BACKGROUND:Although Sweden and Canada are high-income countries with similar social structures, obesity prevalence is significantly higher in Canada. This study explored country-specific differences in the association between socioeconomic and behavioural risk factors for obesity in Sweden and Canada, using data from the Prospective Urban Rural Epidemiological (PURE) study. METHODS:This cross-sectional study included 9 790 adults aged 34-60 years from Canada (n = 6 652, 55% women) and Sweden (n = 3 138, 54% women). The Boruta algorithm was used to identify relevant factors that were associated with obesity among individual with normal weight (body mass index [BMI]: 18.5-<25 kg/m2) compared to individuals with obesity (BMI > 30 kg/m2). Logistic regression models with 95% confidence intervals (CI) estimated odds ratios (OR) of obesity by country in relation to selected risk factors for obesity. RESULTS:More Canadians than Swedes had obesity (26 vs. 16%, p-value: <0.001). Ultra-processed food (UPF) and the Alternative Healthy Eating Index (AHEI-2010) score were identified as the main drivers of obesity risk. The highest UPF intake group was strongly associated with obesity in both Canada (OR = 2.31 [CI = 1.57-3.37]) and Sweden (OR = 2.83 [CI = 2.30-3.49]). Canadian men had higher UPF intake and were found to have a significantly higher risk of obesity (p for interaction: 0.032 and 0.021 for middle and highest tertiles), compared to Swedish males. Among women, low socioeconomic status (rural residence (OR = 2.30 [CI = 1.66-3.17] vs. OR = 1.42 [CI = 1.19-1.70]), low income (OR = 4.75 [CI = 2.71-8.95] vs. OR = 2.62 [CI = 2.16-3.18]), not working (OR = 2.24 [CI = 1.51-3.29] vs. OR = 1.32 [CI = 1.07-1.63]), and unskilled occupation (OR = 5.08 [CI = 3.05-8.45] vs. OR = 1.78 [CI = 1.38-2.28]) was more strongly associated with obesity in Sweden than in Canada. CONCLUSIONS:This study highlights important differences in obesity-related risk factors between Sweden and Canada. UPF consumption, the AHEI-2010 score and socioeconomic disadvantage emerged as key drivers of obesity, with notable sex- and country-specific patterns. These findings underscore the importance of tailored, context-specific public health strategies to address obesity in different national settings.

Participation in exercise-based cardiac rehabilitation (ExCR) lowers hospitalisation risk in people with coronary heart disease. We investigated whether improvements in health-related quality of life (HRQoL), including physical and mental dimensions, mediated the effect of ExCR on hospitalisation risk in people with coronary heart disease. Individual participant data from five randomised controlled trials were pooled, which randomized participants to ExCR or usual care. All trials had to be published since 2010 to reflect contemporary medicine. A one-stage meta-analysis was performed to assess whether changes in HRQoL, including physical and mental dimensions, mediated the effect of ExCR on all-cause and cardiovascular disease (CVD)-related hospitalisation risk. HRQoL was assessed before and directly following the intervention period, and preceded hospitalisation assessments at 1- and 2-year follow-up. Compared to controls (n = 1,986), ExCR (n = 1,973) did not reduce 1-year, but significantly reduced 2-year all-cause (hazard ratio [HR] 0.72, 95

