Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane,Japan

BackgroundPrevention of aneurysmal subarachnoid hemorrhage (SAH) can be achieved by reducing risk factors, which include those for aneurysm formation and aneurysm rupture. However, neither of these 2 factors has been discussed separately so far. A case control study was undertaken in Shimane, Japan, to identify modifiable risk factors for the formation and rupture of aneurysms.MethodsThis study included 858 patients with ruptured aneurysms, 285 patients with unruptured aneurysms without a history of SAH, and 798 control subjects. Hypertension, diabetes mellitus, heart disease, hypercholesterolemia, cigarette smoking, and alcohol consumption were assessed as risk factors by using conditional logistic regression.ResultsAfter adjustment for other risk factors, hypertension was the most powerful risk factor for aneurysm formation, regardless of age and sex, followed by hypercholesterolemia, heart disease, and cigarette smoking, whereas diabetes mellitus and daily drinking were insignificant for aneurysm formation. Hypertension and daily drinking were not related to the risk of aneurysm rupture, regardless of age and sex, whereas cigarette smoking was associated with an increased risk of aneurysm rupture in patients 60 years or older and in men. In contrast, hypercholesterolemia was strongly associated with a decreased risk of rupture, regardless of age and sex, and in patients with small aneurysms (<5 mm). Diabetes mellitus and heart disease were also related to a decreased risk of rupture in patients 60 years or older and in women.ConclusionIdentification of risk factors for aneurysm formation and rupture separately seems to be pivotal for reducing the incidence of SAH.     

Risk factors for primary intracerebral hemorrhage in patients in Izumo City,Japan

The annual incidence rate of primary intracerebral hemorrhage (ICH) in Izumo City, Japan, appears to be the highest rate among those reported. Despite improvement of management and surgical therapy, the overall morbidity and mortality after ICH are still high. The author investigated the risk factors for ICH in patients in Izumo. A case-control study of 242 patients (137 men and 105 women with ages ranging from 34 to 97 years) with primary ICH was conducted in Izumo between 1991 and 1998. Hypertension, diabetes mellitus, heart disease, liver disease, alcohol consumption, cigarette smoking, and serum levels of total cholesterol, aspartate aminotransferase, and alanine aminotransferase were assessed as possible risk factors for ICH by using conditional logistic regression. The prevalence of hypertension among ICH patients was 77% and the odds ratio (OR) for hypertension was 17.07 (95% CI: 8.30–35.09), which are much higher than figures reported from Western countries. The OR for hypertension was higher in individuals ≤69 years of age than in those ≥70 years of age and lower for lobar hemorrhage than for hemorrhages at other sites. High serum total cholesterol (≥220 mg/dl) was the second most important risk factor for ICH (OR: 2.52; 95% CI: 1.23–5.14), and low total cholesterol (<160 mg/dl) decreased the risk of ICH (OR: 0.47; 95% CI: 0.27–0.82). In contrast, heart disease decreased the risk of ICH, and there was no observed association between alcohol consumption, cigarette smoking, or diabetes mellitus and ICH. This study conducted in Izumo suggests that hypertension is the most important risk factor for ICH and contrary to most previous studies indicates that serum total cholesterol concentration is also positively associated with the risk of ICH. In contrast, heart disease may decrease the risk of ICH.     

Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Part I: incidence and seasonal and diurnal variations

OBJECT: The purpose of this community-based study was first to estimate the incidence rates of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) in Izumo City, Japan, and second to investigate whether there were seasonal and diurnal periodicities in their onset. METHODS: During 1991 through 1996, 267 patients with primary ICH and 123 with aneurysmal SAH were treated in Izumo City. The crude and the age- and sex-adjusted annual incidence rates per 100,000 population for all ages were 52 and 48 for ICH and 24 and 23 for SAH, respectively. These incidence rates were higher than those previously published for any other geographical region. The incidence rates of both ICH and SAH increased almost linearly with age. For ICH, a significant seasonal pattern was observed in men and in patients younger than 65 years, with a peak in winter and a trough in summer. However, no significant seasonal fluctuation was found in women or in individuals aged 65 years or older. There was no significant seasonal periodicity for SAH, even when patients were analyzed according to sex and age. Diurnal variations in the onset of both ICH and SAH were significant (except in men with SAH), with a nadir between midnight and 6:00 a.m. CONCLUSIONS: The actual incidence rates of both primary ICH and aneurysmal SAH seem to be much higher than have been reported so far. In addition, the data indicate the existence of seasonal periodicity for men and younger patients with ICH, and that the risk of both ICH and SAH is lower during nighttime.     

