Obesity, Hypertension, Hypercholesterolemia and Diabetes Mellitus in Women Aged 20-69, Living in a Highland Community of Crete

Risk factors for coronary heart disease were studied in a femalepopulation aged 20 to 69 years living in a highland communityof Crete. 375 women participated in the study. Mean value oftotal cholesterol was 6.23 mmol/l, of HDL-cholesterol 1.41 mmol/l,of serum triglycerides 1.58 mmol/l, of serum glucose 5.36 mmol/l,of systolic blood pressure 130.64 mmHg and of diastolic bloodpressure 78.07 mmHg. 46% of the study population had a bodymass index higher than 27. Upon multiple regression analysis,the body mass index correlated positively and independentlyof age with serum lipid level and the systolic and diastolicblood pressure. The results of this study agree with data fromother studies suggesting an increase in frequency of coronaryheart disease risk factors in Crete over the past 20 years.     

Policies and practices for the assessment and management of risk factors for coronary heart disease prevention: The perspective of the general practitioner

Recent government policy in the United Kingdom has prescribedan important role for primary health care In the key priorityarea of coronary heart disease prevention. One of the recommendationswas to explore ways of developing existing health promotionarrangements in primary care in response to the national strategy.We sought to identify what these existing arrangements were.Information was collected through a survey and in-depth interviewswith a random sample of general practitioners (GPs) in Englandduring 1991 and 1992. General practitioners' policies and practicesin relation to risk factor assessment and management as wellas the policies employed in health promotion clinics were examined.General practitioners' involvement was confined to opportunisticrisk assessment and management in the consultation. However,there was little evidence of systematic opportunistic risk factorassessment as emphasis was placed primarily upon blood pressureand smoking. The majority of the general practices had well-personclinics, which were usually run by nurses. There was a greaterlikelihood of systematic tests and measurements and assessmentof risk factors in well-person clinics than in the context ofthe normal GP consultation.     

Exploring gender and socioeconomic differences in treatment of coronary heart disease

BACKGROUND: Earlier studies on gender and socioeconomic differences in the treatment of coronary heart disease have focused mainly on structural features of the health-care system on the one hand and on coronary patients' psychosocial characteristics on the other. The aim of this exploratory qualitative study was to trace key points in the pathways of treatment where patients' experience varies and which can contribute to gender and socioeconomic differences in treatment. METHODS: The data consist of 30 interviews among persons diagnosed with or suspected to have coronary heart disease in the Health 2000, a representative cross-sectional interview and health examination survey. Purposive sampling was used to ensure variation in gender, socioeconomic status and disease severity. The data were analysed using qualitative content analysis. RESULTS: Gender and socioeconomic differences were found in two key points in the pathways of treatment: doctor-patient interaction and the organization of primary care. The three features commonly distinguished in doctor-patient interaction, i.e. treatment decision-making, information exchange and interpersonal relationship, were all found to be relevant. A second key point was organization of primary care in terms of both access to examinations and care, and continuity of care. CONCLUSIONS: These results should sensitize us to gender and socioeconomic differences in coronary patients' problems in access to and continuity of care, as well as to potential problem areas in doctor-patient interaction.     

Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985-2000

STUDY OBJECTIVES: To examine the proportion of the recent decline in coronary heart disease (CHD) deaths in Ireland attributable to (a) "evidence based" medical and surgical treatments, and (b) changes in major cardiovascular risk factors. DESIGN SETTING: IMPACT, a previously validated model, was used to combine and analyse data on the use and effectiveness of specific cardiology treatments and risk factor trends, stratified by age and sex. The main data sources were published trials and meta-analyses, official statistics, clinical audits, and observational studies. RESULTS: Between 1985 and 2000, CHD mortality rates in Ireland fell by 47% in those aged 25-84. Some 43.6% of the observed decrease in mortality was attributed to treatment effects and 48.1% to favourable population risk factor trends; specifically declining smoking prevalence (25.6%), mean cholesterol concentrations (30.2%), and blood pressure levels (6.0%), but offset by increases in adverse population trends related to obesity, diabetes, and inactivity (-13.8%). CONCLUSIONS: The results emphasise the importance of a comprehensive strategy that maximises population coverage of effective treatments, and that actively promotes primary prevention, particularly tobacco control and a cardioprotective diet.     

