Als Teil des WHO-MONICA-Projektes sind seit 1984/85 drei bevölkerungsrepräsentative Querschnittss... more Als Teil des WHO-MONICA-Projektes sind seit 1984/85 drei bevölkerungsrepräsentative Querschnittsstudien in der Region Augsburg durchgeführt worden, um die zeitlichen Trends der klassischen Risikofaktoren abzubilden. Im Rahmen von KORA wird die Bedeutung der untersuchten Parameter für die sich verändernde kardiovaskuläre Gesundheit erforscht. Für die MONI-CA-Surveys wurden drei voneinander unabhängige Zufallsstichproben rekrutiert (1984/85 S1: Alter 25-64 Jahre, 1989/90 S2: Alter 25-74 Jahre und 1994/95 S3: Alter 25-74 Jahre). Die nach Alter und Geschlecht stratifizierte 2-stufige Clusterstichprobe bestand aus einer Zufallsauswahl in der Stadt Augsburg und einer nach Wohnortgröße erfolgten zufälligen Auswahl von 16 Kommunen aus den beiden angrenzenden Landkreisen. Durch die Zufallsauswahl wurden einige Personen für mehr als einen Survey ausgewählt, weshalb sich für 13 427 Personen insgesamt 13 818 Studienteilnahmen ergaben. Von 1984 bis 1995 wurden bei Bluthochdruck keine Veränderungen beobachtet. Für Fettstoffwechselstörungen (Ratio von Gesamt-/HDL-Cholesterin ‡ 5,0) gab es Zunahmen um 15 % (Männer) bis 30 % (Frauen), während Zigarettenrauchen bei 55-bis 64-jährigen Männern ab-und bei 35-bis 64-jährigen Frauen zunahm. Die Risikoprädiktion für inzidente akute Myokardinfarkte je 100 000 Personenjahre ist am größten für das Zigarettenrauchen (Männer 880, Frauen 360), gefolgt von Blutfettstörungen (Männer 739, Frauen 318) und systolischen Blutdruckwerten größer oder
The American Journal of Human Genetics, May 13, 2011
Thyroid disorders such as goiters represent important diseases, especially in iodine-deficient ar... more Thyroid disorders such as goiters represent important diseases, especially in iodine-deficient areas. Sibling studies have demonstrated that genetic factors substantially contribute to the interindividual variation of thyroid volume. We performed a genome-wide association study of this phenotype by analyzing a discovery cohort consisting of 3620 participants of the Study of Health in Pomerania (SHIP). Four genetic loci were associated with thyroid volume on a genome-wide level of significance. Of these, two independent loci are located upstream of and within CAPZB, which encodes the b subunit of the barbed-end F-actin binding protein that modulates actin polymerization, a process crucial in the colloid engulfment during thyroglobulin mobilization in the thyroid. The third locus marks FGF7, which encodes fibroblast growth factor 7. Members of this protein family have been discussed as putative signal molecules involved in the regulation of thyroid development. The fourth locus represents a ''gene desert'' on chromosome 16q23, located directly downstream of the predicted coding sequence LOC440389, which, however, had already been removed from the NCBI database as a result of the standard genome annotation processing at the time that this study was initiated. Experimental proof of the formerly predicted mature mRNA, however, demonstrates that LOC440389 indeed represents a real gene. All four associations were replicated in an independent sample of 1290 participants of the KORA study. These results increase the knowledge about genetic factors and physiological mechanisms influencing thyroid volume.
The American Journal of Clinical Nutrition, Sep 1, 2006
Background: It remains controversial whether body mass index (BMI), waist circumference (WC), or ... more Background: It remains controversial whether body mass index (BMI), waist circumference (WC), or waist-hip ratio (WHR) is a better risk predictor of type 2 diabetes. Objective: The objective was to examine the sex-specific relevance of WC, WHR, and BMI to the development of type 2 diabetes. Design: The prospective population-based cohort study was based on 3055 men and 2957 women aged 35-74 y who participated in the second (1989 -1990) or third (1994 -1995) MONICA (Monitoring Trends and Determinants on Cardiovascular Diseases) Augsburg survey. The subjects were free of diabetes at baseline. Hazard ratios (HRs) were estimated from Cox proportional hazards models. Results: During a mean follow-up of 9.2 y, 243 cases of incident type 2 diabetes occurred in men and 158 occurred in women. Multivariable-adjusted HRs across quartiles of BMI were 1.0, 1.37, 2.08, and 4.15 in men and 1.0, 3.77, 4.95, and 10.58 in women; those of WC were 1.0, 1.15, 1.57, and 3.40 in men and 1.0, 3.21, 3.98, and 10.70 in women; those of WHR were 1.0, 1.14, 1.80, and 2.84 in men and 1.0, 0.82, 2.06, and 3.51 in women. In joint analyses, the highest risk was observed in men and women with a high BMI in combination with a high WC and a high WHR. Conclusions: Both overall and abdominal adiposity were strongly related to the development of type 2 diabetes. Because there was an additive effect of overall and abdominal obesity on risk prediction, WC should be measured in addition to BMI to assess the risk of type 2 diabetes in both sexes.
