Prevalence of ventricular conduction blocks in the resting electrocardiogram in a general population: The Health 2000 Survey

Aims

The prevalence of eight different ventricular conduction blocks and their association with risk factors and major cardiovascular diseases were studied in a major Finnish population study.

Methods

Data, including 12-lead electrocardiograms, were collected from 6315 subjects. The prevalence of left bundle branch block (LBBB), right bundle branch block (RBBB), non-specific ventricular block, incomplete LBBB, incomplete RBBB, R–R′-pattern, left anterior hemiblock (LAHB), and left posterior hemiblock (LPHB) was calculated for both genders in three age groups. Their association with risk factors and cardiovascular diseases was studied.

Results

R–R′-pattern was the most common ventricular conduction block in all age groups (3.9%, p < 0.001 for comparison between groups), but it showed no association with cardiovascular diseases. Males had more RBBB (1.5% vs. 0.7%, p < 0.001), incomplete LBBB (1.8 vs. 0.4, p < 0.001) and non-specific ventricular block (1.1% vs. 0.1%, p < 0.001).With increasing age (< 45 years vs. > 55 years) LBBB, RBBB and LAHB (0 vs. 2.2%, 0.3 vs. 2.2%, 0.2 vs. 1.9% respectively, p-values < 0.001) became more prevalent. LBBB, RBBB and non-specific ventricular conduction block were associated with coronary heart disease (angina pectoris in 28.3, 20.3 and 22.9%, respectively) and heart failure (25.0, 10.1 and 11.4%, respectively). LBBB and RBBB were also associated with peripheral vascular disease (8.8%).

Conclusions

Ventricular conduction blocks differ in prevalence between sexes and age groups. They also show disparate association with cardiovascular diseases. These differences need to be taken into consideration in everyday clinical practice.     

Prevalence of diabetes in a large, nationally representative population sample in Hungary

We examined the prevalence of diabetes in a large, Hungarian, nationally representative adult population sample. The overall prevalence of diabetes was 6.2% (95% CI: 5.7–6.6). Increasing age and body mass index (BMI), male gender, physical inactivity, lower self-reported financial status, hypertension and non-smoking were independently associated with diabetes.     

Prevalence,clinical characteristics and morbidity of the Asthma-COPD overlap in a general population sample

Objective: Although asthma and chronic obstructive pulmonary disease (COPD) have been regarded as distinct conditions, emerging literature suggests that overlapping phenotypes, called asthma-COPD overlap (ACO), exists. The aim of this study was to describe prevalence, patient characteristics and morbidity of ACO. Methods: From a cross-sectional population sample, the West Sweden Asthma Study, subjects with suspected asthma, chronic bronchitis or COPD, and a random sample, were invited to clinical examinations. ACO was defined as doctor-diagnosed asthma, or clear clinical signs of asthma at examination, with a FEV₁/FVC < 0.7. Results: Subjects were categorized as ACO (N = 181), COPD only (N = 89), asthma only (N = 651) or healthy (n = 1036) based on clinical examinations. Prevalence of ACO was 3.4% in the random sample (N = 1172) and 18.1% among asthmatics (N = 138) in the random sample. Subjects with ACO (mean age 59 years, 54% women) had an age and gender distribution in between asthma only (45 years, 63% women) and COPD only (62 years, 41% women). Ever-smoking was reported by 71%, 48% and 74% in the ACO, asthma only and COPD only groups, respectively. Subjects with ACO had worse lung function (mean FEV₁% of predicted normal 76%) than asthma only (100%) and COPD only (87%) and reported more respiratory symptoms. Also respiratory related emergency visits were more common in ACO compared to asthma only and COPD only, respectively. Conclusions: ACO is present in 3.4% of the population and common among subjects with both asthma and COPD. Subjects with ACO had worse lung function and more symptoms than subjects with asthma or COPD only.     