Risk factors for subarachnoid hemorrhage

OBJECTIVE: Cigarette smoking has been demonstrated to increase the risk of subarachnoid hemorrhage (SAH). Whether cessation of smoking decreases this risk remains unclear. We performed a case-control study to examine the effect of smoking and other known risk factors for cerebrovascular disease on the risk of SAH. METHODS: We reviewed the medical records of all patients with a diagnosis of SAH (n = 323) admitted to Johns Hopkins Hospital between January 1990 and June 1997. Controls matched for age, sex, and ethnicity (n = 969) were selected from a nationally representative sample of the Third National Health and Nutrition Examination Survey. We determined the independent association between smoking (current and previous) and various cerebrovascular risk factors and SAH by use of multivariate logistic regression analysis. A separate analysis was performed to determine associated risk factors for aneurysmal SAH. RESULTS: Of 323 patients admitted with SAH (mean age, 52.7+/-14 yr; 93 were men), 173 (54%) were hypertensive, 149 (46%) were currently smoking, and 125 (39%) were previous smokers. In the multivariate analysis, both previous smoking (odds ratio [OR], 4.5; 95% confidence interval [CI], 3.1-6.5) and current smoking (OR, 5.2; 95% CI, 3.6-7.5) were significantly associated with SAH. Hypertension was also significantly associated with SAH (OR, 2.4; 95% CI, 1.8-3.1). The risk factors for 290 patients with aneurysmal SAH were similar and included hypertension (OR, 2.4; 95% CI, 1.8-3.2), previous smoking (OR, 4.1; 95% CI, 2.7-6.0), and current smoking (OR, 5.4; 95% CI, 3.7-7.8). CONCLUSION: Hypertension and cigarette smoking increase the risk for development of SAH, as found in previous studies. However, the increased risk persists even after cessation of cigarette smoking, which suggests the importance of early abstinence from smoking.     

Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty.

OBJECTIVES: Aim of this study is to correlate distribution pattern of lower limb atherosclerosis with cardiovascular risk factor profile of patients with peripheral arterial occlusive disease (PAD). PATIENTS AND METHODS: Analysis is based on a consecutive series of 2659 patients (1583 men, 1076 women, 70+/-11 years) with chronic PAD of atherosclerotic origin undergoing primary endovascular treatment of lower extremity arteries. Pattern of atherosclerosis was grouped into iliac (n=1166), femoropopliteal (n=2151) and infrageniculate (n=888) disease defined according to target lesions treated. A multivariable multinomial logistic regression analysis was performed to assess relation with age, gender and classical cardiovascular risk factors (diabetes mellitus, arterial hypertension, hypercholesterolemia, cigarette smoking) using femoropopliteal disease as reference. RESULTS: Iliac disease was associated with younger age (RRR 0.95 per year of age, 95%-CI 0.94-0.96, p<0.001), male gender (RRR 1.32, 95%-CI 1.09-1.59, p=0.004) and cigarette smoking (RRR 2.02, 95%-CI 1.68-2.42, p<0.001). Infrageniculate disease was associated with higher age (RRR 1.02, 95%-CI 1.01-1.02, p<0.001), male gender (RRR 1.23, 95%-CI 1.06-1.41, p=0.005) and diabetes mellitus (RRR 1.68, 95%-CI 1.47-1.92, p<0.001). Hypercholesterolemia was less prevalent in patients with lesions below the knee (RRR 0.82, 95%-CI 0.71-0.94, p=0.006), whereas no distinct pattern was apparent related to arterial hypertension. CONCLUSION: Clinical phenotype of peripheral atherosclerosis varies with prevalence of cardiovascular risk factors suggesting differences in mechanisms involved in iliac as compared with infrageniculate lesions. Identification of molecular mechanism might have influence on future therapeutic strategies in PAD patients.     