Aims Limited data are available for European populations regarding the prevalence of diabetes and... more Aims Limited data are available for European populations regarding the prevalence of diabetes and disturbed glucose metabolism in younger individuals. Our aim was to estimate the prevalence of diagnosed and undiagnosed diabetes, isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT) and combined IFG ⁄ IGT in a population-based sample (n = 1653) from Southern Germany aged 35-59 years.
Aims Limited data are available for European populations regarding the prevalence of diabetes and... more Aims Limited data are available for European populations regarding the prevalence of diabetes and disturbed glucose metabolism in younger individuals. Our aim was to estimate the prevalence of diagnosed and undiagnosed diabetes, isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT) and combined IFG ⁄ IGT in a population-based sample (n = 1653) from Southern Germany aged 35-59 years.
Reliable burden of disease (BOD) estimates are needed to support decision making in health care. ... more Reliable burden of disease (BOD) estimates are needed to support decision making in health care. The objective of this study was to introduce an analysis approach based on individual-level longitudinal survey data that estimates the burden of diabetes in patients with coronary heart disease in terms of quality-adjusted life-years (QALYs) lost. Data from two postal surveys (2006, N = 1022; 2010-2011, N = 716) of survivors from the KORA Myocardial Infarction Registry in Southern Germany were analyzed. Accumulated QALYs were calculated for each participant over a mean observation time of 4.1 years, considering the noninformative censoring structure of the follow-up study. Linear regression models were used to estimate the loss in (quality-unadjusted) life-years and QALYs between patients with and without diabetes, and generalized additive models were used to analyze the nonlinear association with age. The cross-sectional and longitudinal association with quality of life (QOL) and QOL change and the impact on mortality were analyzed to enhance the understanding of the observed results. Diabetes was associated with a reduced QOL at baseline (cross-sectional: β = -0.069; P < 0.001), but not with a significant longitudinal QOL change. Mortality in patients with diabetes was increased (hazard ratio = 1.68; P < 0.005). This resulted in a loss of 0.14 life-years (P = 0.003) and 0.37 QALYs (P < 0.001). Results from generalized additive models indicated that the burden of diabetes is less pronounced in older subjects. The application of the proposed approach provides confounder-adjusted BOD estimates for the studied time horizon and can be used to compare the BOD across different chronic conditions. Curative efforts are needed to diminish the substantial diabetes-related QALY gap.
Myocardial infarction (MI) is the main single cause of death in adult populations. For the MONICA... more Myocardial infarction (MI) is the main single cause of death in adult populations. For the MONICA Augsburg population, MI-morbidity, mortality, and 28-day case fatality and their determinants were assessed by gender, and suggestions for an intensified acute care program were presented. From 1985 to 1998, 13 499 25- to 74-year-old MI cases (9537 men, 3962 women) were registered; 7873 cases (5300 men, 2573 women) died within 28 days. Cardiac deaths were identified by regional health departments; causes of death were validated by the last treating physician and the coroner (response > 90 %). Hospitalized patients were interviewed about history and circumstances of the acute event; treatment data were abstracted from hospital charts. The prehospital phase, the first and the 2nd to 28thday after hospitalization were analyzed separately. MI-morbidity per 100 000 population declined from 560 to 397 MI cases in men and from 161 to 145 in women; mortality decreased from 317 to 232 in men and from 101 to 96 in women. The decline in men was due to decreasing incident and recurrent MI whereas in women it was only due to a reduction of recurrent MI. One third died before hospitalization, mainly at home. Case fatality (CF) on the first day in hospital increased. In 24 hour survivors, evidence based treatment increased considerably, and was accompanied by decreasing 28-day-CF from 13.0 % to 8.4 % in men, and from 12.5 % to 10.7 % in women. Aggressive risk factor management and education of patients with cardiovascular risk factors concerning acute symptoms and the use of the emergency system will consequently improve pre-hospital and 28-day survival of the population.