AIMS:The effectiveness of exercise-based cardiac rehabilitation (ExCR) for coronary heart disease (CHD) has been debated during the past decade. The objectives of the Cardiac Rehabilitation Meta-Analysis of Trials in people with CHD using individual participant data (IPD) (CaReMATCH) study were to (i) provide contemporary estimates on the effectiveness of ExCR for CHD and (ii) examine potential differential effects of ExCR across subgroups. METHODS AND RESULTS:Individual participant data from randomized controlled trials comparing ExCR with no ExCR controls were pooled. To reflect contemporary ExCR practice, trials had to be published since 2010. The outcomes of all-cause and cardiovascular disease (CVD)-related mortality and hospitalization and health-related quality of life (HRQoL) were analysed. From 30 eligible trials (10 677 participants), IPD were obtained from eight trials (4975 participants, 93.5% post-myocardial infarction). Compared with controls, participation in ExCR resulted in a lower risk for all-cause [hazard ratio (HR) 0.68, 95% confidence interval (CI): 0.53, 0.87] and CVD-related hospitalization (HR 0.62, 95% CI: 0.47, 0.83) and higher HRQoL up to 12 months of follow-up (mean difference in utility index: 0.032, 95% CI: 0.003, 0.061). No differences were found in all-cause and CVD mortality (HR 0.99, 95% CI: 0.74, 1.32; HR 0.80, 95% CI: 0.32, 2.04, respectively). Subgroup analyses showed stronger improvements of HRQoL with ExCR in people with lower HRQoL and lower education level and larger reductions in hospitalization risk in those with a lower left ventricular ejection fraction, lower baseline exercise capacity, beta-blockers use, and with a previous history of CVD. No other subgroup effects were observed. CONCLUSION:Our IPD meta-analysis, reflecting trials published since 2010, highlighted that contemporary ExCR is effective in reducing risk of hospitalization and improving HRQoL in those with CHD. Importantly, we reveal treatment benefits to be robust and consistent across most participant subgroups. Together, these data support the class I recommendation of international clinical guidelines that ExCR should be offered to all people with CHD. REGISTRATION:PROSPERO: CRD42020204988.

BACKGROUND:Air pollution is a risk factor for dementia, but its role in early cognitive dysfunction is not clear. We aimed to investigate the association of air pollution with cognitive function, and the role of cardiovascular risk factors and greenspace in this association. METHODS:The CAHHM (Canadian Alliance for Healthy Hearts and Minds Cohort Study) is a cohort of Canadian adults recruited between 2014 and 2018, for whom averages of exposures to NO2 and fine particulate matter were estimated for 5 years before recruitment. Outcomes included the Montréal Cognitive Assessment and Digit Symbol Substitution Test for cognitive function, and magnetic resonance imaging-measured covert vascular brain injury. Generalized linear mixed models assessed pollutant associations with outcomes in this cross-sectional analysis. RESULTS:A total of 6878 adults participated in the study, with a mean age of 57.6 years (SD=8.8), and 55.6% were women. Mean (SD; range) 5-year pollutant concentrations preceding enrollment for fine particulate matter were 6.9 μg/m3 (2.0 [1.8-11.2]), and for NO2 were 12.9 parts per billion (5.9 [0.9-33.9]). In adjusted models, a 5 μg/m3 higher fine particulate matter concentration was associated with 0.44 points lower Montréal Cognitive Assessment (95% CI, -0.62 to -0.25) and 1.31 points lower Digit Symbol Substitution Test (95% CI, -2.41 to -0.22) scores. A 5 parts per billion higher NO2 concentration was associated with 0.12 points lower Montréal Cognitive Assessment (95% CI, -0.17 to -0.07) and 0.38 points lower Digit Symbol Substitution Test (95% CI, -0.70 to -0.05) scores. A 5 parts per billion higher NO2 concentration was associated with higher odds of covert vascular brain injury (adjusted odds ratio, 1.08 [95% CI, 1.00-1.17]). Cardiovascular risk factors and greenspace did not change these associations. CONCLUSIONS:Fine particulate matter and NO2 were associated with lower cognitive function scores in middle-aged adults living in Canada, independent of cardiovascular risk factors. Our results warrant longitudinal follow-up to study the impact of air pollution on cognitive decline.

