myocardial infarction; Incidence; Time Trends; Population; Prevention; Risk factors
9.  How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease? 
Addiction (Abingdon, England)  2010;105(4):639-645.
Objective
To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD) taking account of variation in intake during follow up
Method
Prospective cohort study of 5,411 male civil servants aged 35-55 years at entry to the Whitehall II study in 1985-88. Alcohol consumption was reported five times over a 15 year period. Mortality, fatal CHD, clinically verified incident non-fatal myocardial infarction and definite angina were ascertained during follow-up.
Results
We found evidence that drinkers who vary their intake during follow-up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI 1.07 to 2.17), but not of incident CHD. Using average consumption level, as opposed to just a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers, at the extremes of the drinking range.
Conclusions
Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time.
doi:10.1111/j.1360-0443.2009.02832.x
PMCID: PMC2862167  PMID: 20148795
10.  Socioeconomic status moderates the association between carotid intima-media thickness and cognition in midlife: evidence from the Whitehall II study 
Atherosclerosis  2007;197(2):541-548.
Background
Common carotid artery intima media thickness (IMT) is a measure of generalized atherosclerosis and has been shown to be associated with cognitive function. We examine two questions: does socioeconomic status (SES) moderate this association and is IMT more strongly associated with specific aspects of cognitive function?
Methods
Data are drawn from the Phase 7 (2003–2004) of the Whitehall II study (N=3896). In cross-sectional analyses the association between IMT and six measures of cognition (short term verbal memory, inductive reasoning, vocabulary, semantic and phonemic fluency and a measure of global cognitive status) was examined in analyses adjusted for previous history of coronary heart disease, health behaviours and other vascular risk measures such as blood pressure, cholesterol and body mass index.
Results
The overall association between IMT and the 6 measures of cognition was restricted to the low SES group (p=0.02). Within this group, IMT was significantly associated with inductive reasoning (p=0.001), vocabulary (p=0.002), phonemic (p=0.006) and semantic fluency (p=0.02). The covariates examined explained about a quarter of the association between IMT and cognition in the low SES group. The associations with the measure of inductive reasoning (p=0.02), vocabulary (p=0.02) and phonemic fluency (p=0.04) remained after adjustment for all covariates.
Conclusions
SES is an important modifier of the association between IMT and cognition, an inverse association between the two was observed only in the low SES group. It is possible that high cognitive reserve among the high SES individuals prevents the functional manifestations of atherosclerosis. Verbal memory was not one of the cognitive domains associated with IMT.
doi:10.1016/j.atherosclerosis.2007.08.010
PMCID: PMC2759091  PMID: 17854813
cerebrovascular diseases; cognitive aging; carotid intima-media thickness
11.  History of coronary heart disease and cognitive performance in midlife: the Whitehall II study 
Aims
Some studies show coronary heart disease (CHD) to be a risk factor for cognitive function while others report no association between the two. We examine the effect of CHD history and duration on cognition in a middle-aged population.
Methods
Data come from the Whitehall II study of 10308 participants (33% women), aged 35–55 years at baseline (phase 1; 1985–1988). CHD events were assessed up to Phase 7 (2002–2004) when 5837 participants (28.4% women) undertook 6 cognitive tests: reasoning, vocabulary, phonemic and semantic fluency, memory and the Mini-Mental-State-Examination (MMSE); standardized to T-scores (mean=50, standard deviation=10). Analysis of covariance was used first to model the association between CHD history and cognition and then to examine the effect of time since first CHD event (in the last 5 years, 5–10 years ago, over 10 years ago).
Results
Among men, in analyses adjusted for age, education, marital status and medication for cardiovascular disease, CHD history was associated with lower T-scores on reasoning (−1.16; 95% Confidence Interval (CI)= −2.07, −0.25), vocabulary (−2.11; 95% CI=−3.01, −1.21), and the MMSE (−1.45; 95% CI=−2.42, −0.49). In women, these effects were also evident for phonemic and semantic fluency. Among men, the trend within CHD cases suggested progressively lower scores on reasoning, vocabulary and semantic fluency among those with longer duration of CHD.