Although the population-based German disease management programs (DMPs) for diabetes mellitus (DM... more Although the population-based German disease management programs (DMPs) for diabetes mellitus (DM) and coronary heart disease (CHD) are among the biggest worldwide, evidence on the effectiveness of these programs is still inconclusive or missing, particularly for high risk patients with comorbidities. The objective of this study was therefore to analyze the impact of DMPs on process and outcome parameters in patients with both, type 2 DM and CHD. Analyses are based on two postal surveys of patients from the KORA myocardial infarction registry (southern Germany) with type 2 DM and on two postal validation studies with patients' general physicians (2006, n = 312 and 2011, n = 212). The association between DMP enrollment (being enrolled in either DMP-DM or DMP-CHD) and guideline care (defined by several process indicators) at baseline (2006) and its development until follow-up (2011) was analyzed using logistic regression models accounting for the repeated measurements structure. T...
Lower levels of hemoglobin A1c (HbA1c) are associated with a decreased risk of cardiovascular com... more Lower levels of hemoglobin A1c (HbA1c) are associated with a decreased risk of cardiovascular complications in diabetic and non-diabetic individuals. The aim of the study was to longitudinally investigate the association between the use of 11 vitamins and minerals (vitamins E, C, D, B1, folic acid, carotenoids, calcium, magnesium, zinc, iron, and selenium) and change in HbA1c levels over 10 years in non-diabetic individuals drawn from the general population. Baseline data were available from 4447 subjects included in the population-based "Monitoring of Trends and Determinants in Cardiovascular Diseases" (MONICA) Augsburg S3 survey (1994/95). Follow-up data were derived from 2774 participants in the follow-up survey named "Cooperative Health Research in the Region of Augsburg" (KORA) F3 (2004/05). Vitamin/mineral intake from supplements and medications was assessed in a personal interview, where participants were asked to bring product packages of preparations tha...
To examine the relationship between symptoms of insomnia and sleep duration and incident total (n... more To examine the relationship between symptoms of insomnia and sleep duration and incident total (non-fatal plus fatal) strokes, non-fatal strokes, and fatal strokes in a large cohort of men and women from the general population in Germany. In four population-based MONICA (monitoring trends and determinants in cardiovascular disease)/KORA (Cooperative Health Research in the Region of Augsburg) surveys conducted between 1984 and 2001, 17,604 men and women (aged 25 to 74 years) were asked about issues like sleep, health behavior, and medical history. In subsequent surveys and mortality follow-ups, incident stroke cases (cerebral hemorrhage, ischemic stroke, transient ischemic attack, unknown stroke type) were gathered prospectively until 2009. Sex-specific hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using sequential Cox proportional hazards regression models. During a mean follow-up of 14 years, 917 strokes (710 non-fatal strokes and 207 fatal strokes) were...
To examine the relationship between symptoms of insomnia and sleep duration and incident total (n... more To examine the relationship between symptoms of insomnia and sleep duration and incident total (non-fatal plus fatal) strokes, non-fatal strokes, and fatal strokes in a large cohort of men and women from the general population in Germany. In four population-based MONICA (monitoring trends and determinants in cardiovascular disease)/KORA (Cooperative Health Research in the Region of Augsburg) surveys conducted between 1984 and 2001, 17,604 men and women (aged 25 to 74 years) were asked about issues like sleep, health behavior, and medical history. In subsequent surveys and mortality follow-ups, incident stroke cases (cerebral hemorrhage, ischemic stroke, transient ischemic attack, unknown stroke type) were gathered prospectively until 2009. Sex-specific hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using sequential Cox proportional hazards regression models. During a mean follow-up of 14 years, 917 strokes (710 non-fatal strokes and 207 fatal strokes) were...