Abstract Context Accurate assessment of excess body fat and its cardiometabolic risk is essential in clinical and epidemiologic research. Body mass index (BMI), although widely used, does not capture visceral or ectopic fat. Objective To evaluate how anthropometric measures—BMI, percent body fat, waist circumference (WC), and waist-to-hip ratio (WHR)—relate to MRI-measured visceral adipose tissue (VAT) and hepatic fat fraction (HFF), overall and by sex. Design Cross-sectional analysis within the Canadian Alliance for Healthy Heart and Minds (CAHHM) cohort. Setting Community-based, pan-Canadian prospective study. Patients or Other Participants 6,683 apparently healthy adults (mean age 57±9 years; 3,665 females) with baseline anthropometric and MRI measures; analyses adjusted for study center. Intervention(s) Not applicable. Main Outcome Measure(s) MRI-derived VAT and HFF. Associations were estimated using linear regression and mixed models, stratified by sex, ethnicity, age, and BMI category. Results . Mean BMI was 26.7 kg/m2, WC 88.3 cm, VAT 71 mL, and HFF 5.7%. Females had lower VAT and HFF than males. Correlations with VAT ranged from 0.35–0.77 and with HFF from 0.26–0.47. Each 10-cm higher WC was associated with 21.0 mL higher VAT and 2.1% higher HFF; each 5-kg/m2 higher BMI predicted 24.7 mL and 2.8% higher values. When modeled jointly, WC remained strongly predictive, while BMI contributed modestly. Associations were smaller in females. VAT and HFF increased across WC tertiles within BMI categories. Conclusions . WC is a robust surrogate for visceral and hepatic fat across BMI categories, supporting its use when MRI is not feasible.

Abstract As recreational running grows in popularity, the concepts of runnability and runnable cities have emerged as important dimensions of urban livability. This study examined the environmental characteristics of Vancouver's most popular running routes to determine what makes a city runnable. Using Strava data, the most frequented running trajectories were identified through linear hotspot discovery. In‐person audits assessed environmental correlates of runnability along these routes, guided by an environmental scan instrument developed from a comprehensive literature review. This mixed‐method approach provided qualitative, on‐the‐ground insight into how runners experience and perceive runnable environments. This supports previous suggestions that nuanced, subjective observations are critical to capturing the complexity of runnability. Findings indicate correlates along popular routes largely align with emerging literature highlighting a strong preference for greenspaces over urban streetscapes. However, several findings diverged: bike‐only segments were heavily used despite literature suggesting cyclists deter runners; stairs and ramps were common despite the presumed preference for flat terrain; and wildlife encounters did not substantially influence route choice. Novel findings indicate that dedicated paths integrating natural features into the built environment, as well as dog off‐leash areas, contribute strongly to urban runnability.

BACKGROUND:Prolonged sedentary time is associated with adverse outcomes, but evidence in low-exposure ranges remains limited. The health effects of reallocating time between sitting, physical activity, and sleep have not been comprehensively examined. METHODS:We analyzed 41,733 adults (mean age = 50.6 years) from the Prospective Urban Rural Epidemiology (PURE)-China cohort, recruited between 2005 and 2009 and followed for a median of 11.9 years. Sitting, physical activity, and sleep were assessed using validated questionnaires. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty and isotemporal substitution models were applied. RESULTS:Median sitting time was 3.0 h/day (interquartile range (IQR): 1.7-4.6). Sitting showed a J-shaped association with outcomes, with lowest risk around 4 h/day. Both low (<2 h/day) and high (≥6 h/day) sitting were associated with higher risk. Among participants sitting ≥4 h/day, replacing 30 min of sitting with physical activity was associated with a 3%-4% lower risk of the composite outcome, with stronger associations observed for all-cause mortality (6%-7%). In contrast, among those sitting <4 h/day, reallocating 30 min of physical activity or prolonged sleep to sitting was associated a 4%-6% lower risk of the composite outcome and a 4%-10% lower risk of all-cause mortality. CONCLUSION:Sitting time demonstrates context-dependent associations with health. The finding that moderate sitting was protective in highly active individuals reflects a potential "sitting paradox". Our study highlights the bidirectional effects of reallocating sitting, activity, and sleep, underscoring the need for more context-specific guidance.

