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      Strength Training and All‐Cause, Cardiovascular Disease, and Cancer Mortality in Older Women: A Cohort Study

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          Abstract

          Background

          Few data exist on the association between strength training and mortality rates. We sought to examine the association between strength training and all‐cause, cardiovascular disease, and cancer mortality.

          Methods and Results

          Beginning in 2001 to 2005, 28 879 women throughout the United States (average baseline age, 62.2 years) from the Women's Health Study who were free of cardiovascular disease, diabetes mellitus, and cancer reported their physical activities, including strength training. During follow‐up (average, 12.0 years) through 2015, investigators documented 3055 deaths (411 from cardiovascular disease and 748 from cancer). After adjusting for covariables, including aerobic activity, time in strength training showed a quadratic association with all‐cause mortality ( P=0.36 for linear trend; P<0.001 for quadratic trend); hazard ratios across 5 categories of strength training (0, 1–19, 20–59, 60–149, and ≥150 min/wk) were 1.0 (referent), 0.73 (95% confidence interval, 0.65–0.82), 0.71 (0.62–0.82), 0.81 (0.67–0.97), and 1.10 (0.77–1.56), respectively. A significant quadratic association was also observed for cardiovascular disease death ( P=0.007) but not cancer death ( P=0.41). Spline models also indicated a J‐shaped nonlinear association for all‐cause mortality ( P=0.020); the point estimates of hazard ratios were <1.00 for 1 to 145 min/wk of strength training, compared with 0 min/wk, whereas hazard ratios were >1.00 for ≥146 min/wk of strength training. However, confidence intervals were wide at higher levels of strength training.

          Conclusions

          Time in strength training showed a J‐shaped association with all‐cause mortality in older women. A moderate amount of time in strength training seemed beneficial for longevity, independent of aerobic activity; however, any potential risk with more time (≈≥150 min/wk) should be further investigated.

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          Most cited references21

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          A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women.

          Randomized trials have shown that low-dose aspirin decreases the risk of a first myocardial infarction in men, with little effect on the risk of ischemic stroke. There are few similar data in women. We randomly assigned 39,876 initially healthy women 45 years of age or older to receive 100 mg of aspirin on alternate days or placebo and then monitored them for 10 years for a first major cardiovascular event (i.e., nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes). During follow-up, 477 major cardiovascular events were confirmed in the aspirin group, as compared with 522 in the placebo group, for a nonsignificant reduction in risk with aspirin of 9 percent (relative risk, 0.91; 95 percent confidence interval, 0.80 to 1.03; P=0.13). With regard to individual end points, there was a 17 percent reduction in the risk of stroke in the aspirin group, as compared with the placebo group (relative risk, 0.83; 95 percent confidence interval, 0.69 to 0.99; P=0.04), owing to a 24 percent reduction in the risk of ischemic stroke (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.93; P=0.009) and a nonsignificant increase in the risk of hemorrhagic stroke (relative risk, 1.24; 95 percent confidence interval, 0.82 to 1.87; P=0.31). As compared with placebo, aspirin had no significant effect on the risk of fatal or nonfatal myocardial infarction (relative risk, 1.02; 95 percent confidence interval, 0.84 to 1.25; P=0.83) or death from cardiovascular causes (relative risk, 0.95; 95 percent confidence interval, 0.74 to 1.22; P=0.68). Gastrointestinal bleeding requiring transfusion was more frequent in the aspirin group than in the placebo group (relative risk, 1.40; 95 percent confidence interval, 1.07 to 1.83; P=0.02). Subgroup analyses showed that aspirin significantly reduced the risk of major cardiovascular events, ischemic stroke, and myocardial infarction among women 65 years of age or older. In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes, leading to a nonsignificant finding with respect to the primary end point. Copyright 2005 Massachusetts Medical Society.
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            Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements.

            Previous cohort studies of fat intake and risk of coronary heart disease (CHD) have been inconsistent, probably due in part to methodological differences and various limitations, including inadequate dietary assessment and incomplete adjustment for total energy intake. The authors analyzed repeated assessment of diet from the Nurses' Health Study to examine the associations between intakes of four major types of fat (saturated, monounsaturated, polyunsaturated, and trans fats) and risk of CHD during 14 years of follow-up (1980-1994) by using alternative methods for energy adjustment. In particular, the authors compared four risk models for energy adjustment: the standard multivariate model, the energy-partition model, the nutrient residual model, and the multivariate nutrient density model. Within each model, the authors compared four different approaches for analyzing repeated dietary measurements: baseline diet only, the most recent diet, and two different algorithms for calculating cumulative average diets. The substantive results were consistent across all models; that is, higher intakes of saturated and trans fats were associated with increased risk of CHD, while higher intakes of monounsaturated and polyunsaturated fats were associated with reduced risk. When nutrients were considered as continuous variables, the four energy-adjustment methods yielded similar associationS. However, the interpretation of the relative risks differed across models. In addition, within each model, the methods using the cumulative averages in general yielded stronger associations than did those using either only baseline diet or the most recent diet. When the nutrients were categorized according to quintiles, the residual and the nutrient density models, which gave similar results, yielded statistically more significant tests for linear trend than did the standard and the partition models.
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              Low-dose aspirin in the primary prevention of cancer: the Women's Health Study: a randomized controlled trial.