Association of passive smoking with increased coronary heart disease risk is not explained by elevation of leucocyte count

The increased risk of coronary heart disease in cigarette smokersmay be due at least partly to an elevation of the leucocytecount Chronic passive smoking has also been found to be associatedwith an increased risk of coronary heart disease, but its effecton the leucocyte count has not been reported. In this study250 male factory employees aged 20–64 years were interviewedon smoking behaviour and exposure to environmental tobacco smoke,and blood counts were determined. Urinary cotinine was measureby radio-immunoassay and corrected for urinary creatinine concentrations.Mean leucocyte count was significantly higher among smokerscompared with non-smokers (8,666 compared to 6, 900; p<0.001).On the basis of smoking history, passive smokers had leucocytecounts similar to non-smokers. These findings were confirmedwhen leucocyte counts were compared with urine cotinine to creatinineratios. The association of haematocrlt and haemoglobin withsmoking was similar to that of leucocyte count These findingssuggest that any association of passive smoking with coronaryheart disease is not through an elevation of leucocyte count.     

Job stress, absenteeism and coronary heart disease European cooperative study (the JACE study): Design of a multicentre prospective study

Background: The motives, objectives and design of a multicentreprospective study on job stress, absenteeism and coronary heartdisease in Europe (the JACE study) is presented in this paper.Some specific gaps in the reviewed literature are explicitlytapped into by the JACE study. Its objectives are i) to comparethe distributions of the Karasek job stress scales for the samebroad categories of occupations in different European countries(in males and females), ii) to study the predictive power ofthe job stress scales and the job strain model for one yearof sickness absence (in males and females) and iii) to studythe predictive power of the job stress scales and the job strainmodel for a three year incidence of coronary heart disease (Inmales only). Methods: In answering these questions, relationsare studied controlling for gender, age, level of education,company size, physical work risks and shift work, as well astraditional risk factors for CHD (i.e serum cholesterol, serumHDL cholesterol, smoking habits and blood pressure). The JACEstudy is a Biomed 1 concerted action. The JACE group consistsof eight participating centres from six countries, i.e. fromBelgium and Sweden (two centres), France, Italy, Spain, Swedenand The Netherlands (each one centre). The coordination of thegroup is in Brussels. The participating centres brought in over15, 000 European workers to test the hypotheses.     

Trends in ischaemic heart disease mortality and its determinants in Spain, 1940-1988

Trends of ischaemic heart disease (IHD) mortality and of manyof their determinants in Spain from 1940–1988 resemblethose of other Mediterranean countries and some Western countrieswith a lag of 10 years. Mortality from IHD Increased from 1955to 1975 and then declined. This trend affected both sexes andalmost all age groups. Tobacco smoking increased from 3.2 gper capita per day in 1940 to 8 g per capita per day in themid-1970s and then levelled off. The prevalence of smoking hasdecreased in all ages among men but has Increased among womenover the last 15 years. Since 1940 there has been a steady increasein the intake of meat and dairy products and a moderate riseof eggs, fish and sunflower oil. Consumption of olive oil hasremained relatively constant. These trends have been translatedinto an increase of total lipid intake and of saturated, monounsaturatedand polyunsaturated fatty acids and cholesterol over the period1940–1988. The number of physicians, primary health carecentres, cardiac function diagnostic facilities, heart operationsand the consumption of cardiovascular drugs have also Increasedsince the mid- 1970s. The authors conclude that the reductionin smoking among men and the improvement of the health caresystem may have contributed to the decline in IHD mortalityrates in Spain since 1975.     