Seasonal variation in the incidence of aneurysmal subarachnoid hemorrhage in hospital- and community-based studies

OBJECT: The aim of this study was to examine seasonal variations in the onset of aneurysmal subarachnoid hemorrhage (SAH) in one hospital-based and one community-based patient series. METHODS: The study population consisted of 941 patients with aneurysmal SAH who were admitted to Shimane Prefectural Central Hospital and 358 patients who were treated in Izumo City, Japan. When investigated as a whole, no significant seasonal variations were found in either population; however, in both series, statistically significant seasonal trends, with a peak in winter and a nadir in summer, were found among patients aged 59 years or younger (p < 0.05 for the hospital-based series and p < 0.005 for the community-based series), but not among those aged 60 years or older, regardless of sex. In the hospital-based series, seasonal variations were most apparent at certain times of day, with significant variations observed between 8:00 a.m. and 10:00 a.m. or 8:00 a.m. and noon (p < 0.001 and p < 0.005, respectively), regardless of patient age, and between 4:00 p.m. and 6:00 p.m. for patients aged 59 years or younger (p < 0.05). Consequently, seasonal variations were significant during daytime hours (between 8:00 a.m. and 8:00 p.m., p < 0.005) but not during the night (between 8:00 p.m. and 8:00 a.m.). Similar tendencies were found in the community-based series. Among patients aged 59 years or younger who had no risk factors for SAH, these seasonal variations were significant in both series. In patients with untreated hypertension, who were current smokers and daily alcohol drinkers, however, no significant patterns were observed in either series, even among younger patients. CONCLUSIONS: In both hospital- and community-based studies, aneurysmal SAH appears to undergo seasonal variation, with a peak in winter and a nadir in summer. This seasonal pattern may be derived mainly from the occurrence of SAH in the morning, but may also be modified by patient age and SAH risk factors, resulting in the masking of significant seasonal patterns when all patients are considered together.     

Prevalence of risk factors for aneurysmal subarachnoid haemorrhage: results of a Japanese multicentre case control study for stroke

The pathogenesis of subarachnoid haemorrhage (SAH) is still unclear. To evaluate the risk factors for aneurysmal SAH, we conducted a multicentre case control study. All aneurysms were detected by cerebral angiography and the patients with SAH other than ruptured aneurysms were excluded. Information on past medical histories and other possible risk factors for SAH were assessed by a structured questionnaire. Data on the total 127 pairs (59 male and 68 female) were analysed. In a univariate analysis, family history of SAH [odds ratio (OR) 9.45], systemic hypertension (OR 2.65), cigarette smoking (OR 2.54) and regular alcohol consumption (OR 1.92) were significant risk factors for aneurysmal SAH. Heavy alcohol consumption (>350 g ethanol/week) was significant (OR 3.22), whereas light consumption (=<350 g/week) did not to increase the risks (OR 0.95). Both light (<20 cigarettes/day, OR 2.44) and heavy smoking (>=20 cigarettes/day, OR 2.72) were associated with an increased risk of SAH. In a multivariate analysis, after adjustment for other risk factors, family history of SAH, cigarette smoking and hypertension remained significant.     