              Basic research and observational evidence as well as results from trials of colon polyp recurrence suggest a role for aspirin in the chemoprevention of cancer. To examine the effect of aspirin on the risk of cancer among healthy women. In the Women's Health Study, a randomized 2 x 2 factorial trial of aspirin and vitamin E conducted between September 1992 and March 2004, 39 876 US women aged at least 45 years and initially without previous history of cancer, cardiovascular disease, or other major chronic illness were randomly assigned to receive either aspirin or aspirin placebo and followed up for an average of 10.1 years. A dose of 100 mg of aspirin (n=19 934) or aspirin placebo (n=19 942) administered every other day. Confirmed newly diagnosed invasive cancer at any site, except for nonmelanoma skin cancer. Incidence of breast, colorectal, and lung cancer were secondary end points. No effect of aspirin was observed on total cancer (n = 2865; relative risk [RR], 1.01; 95% confidence interval [CI], 0.94-1.08; P = .87), breast cancer (n = 1230; RR, 0.98; 95% CI, 0.87-1.09; P = .68), colorectal cancer (n = 269; RR, 0.97; 95% CI, 0.77-1.24; P = .83), or cancer of any other site, with the exception of lung cancer for which there was a trend toward reduction in risk (n = 205; RR, 0.78; 95% CI, 0.59-1.03; P = .08). There was also no reduction in cancer mortality either overall (n = 583; RR, 0.95; 95% CI, 0.81-1.11; P = .51) or by site, except for lung cancer mortality (n = 140; RR, 0.70; 95% CI, 0.50-0.99; P = .04). No evidence of differential effects of aspirin by follow-up time or interaction with vitamin E was found. Results from this large-scale, long-term trial suggest that alternate day use of low-dose aspirin (100 mg) for an average 10 years of treatment does not lower risk of total, breast, colorectal, or other site-specific cancers. A protective effect on lung cancer or a benefit of higher doses of aspirin cannot be ruled out.
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                Author and article information

                Contributors
                kamada@gakushikai.jp
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                31 October 2017
                November 2017
                : 6
                : 11 ( doiID: 10.1002/jah3.2017.6.issue-11 )
                : e007677
                Affiliations
                [ 1 ] Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston MA
                [ 2 ] Department of Physical Activity Research National Institute of Health and Nutrition NIBIOHN Shinjuku‐ku Tokyo Japan
                [ 3 ] Laboratory of Epidemiology and Population Science Intramural Research Program of the National Institutes of Health National Institute on Aging Bethesda MD
                [ 4 ] Division of Preventive Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
                [ 5 ] Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
                Author notes
                [*] [* ] Correspondence to: Masamitsu Kamada, PhD, MEd, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Dr, Floor 4 West, Boston, MA 02215. E‐mail: kamada@ 123456gakushikai.jp
                Article
                JAH32696
                10.1161/JAHA.117.007677
                5721806
                29089346
                9f6b0c04-b0ac-4d20-b7ac-da6c58ce3574
                © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 21 September 2017
                : 26 September 2017
                Page count
                Figures: 1, Tables: 4, Pages: 14, Words: 7671
                Funding
                Funded by: National Institutes of Health
                Award ID: CA047988
                Award ID: CA182913
                Award ID: HL043851
                Award ID: HL080467
                Award ID: HL099355
                Funded by: Japan Society for the Promotion of Science Postdoctoral Fellowships for Research Abroad and Young Scientists
                Funded by: Sasakawa Sports Foundation
                Funded by: Intramural Research Program of the National Institutes of Health
                Funded by: National Institute on Aging
                Categories
                Original Research
                Original Research
                Epidemiology
                Custom metadata
                2.0
                jah32696
                November 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.6 mode:remove_FC converted:21.11.2017

                Cardiovascular Medicine
                exercise,longevity,longitudinal cohort study,muscle‐strengthening activity,weight training,epidemiology

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