围绝经期女性冠心病60例临床分析

目的提高对围绝经期女性冠心病的认识及防治效果。方法对60例经冠脉造影确诊的围绝经期女性冠心病患者进行回顾性分析,对其危险因素、诱发因素、临床特点及预后进行调查。结果绝经前发病12例(占20.00%),2个危险因素同时存在占58.33%;绝经后发病48例(占80.00%),≥3个危险因素占45.83%。发病诱因情绪激动占53.33%,其中胸痛为首发症状的占76.67%。心电图、运动试验、核素心肌扫描阳性率分别为80.00%、75.00%、77.78%,超声心动图左室舒张功能障碍占100.00%。结论将冠心病危险因素和临床表现及辅助检查的敏感性、特异性结合起来评估围绝经期女性冠心病的诊断。对有明显症状和危险因素,但冠脉造影为阴性的患者应加强随访,积极纠正危险因素。     

Truck drivers and heart disease in the United States, 1979-1990

BACKGROUND: Studies of truck drivers and cardiovascular disease (CVD), myocardial infarction, or ischemic heart disease (IHD) are limited, although studies of other professional drivers reported increased risk. METHODS: US mortality data from 1979 to 1990 for ages 15-90 were used to calculate proportional mortality ratios (PMRs) for heart disease and lung cancer for short and long haul truck drivers. Analysis was performed for Black (998 short haul and 13,241 long haul) truck drivers and White (4,929 short and 74,315 long haul) truck drivers separately. RESULTS: The highest significantly elevated proportionate heart disease (IHD, acute myocardial infarction (AMI), and other forms of heart disease) and lung cancer mortality was found for White and Black male long haul truck drivers age 15-54. Mortality was not significantly elevated for short haul truck drivers of either race or gender, nor for truck drivers who died after age 65, except for lung cancer among White males. An indirect adjustment suggested that smoking could explain the excess IHD mortality, but no direct data for smoking or the other known risk factors for heart disease were available and occupational exposures were not measured. CONCLUSIONS: The highest significant excess proportionate mortality for lung cancer, IHD and AMI was found for long haul truck drivers who were under age 55 at death. A cohort or longitudinal study of heart disease among long haul truck drivers, that obtains data for occupational exposures as well as lifestyle risk factors, could help explain inconsistencies between the findings of this and previous studies.     

Prevalence of overweight and smoking patients with coronary heart disease in rural China

Objective: To investigate the prevalence of overweight and/or smoking patients with coronary artery disease in rural China.
Design: A prospective survey with qualitative, open-ended questionnaires.
Setting: Tertiary referral centre.
Subjects: 158 hospitalised patients (71 men and 87 women) with established coronary heart disease.
Main outcome measures: To determine the prevalence of overweight and /or smoking hospitalised patients who had a definitive diagnosis of coronary artery disease and to determine participants understanding of these risk factors.
Results: Being overweight and smoking cigarettes were found in 32.7% and 15.2% of the participants, respectively. More than 70% of the overweight participants had neither knowledge nor counselling on their weight before the study. Most smokers believed smoking was harmful to their health and cardiac condition, and had tried unsuccessfully to quit smoking.
Conclusions: There was a high prevalence of overweight and/or smoking patients with coronary heart disease. A systematic approach is urgently required to educate patients and primary care physicians, and to improve the management of being overweight and smoking cigarettes.     

Physical activity and coronary heart disease in older adults. A systematic review of epidemiological studies

BACKGROUND: While there is good evidence to suggest an inverse relation of physical activity and cardiorespiratory fitness with coronary heart disease (CHD) in middle-aged men and women, much less is known about this association in older adults. The purpose of this paper was to explore the relation of physical activity and cardiorespiratory fitness with CHD in older adults by reviewing relevant studies. METHODS: Publications were identified in two ways: i) conducting a PUBMED search from its inception in 1966 until January 2001; and ii) scrutinizing the reference sections of identified papers. RESULTS: Ten studies relating physical activity and two relating cardiorespiratory fitness in older people to CHD met the inclusion criteria. With one exception, the studies were observational in nature and the majority of these were of prospective cohort design. Most studies featured men only. Of the eleven studies that presented data on older men, eight reported an inverse relation between physical activity or cardiorespiratory fitness and CHD, and statistical significance was seen in five of these. There were too few data on older women to draw clear conclusions regarding the association in this group. CONCLUSIONS: This review suggests that, in older adult men, physical activity and cardiorespiratory fitness are inversely related to CHD risk. This association is unlikely to be attributable to reverse causality or confounding. Except where such advice is contraindicated, older adult men may benefit from physical activity in terms of reduced CHD risk.     