Risk factors for the formation of multiple intracranial aneurysms

OBJECT: Several factors are known to increase the risk of subarachnoid hemorrhage (SAH) and spontaneous intracerebral hematoma. However, information on the roles of these same factors in the formation of multiple aneurysms is less well defined. The purpose of this study was to examine factors associated with an increased risk of multiple aneurysm formation. METHODS: A retrospective review of the medical records of all patients with a diagnosis of SAH and intracranial aneurysms who were admitted to a single institution between 1985 and 1997 was undertaken. The authors examined associations between risk factors (patient age and sex, menopausal state of female patients, hypertension, cigarette smoking, alcohol consumption, history of cardiovascular disease or diabetes mellitus, and family history of cerebrovascular disease) and the presence of multiple aneurysms by using the Fisher exact test and logistic regression analysis. Of 400 patients admitted with a diagnosis of cerebral aneurysms, 392 were included in the study (287 women and 105 men). Two hundred eighty-four patients harbored a single aneurysm and 108 harbored multiple aneurysms (2 aneurysms in 68 patients, three aneurysms in 22 patients, four aneurysms in 13 patients, and five aneurysms in five patients). CONCLUSIONS: Statistical analysis revealed that, as opposed to the occurrence of a single aneurysm, there was a significant association between the presence of multiple aneurysms and hypertension (p < 0.001), cigarette smoking (p < 0.001), family history of cerebrovascular disease (p < 0.001), female sex (p < 0.001), and postmenopausal state in female patients (p < 0.001).     

The coexistence of major coronary heart disease risk factors in the coloured population of the Cape Peninsula (CRISIC study)

A cross-sectional study of risk factors for coronary heart disease in a random sample of 976 people from a South African coloured population revealed this group to be at great risk. The prevalences of individual and of coexisting reversible risk factors--hypercholesterolaemia, hypertension and smoking--were highest in the older subjects, who use medical services more often. One or more of the three risk factors was present in 80% of men aged 45 years or over. Smoking was the most common single risk factor for both sexes, and almost 30% of women aged 45 years or over were hypertensive. Hypertension and smoking was the most common combination for males and hypertension and hypercholesterolaemia the most common for females. Medical personnel could identify and treat these very-high-risk patients if they were to screen for all the risk factors after identifying any one risk factor. Younger people at risk and particularly younger men, who rarely utilise health services, should be reached at their workplace for early identification of risk factors.     

Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland

Chronic kidney disease (CKD) is an increasing cause of morbidity and mortality in the United States. Prospective data on risk factors for CKD are limited to men, and few studies examine the importance of smoking. The authors performed a community-based, prospective observational study of 20-yr duration to examine the association between hypertension and smoking on the future risk of CKD in 23,534 men and women in Washington County, Maryland. CKD was identified as end-stage renal disease in the Health Care Financing Administration database or kidney disease listed on the death certificate. All cases were confirmed as CKD by medical chart review. Adjusted relative hazards of CKD were modeled using Cox proportional hazards regression including age as the time variable and baseline BP, cigarette smoking, gender, and diabetes status as risk factors. The adjusted hazard ratio (95% confidence interval) of developing CKD among women was 2.5 (0.05 to 12.0) for normal BP, 3.0 (0.6 to 14.4) for high-normal BP, 3.8 (0.8 to 17.2) for stage 1 hypertension, 6.3 (1.3 to 29.0) for stage 2 hypertension, and 8.8 (1.8 to 43.0) for stages 3 or 4 hypertension compared with individuals with optimal BP. In men, the relationship was similar but somewhat weaker than in women, with corresponding hazard ratios of 1.4 (0.2 to 12.1), 3.3 (0.4 to 25.6), 3.0 (0.4 to 22.2), 5.7 (0.8 to 43.0), and 9.7 (1.2 to 75.6), respectively. Current cigarette smoking was also significantly associated with risk of CKD in both men and women (hazard ratio in women 2.9 [1.7 to 5.0] and in men 2.4 [1.5 to 4.0]). A large proportion of the attributable risk of CKD in this population was associated with stage 1 hypertension (23%) and cigarette smoking (31%). In conclusion, CKD risk shows strong graded relationships to the sixth report of the Joint National Committee (JNC-VI) on Prevention, Detection Evaluation and Treatment of High BP criteria for BP, to diabetes, and to current cigarette smoking that are at least as strong in women as in men.     

