title: Television viewing and incident cardiovascular disease: prospective associations and mediation analysis in the EPIC Norfolk Study.
abstract: BACKGROUND
  Although television viewing time is detrimentally associated with intermediate cardiovascular risk factors, the relationship with incident total (i.e. combined fatal and non-fatal) cardiovascular disease (CVD), non-fatal CVD and coronary heart disease is largely unknown. This study examined whether television viewing time is associated with these three outcomes, independently of physical activity energy expenditure and other confounding variables.
  
  
  RESULTS
  A population-based cohort of 12,608 men and women (aged 61.4±9.0), free from stroke, myocardial infarction and cancer at baseline in 1998-2000 were followed up until 2007 (6.9±1.9 years). Participants self-reported education, smoking, alcohol use, antihypertensive, lipid lowering and antidepressant medication, disease history, total energy intake, sleep duration, physical activity and television viewing. BMI, waist circumference, blood pressure, triglycerides, HDL cholesterol and glycated haemoglobin (HbA(1c)) were measured by standardized procedures; a clustered metabolic risk score was constructed. Every one hour/day increase in television viewing was associated with an increased hazard for total (HR = 1.06, 95%CI = 1.03-1.08; 2,620 cases), non-fatal CVD (HR = 1.06, 95%CI = 1.03-1.09; 2,134 cases), and coronary heart disease (HR = 1.08, 95%CI = 1.03-1.13; 940 cases), independent of gender, age, education, smoking, alcohol, medication, diabetes status, CVD family history, sleep duration and physical activity energy expenditure. Energy intake, BMI, waist circumference, blood pressure, triglycerides, HDL cholesterol, HbA(1c) and the clustered metabolic risk score only partially mediated these associations.
  
  
  CONCLUSIONS
  These results indicate that the most prevalent leisure time (sedentary) behaviour, television viewing, independently contributes to increased CVD risk. Recommendations on reducing television viewing time should be considered.
authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, United Kingdom.
authors.forename: Katrien
authors.initials: K
authors.lastname: Wijndaele
authors.forename: Søren
authors.initials: S
authors.lastname: Brage
authors.forename: Hervé
authors.initials: H
authors.lastname: Besson
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.forename: Amit
authors.initials: A
authors.lastname: Bhaniani
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000378:metabolism; D004734:Energy Metabolism; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013690:Television / Q000706:statistics & numerical data*; D013997:Time Factors