Leg length, insulin resistance, and coronary heart disease risk: The Caerphilly Study

BACKGROUND: Adult height has been inversely associated with coronary heart disease risk in several studies. The mechanism for this association is not well understood, however, and this was investigated by examining components of stature, cardiovascular disease risk factors and subsequent coronary heart disease in a prospective study. METHODS: All men aged 45-59 years living in the town of Caerphilly, South Wales were approached, and 2512 (89%) responded and underwent a detailed examination, which included measurement of height and sitting height (from which an estimate of leg length was derived). Participants were followed up through repeat examinations and the cumulative incidence of coronary heart disease-both fatal and non-fatal-over a 15 year follow up period is the end point in this report. RESULTS: Cross sectional associations between cardiovascular risk factors and components of stature (total height, leg length and trunk length) demonstrated that factors related to the insulin resistance syndrome-the homeostasis model assessment of insulin resistance, fasting triglyceride levels and total to HDL cholesterol ratio-were less favourable in men with shorter legs, while showing reverse or no associations with trunk length. Fibrinogen levels were inversely associated with leg length and showed a weaker association with trunk length. Forced expiratory volume in one second was unrelated to leg length but strongly positively associated to trunk length. Other risk factors showed little association with components of stature. The risk of coronary heart disease was inversely related to leg length but showed little association with trunk length. CONCLUSION: Leg length is the component of stature related to insulin resistance and coronary heart disease risk. As leg length is unrelated to lung function measures it is unlikely that these can explain the association in this cohort. Factors that influence leg length in adulthood-including nutrition, other influences on growth in early life, genetic and epigenetic influences-merit further investigation in this regard. The reported associations suggest that pre-adult influences are important in the aetiology of coronary heart disease and insulin resistance.     

老年冠心病患者脂代谢与凝血功能关系的临床分析

目的探讨血脂和凝血功能在老年冠心病患者发病中的作用及两者的关系。方法本文对220例冠心病患者和70例无冠状动脉病变对照者的血浆测定血浆脂蛋白a[LP(a)]、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、凝血酶—抗凝血酶Ⅲ复合物(TAT)、D-二聚体(D-D)、血浆纤维蛋白原(Fg)水平,根据冠状动脉造影结果将冠心病组分为单支和多支病变组,观察其与各指标之间的关系。结果老年冠心病组血脂水平和血浆Fg、TAT、D-D明显高于对照组,HDL-C低于对照组,且随着冠状动脉病变支数的增加,指标均明显升高(P<0.05)。FgLDL-C、LP(a)与冠状动脉病变程度密切相关(OR分别为1.17、1.10、和1.04、P<0.05)。结论Fg、LDL-C和LP(a)是冠心病发病的独立危险因子;血浆Fg、TAT和D-D浓度的监测对体内高凝状态和冠心病的预防具有重要意义。     

合肥市知识分子人群冠心病患病及危险因素分析

目的分析安徽省合肥市知识分子人群冠心病(CHD)的患病情况及主要危险因素,为冠心病防治提供依据。方法采用整群抽样方法,对合肥市4726名35岁以上知识分子进行冠心病患病情况调查。比较不同年龄、性别的冠心病患病率,同时进行相关危险因素Logistic回归分析。结果调查对象中共检出冠心病患者265例,患病率为5.6%;其中男性为5.1%,女性为6.9%,女性高于男性(χ²=6.126,P<0.05);男女性患病率均随年龄增长呈增加趋势,男性χ²=149.056,P<0.001;女性χ²=111.099,P<0.001)。多因素分析显示,冠心病的主要危险因素为年龄(OR=3.627,95%CI=2.905~4.529,P=0.000)、性别(OR=0.692,95%CI=0.501~0.955,P=0.025)、冠心病家族史(OR=2.347,95%CI=1.656~3.327,P=0.000)、高血压(OR=1.537,95%CI=1.144~2.064,P=0.004)、腰臀比(OR=1.463,95%CI=1.091~1.961,P=0.011)、食盐摄入(OR=1.236,95%CI=1.009~1.516,P=0.041)。结论合肥市知识分子人群冠心病患病率较高,应作为冠心病高危人群进行干预预防。     