Clustering of cardiovascular risk factors. time trends during 28 years

OBJECTIVES: To assess the development in frequency and clustering of hypertension, hypercholesterolaemia, high body mass index (BMI), physical inactivity and tobacco smoking in the period 1964-1992, and to evaluate any sex and age differences. DESIGN: Five cross-sectional investigations on cardiovascular risk factors performed in 1964, 1978, 1982-1984, 1986-1987 and 1991-1992 comprising random samples in a suburban area of Copenhagen, Denmark. Physical activity during leisure time and smoking habits were assessed by self-administered questionnaire. Blood pressure, weight, height and serum total cholesterol were measured according to WHO standards. RESULTS: A total of 8644 persons aged 30, 40, 50 and 60 years participated with an equal number of men and women. Women had fewer risk factors than men and younger persons had fewer risk factors than older persons. In the period 1964-1992 there was a decreasing number of risk factors. The 50 year olds show a sex difference in the period 1982-1992, whereas there was no sex difference among the 60 year olds. Tobacco smoking was the most common risk factor. BMI > 27.5 has become more and more frequent throughout the period, especially in men. The BMI has conquered third place in all age groups. The association of BMI > 27.5 and sedentary leisure time physical activity has become the most frequent. CONCLUSION: Clustering among risk factors decreased over time in both sexes. The association of elevated BMI and sedentary leisure time activity may contribute to the rising frequency of chronic disease such as diabetes mellitus and cardiovascular disease.     

Influence of premorbid factors on survival following subarachnoid hemorrhage

OBJECT: The goal of this study was to explore the relationships between premorbid patient characteristics, especially cigarette smoking, and the risk of death following subarachnoid hemorrhage (SAH). METHODS: A population-based study design was used with multiple overlapping methods of case identification. A strict definition of SAH was used. Relationships between patients' age and sex as well as their cigarette smoking and hypertension statuses were explored by calculating relative risks (RRs). Confounding effects were examined using logistic regression analysis. The author identified 800 cases in which the patient had experienced his or her first SAH. Seventy-seven percent of cases were verified by review of computerized tomography scans, 22% by autopsy, and 1% by lumbar puncture. A prior history of hypertension had no effect on the risk of mortality. There was a higher case mortality rate in female patients than in male patients, but this did not reach statistical significance. The RR of death at 30 days post-SAH for patients older than 60 years compared with those who were younger was 2.95 (95% confidence interval [CI] 2.18-3.97). The RR of death at all time intervals was lower for smokers than for nonsmokers (smokers/nonsmokers RR 0.47 [95% CI 0.32-0.69] at 7 days). The protective effect of smoking diminished on Day 3 post-SAH and increased again on Day 7. CONCLUSIONS: Advanced age is an important determinant of survival following SAH. Smoking appears to have a protective effect. The author presents evidence indicating that increased vasospasm in smokers may reduce the severity of the initial hemorrhage.     

Influence of smoking and obesity on the development of proteinuria

BACKGROUND: Proteinuria is a significant risk factor for end-stage renal disease. Previous evidence suggested that smoking and obesity increase the risk of proteinuria. However, it is unclear whether these risk factors predict the development of proteinuria independently of hypertension and diabetes mellitus. The aim of this study was to analyze the effects of obesity and smoking on the development of proteinuria in a screened cohort of subjects with normal kidney function. METHODS: A total of 5403 subjects (3403 men and 2000 women) who participated in the 1997 and 1999 health screening examinations in Okinawa Japan, and who were normal renal function (serum creatinine < or =1.2 mg/dL in men, < or =1.0 mg/dL in women) and negative proteinuria by dipstick examination in 1997 were eligible for study. Logistic analysis was used to examine the relation between the baseline state of smoking or obesity in 1997, and the development of proteinuria in 1999, adjusted for age, sex, and other confounding factors. RESULTS: Proteinuria developed in 5.8% of participants (6.7% in men, 4.4% in women; dipstick score, 1+ in 277, 2+ in 37, and > or =3+ in 4 participants). The incidence of proteinuria was positively associated with the number of cigarettes smoked per day (P = 0.04), and a body mass index (P < 0.0001) at baseline. Analysis showed that the relative risk (95% confidence interval) of developing proteinuria was 1.32 (1.00 to 1.74), P = 0.04 for cigarette smoking, 1.45 (1.13 to 1.86), P = 0.002 for obesity, 1.56 (1.19 to 2.06), P = 0.001 for hypertension, and 2.27 (1.55 to 3.32), P < 0.0001 for diabetes mellitus. Stratified with men and women, the relative risk was 1.28 (0.96 to 1.72), P = 0.09 for smoking, and 1.60 (1.19 to 2.14), P = 0.001 for obesity in men; the relative risk was 1.30 (0.44 to 3.80), P = 0.62 for smoking, and 1.04 (0.63 to 1.72), P = 0.87 for obesity in women. CONCLUSIONS: Hypertension and diabetes mellitus were superior to smoking and obesity in predicting the development of proteinuria in all subjects. Stratified with men and women, obesity was a significant risk factor for the development of proteinuria independently of both hypertension and diabetes mellitus in men. The risk of developing proteinuria also tended to be increased with cigarette smoking in men. Smoking and obesity in women were not significant in this data set.     