High-income countries like Canada have the highest self-reported levels of life satisfaction in the world, although little is known regarding the experiences of racialized people and immigrants to these countries. This study investigates the factors that influence subjective well-being among a large national cohort study of 8,063 adults from the Canadian Alliance of Healthy Hearts and Minds cohort study recruited between 2014 and 2018, including a subset of 2,142 immigrants. Measures of demographic, socioeconomic, health, healthcare access, and self-reported ethnicity, from which racialized status was derived, were investigated in relation to self-reported life satisfaction as measured by the validated Cantril ladder score. Among 8,063 adults average age of 58 years, approximately half were women, 18.6% were racialized, and 26.6% were immigrants. Racialized immigrants had significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born persons, whether racialized or not. Multivariable analysis showed that factors associated with higher life satisfaction included older age, male sex, having trusted neighbours, and having a language-concordant family doctor. Factors associated with lower life satisfaction included being racialized, having a higher social disadvantage, poorer cardiovascular health, and being unable to afford prescription medications. Amongst immigrants, those racialized were more likely to report experiencing discrimination based on skin colour and reported lower life satisfaction. Although high income countries like Canada have amongst the highest life satisfaction scores in the world, racialized people, especially immigrants, have lower life satisfaction compared to non-racialized people. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement CAHHM was funded by the Canadian Partnership Against Cancer (CPAC), Heart and Stroke Foundation of Canada (HSF-Canada), and the Canadian Institutes of Health Research (CIHR). Financial contributions were also received from the Population Health Research Institute and CIHR Foundation Grant no. FDN-143255 to S.S.A.; FDN-143313 to J.V.T.; and FDN 154317 to E.E.S. In-kind contributions from A.R.M. and S.E.B. from Sunnybrook Hospital, Toronto for MRI reading costs, and Bayer AG for provision of IV contrast. The Canadian Partnership for Tomorrow's Health is supported by the Canadian Partnership Against Cancer, BC Cancer, Genome Quebec, Centre de recherche CHU Sainte-Justine, Ontario Institute for Cancer Research, Alberta Health, Alberta Cancer Foundation, Alberta Health Services, and Dalhousie University. The PURE Study was funded by multiple sources. The Montreal Heart Institute Biobank is funded by Mr Andre Desmarais and Mrs France Chretien-Desmarais and the Montreal Heart Institute Foundation. S.S.A. was supported by the Heart and Stroke Foundation Chair in Population Health. S.A.L is supported by the Pfizer/Heart & Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul's Hospital. P.A. was supported by a Ministry of Research and Innovation of Ontario Investigator Award. S.E.B. was supported by the Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, and the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto. E.L. was supported by the Laval University Chair of Research & Innovation in Cardiovascular Imaging and the Fonds de recherche du Quebec-Sante. J.-C.T. holds the Tier 1 Canada Research Chair in translational and personalized medicine and the Universite de Montreal Pfizer endowed research chair in atherosclerosis. CG is supported by grants from the Swiss National Science Foundation (SNSF, # PP00P3\_163892 and # PP00P3\_190074), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, the Swissheart Foundation, the Helmut Horten Foundation, Switzerland, the University Hospital Zurich (USZ) Foundation, the Iten-Kohaut Foundation, Switzerland, and the EMDO Foundation, Switzerland. Some of the data used in this research were made available by the Canadian Partnership for Tomorrow's Health along with BC Generations Project, Alberta's Tomorrow Project, Ontario Health Study, CARTaGENE, and the Atlantic PATH. Data were harmonized by Maelstrom Research and access policies and procedures were developed by the Centre of Genomics and Policy in collaboration with the Cohorts. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Hamilton Integrated Research Ethics Board gave ethical approval for this work (HiREB #13-255). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying this article will be shared on reasonable request to the corresponding author.