健康干预对冠心病患者戒烟、他汀类及阿司匹林使用的影响简

目的：观察健康干预对冠心病患者戒烟,他汀类及阿司匹林使用等行为的改善作用。方法选择有吸烟史的冠心病患者300例,通过多种途径开展健康干预,采取问卷调查评价干预前后吸烟、他汀类和阿司匹林的使用情况以及失败原因。结果干预前后吸烟率、他汀类的使用人数比较差异有统计学意义（P＜0．05）,但阿司匹林的使用人数比较差异无统计学意义（P＞0．05）;戒烟不成功、未使用他汀类及阿司匹林的主要原因分别为缺乏自我控制能力、认为血脂正常不需要服药、合并消化道疾病等。结论健康干预能提高冠心病患者戒烟率,他汀类和阿司匹林的使用率,是基层地区慢性病适宜技术推广的有效途径之一。     

Can excess iron increase the risk for coronary heart disease and cancer?

Summary It has been hypothesised that high iron stores increase the risk of diseases such as coronary heart disease and cancer. In summary, in spite of the theoretical possibilities that high exposure to either dietary or systemic iron might increase heart disease or cancer risk, the evidence suggests that this is not the case in healthy individuals. However, some questions remain unanswered including the risk of colon cancer in individuals with high dietary iron intakes (either via a high intake of red meat, fortified foods or frequent supplement use). It is probable that much of the non-haem iron will remain unabsorbed, which potentially may damage the colonic mucosa and increase the risk of large bowel cancer. Furthermore, the risk of cardiovascular disease and cancer in individuals who carry a mutation of HFE, the gene for haemochromatosis, many of whom may be asymptomatic, may be greater than the general population, particulary when dietary iron intake is high. This paper summarises the basis of iron metabolism and examines the theoretical reasons for an association between iron and cardiovascular disease (CVD; includes coronary disease, vascular disease & myocardial infarction) and cancer. It also revisits the studies designed to investigate the role of iron in CVD and cancer.     

Unscrambling the research: Eggs, serum cholesterol and coronary heart disease

The role of dietary cholesterol in raising plasma cholesterol levels has been debated over the past 25 years. Consequently, eggs, as a food high in dietary cholesterol, have been targeted as a food to limit when advising patients on a diet to lower serum cholesterol levels. The aim of the present review was to evaluate the literature to address the effects of dietary cholesterol from eggs on serum cholesterol levels and risk of coronary heart disease. An increase in dietary cholesterol from eggs by 100 mg daily, equivalent to half a medium egg or three to four eggs a week, results in an increase of approximately 0.05 mmol/L in LDL cholesterol. Adding 100 mg of cholesterol per day (equivalent to three to four eggs a week) to a high saturated fat diet caused an increase in LDL cholesterol of 0.061 ± 0.006 mmol/L, whereas adding the same quantity of cholesterol to a low saturated fat diet caused an increase in LDL cholesterol of only 0.036 ± 0.004 mmol/L (P = 0.03). Despite the small increase in LDL‐cholesterol levels with increasing egg intake, most epidemiological studies have shown little or no association between egg intake and risk of coronary heart disease. However, the impact of dietary cholesterol for people with type 2 diabetes has been poorly studied. In conclusion, in a healthy Western population, there is insufficient evidence to excessively restrict egg intake as part of a healthy diet. Eggs should be considered in a similar way as other protein‐rich foods and selected as part of a varied diet that is low in saturated fat and contains a variety of cardio‐protective foods such as fish, wholegrains, fruits, vegetables, legumes and nuts.     