Prevalence of extracranial carotid artery disease: a survey of an asymptomatic population with noninvasive techniques

To investigate the prevalence of internal carotid arterial stenosis in an unselected asymptomatic population over 50 years of age, 102 volunteers from one church congregation were studied with ultrasonic arteriography, spectral analysis, and ocular pneumoplethysmography. Fifty subjects were 50 to 59 years old; 33 were 60 to 69 years of age; and 19 were older than 70 years. Forty-five were men and 57 were women. Risk factors included diabetes mellitus (4%), heart disease (9%), hypertension (24%), peripheral vascular disease (20%), and smoking (46%). Disease was found in 11 subjects (10.8%). Of the 204 internal carotid arteries, 13 (6.4%) were abnormal. Two vessels had 20% diameter stenosis; four had stenoses of 20% to 39%; five had stenoses of 40% to 59%; one had a stenosis of 60% to 79%; and one was occluded. Stenoses greater than 40% occurred in 4% of the 50 to 59 years of age group, 6% of the 60 to 69 years of age group, and 11% of the greater than 70 years of age group. Although the prevalence of carotid stenosis was increased in all subjects who had risk factors, only the association with heart disease reached statistical significance. These results indicate that carotid stenosis is present in an appreciable number of asymptomatic subjects over the age of 50 years and suggest that its prevalence is associated with age and other risk factors.     

Prevalence of and risk factors for nocturia: Analysis of a health screening program

BACKGROUND: We examined the prevalence of and risk factors for nocturia in Kurashiki city and the surrounding area, a rural area in Japan. MATERIALS AND METHODS: We collected data on 6517 individuals (4568 men and 1949 women) who participated in a multiphasic health screening. We analyzed the relationships between nocturia assessed by a questionnaire (voiding twice or more during night) and other variables including age, hypertension, cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes mellitus (DM), chronic renal failure, benign prostatic hyperplasia (BPH), smoking habit and alcohol intake. RESULTS: Overall, 1856 individuals (28.5%) answered that they arose to urinate at least twice during the night. This rate increased with age from 16.5% in individuals younger than 50 to 60.0% in those older than 69. Logistic regression analysis revealed that cohorts of subjects 50-59, 60-69, and 70 years old or over had, respectively, 1.75, 3.35, and 6.21 times the prevalence of nocturia of the 49 years or younger cohort. Hypertension (odds ratio [OR] 1.64) and DM (OR 1.70) were other independent positive risk factors for nocturia. On the other hand, current smokers who smoked 20 or more cigarettes per day were less likely to have nocturia than non-smokers (OR 0.72). In male individuals, BPH was another independent positive risk factor (OR 1.35). Gender was not associated with nocturia. CONCLUSIONS: Although population bias is an important limitation to this study, nocturia is associated with various factors suggesting that multiple approaches are needed to the treatment of patients with nocturia.     

