Impact of national guidelines for cholesterol risk factor screening. The Framingham Offspring Study

Recently published guidelines from the National Cholesterol Education Program were applied to 792 men and 853 women aged 30 to 69 years who participated in Framingham Offspring examination 3 from 1983 to 1987. Using nationally recommended algorithms, cholesterol levels are desirable in 50% of men and women, borderline in 12% of men and 30% of women, and elevated in 35% of men and 19% of women. Assuming that diet reduces low-density lipoprotein cholesterol levels 20%, 10%, or 5%, rates of lipid medication use are projected as 2%, 5%, or 10%, respectively. Applying 6-year estimates of coronary risk derived from the original Framingham cohort to their offspring, the nationally recommended algorithm lacks specificity in women younger than 40 years and in both men and women older than 60 years. This study suggests that effective diet probably will be the cornerstone of current guidelines, and individuals aged 40 to 60 years might benefit most.     

Cigarette smoking and risk of premature stroke in men and women

A case-control study was carried out of the relation between cigarette smoking and hypertension and stroke. A total of 132 cases of stroke (79 in men, 53 in women) identified as a part of a population based register were compared with 1586 controls (1017 men, 569 women) from a survey of cardiovascular risk factors conducted in the same population. Cigarette smokers had a threefold increase in the risk of stroke compared with current non-smokers. This association remained significant after adjusting for hypertension. Those who both smoked and had hypertension had an increased risk of stroke of almost 20-fold compared with those who neither smoked nor had hypertension. Overall, in this population roughly 37% of stroke events may be attributed to cigarette smoking and 36% to hypertension.     

Trends in major risk factors. Cigarette smoking

The object of this paper is to examine the role of smoking as a risk factor in coronary heart disease, starting with a brief history of smoking in the U.K. and a reminder of the epidemiological evidence linking smoking and cardiovascular disease. This is followed by a more detailed look at the trends in consumption of tobacco and the major factors influencing those trends, together with an outline of the main components of a smoking control policy designed to combat our epidemic of smoking-induced disease.     

Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke

Context  Recent studies suggest that factors other than the degree of carotid stenosis are involved in ischemic stroke pathogenesis, especially modifications of plaque composition and related complications. Objective  To examine the role of carotid plaque rupture and thrombosis in ischemic stroke pathogenesis in patients undergoing carotid endarterectomy, excluding those with possible cardiac embolization or with severe stenosis of the circle of Willis. Design, Setting, and Patients  A total of 269 carotid plaques selected from an Interinstitutional Carotid Tissue Bank were studied by histology after surgical endarterectomy between January 1995 and December 2002. A total of 96 plaques were from patients with ipsilateral major stroke, 91 plaques from patients with transient ischemic attack (TIA), and 82 plaques from patients without symptoms. Main Outcome Measures  Differences in the frequency of thrombosis, cap rupture, cap erosion, inflammatory infiltrate, and major cardiovascular risk factors between study groups. Results  A thrombotically active carotid plaque associated with high inflammatory infiltrate was observed in 71 (74.0%) of 96 patients with ipsilateral major stroke (and in all 32 plaques from patients operated within 2 months of symptom onset) compared with 32 (35.2%) of 91 patients with TIA (P < .001) or 12 (14.6%) of 82 patients who were without symptoms (P < .001). In addition, a fresh thrombus was observed in 53.8% of patients with stroke operated 13 to 24 months after the cerebrovascular event. An acute thrombus was associated with cap rupture in 64 (90.1%) of 71 thrombosed plaques from patients with stroke and with cap erosion in the remaining 7 cases (9.9%). Ruptured plaques of patients affected by stroke were characterized by the presence of a more severe inflammatory infiltrate, constituted by monocytes, macrophages, and T lymphocyte cells compared with that observed in the TIA and asymptomatic groups (P = .001). There was no significant difference between groups in major cardiovascular risk factors. Conclusion  These results demonstrate a major role of carotid thrombosis and inflammation in ischemic stroke in patients affected by carotid atherosclerotic disease.      

Fibrinogen and risk of cardiovascular disease. The Framingham Study

During the tenth biennial examination of the Framingham Study, 1315 participants who were free of cardiovascular disease had fibrinogen levels measured. During the ensuing 12 years, cardiovascular disease developed in 165 men and 147 women. For both sexes, the risk of cardiovascular disease was correlated positively to antecedent fibrinogen values higher than the 1.3 to 7.0 g/L (126 to 696 mg/dL) range. The magnitude of the risk diminished with advancing age in women but not in men. Risk for coronary heart disease also was significantly related to fibrinogen level. Here, the magnitude of risk displayed diminishing impact with age, again only in women. Risk of stroke increased progressively with fibrinogen level in men but not in women. The impact of fibrinogen value, considered as a separate variable, on cardiovascular disease was comparable with the major risk factors, such as blood pressure, hematocrit, adiposity, cigarette smoking, and diabetes. Fibrinogen values were also significantly related to these risk factors. Taking all these into account in a multivariate analysis, fibrinogen level was still significantly related to the incidence of cardiovascular disease in men and marginally significant in women. For coronary heart disease, the fibrinogen level was significant for both men and women. Elevated fibrinogen level is a predictor of cardiovascular disease that should be added to the cardiovascular risk factor profile.     