The NorVold Abuse Questionnaire (NorAQ): validation of new measures of emotional, physical, and sexual abuse, and abuse in the health care system among women

BACKGROUND: In the literature about abuse, large variations in prevalence rates exist. Validated research instruments are scarce and are needed urgently. Our aim was to validate the 13 questions concerning the experiences of abuse among women in the NorVold Abuse Questionnaire against an interview and two validated questionnaires. METHOD: Data collection was in two parts. i) The NorVold Abuse Questionnaire was sent to a random sample of 2000 women in Osterg?tland. ii) A subsample of 64 women was interviewed, and filled in the Conflict Tactic Scale, the Sexual Abuse Questionnaire, and the NorVold Abuse Questionnaire for a second time. The interview had open questions about abuse and was considered our gold standard. RESULTS: The response rate was 61%. The abuse variables in The NorVold Abuse Questionnaire showed good test-retest reliability (84-95%). Specificity was 98% for all kinds of abuse except physical (85%). Sensitivity ranged from 75% (emotional) to 96% (physical). The likelihood ratio ranged from 38 to 43 for all kinds of abuse except physical (likelihood ratio 6). NorAQ performed better against the interview than against the Sexual Abuse Questionnaire and equally against the Conflict Tactic Scale. High lifetime prevalence rates of abuse were found: emotional 21.4%; physical 36.4%; sexual 16.9%; abuse in the health care 15.6%. Prevalence rates of abuse dropped considerably when a criterion of current suffering was added. CONCLUSIONS: The abuse variables in NorAQ have good reliability and validity.     

Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches

STUDY OBJECTIVES: There are contradictory perspectives on the importance of conventional coronary heart disease (CHD) risk factors in explaining population levels and social gradients in CHD. This study examined the contribution of conventional CHD risk factors (smoking, hypertension, dyslipidaemia, and diabetes) to explaining population levels and to absolute and relative social inequalities in CHD. This was investigated in an entire population and by creating a low risk sub-population with no smoking, dyslipidaemia, diabetes, and hypertension to simulate what would happen to relative and social inequalities in CHD if conventional risk factors were removed. DESIGN, SETTING, AND PARTICIPANTS: Population based study of 2682 eastern Finnish men aged 42, 48, 54, 60 at baseline with 10.5 years average follow up of fatal (ICD9 codes 410-414) and non-fatal (MONICA criteria) CHD events. MAIN RESULTS: In the whole population, 94.6% of events occurred among men exposed to at least one conventional risk factor, with a PAR of 68%. Adjustment for conventional risk factors reduced relative social inequality by 24%. However, in a low risk population free from conventional risk factors, absolute social inequality reduced by 72%. CONCLUSIONS: Conventional risk factors explain the majority of absolute social inequality in CHD because conventional risk factors explain the vast majority of CHD cases in the population. However, the role of conventional risk factors in explaining relative social inequality was modest. This apparent paradox may arise in populations where inequalities in conventional risk factors between social groups are low, relative to the high levels of conventional risk factors within every social group. If the concern is to reduce the overall population health burden of CHD and the disproportionate population health burden associated with the social inequalities in CHD, then reducing conventional risk factors will do the job.     

Milk consumption and prevalence of coronary heart disease in men and women from the Scottish Heart Health Study

This report uses cross-sectional results from the Scottish Heart Health Study to investigate whether milk consumption has an independent effect on the prevalence of coronary heart disease. Milk consumption was assessed by questionnaire in men and women aged 40–59 years (n = 10359) who participated in a survey of risk factors for coronary heart disease between 1984 and 1986. Odds ratios for coronary heart disease were calculated according to volume and type of milk consumed for subjects with and without symptoms of coronary heart disease. Statistical adjustment was made for the classicial risk factors.
A higher percentage of men and women with diagnosed coronary heart disease (CHD) usually consume low-fat milk, compared with asymptomatic controls. Odds ratios for having undiagnosed heart disease did not differ significantly with volume or type of milk. However, the odds ratios for having diagnosed heart disease were lower in the moderate (0.5–1 pint/d) milk consumption group. Patterns of milk consumption in patients diagnosed as having CHD are likely to be confounded by dietary changes post-diagnosis. Milk consumption appears to have little independent effect on the prevalence of coronary heart disease in this Scottish population.