European journal of endocrinology / European Federation of Endocrine Societies, Jan 20, 2015
Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for fe... more Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for ferritin, evidence is sparse for other markers of iron metabolism which are regulated differently and might act through independent pathways. We therefore investigated the associations of serum ferritin, transferrin, soluble transferrin receptor (sTfR), transferrin saturation (TSAT), sTfR-to-log10ferritin (sTfR-F) index, and iron with impaired glucose metabolism (IGM / 'prediabetes'), type 2 diabetes, and four continuous glycemic traits. Data from 2,893 participants of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 study (Germany) was investigated through regression analysis. The results were adjusted for socio-demographic, life-style and obesity measures as well as metabolic, inflammatory and other iron biomarkers following a step-wise approach. Non-linearity was tested by adding a non-linear spline component to the model. Ferritin and transfe...
European journal of endocrinology / European Federation of Endocrine Societies, Jan 20, 2015
Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for fe... more Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for ferritin, evidence is sparse for other markers of iron metabolism which are regulated differently and might act through independent pathways. We therefore investigated the associations of serum ferritin, transferrin, soluble transferrin receptor (sTfR), transferrin saturation (TSAT), sTfR-to-log10ferritin (sTfR-F) index, and iron with impaired glucose metabolism (IGM / 'prediabetes'), type 2 diabetes, and four continuous glycemic traits. Data from 2,893 participants of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 study (Germany) was investigated through regression analysis. The results were adjusted for socio-demographic, life-style and obesity measures as well as metabolic, inflammatory and other iron biomarkers following a step-wise approach. Non-linearity was tested by adding a non-linear spline component to the model. Ferritin and transfe...
Some studies suggest that transitions to and from daylight saving time (DST) have an influence on... more Some studies suggest that transitions to and from daylight saving time (DST) have an influence on acute myocardial infarction (AMI) incidence. However, the available publications have a number of limitations e.g. regarding sample size, exclusion of fatal AMI cases, precise assessment of AMI onset, and consideration of possible confounders, and they were conducted in countries with different geographical location. The objective of this study was to examine the association of DST transitions with AMI incidence recorded in the population-based German MONICA/KORA Myocardial Infarction Registry. The study sample consisted of 25,499 coronary deaths and non-fatal AMI cases aged 25-74 years. We used Poisson regression with indicator variables for the 3 days or the week after the spring and the autumn transition and adjusted for potential confounders to model the association between DST transitions and AMI incidence. In addition, we built an excess model by calculating observed over expected...
Als Teil des WHO-MONICA-Projektes sind seit 1984/85 drei bevölkerungsrepräsentative Querschnittss... more Als Teil des WHO-MONICA-Projektes sind seit 1984/85 drei bevölkerungsrepräsentative Querschnittsstudien in der Region Augsburg durchgeführt worden, um die zeitlichen Trends der klassischen Risikofaktoren abzubilden. Im Rahmen von KORA wird die Bedeutung der untersuchten Parameter für die sich verändernde kardiovaskuläre Gesundheit erforscht. Für die MONI-CA-Surveys wurden drei voneinander unabhängige Zufallsstichproben rekrutiert (1984/85 S1: Alter 25-64 Jahre, 1989/90 S2: Alter 25-74 Jahre und 1994/95 S3: Alter 25-74 Jahre). Die nach Alter und Geschlecht stratifizierte 2-stufige Clusterstichprobe bestand aus einer Zufallsauswahl in der Stadt Augsburg und einer nach Wohnortgröße erfolgten zufälligen Auswahl von 16 Kommunen aus den beiden angrenzenden Landkreisen. Durch die Zufallsauswahl wurden einige Personen für mehr als einen Survey ausgewählt, weshalb sich für 13 427 Personen insgesamt 13 818 Studienteilnahmen ergaben. Von 1984 bis 1995 wurden bei Bluthochdruck keine Veränderungen beobachtet. Für Fettstoffwechselstörungen (Ratio von Gesamt-/HDL-Cholesterin ‡ 5,0) gab es Zunahmen um 15 % (Männer) bis 30 % (Frauen), während Zigarettenrauchen bei 55-bis 64-jährigen Männern ab-und bei 35-bis 64-jährigen Frauen zunahm. Die Risikoprädiktion für inzidente akute Myokardinfarkte je 100 000 Personenjahre ist am größten für das Zigarettenrauchen (Männer 880, Frauen 360), gefolgt von Blutfettstörungen (Männer 739, Frauen 318) und systolischen Blutdruckwerten größer oder
The American Journal of Human Genetics, May 13, 2011
Thyroid disorders such as goiters represent important diseases, especially in iodine-deficient ar... more Thyroid disorders such as goiters represent important diseases, especially in iodine-deficient areas. Sibling studies have demonstrated that genetic factors substantially contribute to the interindividual variation of thyroid volume. We performed a genome-wide association study of this phenotype by analyzing a discovery cohort consisting of 3620 participants of the Study of Health in Pomerania (SHIP). Four genetic loci were associated with thyroid volume on a genome-wide level of significance. Of these, two independent loci are located upstream of and within CAPZB, which encodes the b subunit of the barbed-end F-actin binding protein that modulates actin polymerization, a process crucial in the colloid engulfment during thyroglobulin mobilization in the thyroid. The third locus marks FGF7, which encodes fibroblast growth factor 7. Members of this protein family have been discussed as putative signal molecules involved in the regulation of thyroid development. The fourth locus represents a ''gene desert'' on chromosome 16q23, located directly downstream of the predicted coding sequence LOC440389, which, however, had already been removed from the NCBI database as a result of the standard genome annotation processing at the time that this study was initiated. Experimental proof of the formerly predicted mature mRNA, however, demonstrates that LOC440389 indeed represents a real gene. All four associations were replicated in an independent sample of 1290 participants of the KORA study. These results increase the knowledge about genetic factors and physiological mechanisms influencing thyroid volume.