Prevalence of primary aldosteronism without hypertension in the general population: Results in Shika study

Objective: Recent studies have reported a high prevalence of primary aldosteronism (PA) among hypertensive patients. However, few data exist regarding the prevalence of PA in the general population. Therefore, we examined the prevalence of PA in the general population including normotensive subjects. Methods: Plasma renin activity (ng/mL/hr), plasma aldosterone concentration (pg/mL) and aldosterone renin ratio (ARR) were determined in 309 subjects aged >40 years in Horimatsu and Higashi-Matsuho district, Shika-machi, Ishikawa, Japan. Results: Among them, 195 subjects (78 males, mean age: 62 ± 11 years) did not take antihypertensive agents: 113 normotensive subjects and 82 hypertensive subjects. Under these conditions, 68 subjects (13 males, age 62 ± 10 years) had an ARR >200. In 14 subjects who underwent captopril suppression test, PA was documented in 5 subjects, yielding a minimum prevalence of 2.6% in total subjects (1.8% in normotensive subjects and 3.7% in hypertensive subjects). Interestingly, females subjects demonstrated significant differences in ARR between subjects with age <50 (172 ± 105) and those with age 51–60 (388 ± 531), although there were no differences in male subjects. Conclusions: These results demonstrate that PA including normotensive subjects exists more commonly than that expected in the general population. We suggest further investigation about the cause and progression of PA associated with sex and aging.     

Prevalence of left ventricular diastolic dysfunction in the community. Results from a Doppler echocardiographic-based survey of a population sample.

AIMS: The prevalence of left ventricular diastolic abnormalities in the general population is largely unclear. Thus, the aim of this study was, firstly, to identify abnormal diastolic function by echocardiography in an age-stratified population-based European sample (MONICA Augsburg, n=1274, 25 to 75 years, mean 51+/-14) and, secondly, to analyse clinical and anthropometric parameters associated with diastolic abnormalities. METHODS AND RESULTS: The overall prevalence of diastolic abnormalities, as defined by the European Study Group on Diastolic Heart Failure (i.e. age dependent isovolumic relaxation time (92-105 ms) and early (E-wave) and late (A-wave) left ventricular filling (E/A-ratio, 1-0.5)) was 11.1%. When only subjects treated with diuretics or with left atrial enlargement were considered (suggesting diastolic dysfunction) the prevalence was 3.1%. The prevalence of diastolic abnormalities varied according to age: from 2.8% in individuals aged 25-35 years to 15.8% among those older than 65 years (P<0.01). Significantly higher rates of diastolic abnormalities were observed in men as compared to women (13.8% vs 8.6%, P<0.01). Independent predictors of diastolic abnormalities were arterial hypertension, evidence of left ventricular (LV) hypertrophy, and coronary artery disease. Interestingly, in the absence of these predisposing conditions, diastolic abnormalities (4.3%) or diastolic dysfunction (1.1%) were rare, even in subjects older than 50 years of age (4.6%) and (1.2%), respectively. In addition to these factors, diastolic dysfunction was related to high body mass index, high body fat mass, and diabetes mellitus. CONCLUSION: The prevalences of diastolic abnormalities and diastolic dysfunction are higher than that of systolic dysfunction and are increased (despite age-dependent diagnostic criteria) in the elderly. However, in the absence of risk factors for diastolic abnormalities or diastolic dysfunction, namely LV hypertrophy, arterial hypertension, coronary artery disease, obesity and diabetes the condition is rare even in elderly subjects. These data allow speculation on whether diastolic heart failure may be prevented by improved implementation of measures directed against predisposing conditions.     

Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients

AIM To assess the prevalence of possible risk factors of upper gastrointestinal bleeding(UGIB) and their agegroup specific trend among the general population and osteoarthritis patients.METHODS We utilized data from the National Health InsuranceService that included claims data and results of the national health check-up program. Comorbid conditions(peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs(aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits(smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori(H. pylori) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others.RESULTS A total of 801926 subjects(93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits(smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups.CONCLUSION Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians s h o u ld c o n s id e r in d i v i d u a li z e d r i s k a s s e s s m e n t regardless of age when prescribing drugs or performing procedures that may increase the risk of UGIB, and take necessary measures to reduce modifiable risk factors such as H. pylori eradication or lifestyle counseling.     

Prevalence of linked angina and gastroesophageal reflux disease in general practice

AIM： To evaluate the association between gastroesophageal reflux diseases （GERD） and coronary heart diseases. METHODS： One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled. All of the patients who first attend our hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography （ECG） was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as ST- segment depression based on the Minnesota code. RESULTS： Among 712 patients （36%） with GERD, ECG was performed in 171 （24%）, and ischemic changes were detected in eight （5%）. Four （50%） of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients （0.6%; 4/712） were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of 281 patients who underwent ECG and did not have GERD symptoms, 20 （7%） had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% （8/1970 patients）.CONCLUSION： The present study suggested that ischemic heart disease might be found although a patient was referred to the hospital with a complaint of GERD symptoms. Physicians have to be concerned about missing clinically important coronary artery disease while evaluating patients for GERD symptoms.     