Requirements of a coronary heart disease risk factor intervention programme for the coloured population of the Cape Peninsula

The coloured population of the Cape Peninsula has been identified as having a high prevalence of risk factors for coronary heart disease (CHD), notably hypertension, cigarette smoking and hypercholesterolaemia. The need for an appropriate and effective CHD intervention programme, directed at the population as a whole, has become urgent. Three central problem areas relating to hypertension control--diagnosis, management and compliance--will have to be addressed. Hypertension was underdiagnosed among men, particularly those aged 25-44 years. Apart from educating this group regarding the need to have their blood pressure measured, detection programmes are therefore needed at the workplace to improve hypertension diagnosis. Inadequate management of hypertension was commonest in women aged over 45 years. Compliance with hypertension treatment regimens was poor in all men as well as in both sexes belonging to the lower socio-economic strata. Establishing easily accessible blood pressure stations for monitoring blood pressure and educating hypertensives regarding their condition could lead to improved management and compliance. Coloureds were found to smoke heavily, and the women had the highest smoking prevalence of all South African women. Furthermore, the age of onset of smoking is decreasing among coloured children. A general anti-smoking campaign directed at all South Africans is necessary to control smoking. Anti-smoking education programmes at primary school level are of particular importance to prevent the onset of the habit. More than 70% of coloureds had a serum cholesterol level imparting CHD risk, few followed a prudent diet and their knowledge of the prudent diet was poor. Health education programmes to promote the prudent diet are required.(ABSTRACT TRUNCATED AT 250 WORDS)     

Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening

OBJECTIVE: Accurate data regarding the prevalence and associated risk factors for aneurysmal disease is essential when determining the appropriateness of screening for abdominal aortic aneurysms (AAA). Although women are poorly represented in most large studies of AAA prevalence, the US Preventative Services Task Force recently recommended against primary screening for AAA in women. The purpose of this analysis was to define the prevalence and risk factors associated with the development of AAA in women. METHODS: A free duplex ultrasound screening was offered to men and women with cardiovascular risk factors or a family history of AAA. Patients were recruited through advertising at local screening centers and screenings were performed between 2004 and 2006. Demographic information and cardiovascular and aneurysmal disease risk factors were obtained for each patient through a questionnaire. A total of 17,540 subjects were screened for AAA, including 10,012 women (mean age 69.6 years) and 7528 men (mean age 70.0 years). Univariate and multivariable logistic regression analysis was performed on the subset of women that were screened to determine risk factors for and prevalence of AAA. RESULTS: Seventy-four aneurysms were detected in women (including four aneurysms >5 cm diameter and 70 aneurysms 3 to 5 cm diameter) while 291 were detected in men, resulting in prevalence rates of 0.7% and 3.9%, respectively. Increasing age (odds ratio [OR]= 4.57, 95% confidence interval [CI] 1.98 to 10.54, P < .0001), history of tobacco use (OR = 3.29, 95% CI 1.86 to 5.80, P < .0001), and cardiovascular disease (OR= 3.57, 95% CI 2.19 to 5.84, P < .0001) were independently associated with AAA in women on univariate and multivariable analysis. Women with multiple atherosclerotic risk factors were more commonly found to have AAAs and had a prevalence rate of AAA as high as 6.4%. CONCLUSION: Although the medical literature suggests a low prevalence rate of AAA in women in the general population, specific risk factors are associated with the development of AAA, and subgroups of women can be identified that are at a substantially increased risk of aneurysmal disease. In particular, elevated rates of AAA were found among women of advanced age (> or =65 years) with a history of smoking or heart disease. These data support the notion that women with such risk factors should be considered for AAA screening.     

Diurnal and seasonal variations in the onset of primary intracerebral hemorrhage in individuals living in Izumo City,Japan

OBJECT: Little is known about the temporal patterns of primary intracerebral hemorrhage (ICH) among the general population. The aim of this study was to examine diurnal and seasonal variations in the onset of ICH in a community-based series. METHODS: The study population consisted of 350 patients who presented with primary ICH for the first time and were treated between 1991 and 1998 in Izumo City, Japan. Among the entire patient population, the onset of hemorrhage was rarely observed during the night and a peak was observed in the late afternoon. In men 69 years of age or younger, the onset of ICH exhibited a bimodal distribution, with an initial high peak between 8:00 and 10:00 a.m. and a second, lower peak between 6:00 and 8:00 p.m. In contrast, in men 70 years of age or older and in women regardless of age, only a single evening peak, between approximately 6:00 and 10:00 p.m., was found, and no morning peak was observed. For the entire patient population (for both sexes), and for men alone, seasonal variations--a peak in winter and a trough in summer-were significant for all age groups combined. This factor was significant for patients 69 years of age or younger, during the daytime hours (8:00 a.m.-8:00 p.m.), and for patients with untreated hypertension; however, it was not significant for patients 70 years of age or older, during nighttime hours (10:00 p.m.-8:00 a.m.), or for treated hypertensive and normotensive patients. In women, no significant seasonal patterns were found, regardless of patient age, time of day at onset of ICH, or the presence of risk factors. Seasonal variations were statistically significant for patients with hematomas larger than 5 ml, but not for those with hematomas 5 ml or smaller. CONCLUSIONS: Temporal distributions in the onset of ICH seem to be influenced by patient sex and age. The seasonal patterns of ICH occurrence may result mainly from changes that occur during the daytime, and may also be modified by the presence of untreated hypertension and by the volume of the hematoma.     