Conclusion
Our findings go some way towards suggesting an association between CHD history and cognitive performance in middle-aged adults.
doi:10.1093/eurheartj/ehn298
PMCID: PMC2740873  PMID: 18648106
12.  History of coronary heart disease and cognitive performance in midlife: the Whitehall II study 
European Heart Journal  2008;29(17):2100-2107.
Aims
Some studies show coronary heart disease (CHD) to be a risk factor for cognitive function while others report no association between the two. We examined the effect of CHD history and duration on cognition in a middle-aged population.
Methods and results
Data come from the Whitehall II study of 10 308 participants (33% women), aged 35–55 years at baseline (Phase 1; 1985–88). CHD events were assessed up to Phase 7 (2002–04) when 5837 participants (28.4% women) undertook six cognitive tests: reasoning, vocabulary, phonemic and semantic fluency, memory and the mini-mental-state-examination (MMSE); standardized to T-scores (mean = 50, standard deviation = 10). Analysis of covariance was used first to model the association between CHD history and cognition and then to examine the effect of time since first CHD event (in the last 5 years, 5–10 years ago, >10 years ago). Among men, in analyses adjusted for age, education, marital status and medication for cardiovascular disease, CHD history was associated with lower T-scores on reasoning [−1.16; 95% confidence interval (CI) = −2.07, −0.25], vocabulary (−2.11; 95% CI = −3.01, −1.21), and the MMSE (−1.45; 95% CI = −2.42, −0.49). In women, these effects were also evident for phonemic and semantic fluency. Among men, the trend within CHD cases suggested progressively lower scores on reasoning, vocabulary and semantic fluency among those with longer duration of CHD.
Conclusion
Our findings go some way towards suggesting an association between CHD history and cognitive performance in middle-aged adults.
doi:10.1093/eurheartj/ehn298
PMCID: PMC2740873  PMID: 18648106
Coronary heart disease; Epidemiology; Cognitive function
13.  Successful aging: the contribution of early-life and midlife risk factors 
Objectives
To test whether early life factors (education, height, father’s social position) and midlife social, behavioral and psychosocial factors were associated with entering older age without disease and good functioning.
Design
A longitudinal, British civil service-based cohort study. Participants were followed for 17 years to assess successful aging. This was defined as being free of major disease and in the top tertile of physical and cognitive functioning measured in 2002–4.
Setting
Twenty London-based Civil Service departments
Participants
Four thousand, one hundred and forty men and 1823 women, free of major disease at baseline in 1985–8 (mean age 44, range 35–55 years)
Measurements
Behavioral, biological and psychosocial risk factors, physical and cognitive functioning and disease outcomes
Results
548 (12.8%) men and 246 (14.6%) women were successfully aging at follow up. This was strongly predicted by midlife socioeconomic position (age adjusted odds ratio for men highest vs. lowest 7.06, 95% CI 3.4, 14.6). Height, education (men), not smoking, diet, exercise, moderate alcohol (women) and work support (men) were related to a favorable older life after adjustment for age and socioeconomic position.
Conclusion
Interventions to promote adult healthy behavior may attenuate harmful effects of less modifiable risk factors and reduce social inequalities.
doi:10.1111/j.1532-5415.2008.01740.x
PMCID: PMC2696176  PMID: 18482302
Adult; Aging; psychology; Female; Health Behavior; Health Promotion; Health Status; Humans; Life Style; Logistic Models; London; epidemiology; Male; Middle Aged; Risk Factors; Social Support; Socioeconomic Factors; Aging, cohort studies, health behaviors; inequalities
14.  The Association between Heart Rate Variability and Cognitive Impairment in Middle-Aged Men and Women. The Whitehall II Cohort Study 
Neuroepidemiology  2008;31(2):115-121.
Background
To examine the relationship between reduced heart rate variability (HRV) and cognitive function in middle aged adults in the general population
Methods
HRV, in both time and frequency domains, and cognitive function were measured twice, at mean ages 55 and 61 years, in 5,375 male and female participants of the UK Whitehall II study. Logistic regression was used to model associations between HRV and cognition (short-term verbal memory, reasoning (AH4-I), vocabulary, phonemic and semantic fluency). Cross-sectional associations were assessed at both waves and longitudinal associations as change in cognition over the 5 year follow-up.