The American Journal of Clinical Nutrition, Sep 1, 2006
Background: It remains controversial whether body mass index (BMI), waist circumference (WC), or ... more Background: It remains controversial whether body mass index (BMI), waist circumference (WC), or waist-hip ratio (WHR) is a better risk predictor of type 2 diabetes. Objective: The objective was to examine the sex-specific relevance of WC, WHR, and BMI to the development of type 2 diabetes. Design: The prospective population-based cohort study was based on 3055 men and 2957 women aged 35-74 y who participated in the second (1989 -1990) or third (1994 -1995) MONICA (Monitoring Trends and Determinants on Cardiovascular Diseases) Augsburg survey. The subjects were free of diabetes at baseline. Hazard ratios (HRs) were estimated from Cox proportional hazards models. Results: During a mean follow-up of 9.2 y, 243 cases of incident type 2 diabetes occurred in men and 158 occurred in women. Multivariable-adjusted HRs across quartiles of BMI were 1.0, 1.37, 2.08, and 4.15 in men and 1.0, 3.77, 4.95, and 10.58 in women; those of WC were 1.0, 1.15, 1.57, and 3.40 in men and 1.0, 3.21, 3.98, and 10.70 in women; those of WHR were 1.0, 1.14, 1.80, and 2.84 in men and 1.0, 0.82, 2.06, and 3.51 in women. In joint analyses, the highest risk was observed in men and women with a high BMI in combination with a high WC and a high WHR. Conclusions: Both overall and abdominal adiposity were strongly related to the development of type 2 diabetes. Because there was an additive effect of overall and abdominal obesity on risk prediction, WC should be measured in addition to BMI to assess the risk of type 2 diabetes in both sexes.
Aims Limited data are available for European populations regarding the prevalence of diabetes and... more Aims Limited data are available for European populations regarding the prevalence of diabetes and disturbed glucose metabolism in younger individuals. Our aim was to estimate the prevalence of diagnosed and undiagnosed diabetes, isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT) and combined IFG ⁄ IGT in a population-based sample (n = 1653) from Southern Germany aged 35-59 years.
Aims Limited data are available for European populations regarding the prevalence of diabetes and... more Aims Limited data are available for European populations regarding the prevalence of diabetes and disturbed glucose metabolism in younger individuals. Our aim was to estimate the prevalence of diagnosed and undiagnosed diabetes, isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT) and combined IFG ⁄ IGT in a population-based sample (n = 1653) from Southern Germany aged 35-59 years.