Risk Factors Associated with Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

We studied the risk factors associated with cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). The subjects were 370 patients with ruptured aneurysms who fulfilled all of the following criteria: admission by day 2 after onset, operation performed by day 3 by the same surgeon (T.I.), Hunt-Hess grade I–IV, availability of bilateral carotid angiograms acquired by day 2 and repeated between days 7 and 9. The demographic, clinical, radiographic, surgical, laboratory, and electrocardiographic data were analyzed for angiographic vasospasm (AV), symptomatic vasospasm (SV), and cerebral infarction on computed tomography (CT) scan. Both CT-evident SAH and AV were graded as 0–IV. Among the 370 patients, AV grade III–IV, SV, and cerebral infarction occurred in 26%, 24%, and 20%, respectively. Univariate analysis showed that Hunt-Hess grade III–IV, SAH grade III–IV, intracerebral or/and intraventricular hemorrhage, rebleeding, cigarette smoking, hypertension, alcohol intake, leukocytosis, hyperglycemia, and electrocardiographic QTc prolongation, left ventricular hypertrophy (LVH), and ST depression were significantly related to at least one of AV grade III–IV, SV, or cerebral infarction. Multivariate analysis showed that SAH grade III–IV was the most important risk factor for vasospasm followed by LVH on electrocardiogram, cigarette smoking, and hypertension. AV grade III– IV, SV, and cerebral infarction occurred in 57%, 54%, and 39% of the 46 smokers with LVH, and in 43%, 49%, and 35% of the 68 patients who had both LVH and hypertension, respectively. CT-evident SAH, LVH, cigarette smoking, and hypertension are associated with vasospasm. In smokers or hypertensive patients, premorbid LVH appears to predict much more severe vasospasm.     

Characterization of risk factor differences in perimesencephalic subarachnoid hemorrhage.

OBJECTIVE: The non-aneurysmal perimesencephalic subarachnoid hemorrhage (p-SAH) has a favorable outcome. Our objective was to provide a reason for that assessing the association of putative risk factors with this different type of hemorrhage in comparison to the aneurysmal subarachnoid hemorrhage (a-SAH). METHODS: We selected 185 consecutive cases of subarachnoid hemorrhage between September 1994 and August 1998 in a hospital-based case-control study and investigated the influence of hypertension, body weight, smoking and the three interacting blood factors hematocrit, fibrinogen and leukocrit. RESULTS: 1) Risk factors for SAH: For the entire study group an association of hypertension with the incidence of SAH was found both in the univariate analysis of this variable alone (P=0.001) and in the multivariate logistic regression (P=0.0001), aside from the risk factors smoking (P=0.0047) and hematocrit (P=0.0001). As to the risk of hypertensive subjects to experience SAH for different reasons, the logistic regression yielded an odds ratio (OR) of 3.54 [CI (95 %): 2.21-5.56]. 2) Risk factors for p-SAH: Patients with p-SAH differ in their risk profile from typical aneurysmal SAH cases with respect to their blood pressure status (P=0.019) and the investigated hemorheological parameters. CONCLUSIONS: A different association between possible risk factors and the two types of subarachnoid hemorrhages was ascertained. In general there seem to be fewer putative risk factors in the perimesencephalic SAH cases compared to the typical aneurysmal hemorrhages.