Following a primary cardiovascular disease (CVD) event, patients with established Coronary Heart Disease (CHD) remain at high risk for secondary CVD events and related mortality. However, this risk is reduced by secondary prevention therapies (comprising medication and lifestyle approaches), with an absolute reduc-tion in CVD events being directly related to risk factor control. Unfortunately, adherence to secondary pre-vention therapies remains poor. Text Message Interventions (TMIs) using short message service (SMS) may have a role in improving cardiovascular medication adherence, particularly owing to their simplicity, accessi-bility and scalability as compared to other approaches. To determine the effect of TMIs on cardiovascular medication among CHD patients, using a pooled analysis of individual patient data (IPD) from randomised clinical trials (RCTs). Eligible RCTs were identified via systematic review and their corresponding authors were invited to submit IPD for a pooled analysis. Eligible RCTs included participants diagnosed with CHD prior to the intervention and used TMIs to provide participants with educational information. Control groups comprised standard care. The primary outcome was cardiovascular medication adherence (yes/no), and the secondary outcomes were defined as: LDL < 70mg/dL, blood pressure < 140/90, BMI < 25kg/m2, physical activity guideline met, smoking status (current vs never/previous). Of 21 eligible RCTs, IPD was available from five studies totalling 3488 trial participants (Table 1). IPD analysis found no statistically significant association between the use of TMIs and medication adherence (odds ratio (OR): 1.17, 95% CI: 0.67-2.07, p=0.576); LDL targets (OR: 1.05, 95% CI: 0.89-1.23, p=0.6); blood pressure targets (OR: 0.92, 95% CI: 0.71-1.2, p=0.6); and, smoking status (OR: 0.96, 95% CI: 0.73-1.25, p=0.7). However, there was a statistically significant association between the use of TMIs and BMI targets (OR: 1.39, 95% CI: 1.1-1.75, p=0.006), and meeting physical activity guidelines (OR: 1.94, 95% CI: 1.12-3.34, p=0.017). Interaction analysis revealed that TMIs had a greater effect on adherence in men (OR: 1.12, 95% CI: 0.95-1.31) than in women (OR: 0.72, 95% CI: 0.57-0.93, p=0.015). Prediction analysis revealed that fe-male participants (OR: 0.66, 95% CI: 0.49, 0.88) and retired participants (OR:0.41, 95% CI: 0.31, 0.55) were significantly less likely to adhere to the prescribed medication regimen. Having a partner (OR: 1.31, 95% CI: 1.02, 1.68) and being on more medications (OR: 1.44, 95% CI: 1.34, 1.55) were positively associated with medication adherence. While the statistical significance of TMIs effect on medication adherence remains uncertain, this analysis cor-roborated prior studies findings’ on the factors determining adherence, including gender, employment sta-tus, and marital status. Process evaluation with realist approaches might better elucidate the role of these factors. However, heterogeneity in adherence measures between studies was an issue in this and several pri-or metanalyses that should be addressed in future work.

High-income countries like Canada report some of the worlds' highest life-satisfaction levels, yet less is known about how life satisfaction varies by race and immigration status. This study investigates the factors that influence subjective well-being among 8,063 adults from the Canadian Alliance of Healthy Hearts and Minds study recruited between 2014 and 2018, including a subset of 2,142 immigrants. Measures of demographic, socioeconomic, health, healthcare access, and self-reported ethnicity were investigated in relation to self-reported life satisfaction as measured by the validated Cantril ladder score in which people were classified as suffering [1-4], struggling [5-6], or thriving [7-10]. Among 8,063 adults, approximately half were women, 18.6% were racialized, and 26.6% were immigrants. The mean life satisfaction score was 7.2 (1.4), with 71% classified as thriving. However racialized immigrants reported significantly lower life satisfaction than Canadian born non-racialized participants [6.6 (1.6) vs 7.2 (1.4); P < 0.001, and a lower proportion were classified as thriving [57% vs 73%]. In the overall sample, multivariable linear regression showed higher life satisfaction was associated with older age, male sex, having trusted neighbours, and having a language-concordant family doctor. Lower life satisfaction was associated with social disadvantage, being female, having poorer cardiovascular health, being unable to afford prescription medications, seeking care in an emergency department, and being racialized. Amongst the subset of immigrants, the life satisfaction associated factors were directionally consistent and racialized immigrants reported lower life satisfaction due to discrimination based on skin colour. Although Canada has amongst the highest life-satisfaction scores globally, the average masks persistent inequities as racialized people (especially racialized immigrants) have lower life satisfaction than non-racialized people. The findings highlight actionable levers-language-concordant primary care attachment, affordable medications, neighbourhood trust, and improved cardiometabolic health-that can be targeted to close the observed well-being gap.