Prevalence of secondary hypertension in a population sample of Swedish women

In a comprehensive population study of 1462 women aged 38–60in Goteborg, Sweden, the prevalence of secondary hypertensionwas estimated to be 0.8% of the total population sample and4.6% of those who were hypertensive (defined as systolic bloodpressure > 160 mmHg or diastolic blood pressure > 95 mmHgor both or antihypertensive treatment irrespective of bloodpressure levels). These figures were based on thorough clinicaland laboratory investigations and a follow-up period of 12 years.Women with arterial hypertension reported a history of toxaemiaof pregnancy and a family history of hypertension more oftenthan non-hypertensive women. In comparison with non-hypertensivewomen, in both untreated and treated hypertensive women, serumuric acid, urinary methoxycatecholamine excretion, body weightand the prevalence of albuminuria were increased and serum potassiumdecreased (statistically significant differences).     

Prevalence of nocturnal asthma in a general population sample: determinants and effect of aging.

Nocturnal asthma (NA) is important because of clinical and prognostic implications. Previous data on prevalence may be overestimated, because they are derived from selected series. Observations on monitoring of peak expiratory flow in elderly asthmatics suggested that prevalence of NA may increase with age. This study was designed to estimate the prevalence of NA-related symptoms in a sample drawn from a general population and evaluate the role of aging. Subjects (1,100, mean age 41.9, SD 22.8 years) were randomly selected from the lists of seven general practitioners. A questionnaire on nighttime and morning NA-associated symptoms was used and frequency of occurrence was rated as never, sometimes (less than once a week), and often (once a week or more). In the overall sample, symptoms were experienced "sometimes" by 2.3%-4.9% of subjects, whereas the response "often" was given by 0.9%-1.6% of subjects. Among subjects with a diagnosis of asthma, symptoms occurred sometimes in 16.7%-23.7% and often in 5%-15%. Symptoms reported the morning after were significantly more frequent among patients aged 65 years and older (p < 0.005), whereas the difference for nighttime symptoms was not statistically significant in different age groups, confirming an age-related blunted sensitivity. Logistic regression analysis shows that a diagnosis of asthma is the most important correlate of symptoms, with odds ratio (OR) up to 14.78 for cough; advanced age also proved to be an independent risk factor (OR 3.35-4.97). In conclusion, although the prevalence of NA was previously overestimated, our results indicate its importance, particularly among elderly patients who are exposed to a prominent risk of underdiagnosis and undertreatment.     

Validity of a postal questionnaire with regard to the prevalence of myocardial infarction in a general population sample

In order to evaluate the possibility of finding persons whohave suffered a myocardial infarction (MI) by postal questionnaire,a self-administered questionnaire was sent to a random sampleof 4400 men aged 45–64 years, drawn from the general population.The response rate was 95%. 176 men indicated that they had beenhospitalized for MI, out of which 124 cases could be verifiedfrom medical records. Of the remaining men, 33 had evidenceof cardiovascular disease (CVD) in their records but no MI,and 19 men had no evidence of CVD. The sensitivity (estimatedfrom a subsample) was 100% and the specificity 98.7%. The predictivevalue was 100% for a negative response and 70.5% for a positiveresponse. The 33 positive responders whose MI could not be verified butwho had evidence of CVD had characteristics fairly similar tothe responders with verified Mis. However, the 19 positive responderswhose MI could not be verified and who had no evidence of CVDhad characteristics that were dissimilar from the MI group aswell as from the negative responders. The questionnaire thus identified all the MI cases. The needfor validation can be limited to the relatively small groupof positive responders.     

Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan

AIM：To examine the prevalence of gastroesophageal reflux disease （GERD） symptoms in a large unselected general population in Japan.
METHODS： In Japan, mature adults are offered regular check-ups for the prevention of gastric cancer. A notice was sent by mail to all inhabitants aged 〉 40 years. A total of 160 983 Japanese （60 774 male, 100 209 female; mean age 61.9 years） who underwent a stomach check up were enrolled in this study. In addition, from these 160 983 subjects, we randomly selected a total of 82 894 （34 275 male, 48 619 female; mean age 62.4 years） to evaluate the prevalence of abdominal pain. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a 1 mo period.
RESULTS： The respective prevalences of the symptoms in males and females were： heartburn, 15.8% vs 20.7%; dysphagia, 5.4% vs 7.8%; and abdominal pain, 6.6% vs 9.6%. Among these symptoms, heartburn was significantly high compared with the other symptoms, and the prevalence of heartburn was significantly more frequent in females than in males in the 60-89-year agegroup. Dysphagia was also significantly more frequent in female patients.
CONCLUSION： The prevalence of typical GERD symptoms （heartburn） was high, at about 20% of the Japan population, and the frequency was especially high in females in the 60-89 year age group.     

Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus

Aims/hypothesis Post-prandial glucose may be a risk factor for cardiovascular disease and chronic diabetic complications. We tested the hypothesis that post-prandial hyperglycaemia is common in type 2 diabetes, even among patients in apparently good glycaemic control, and that simple clinical characteristics identify subsets of diabetic patients with frequent post-prandial hyperglycaemia.Subjects and methods Three self-assessed daily blood glucose profiles over a 1-week period, including 18 glucose readings before and 2 h after meals, were obtained from 3,284 unselected outpatients (men 51%; age 63±10 years) with non-insulin-treated type 2 diabetes mellitus attending 500 different diabetes clinics operating throughout Italy.Results A post-prandial blood glucose value >8.89 mmol/l (160 mg/dl) was recorded at least once in 84% of patients, and 81% of patients had at least one Δglucose ≥2.22 mmol/l (40 mg/dl). Among patients with apparently good metabolic control, 38% had >40% of post-prandial blood glucose readings >8.89 mmol/l (≥4 of 9 meals in total), and 36% had >40% Δglucose ≥2.22 mmol/l. In multivariate analysis adjusted for pre-prandial glucose levels, older age, longer duration of diabetes, absence of obesity, hyperlipidaemia and hypertension, as well as treatment with sulfonylureas, were significantly associated with greater glucose excursions after meals.Conclusions/interpretation These results indicate that post-prandial hyperglycaemia is a very frequent phenomenon in patients with type 2 diabetes mellitus on active treatment; can occur even when metabolic control is apparently good; and can be predicted by simple clinical features.     

Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US

Background: Recently, a Joint Scientific Statement bridged differences between previous definitions of metabolic syndrome. Our objective was to estimate the prevalence of metabolic syndrome in a representative sample of US adults and to examine its correlates. Methods: We analyzed data for up to 3461 participants aged ≥20 years of the 2003–2006 National Health and Nutrition Examination Survey. Results: Using waist circumference thresholds of ≥102 cm for men and ≥88 cm for women, the age‐adjusted prevalence of metabolic syndrome was 34.3% among all adults, 36.1% among men, and 32.4% among women. Using racial‐ or ethnic‐specific International Diabetes Federation criteria for waist circumference, the age‐adjusted prevalence of metabolic syndrome was 38.5% for all participants, 41.9% for men, and 35.0% for women. Prevalence increased with age, peaking among those aged 60–69 years. Prevalence was lower among African American men than White or Mexican American men, and lower among White women than among African American or Mexican American women. In a multivariate regression model, significant independent associations were noted for age (positive), gender (men higher than women), race or ethnicity (African Americans and participants of another race lower than Whites), educational status (inverse), hypercholesterolemia (positive), concentrations of C‐reactive protein (positive), leisure time physical activity (inverse), microalbuminuria (positive), and hyperinsulinemia (positive). Additional adjustment for body mass index weakened many of the associations, with educational status and microalbuminuria no longer significant contributors to the model. Conclusion: Metabolic syndrome continues to be highly prevalent among adults in the US.     

新疆地区居民艾滋病相关知识 态度 行为调查分析

目的了解新疆地区不同人群艾滋病相关知识、行为、态度的现状,以及时发现工作中存在的薄弱环节和问题,控制艾滋病在当地的流行蔓延。方法采取现况流行病学调查方法,由培训合格的调查员对选取的239名居民进行面对面的问卷调查,用SPSS 13.0统计软件进行统计描述。结果新疆一般人群对艾滋病相关基本知识总知晓率为66.94%,艾滋病传播途径知晓率为76.23%,非传播途径知晓率为72.93%,预防艾滋病知识知晓率为51.70%,对感染者的态度正确率为83.27%。注射毒品者占14.64%,共用注射器的占12.97%。结论有针对性地制定艾滋病相关知识宣传教育计划,加强薄弱环节特别是少数民族地区,开发相应的语言文字的信息传播,使目标人群全面、正确地了解和掌握艾滋病防治知识,减少传播HIV的风险。