Reliable burden of disease (BOD) estimates are needed to support decision making in health care. ... more Reliable burden of disease (BOD) estimates are needed to support decision making in health care. The objective of this study was to introduce an analysis approach based on individual-level longitudinal survey data that estimates the burden of diabetes in patients with coronary heart disease in terms of quality-adjusted life-years (QALYs) lost. Data from two postal surveys (2006, N = 1022; 2010-2011, N = 716) of survivors from the KORA Myocardial Infarction Registry in Southern Germany were analyzed. Accumulated QALYs were calculated for each participant over a mean observation time of 4.1 years, considering the noninformative censoring structure of the follow-up study. Linear regression models were used to estimate the loss in (quality-unadjusted) life-years and QALYs between patients with and without diabetes, and generalized additive models were used to analyze the nonlinear association with age. The cross-sectional and longitudinal association with quality of life (QOL) and QOL change and the impact on mortality were analyzed to enhance the understanding of the observed results. Diabetes was associated with a reduced QOL at baseline (cross-sectional: β = -0.069; P < 0.001), but not with a significant longitudinal QOL change. Mortality in patients with diabetes was increased (hazard ratio = 1.68; P < 0.005). This resulted in a loss of 0.14 life-years (P = 0.003) and 0.37 QALYs (P < 0.001). Results from generalized additive models indicated that the burden of diabetes is less pronounced in older subjects. The application of the proposed approach provides confounder-adjusted BOD estimates for the studied time horizon and can be used to compare the BOD across different chronic conditions. Curative efforts are needed to diminish the substantial diabetes-related QALY gap.
Myocardial infarction (MI) is the main single cause of death in adult populations. For the MONICA... more Myocardial infarction (MI) is the main single cause of death in adult populations. For the MONICA Augsburg population, MI-morbidity, mortality, and 28-day case fatality and their determinants were assessed by gender, and suggestions for an intensified acute care program were presented. From 1985 to 1998, 13 499 25- to 74-year-old MI cases (9537 men, 3962 women) were registered; 7873 cases (5300 men, 2573 women) died within 28 days. Cardiac deaths were identified by regional health departments; causes of death were validated by the last treating physician and the coroner (response > 90 %). Hospitalized patients were interviewed about history and circumstances of the acute event; treatment data were abstracted from hospital charts. The prehospital phase, the first and the 2nd to 28thday after hospitalization were analyzed separately. MI-morbidity per 100 000 population declined from 560 to 397 MI cases in men and from 161 to 145 in women; mortality decreased from 317 to 232 in men and from 101 to 96 in women. The decline in men was due to decreasing incident and recurrent MI whereas in women it was only due to a reduction of recurrent MI. One third died before hospitalization, mainly at home. Case fatality (CF) on the first day in hospital increased. In 24 hour survivors, evidence based treatment increased considerably, and was accompanied by decreasing 28-day-CF from 13.0 % to 8.4 % in men, and from 12.5 % to 10.7 % in women. Aggressive risk factor management and education of patients with cardiovascular risk factors concerning acute symptoms and the use of the emergency system will consequently improve pre-hospital and 28-day survival of the population.
Although the population-based German disease management programs (DMPs) for diabetes mellitus (DM... more Although the population-based German disease management programs (DMPs) for diabetes mellitus (DM) and coronary heart disease (CHD) are among the biggest worldwide, evidence on the effectiveness of these programs is still inconclusive or missing, particularly for high risk patients with comorbidities. The objective of this study was therefore to analyze the impact of DMPs on process and outcome parameters in patients with both, type 2 DM and CHD. Analyses are based on two postal surveys of patients from the KORA myocardial infarction registry (southern Germany) with type 2 DM and on two postal validation studies with patients' general physicians (2006, n = 312 and 2011, n = 212). The association between DMP enrollment (being enrolled in either DMP-DM or DMP-CHD) and guideline care (defined by several process indicators) at baseline (2006) and its development until follow-up (2011) was analyzed using logistic regression models accounting for the repeated measurements structure. T...
Lower levels of hemoglobin A1c (HbA1c) are associated with a decreased risk of cardiovascular com... more Lower levels of hemoglobin A1c (HbA1c) are associated with a decreased risk of cardiovascular complications in diabetic and non-diabetic individuals. The aim of the study was to longitudinally investigate the association between the use of 11 vitamins and minerals (vitamins E, C, D, B1, folic acid, carotenoids, calcium, magnesium, zinc, iron, and selenium) and change in HbA1c levels over 10 years in non-diabetic individuals drawn from the general population. Baseline data were available from 4447 subjects included in the population-based "Monitoring of Trends and Determinants in Cardiovascular Diseases" (MONICA) Augsburg S3 survey (1994/95). Follow-up data were derived from 2774 participants in the follow-up survey named "Cooperative Health Research in the Region of Augsburg" (KORA) F3 (2004/05). Vitamin/mineral intake from supplements and medications was assessed in a personal interview, where participants were asked to bring product packages of preparations tha...