Snoring as a risk factor for ischaemic heart disease and stroke in men

The association of snoring with ischaemic heart disease and stroke was studied prospectively in 4388 men aged 40-69. The men were asked, in a questionnaire sent to them, whether they snored habitually, frequently, occasionally, or never. Hospital records and death certificates were checked for the next three years to establish how many of the men developed ischaemic heart disease or stroke: the numbers were 149 and 42, respectively. Three categories of snoring were used for analysis: habitual and frequent snorers (n = 1294), occasional snorers (n = 2614), and non-snorers (n = 480). The age adjusted relative risk of ischaemic heart disease between habitual plus frequent snorers and non-snorers was 1.91 (p less than 0.01) and for ischaemic heart disease or stroke, or both, 2.38 (p less than 0.001). There were no cases of stroke among the non-snorers. Adjustment for age, body mass index, history of hypertension, smoking, and alcohol use did not significantly decrease the relative risks, which were 1.71 (p greater than 0.05) for ischaemic heart disease and 2.08 (p less than 0.01) for ischaemic heart disease and stroke combined. At the beginning of follow up in 1981, 462 men reported a history of angina pectoris or myocardial infarction. For them the relative risk of ischaemic heart disease between habitual plus frequent snorers and non-snorers was 1.30 (NS); for men without previous ischaemic heart disease 2.72 (p less than 0.05). Snoring seems to be a potential determinant of risk of ischaemic heart disease and stroke.     

The day care center as a risk factor for acute respiratory infections.

BACKGROUND: This study was conducted to assess the magnitude of the risk of high morbidity (> or = 7 episodes/year) for acute respiratory infections (ARI) in infants attending day care centers (DCC), and to compare the incidence, duration, and severity of ARI in children staying at home (Home). METHODS: Using a cohort design, 282 infants (DCC, 138 and Home, 144) were followed for a year. Age at entry into the study ranged from 43 days to 4 months. During follow-up, social workers interviewed the mothers weekly to register whether the infants had an ARI. Also, infant health conditions and physical growth were updated monthly. RESULTS: ARI incidence was 14 episodes per child/year among DCC infants with a median of 74 sick days, while among children at home, the ARI incidence was 6 episodes, and the median was 40 days. The incidence density ratio for DCC children was 2.33 (95% CI, 2.13-2.54); after adjusting for other covariates, the relative risk increased to 5.27 (95% CI, 3.54-7.83). CONCLUSIONS: Infants attending DCCs will suffer ARI more frequently than children cared for at home. We did not find seasonal variations in the incidence rates among DCC infants. The quality of care provided at these facilities should be analyzed in more depth for proposing measures to decrease ARI incidence.     

农村居民吸烟行为的危险因素探讨

目的：调查农村居民吸烟情况及其危险因素。方法：通过整群抽样方法调查了12696名15岁以上农村居民的吸烟情况,同时收集其他相关信息。利用SAS软件包对这些资料进行卡方检验及logistic回归等分析。结果：观察烟者占3．12％,男性现吸烟率（61．68％）明显高于女性（3．37％）人群总戒烟率为11．78％,其中因“患病”而戒烟者占72．14％,经Loistic回归分析,发现性别、年龄、低文化程度、婚史、家庭成员有吸烟者均为吸烟行为的影响因素,结论：那些离异、文化程度低、年龄小于45岁的男性为吸烟行为的高危人群。     

农村居民吸烟行为的危险因素探讨

目的调查农村居民吸烟情况及其危险因素。方法通过整群抽样方法调查了12696名15岁以上农村居民的吸烟情况,同时收集其他相关信息。利用SAS软件包对这些资料进行卡方检验及logistic 回归等分析。结果现吸烟者占3.12%, 男性现吸烟率（61.68%）明显高于女性(3.37%);人群总戒烟率为11.78%,其中因“”患病”而戒烟者占72.14%;经Logistic回归分析,发现性别、年龄、低文化程度、婚史、家庭成员有吸烟者均为吸烟行为的影响因素。结论那些离异、文化程度低、年龄小于45岁的男性为吸烟行为的高危人群。     

Cigarette smoking and the young: a national survey.

Cigarette smoking behaviour among the young was examined in the light of the responses of over 78 000 students to a 1972 questionnaire survey of Canadian schools. As few as 2% (8-year-old girls) and as many as 60% (16 year--old boys) were smoking one or more cigarettes per week. The prevalence of smoking was higher than that reported in earlier studies. Students, particularly girls, were beginning to smoke at progressively earlier ages. Some differences in smoking behaviour were found between regions, language groups and groups of children whose parents did or did not smoke. Recognition of immediate rather than long-term effects of smoking on health was reported as an important consideration in not smoking.     

Cigarette Smoking Increases Risk for Incident Metabolic Syndrome in Chinese Men—Shanghai Diabetes Study

Objective To determine whether smoking increases the risk for developing metabolic syndrome (MetS) in Chinese men.Methods A total of 693 men with no MetS at baseline were followed for 2.9‐5.5 years.Subjects were divided into nonsmokers,ex‐smokers,and current smokers according to baseline smoking status.Results After adjusting for age,education level,alcohol intake,fasting plasma insulin,HOMA‐IR index,and BMI at baseline and weight change,current smokers were dose‐dependently associated with increased risk f...