Visceral adipose tissue (VAT) and hepatic fat (HF) contribute to multiple health risks, including diabetes, hypertension, cardiovascular disease, cognitive decline, and cancer. The objective of this study is to determine whether VAT and HF are associated with carotid atherosclerosis beyond traditional cardiovascular risk factors. Participants in the Canadian Alliance of Healthy Hearts and Minds (CAHHM) cohort study (n = 6760; average age= 57.1; 54.9

It is unclear whether variation in covert cerebrovascular disease prevalence is attributable to ethnic differences or to other factors. We aimed to examine the associations of country of residence with covert vascular brain injury (VBI) and cognitive dysfunction among Chinese adults residing in Canada and China. This was a multisite cross-sectional study of Chinese adults aged 40-80 years in the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM; January 1, 2014, to December 31, 2018) and Prospective Urban Rural Epidemiological-Mind (PURE-MIND; November 1, 2010, to July 31, 2015) cohorts living in Canada and China. The exposure was country of residence. The co-primary outcomes were covert VBI (defined as MRI findings of high white matter hyperintensities or covert brain infarct) and cognitive dysfunction (defined as a Montreal Cognitive Assessment [MoCA] score <26). We used generalized linear models to describe the association between country of residence and each outcome, adjusting for selected covariates. We included 884 adults living in Canada (mean age 57.3 years, 55.4% female) and 473 living in China (mean age 56.8 years, 60.3% female). Participants in Canada had a lower prevalence of covert VBI (age 65-79 years: male, 11.5%; female, 12.2%) than those living in China (age 65-79 years: male, 62.9%; female, 52.1%). Prevalence of MoCA score <26 was lower among men and women in Canada (age 65-79 years: 40.2% and 30.0%, respectively) than among men and women in China (age 65-79 years: 74.3% and 79.2%). Living in China was associated with a 6-fold increase in the odds of covert VBI (5.85, 4.06-8.45), which remained significant after covariate adjustment. Living in China was associated with a 7-fold increase in the odds of MoCA score <26 (6.98, 5.38-9.04), which was no longer significant after covariate adjustment. Despite sharing a similar ethnicity, the prevalence of covert VBI and cognitive dysfunction varied substantially by country of residence. Disparities in cognitive dysfunction were completely explained by differences in education and traditional cerebrovascular risk factors, whereas disparities in covert VBI prevalence were only partially explained by differences in such factors, suggesting a role for other environmental factors.

Rationale: Despite increasing complexity and disease severity of critical illness admissions to the intensive care unit (ICU), more people are surviving critical illness than in previous decades; however, post intensive care mortality remains high. There are currently no prognostic tools that are used to predict long-term outcomes in post-ICU survivors. Functional status, a measure of an individual's physical independence, is used prognostically to inform clinical decision making in diseases with high risk of long-term mortality, such as cardiorespiratory diseases and cancer. Thus, the purpose of this study was to investigate the prognostic significance of ICU functional status to predict long-term mortality in critical illness survivors. Methods: Using a retrospective design, functional status measured daily in patients who were in the ICU at St. Paul's Hospital in Vancouver, B.C. between 2019-2022 were collected. Patients were classified as having a high peak ICU functional status (i.e., standing or walking; n=311) or a low peak functional status (peak mobility of awake but supine; n=328). Patients were excluded if they were admitted to the ICU for <48 hours and if there were multiple admissions for an individual, only the index admission was included. Kaplan Meier estimates were performed to determine the independent association between functional status and survival. A multivariable cox proportional model was used to determine risk of all-cause mortality with adjustment for important covariates such as age, ICU length of stay, disease severity at ICU entry (APACHE II score), length of mechanical ventilation, the use of vasoactive drugs, and the presence of delirium. Results: There was a total of 2584 admissions to the ICU between 2019-2022. Of those, 311 were classified as having a high functional status and 328 as having low functional status. Median follow-up time was 24 months; 244 deaths were reported during this period. High ICU functional status was an independent predictor of overall survival in the Kaplan Meier analysis (p=0.024). Compared with low ICU functional status, the adjusted Hazard Ratio (HR) for all-cause mortality was 0.76 (CI, 0.58-0.9) for the high functional status group. Conclusions: Peak ICU functional status predicts long-term survival probability. Individuals with high ICU functional status experience a significantly lower risk of mortality after ICU discharge.