To examine the relationship between symptoms of insomnia and sleep duration and incident total (n... more To examine the relationship between symptoms of insomnia and sleep duration and incident total (non-fatal plus fatal) strokes, non-fatal strokes, and fatal strokes in a large cohort of men and women from the general population in Germany. In four population-based MONICA (monitoring trends and determinants in cardiovascular disease)/KORA (Cooperative Health Research in the Region of Augsburg) surveys conducted between 1984 and 2001, 17,604 men and women (aged 25 to 74 years) were asked about issues like sleep, health behavior, and medical history. In subsequent surveys and mortality follow-ups, incident stroke cases (cerebral hemorrhage, ischemic stroke, transient ischemic attack, unknown stroke type) were gathered prospectively until 2009. Sex-specific hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using sequential Cox proportional hazards regression models. During a mean follow-up of 14 years, 917 strokes (710 non-fatal strokes and 207 fatal strokes) were...
To examine the relationship between symptoms of insomnia and sleep duration and incident total (n... more To examine the relationship between symptoms of insomnia and sleep duration and incident total (non-fatal plus fatal) strokes, non-fatal strokes, and fatal strokes in a large cohort of men and women from the general population in Germany. In four population-based MONICA (monitoring trends and determinants in cardiovascular disease)/KORA (Cooperative Health Research in the Region of Augsburg) surveys conducted between 1984 and 2001, 17,604 men and women (aged 25 to 74 years) were asked about issues like sleep, health behavior, and medical history. In subsequent surveys and mortality follow-ups, incident stroke cases (cerebral hemorrhage, ischemic stroke, transient ischemic attack, unknown stroke type) were gathered prospectively until 2009. Sex-specific hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using sequential Cox proportional hazards regression models. During a mean follow-up of 14 years, 917 strokes (710 non-fatal strokes and 207 fatal strokes) were...
European journal of endocrinology / European Federation of Endocrine Societies, Jan 20, 2015
Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for fe... more Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for ferritin, evidence is sparse for other markers of iron metabolism which are regulated differently and might act through independent pathways. We therefore investigated the associations of serum ferritin, transferrin, soluble transferrin receptor (sTfR), transferrin saturation (TSAT), sTfR-to-log10ferritin (sTfR-F) index, and iron with impaired glucose metabolism (IGM / 'prediabetes'), type 2 diabetes, and four continuous glycemic traits. Data from 2,893 participants of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 study (Germany) was investigated through regression analysis. The results were adjusted for socio-demographic, life-style and obesity measures as well as metabolic, inflammatory and other iron biomarkers following a step-wise approach. Non-linearity was tested by adding a non-linear spline component to the model. Ferritin and transfe...
European journal of endocrinology / European Federation of Endocrine Societies, Jan 20, 2015
Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for fe... more Iron has been suggested to play a role in the etiology of type 2 diabetes mellitus. Except for ferritin, evidence is sparse for other markers of iron metabolism which are regulated differently and might act through independent pathways. We therefore investigated the associations of serum ferritin, transferrin, soluble transferrin receptor (sTfR), transferrin saturation (TSAT), sTfR-to-log10ferritin (sTfR-F) index, and iron with impaired glucose metabolism (IGM / 'prediabetes'), type 2 diabetes, and four continuous glycemic traits. Data from 2,893 participants of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 study (Germany) was investigated through regression analysis. The results were adjusted for socio-demographic, life-style and obesity measures as well as metabolic, inflammatory and other iron biomarkers following a step-wise approach. Non-linearity was tested by adding a non-linear spline component to the model. Ferritin and transfe...
Some studies suggest that transitions to and from daylight saving time (DST) have an influence on... more Some studies suggest that transitions to and from daylight saving time (DST) have an influence on acute myocardial infarction (AMI) incidence. However, the available publications have a number of limitations e.g. regarding sample size, exclusion of fatal AMI cases, precise assessment of AMI onset, and consideration of possible confounders, and they were conducted in countries with different geographical location. The objective of this study was to examine the association of DST transitions with AMI incidence recorded in the population-based German MONICA/KORA Myocardial Infarction Registry. The study sample consisted of 25,499 coronary deaths and non-fatal AMI cases aged 25-74 years. We used Poisson regression with indicator variables for the 3 days or the week after the spring and the autumn transition and adjusted for potential confounders to model the association between DST transitions and AMI incidence. In addition, we built an excess model by calculating observed over expected...
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Papers by Margit Heier