Results
No consistent associations were found in men or women, either in cross-section, prospective or the longitudinal analysis of decline in cognition.
Conclusion
Reduced cardiovascular autonomic function does not contribute to cognitive impairment in this middle-aged population. Further studies are needed to verify the potential role of HRV measures in predicting the degeneration of cognitive function at older ages.
doi:10.1159/000148257
PMCID: PMC2527026  PMID: 18667838
autonomic function; cognitive impairment; heart rate variability; cohort studies
15.  Does High C-reactive Protein Concentration Increase Atherosclerosis? The Whitehall II Study 
PLoS ONE  2008;3(8):e3013.
Background
C-reactive protein (CRP), a marker of systemic inflammation, is associated with risk of coronary events and sub-clinical measures of atherosclerosis. Evidence in support of this link being causal would include an association robust to adjustments for confounders (multivariable standard regression analysis) and the association of CRP gene polymorphisms with atherosclerosis (Mendelian randomization analysis).
Methodology/Principal Findings
We genotyped 3 tag single nucleotide polymorphisms (SNPs) [+1444T>C (rs1130864); +2303G>A (rs1205) and +4899T>G (rs 3093077)] in the CRP gene and assessed CRP and carotid intima-media thickness (CIMT), a structural marker of atherosclerosis, in 4941 men and women aged 50–74 (mean 61) years (the Whitehall II Study). The 4 major haplotypes from the SNPs were consistently associated with CRP level, but not with other risk factors that might confound the association between CRP and CIMT. CRP, assessed both at mean age 49 and at mean age 61, was associated both with CIMT in age and sex adjusted standard regression analyses and with potential confounding factors. However, the association of CRP with CIMT attenuated to the null with adjustment for confounding factors in both prospective and cross-sectional analyses. When examined using genetic variants as the instrument for serum CRP, there was no inferred association between CRP and CIMT.
Conclusions/Significance
Both multivariable standard regression analysis and Mendelian randomization analysis suggest that the association of CRP with carotid atheroma indexed by CIMT may not be causal.
doi:10.1371/journal.pone.0003013
PMCID: PMC2507732  PMID: 18714381
16.  The Association between Heart Rate Variability and Cognitive Impairment in Middle-Aged Men and Women 
Neuroepidemiology  2008;31(2):115-121.
Background
To examine the relationship between reduced heart rate variability (HRV) and cognitive function in middle-aged adults in the general population.
Methods
HRV, in both time and frequency domains, and cognitive functioning were measured twice in 5,375 male and female participants of the UK Whitehall II study (mean ages = 55 and 61 years, respectively). Logistic regression was used to model associations between HRV and cognition [short-term verbal memory, reasoning (Alice Heim 4-I), vocabulary, phonemic and semantic fluency]. Cross-sectional associations were assessed at both waves, and longitudinal associations were measured as changes in cognition over the 5-year follow-up.
Results
No consistent associations were found in men or women, either in the cross-sectional, prospective or the longitudinal analyses of declines in cognition.
Conclusion
Reduced cardiovascular autonomic function does not contribute to cognitive impairment in this middle-aged population. Further studies are needed to verify the potential role of HRV measures in predicting the degeneration of cognitive function at older ages.
doi:10.1159/000148257
PMCID: PMC2527026  PMID: 18667838
Autonomic function; Cognitive impairment; Heart rate variability; Cohort studies
17.  How much and how often should we drink? 
BMJ : British Medical Journal  2006;332(7552):1224-1225.
PMCID: PMC1471939  PMID: 16735306
18.  Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study 
BMJ : British Medical Journal  2004;329(7461):318.
Objective To determine whether access to cardiac procedures and drugs contributes to social and ethnic differences in coronary heart disease in a population setting.
Design Prospective study with follow up over 15 years. Civil service employment grade was used as a measure of individual socioeconomic position. Need for cardiac care was determined by the presence of angina, myocardial infarction, and coronary risk factors.
Setting 20 civil service departments originally located in London.
Participants 10 308 civil servants (3414 women; 560 South Asian) aged 35-55 years at baseline in 1985-8.