AIMS:This study aims to assess aspects of health knowledge: i) awareness of health effect of tobacco smoking and ii) awareness of preventive actions for heart disease and stroke, and their relationships with adoption of heart healthy behaviours (smoking cessation and utilisation of antihypertensive treatment). METHODS:In this multi-cohort study, we recruited adults aged 35 to 70 years from 21 countries. Data on health effects of tobacco smoking (10 questions) and health actions to prevent heart disease or stroke (11 questions) were collected at baseline. Logistic regression analyses were used to examine the relationship with the outcomes of smoking cessation and use of antihypertensive treatment adjusting for adjusting for possible confounders. RESULTS:Of the 12,962 included in the descriptive analysis, 50.0% were female, 42.9% had no or primary education, and 53.3 % were residing in low or lower middle-income country. Among current and former smokers, having knowledge of health effect of tobacco smoking on heart disease [Adjusted Odds Ratio (aOR): 1.70, 95% CI: 1.19, 2.43)], stroke (1.41, 1.08,1.86), and on heart disease in non-smokers exposed to others smoking (1.40, 1.06,1.86) were significantly and positively associated with smoking cessation compared to those who were not aware of health effects. Knowledge of the importance of reducing dietary salt aOR 1.62 (1.23,2.13), dietary fat aOR 1.56 (1.17,2.08) and exercising more aOR 1.48 (1.22,1.80) to prevent heart disease or stroke were positively associated with taking anti-hypertensive medication compared to those who were not aware of preventative actions. CONCLUSION:This study reinforces that better health knowledge shapes adoption of heart healthy behaviours such as smoking cessation and taking anti-hypertensive treatment even after accounting for baseline education and wealth.

[This corrects the article DOI: 10.1371/journal.pgph.0003490.].

BACKGROUND AND OBJECTIVE:It is unclear whether variation in covert cerebrovascular disease prevalence is attributable to ethnic differences or to other factors. We aimed to examine the associations of country of residence with covert vascular brain injury (VBI) and cognitive dysfunction among Chinese adults residing in Canada and China. METHODS:This was a multisite cross-sectional study of Chinese adults aged 40-80 years in the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM; January 1, 2014, to December 31, 2018) and Prospective Urban Rural Epidemiological-Mind (PURE-MIND; November 1, 2010, to July 31, 2015) cohorts living in Canada and China. The exposure was country of residence. The co-primary outcomes were covert VBI (defined as MRI findings of high white matter hyperintensities or covert brain infarct) and cognitive dysfunction (defined as a Montreal Cognitive Assessment [MoCA] score <26). We used generalized linear models to describe the association between country of residence and each outcome, adjusting for selected covariates. RESULTS:We included 884 adults living in Canada (mean age 57.3 years, 55.4% female) and 473 living in China (mean age 56.8 years, 60.3% female). Participants in Canada had a lower prevalence of covert VBI (age 65-79 years: male, 11.5%; female, 12.2%) than those living in China (age 65-79 years: male, 62.9%; female, 52.1%). Prevalence of MoCA score <26 was lower among men and women in Canada (age 65-79 years: 40.2% and 30.0%, respectively) than among men and women in China (age 65-79 years: 74.3% and 79.2%). Living in China was associated with a 6-fold increase in the odds of covert VBI (5.85, 4.06-8.45), which remained significant after covariate adjustment. Living in China was associated with a 7-fold increase in the odds of MoCA score <26 (6.98, 5.38-9.04), which was no longer significant after covariate adjustment. DISCUSSION:Despite sharing a similar ethnicity, the prevalence of covert VBI and cognitive dysfunction varied substantially by country of residence. Disparities in cognitive dysfunction were completely explained by differences in education and traditional cerebrovascular risk factors, whereas disparities in covert VBI prevalence were only partially explained by differences in such factors, suggesting a role for other environmental factors.