Main outcome measures Use of exercise electrocardiography, coronary angiography, and coronary revascularisation procedures and secondary prevention drugs.
Results Inverse social gradients existed in incident coronary morbidity and mortality. South Asian participants also had higher rates than white participants. After adjustment for clinical need, social position showed no association with the use of cardiac procedures or secondary prevention drugs. For example, men in the low versus high employment grade had an age adjusted odds ratio for angiography of 1.87 (95% confidence interval 1.32 to 2.64), which decreased to 1.27 (0.83 to 1.94) on adjustment for clinical need. South Asians tended to be more likely to have cardiac procedures and to be taking more secondary prevention drugs than white participants, even after adjustment for clinical need.
Conclusion This population based study, which shows the widely observed social and ethnic patterning of coronary heart disease, found no evidence that low social position or South Asian ethnicity was associated with lower use of cardiac procedures or drugs, independently of clinical need. Differences in medical care are unlikely to contribute to social or ethnic differences in coronary heart disease in this cohort.
doi:10.1136/bmj.38156.690150.AE
PMCID: PMC506850  PMID: 15237088
19.  Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study 
BMJ : British Medical Journal  2003;327(7420):895.
Objective To investigate the prognosis of angina among people with and without diagnosis by a doctor and an abnormal cardiovascular test result.
Design Prospective cohort study with a median follow up of 11 years.
Setting 20 civil service departments originally located in London.
Participants 10 308 civil servants aged 35-55 years at baseline.
Main outcome measures Recurrent reports of angina; quality of life (SF-36 physical functioning); non-fatal myocardial infarction; death from any cause (n = 344).
Results 1158 (11.4%) participants developed angina, and 813 (70%) had no evidence of diagnosis by a doctor at the time of the initial report. Participants without a diagnosis had an increased risk of impaired physical functioning (age and sex adjusted odds ratio of 2.36 (95% confidence interval 1.91 to 2.90)) compared with those who had neither angina nor myocardial infarction throughout follow up. Among reported cases of angina without a diagnosis, the 15.5% with an abnormality on a study electrocardiogram had an increased risk of death (hazard ratio 2.37 (1.16 to 4.87)). These effects were similar in magnitude to those in participants with a diagnosis of angina.
Conclusion Undiagnosed angina was common and had an adverse impact on prognosis comparable to that of diagnosed angina, particularly among people with electrocardiographic abnormalities. Efforts to improve prognosis among people with angina should take account of this submerged clinical iceberg.
PMCID: PMC218810  PMID: 14563744
23.  Cardiovascular disease risk scores in identifying future frailty: the Whitehall II prospective cohort study 
Heart  2013;99(10):737-742.
Objectives
To examine the capacity of existing cardiovascular disease (CVD) risk algorithms widely used in primary care, to predict frailty.
Design
Prospective cohort study. Risk algorithms at baseline (1997–1999) were the Framingham CVD, coronary heart disease and stroke risk scores, and the Systematic Coronary Risk Evaluation.
Setting
Civil Service departments in London, UK.
Participants
3895 participants (73% men) aged 45–69 years and free of CVD at baseline.
Main outcome measure
Status of frailty at the end of follow-up (2007–2009), based on the following indicators: self-reported exhaustion, low physical activity, slow walking speed, low grip strength and weight loss.
Results
At the end of the follow-up, 2.8% (n=108) of the sample was classified as frail. All four CVD risk scores were associated with future risk of developing frailty, with ORs per one SD increment in the score ranging from 1.35 (95% CI 1.21 to 1.51) for the Framingham stroke score to 1.42 (1.23 to 1.62) for the Framingham CVD score. These associations remained after excluding incident CVD cases. For comparison, the corresponding ORs for the risk scores and incident cardiovascular events varied between 1.36 (1.15 to 1.61) and 1.64 (1.50 to 1.80) depending on the risk algorithm.
Conclusions
The use of CVD risk scores in clinical practice may also have utility for frailty prediction.
doi:10.1136/heartjnl-2012-302922
PMCID: PMC3632981  PMID: 23503403

Results 1-23 (23)