BACKGROUND:Vigorous intermittent lifestyle physical activity (VILPA) refers to brief bouts of intense physical activity embedded into daily life. OBJECTIVE:To examine sex differences in the dose-response association of VILPA with major adverse cardiovascular events (MACE) and its subtypes. METHODS:Using multivariable-adjusted cubic splines, we examined the associations of daily VILPA duration with overall MACE and its subtypes (incident myocardial infarction, heart failure and stroke) among non-exercisers (individuals self-reporting no leisure-time exercise and no more than one recreational walk per week) in the UK Biobank. We also undertook analogous analyses for vigorous physical activity among exercisers (individuals self-reporting participation in leisure-time exercise and/or recreational walking more than once a week). RESULTS:Among 13 018 women and 9350 men, there were 331 and 488 all MACE, respectively, over a 7.9-year follow-up. In women, daily VILPA duration exhibited a near-linear dose-response association with all MACE, myocardial infarction and heart failure. In men, dose-reponse curves were less clear with less evidence of statistical signifigance. Compared with women with no VILPA, women's median daily VILPA duration of 3.4 min was associated with hazard ratios (HRs; 95% confidence intervals) of 0.55 (0.41 to 0.75) for all MACE and 0.33 (0.18 to 0.59) for heart failure. Women's minimum doses of 1.2-1.6 min of VILPA per day were associated with HRs of 0.70 (0.58 to 0.86) for all MACE, 0.67 (0.50 to 0.91) for myocardial infarction, and 0.60 (0.45 to 0.81) for heart failure. The equivalent analyses in UK Biobank's accelerometry sub-study exercisers suggested no appreciable sex differences in dose-response. CONCLUSIONS:Among non-exercising women, small amounts of VILPA were associated with a substantially lower risk of all MACE, myocardial infarction and heart failure. VILPA may be a promising physical activity target for cardiovascular disease prevention, particularly in women unable or not willing to engage in formal exercise.

Cardiovascular disease (CVD) is the leading cause of deaths worldwide, with 80% occurring in low- and middle-income countries. These countries are characterized by rapid urbanization, poorly funded health systems, poor access to prevention and treatment strategies, and increasing age and a higher prevalence of chronic disease. Rapid urbanization has contributed to the significant environmental and societal changes affecting daily life habits and cardiovascular health. There is growing awareness that environmental and social exposures and policies can influence CVD directly or through behavioural risk factors. However, much of this knowledge comes from studies in high-income countries and is applied to low- and middle-income countries without evidence to indicate this is appropriate. This state-of-the-art review will present and synthesize key findings from the Prospective Urban Rural Epidemiology study and related studies that have aimed to understand the environmental, social, and policy determinants of cardiovascular health in countries across varying levels of economic development through an urban/rural lens. Emerging from these findings are future policy and research recommendations to accelerate the reduction of the global burden of CVD.

Objectives Long-term exposure to air pollution has been associated with higher risk of cardiovascular mortality. Less is known about the association of air pollution with initial development of cardiovascular disease. Herein, the association between low-level exposure to air pollutants and subclinical carotid atherosclerosis in adults without known clinical cardiovascular disease was investigated. Design Cross-sectional analysis within a prospective cohort study. Setting The Canadian Alliance for Healthy Hearts and Minds Cohort Study; a pan-Canadian cohort of cohorts. Participants Canadian adults (n = 6645) recruited between 2014-2018 from the provinces of British Columbia, Alberta, Ontario, Quebec, and Nova Scotia, were studied, for whom averages of exposures to nitrogen dioxide (NO2), ozone (O-3), and fine particulate matter (PM2.5) were estimated for the years 2008-2012. Main outcome measure Carotid vessel wall volume (CWV) measured by magnetic resonance imaging (MRI). Results In adjusted linear mixed models, PM2.5 was not consistently associated with CWV (per 5 mu g/m(3) PM2.5; adjusted estimate = -8.4 mm(3); 95% Confidence Intervals (CI) -23.3 to 6.48; p = 0.27). A 5 ppb higher NO2 concentration was associated with 11.8 mm(3) lower CWV (95% CI -16.2 to -7.31; p<0.0001). A 3 ppb increase in O-3 was associated with 9.34 mm(3) higher CWV (95% CI 4.75 to 13.92; p<0.0001). However, the coarse/insufficient O-3 resolution (10 km) is a limitation. Conclusions In a cohort of healthy Canadian adults there was no consistent association between PM2.5 or NO2 and increased CWV as a measure of subclinical atherosclerosis by MRI. The reasons for these inconsistent associations warrant further study.